Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam.
Background Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis...
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ftdoajarticles:oai:doaj.org/article:400953ef2c7a4c11bfc0b739173861b0 2023-05-15T15:16:18+02:00 Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. Tomoko Hiraoka Ngo Chi Cuong Sugihiro Hamaguchi Mihoko Kikuchi Shungo Katoh Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Chris Smith Haruhiko Maruyama Lay-Myint Yoshida Do Duy Cuong Pham Thanh Thuy Koya Ariyoshi 2020-12-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0008937 https://doaj.org/article/400953ef2c7a4c11bfc0b739173861b0 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0008937 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008937 https://doaj.org/article/400953ef2c7a4c11bfc0b739173861b0 PLoS Neglected Tropical Diseases, Vol 14, Iss 12, p e0008937 (2020) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2020 ftdoajarticles https://doi.org/10.1371/journal.pntd.0008937 2022-12-31T07:48:33Z Background Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis (PM) remains unclear. Methodology/principal findings Adult and adolescent patients of 13 years old or above with suspected central nervous system (CNS) infections with abnormal CSF findings were prospectively enrolled at a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. Patients with EM or suspected PM (EM/PM) were defined by the presence of either ≥10% eosinophils or an absolute eosinophil cell counts of ≥10/mm3 in the CSF or blood eosinophilia (>16% of WBCs) without CSF eosinophils. In total 679 patients were enrolled: 7 (1.03%) had ≥10% CSF eosinophilia, 20 (2.95%) had ≥10/mm3 CSF eosinophilia, and 7 (1.03%) had >16% blood eosinophilia. The patients with ≥10% CSF eosinophilia were significantly younger (p = 0.017), had a lower body temperature (p = 0.036) than patients with ≥10/mm3 CSF eosinophilia among whom bacterial pathogens were detected in 72.2% (13/18) of those who were tested by culture and/or PCR. In contrast, the characteristics of the patients with >16% blood eosinophilia resembled those of patients with ≥10% CSF eosinophilia. We further conducted serological tests and real-time PCR to identify A. cantonensis. Serology or real-time PCR was positive in 3 (42.8%) patients with ≥10% CSF eosinophilia and 6 (85.7%) patients with >16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm3 CSF eosinophilia. Conclusions The etiology of PM in northern Vietnam is A. cantonensis. The eosinophil percentage is a more reliable predictor of parasitic EM than absolute eosinophil count in the CSF. Patients with PM may present with a high percentage of eosinophils in the peripheral blood but not in the CSF. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Pacific PLOS Neglected Tropical Diseases 14 12 e0008937 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Tomoko Hiraoka Ngo Chi Cuong Sugihiro Hamaguchi Mihoko Kikuchi Shungo Katoh Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Chris Smith Haruhiko Maruyama Lay-Myint Yoshida Do Duy Cuong Pham Thanh Thuy Koya Ariyoshi Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis (PM) remains unclear. Methodology/principal findings Adult and adolescent patients of 13 years old or above with suspected central nervous system (CNS) infections with abnormal CSF findings were prospectively enrolled at a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. Patients with EM or suspected PM (EM/PM) were defined by the presence of either ≥10% eosinophils or an absolute eosinophil cell counts of ≥10/mm3 in the CSF or blood eosinophilia (>16% of WBCs) without CSF eosinophils. In total 679 patients were enrolled: 7 (1.03%) had ≥10% CSF eosinophilia, 20 (2.95%) had ≥10/mm3 CSF eosinophilia, and 7 (1.03%) had >16% blood eosinophilia. The patients with ≥10% CSF eosinophilia were significantly younger (p = 0.017), had a lower body temperature (p = 0.036) than patients with ≥10/mm3 CSF eosinophilia among whom bacterial pathogens were detected in 72.2% (13/18) of those who were tested by culture and/or PCR. In contrast, the characteristics of the patients with >16% blood eosinophilia resembled those of patients with ≥10% CSF eosinophilia. We further conducted serological tests and real-time PCR to identify A. cantonensis. Serology or real-time PCR was positive in 3 (42.8%) patients with ≥10% CSF eosinophilia and 6 (85.7%) patients with >16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm3 CSF eosinophilia. Conclusions The etiology of PM in northern Vietnam is A. cantonensis. The eosinophil percentage is a more reliable predictor of parasitic EM than absolute eosinophil count in the CSF. Patients with PM may present with a high percentage of eosinophils in the peripheral blood but not in the CSF. |
format |
Article in Journal/Newspaper |
author |
Tomoko Hiraoka Ngo Chi Cuong Sugihiro Hamaguchi Mihoko Kikuchi Shungo Katoh Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Chris Smith Haruhiko Maruyama Lay-Myint Yoshida Do Duy Cuong Pham Thanh Thuy Koya Ariyoshi |
author_facet |
Tomoko Hiraoka Ngo Chi Cuong Sugihiro Hamaguchi Mihoko Kikuchi Shungo Katoh Le Kim Anh Nguyen Thi Hien Anh Dang Duc Anh Chris Smith Haruhiko Maruyama Lay-Myint Yoshida Do Duy Cuong Pham Thanh Thuy Koya Ariyoshi |
author_sort |
Tomoko Hiraoka |
title |
Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. |
title_short |
Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. |
title_full |
Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. |
title_fullStr |
Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. |
title_full_unstemmed |
Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam. |
title_sort |
meningitis patients with angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern vietnam. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2020 |
url |
https://doi.org/10.1371/journal.pntd.0008937 https://doaj.org/article/400953ef2c7a4c11bfc0b739173861b0 |
geographic |
Arctic Pacific |
geographic_facet |
Arctic Pacific |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 14, Iss 12, p e0008937 (2020) |
op_relation |
https://doi.org/10.1371/journal.pntd.0008937 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008937 https://doaj.org/article/400953ef2c7a4c11bfc0b739173861b0 |
op_doi |
https://doi.org/10.1371/journal.pntd.0008937 |
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PLOS Neglected Tropical Diseases |
container_volume |
14 |
container_issue |
12 |
container_start_page |
e0008937 |
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