Tomoko Hiraoka1,2, Ngo Chi Cuong2,3, Sugihiro Hamaguchi4, Mihoko Kikuchi5, Shungo Katoh1,2,6, Le Kim Anh7, Nguyen Thi Hien Anh8, Dang Duc Anh8, Chris Smith9,10, Haruhiko Maruyama11, Lay-Myint Yoshida2,12, Do Duy Cuong3, Pham Thanh Thuy3,13, Koya Ariyoshi1,9. 1. Department of Clinical Medicine, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan. 2. Department of Clinical Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 3. Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam. 4. Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan. 5. Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan. 6. Department of General Internal Medicine, Nagasaki Rosai Hospital, Nagasaki, Japan. 7. Vietnam Research Station, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Hanoi, Vietnam. 8. National Institute of Hygiene and Epidemiology, Hanoi, Vietnam. 9. Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan. 10. Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom. 11. Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan. 12. Department of Pediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan. 13. Infection Prevention and Control, The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam.
Abstract
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.
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.
Authors: Yvonne Qvarnstrom; Ana Cristina Aramburu da Silva; John L Teem; Robert Hollingsworth; Henry Bishop; Carlos Graeff-Teixeira; Alexandre J da Silva Journal: Appl Environ Microbiol Date: 2010-06-11 Impact factor: 4.792
Authors: Joel Barratt; Douglas Chan; Indy Sandaradura; Richard Malik; Derek Spielman; Rogan Lee; Deborah Marriott; John Harkness; John Ellis; Damien Stark Journal: Parasitology Date: 2016-05-26 Impact factor: 3.234
Authors: Nghia Ho Dang Trung; Tu Le Thi Phuong; Marcel Wolbers; Hoang Nguyen Van Minh; Vinh Nguyen Thanh; Minh Pham Van; Nga Tran Vu Thieu; Tan Le Van; Diep To Song; Phuong Le Thi; Thao Nguyen Thi Phuong; Cong Bui Van; Vu Tang; Tuan Hoang Ngoc Anh; Dong Nguyen; Tien Phan Trung; Lien Nguyen Thi Nam; Hao Tran Kiem; Tam Nguyen Thi Thanh; James Campbell; Maxine Caws; Jeremy Day; Menno D de Jong; Chau Nguyen Van Vinh; H Rogier Van Doorn; Hien Tran Tinh; Jeremy Farrar; Constance Schultsz Journal: PLoS One Date: 2012-05-25 Impact factor: 3.240
Authors: Angela McBride; Tran Thi Hong Chau; Nguyen Thi Thu Hong; Nguyen Thi Hoang Mai; Nguyen To Anh; Tran Tan Thanh; Tran Thi Hue Van; Le Thi Xuan; Tran Phu Manh Sieu; Le Hong Thai; Ly Van Chuong; Dinh Xuan Sinh; Nguyen Duy Phong; Nguyen Hoan Phu; Jeremy Day; Ho Dang Trung Nghia; Tran Tinh Hien; Nguyen Van Vinh Chau; Guy Thwaites; Le Van Tan Journal: Clin Infect Dis Date: 2017-06-15 Impact factor: 9.079
Authors: Yvonne Qvarnstrom; Maniphet Xayavong; Ana Cristina Aramburu da Silva; Sarah Y Park; A Christian Whelen; Precilia S Calimlim; Rebecca H Sciulli; Stacey A A Honda; Karen Higa; Paul Kitsutani; Nora Chea; Seng Heng; Stuart Johnson; Carlos Graeff-Teixeira; LeAnne M Fox; Alexandre J da Silva Journal: Am J Trop Med Hyg Date: 2015-11-02 Impact factor: 2.345