First report of human angiostrongyliasis acquired in Sydney

THIS IS THE FIRST REPORTED CASE of human eosinophilic meningitis due to Angiostrongylus cantonensis acquired in Sydney. The first A. cantonensis infection in humans reported in Australia was from Brisbane in 1971.1 More recently, a fatal case occurred in a child who ingested molluscs in a suburban Brisbane garden.2 Over the past 10 years, Angiostrongylus has been isolated from dogs, flying foxes, marsupials and zoo primates in Sydney. Angiostrongylus cantonensis, also known as Parastrongylus cantonensis, is the commonest infectious cause of eosinophilic meningitis worldwide and is endemic in South-East Asia and the Pacific Basin.4 The other, rarer parasitic causes of eosinophilic meningitis are not endemic to Australia.5 Non-infectious causes of eosinophilic meningitis include haematological malignancies, antibiotics (ciprofloxacin, intraventricular gentamicin or vancomycin) and idiopathic hypereosinophilic syndrome.6 The lifecycle of the parasite from the adult stage in the definitive rat host through the intermediate mollusc host has been described previously.2 Humans become accidental hosts when they ingest the larval stage in raw or undercooked molluscs or crustaceans or in fresh vegetables contaminated by infected molluscs.5 The diagnosis of angiostrongyliasis in a patient with acute eosinophilic meningoencephalitis is supported by a history of mollusc ingestion, but eliciting this may require specific questioning. Symptoms occur 2–45 days after ingestion.7 The most common symptom is headache. Paraesthesiae are frequently reported.6 In our patient, the acute febrile gastrointestinal illness 6 days after consuming the slugs may have been caused by invasion of the parasite through the intestinal wall. Initial entry into the meninges, and subsequent migration through brain parenchyma, caused the clinical picture of meningitis followed by encephalitis. Seizures or other First report of human angiostrongyliasis acquired in Sydney LESSONS FROM PRACTICE