• Main Authors: Maria Cristina Carvalho do Espírito-Santo, Pedro Luiz Silva Pinto, Dan Jesse Gonçalves da Mota, Ronaldo César Borges Gryschek
• Format: Article
• Language: English
• Published: Universidade de São Paulo 2013-04-01
• Series: Revista do Instituto de Medicina Tropical de São Paulo
• Subjects: Angiostrongylus cantonensis; Eosinophilic meningitis; CSF eosinophilia
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652013000200129

<p id="para1">Introduction:Angiostrongylus cantonensis is a natural parasite found in lung arteries of rats, which in humans may cause eosinophilic meningitis. Objective: To report the first case of eosinophilic meningitis caused by Angiostrongylus cantonensis in the city of S&#227;o Paulo, Brazil. Case report: A male patient, 11 years old, living in the southern area of S&#227;o Paulo, was admitted to the Pediatric Emergency Department with ongoing headaches for three days, but no fever or any other complaint. The presence of snails and rodents was reported in the peridomicile. The child was awake, lucid, oriented; muscular strength preserved, isochoric, photo reagent pupils and terminal nuchal rigidity - Glasgow Coma Scale (GCS) = 15. The laboratory tests showed a mild leukocytosis with 1736 eosinophils/mm3 and the CSF analysis disclosed 160 leukocytes/mm3 with 36% of eosinophils. The bacterial culture was negative. Computed Cerebral Tomography showed no alterations. The RT-PCR assay for detecting Angiostrongylus cantonensis larvae and DNA was negative. ELISA antibodies for IgG anti-A. cantonensis was negative in serum and undetermined in CSF and samples collected five days after the onset of symptoms. Seroconversion was observed in the sample collected 135 days later. Conclusion: the epidemiological and clinical data, the CSF alterations with eosinophilia and the seroconversion strongly suggest Angiostrongylus cantonensis eosinophilic meningitis.<br><p id="para2">Introdu&#231;&#227;o:Angiostrongylus cantonensis &#233; um parasito natural das art&#233;rias de pulm&#245;es de ratos, que pode causar, em humanos, meningite eosinof&#237;lica. Objetivo: Relatar o primeiro caso de meningite eosinof&#237;lica causado por A. cantonensis na cidade de S&#227;o Paulo, Brasil. Relato de caso: Paciente do sexo masculino, 11 anos, residente na zona sul de S&#227;o Paulo, foi admitido no servi&#231;o de emerg&#234;ncia pedi&#225;trica com hist&#243;ria de cefal&#233;ia h&#225; tr&#234;s dias, sem febre ou outras queixas. Relato de presen&#231;a de moluscos e roedores no peridomic&#237;lio. Ao exame f&#237;sico, crian&#231;a desperta acian&#243;tica, anict&#233;rica, hidratada; l&#250;cido, orientado; for&#231;a muscular preservada, isoc&#243;rica, pupilas fotorreagentes e rigidez de nuca terminal - Glasgow Coma Scale = 15. Exames laboratoriais indicaram leve leucocitose com 1736 eosin&#243;filos/mm3 e a an&#225;lise do l&#237;quor revelou a presen&#231;a de 160 leuc&#243;citos/mm3 com 36% de eosin&#243;filos. Cultura para bact&#233;rias negativa. Tomografia cerebral sem altera&#231;&#245;es. Pesquisa direta de larvas e de DNA por PCR-RT para Angiostrongylus cantonensis foi negativa. ELISA para anticorpos IgG anti-A. cantonensis negativo no soro e indeterminado no l&#237;quor nas amostras coletadas ap&#243;s cinco dias do in&#237;cio dos sintomas. Soroconvers&#227;o observada na amostra coletada ap&#243;s 135 dias. Conclus&#227;o: A hist&#243;ria epidemiol&#243;gica, dados cl&#237;nicos, altera&#231;&#245;es liqu&#243;ricas com presen&#231;a de eosinofilia e a soroconvers&#227;o sugerem fortemente o diagn&#243;stico de meningite eosinof&#237;lica por A. cantonensis.