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寄生蟲

人畜共通傳染病

Angiostrongylus cantonensis2

廣東住血線蟲

Angiostrongylus cantonensis

Scientific classificationKingdom: AnimaliaPhylum: NematodaClass: SecernenteaOrder: StrongylidaGenus: AngiostrongylusSpecies: cantonensis

Angiostrongylus cantonensis

is a parasitic nematode

(roundworm) that causes Angiostrongyliasis, the most common cause of eosiniphilic meningitis

in Southeast Asia andthe Pacific Basin.

[1]

It commonly resides in the pulmonary arteries of rats, giving it thenickname the

rat lungworm

. Snails are the primary intermediate hosts, where larvaedevelop until they are infective. Humans are incidental hosts, and may become infectedthrough ingestion of larvae in raw or undercooked snails or other vectors, or contaminatedwater and vegetables. The larvae are then transported via the blood to the central nervoussystem

(CNS), where they are the most common cause of eosiniphilic meningitis, a seriouscondition that can lead to death or permanent brain and nerve damage.

[2]

Identified in1964, Angiostrongyliasis is an infection of increasing public health importance asglobalization

aids in the geographic spread of the disease.

Infectious agent

Angiostrongylus cantonensis

is a helminth of the phylum

Nematoda

, order

strongylida

, andsuperfamily

metastrongyloidea

, but is commonly referred to as the rat lungworm.Nematodes are roundworms characterized by a tough outer cuticle, unsegmented bodies,and a fully developed GI tract. The order

Strongylida

includes hookworms and lungworms.

Metastrongyloidea

are characterized as long, slender, threadlike worms that reside in thelungs of the definitive host.

[3]

Angiostrongylus costaricensis

is a closely related worm thatcauses intestinal Angiostrongyliasis in Central and South America.

Angiostrongylus cantonensis3

History of discovery

Nematodes suspected to be

A. cantonensis

were first identified in the cerebrospinal fluid of a patient with eosiniphilic meningitis by Nomura and Lim in Taiwan in 1944. They calledthe parasite

Haemostrongylus ratti

, and noted that raw food eaten by the patient may havebeen contaminated by rats. Their paper, however, was not translated from the original Japanese into English until just after the parasite had been recognized in 1964, so theirdiscovery was not widely recognized.In 1955, Mackerass and Sanders identified the life cycle of the worm in rats, defining snailsand slugs as the intermediate host and noting the path of transmission through the blood,brain, and lungs in rats.In 1961, an epidemiological study of eosiniphilc meningitis in humans was conducted byRosen, Laigret, and Bories, who hypothesized that the parasite causing these infections wascarried by fish. However Alicata noted that raw fish was consumed by large numbers of people in Hawaii without apparent consequences, and patients presenting with meningitissymptoms had a history of eating raw snails or prawns in the weeks before presenting withsymptoms. This observation along with epidemiology and autopsy of infected brainsconfirmed

A. cantonensis

infection in humans as the cause of the majority of eosiniphilicmeningitis cases in Southeast Asia and the Pacific Islands.

[4]

Clinical presentation in humans

In humans, Angiostrongylus is the most common cause of eosiniphilic meningitis.

[1]

Frequently the infection will resolve without treatment or serious consequences, but incases with a heavy load of parasites the infection can be so severe it can cause permanentdamage to the CNS or death.

[5]

Early symptoms

Infection first presents with severe abdominal pain, nausea, vomiting, and weakness, whichgradually lessens and progresses to fever, and then to CNS symptoms and severe headacheand stiffness of the neck.

Severe/

CNS infection

CNS symptoms begin with mild cognitive impairment and slowed reactions, and in a verysever form often progress to unconsciousness.

[2]

Patients may present with neuropathicpain early in the infection. Eventually severe infection will lead to ascending weakness,quadriparesis, areflexia, respiratory failure, and muscle atrophy, and will lead to death if not treated. Occasionally patients present with cranial nerve palsies, usually in nerves 7and 8, and rarely larvae will enter ocular structures.

[6]

Even with treatment, damage to theCNS may be permanent and result in a variety of negative outcomes depending on thelocation of the infection, and the patient may suffer chronic pain as a result of infection.

[2]