1466. Pediatric Angiostrongylus Cantonensis Infections in Hawaii
Session: Poster Abstract Session: Global Health
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Eosinophilic meningitis (EM) due to Angiostrongylus cantonensis(AC) or rat lungworm is uncommon in continental US.  32 cases of AC have been reported to Hawaii state department of health in the 2002-2012 decade.  Infection is endemic in rats and carried in slugs, snails which could deposit the larvae in vegetables and grass. We report the clinical severity and disease outcomes in hospitalized children with AC meningitis.

Methods: Children admitted to Kapiolani Medical Center for Women and Children in Honolulu between December 2008 and December 2011 with the diagnosis of EM were included.  EM diagnosis was defined as > 6 WBC/mm3 and either > 10% eosinophils or eosinophil count > 10/mm3.   AC larva was either seen at CSF sample (one patient) or identified by serology and PCR. 

Results: We have followed four children with the diagnosis of EM.   The median age was 14.5 months (range: 9 - 26 months).  Three patients were males.  Two patients were fed only breast milk and  baby formula.  None of the patients had known direct exposure to slugs or snails.  They were all from Island of Hawai‘i. CSF findings showed mean WBC 306/ mm3 (range 101- 484/ mm3), mean eosinophil of 21 % (range 16-29 %).  One 9 month-old female died from encephalopathy and respiratory failure.  Another 9 month old patient had hypoxia, pulmonary edema, pulmonary emboli.  He had severe developmental and language delays at two years of age.    One patient had right sided blindness and had delayed speech.  One patient recovered completely.  All of the patients were treated with antihelminthics and steroids.  All of the patients showed brain infarcts on MRIs.  One patient had reported chest X-ray infiltrates prior to admission and two patients developed respiratory failure and lesions consistent with pulmonary emboli.

Conclusion: Adult EM case series demonstrate that AC infection is mostly mild and self-limited.  In contrast, our pediatric patients had severe and protracted disease. One patient died.  The complications and neurodevelopmental sequelae were higher. Two of the four patients had severe pulmonary complications that were insufficiently reported in literature.  There was no significant contact/exposure history among two of the infants.   No significant benefit was seen with steroid treatment.

Guliz Erdem, MD, Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI and Marian Melish, MD, Kapiolani Medical Center for Women and Children, Honolulu, HI; University of Hawaii, Honolulu, HI; Hawaii Hospitals, Honolulu, HI


G. Erdem, None

M. Melish, None

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