Aspectos epidemiológicos, clínicos e laboratoriais de infecção por <i>Angiostrongylus cantonensis</i>: uma revisão integrativa

Carvalho, M. S. N.; Carvalho, M. R.; Santos, J. A. O.; Barbosa, N. D.; Melo, L. C.; Costa, F. H. M.; Carvalho, J. P. F.; Messias, H. B. G.; Fonseca, S. A.; Souza, M. A.; Ferreira-Júnior, G. C.; Lima, R. F.; Costa, J. G.; Cavalcanti, M. G. S.; Matos-Rocha, T. J.

doi:10.1590/1519-6984.262109

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Original Article • Braz. J. Biol. 82 • 2022 • https://doi.org/10.1590/1519-6984.262109 linkcopiar

Aspectos epidemiológicos, clínicos e laboratoriais de infecção por Angiostrongylus cantonensis: uma revisão integrativa

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Este estudo de revisão integrativa da literatura analisa os achados dos últimos 5 anos do parasita Angiostrongylus cantonensis. Sabe-se que esse nematoide é encontrado nas artérias pulmonares de ratos, onde permanece como hospedeiro definitivo. Dos camundongos, o ciclo se espalha para os animais, como os caracóis, que em contato com humanos podem desencadear a doença. Em humanos, o parasita causa diversas manifestações neurológicas, abdominais e principalmente meningite. Com base na revisão de estudos, sua epidemiologia mostra distribuição mundial, embora existam casos endêmicos para esse parasito, como países asiáticos. Os achados laboratoriais geralmente mostraram LCR alterado com turbidez, aumento de proteínas e eosinofilia, o que gerou sinais meníngeos nos pacientes, além disso, os exames de ressonância magnética mostraram múltiplas alterações. Foram relatados achados raros do nematoide no globo ocular, pulmão e sinais de inflamação peritoneal, o que requer mais estudos para o entendimento de toda a fisiopatologia. Por fim, o tratamento conservador à base de anti-helmínticos e anti-inflamatórios trouxe boas respostas, embora haja relatos de óbitos, o que demonstra a importância na prevenção e terapia dessa doença.

Palavras-chave:
epidemiologia; Angiostrongylus cantonensis; verme pulmonar do rato

Author	Country/Year	Age/Gender	Cause	Clinical Manifestations	Diagnosis	Exams	Treatments	Clinical outcome
Dard et al. (2017)	Basse-Terre/2017	8 months old/ Gender Not mentioned	Contact of snails and rodents in the vegetable garden	Meningeal signs, fever, vomiting	CSF sample PCR	Hypereosinophilia and altered CSF	Albendazole, ivermectin and corticosteroids	The patient recovered clinically (after 11 days). Normal laboratory values (after 25 days)
Flerlage et al. (2017)	USA/2017	12 months old/Male	Possible contact with rodent excreta	Fever, irritability, vomiting and anorexia	Western blot	Altered CSF, MRI findings	Albendazole and corticosteroids	The patient's temperature returned to normal and his symptoms solved
Hammoud et al. (2017)	USA/2017	12 months old/ Female	Not mentioned	Fever, lethargy	CSF sample PCR	PCR altered, MRI with alterations	Albendazole and prednisone	Patient's symptoms have completely solved (after 64 days)
Meyer et al. (2017)	USA/2017	22 years old/Male	Not mentioned	Headache, fever and diplopia	Not mentioned	MRI findings, chest CT findings	Corticosteroids and lumbar puncture	Headache solved
Nguyen et al. (2017)	French/2017	54 years old/Female	Not mentioned	Fever, headache, nuchal rigidity, and photophobiaa	Western blot	Mild leukocytosis, altered CSF and altered abdominal CT	Prednisone, albendazole and CSF puncture	Complete regression of symptoms
Prasidthrathsint et al. (2017)	USA/2017	22 years old/Male	Consumption of seafood	Headache, double vision, fever	CSF sample PCR	MRI with signs suggestive of CSF inflammation	Prednisone and lumbar puncture	Significant improvement in clinical symptoms (after 2 months)
Shen et al. (2017)	Not mentioned/2017	56 Years old/Male	Not mentioned	Headache, cognitive impairment and urinary incontinence	Microscopic analysis of CSF	MRI findings	Not mentioned	Not mentioned
Andrade et al. (2018)	Brazil/2018	20 months old/Male.	Contact with snails	Fever, lethargy and vomiting	CSF sample PCR	Findings on blood count and fundus examination.	Albendazole, prednisolone and vitrectomy	Symptomatic improvement
Defo et al. (2018)	French Guiana /2018	10 years old/Male	Exposure to snails	Headache, vomiting and fever	Western blot and CSF sample PCR	Altered CSF, hypereosinophilia and MRI with alterations	Ivermectin, methylprednisolone and prednisolone	Progressive disappearance of symptoms and MRI normality (after 38 days)
Ma et al. (2018)	China/2018	15 months old/Female	Exposure and accidental consumption of slug	Fever, irritability and constipation	CSF analysis and clinical findings	Eosinophilia and altered CSF	Levamisole, prednisone and mannose.	Recovery of all your symptoms (after 72 hours)
McAuliffe et al. (2019)	USA/2018	20 years old/Male	Raw snail consumption	Headache, hyperesthesia and neck stiffness	CSF sample PCR	CSF and MRI findings	Albendazole, prednisolone and lumbar puncture	Improvement of symptoms but remained with erectile dysfunction, intermittent pain and central obstructive sleep apnea
Wang et al. (2018)	China/2018	78 years old/Female	Centipede consumption	Headache and neck stiffnessl	ELISA with serum sample and CSF	Changed CSF	Albendazole and dexamethasone	CSF normality
Wang et al. (2018)	China/2018	46 years old/Male	Centipede consumption	Headache and neck stiffness	ELISA with serum and CSF sample	Altered CSF and lung CT finding	Albendazole and dexamethasone	CSF normality and no lung findings
Berkhout et al. (2019)	Australia/2019	5 years old/Female and 10 years old/Male	ingestion of the snail or contaminated vegetables	Headache and hemiparesis (boy)	CSF sample ELISA	MRI findings	Mebendazole and dexamethasone	Recovery of some function (after 5 months), but not to their previous state, with persistence of hemiparesis (boy)
Chotmongkol and Khamsai (2019)	Thailand/2019	38 years old/Male	Raw snail and shrimp ingestion	Headache	Western blot	CSF and MRI changes	Prednisolone	Numbness in face and limb after 2 weeks on prednisolone. Improvement of symptoms after 6 months
Long et al. (2019)	USA/2019	44 years old/Female	Seafood ingestion	Headache and paresthesia, urinary retention	CSF sample PCR	Eosinophilia, MRI with brain and spinal cord injury and altered CSF	Duloxetine and DMT (disease-modifying therapy)	Normal CSF and improvement of pleocytosis
Tiwari et al. (2019)	India/2019	70 years old/Female	Feeding	Watering and redness in the eye	Direct analysis of the worm in the eye chamber	Eye sclerosis	Moxifloxacin eye drops, dexamethasone and atropine sulfate eye drops	Symptomatic improvement (after 1 week)
Xie et al. (2019)	China/2019	1 year old/Male	Not mentioned	Cough, mental fatigue and fever	CSF sample NGS	CSF and MRI findings	Albendazole and methylprednisolone	Improvement of symptoms (after 10 days) and CSF normality
Xie et al. (2019)	China/2019	1 year old/Male	Not mentioned	Cough, vomiting, mucosal herpes and fever	CSF sample NGS	CSF and MRI findings	Albendazole and methylprednisolone	Improvement of symptoms (after 10 days) and CSF normality
Cucueco et al. (2020)	USA/2020	29 years old/Male	Not mentioned	Headache, fever, allodynia, erythematous flushing, and arthralgia	CSF sample PCR	Altered CSF and MRI	Ibuprofen, acetaminophen, gabapentin, fentanyl, prednisone, lidocaine…	Significant improvement
Dard et al. (2020)	Martinica/2020	8 cases: 3 kids (1 year old); 1 boy (11 years old), anos, 4 adults (age between 37 and 64 years old).	Consumption/contact with mollusks	Headache, seizure, nuchal rigidity, radiculalgia, vomitingand diarrhea	Western blot or serum antigen search.	CSF and MRI with findings	Albendazole, corticosteroids, and lumbar puncture	2 people (no sequelae); 5 people (strabismus and intellectual disability); 1 person (fatal)
Elghawy et al. (2020)	USA/2020	50 years old/Male	Not mentioned	Productive cough, bloody nasal secretions and dyspnea	Lung biopsy	Eosinophilia	Ivermectin	Symptom resolution
Feng et al. (2020)	China/2020	27 years old/Male	Consumption of contaminated meat	Skin itching, emesis, myalgia, quadriparesis, headache and coma.	CSF sample NGS	Altered CSF and CT of the abdomen	Methylprednisolone, and immunoglobulin, ceftriaxone and linezolid	Died (after 38 days)
Meyer (2021)	USA/2020	10 cases (age between 47 and 78 years old): 4 female, 6 male	Not mentioned	Hyperparesthesia, sleep disorders, headache, Hypersensitivity and Urinary retention	CSF sample PCR, direct observation of eye	Altered CSF, eosinophilia	Prednisone, cannabis, lidocaine, tramadol, acupuncture…	Not mentioned
Monteiro et al. (2020)	Brazil/2020	43 years old/Female	Ingestion of raw shellfish	Headache	ELISA and Western blot	Eosinophilia	Crystalline penicillin and albendazole	Improvement of symptoms
Monteiro et al. (2020)	Brazil/2020	35 years old/Male	Ingestion of raw shellfish	Headache, fever and limb pain	ELISA and Western blot	MRI findings	Ivermectin, methylprednisolone and gabapentin	Improvement of symptoms
Monteiro et al. (2020)	Brazil/2020	31 years old/Male	Ingestion of raw shellfish	Headache	ELISA and Western blot	Altered CSF, MRI findings	Ivermectin, methylprednisolone and gabapentin	Improvement of symptoms
Thu et al. (2020)	Vietnam/2020	9 months old/Male	Not mentioned	Seizures and fever	Serum and CSF sample ELISA	CSF and MRI findings	Albendazole, dexamethasone, mannitol and prednisolone	Full recovery
Todaka et al. (2020)	Japan/2020	39 years old/Male	Contaminated food	Headache, fever and nausea	Anti-A test in serum and CSF.	Leukocytosis, CSF findings	Ivermectin and olopatadine	Clinical improvement
Widder et al. (2020)	Japan/2020	20 years old/Male	Raw snail consumption	Headache, neck stiffness, quadriplegia, polyneuropathy, diarrhea and dysuria	CSF sample PCR	MRI and funduscopic examination altered	Prednisolone Ceftriaxone, Acyclovir, Vancomycin, Steroids, Methylprednisolone and Lumbar Puncture	Improved but maintained severe neurological sequelae
Zhang et al. (2020)	China/2020	59 years old/Male	Not mentioned	Headache, nausea, vomiting and fever	CSF sample NGS	Eosinophilia, altered CSF and MRI findings	Albendazole and methylprednisone	Improved consciousness and normal MRI
Yang et al. (2021)	Vietnam/2021	22 years old/Male	Lizard meat ingestion	Headache, arthralgia, vomiting, diarrhea and nausea	CSF sample PCR	changed CSF	Dexamethasone, prednisolone, albendazole.	Improvement of symptoms
Yang et al. (2021)	Vietnam/2021	25 years old/Male	Lizard meat ingestion	Headache, arthralgia and loss of appetite	CSF sample PCR	Not mentioned	Albendazole and steroids	Improvement of symptoms
Yang et al. (2021)	Vietnam/2021	24 years old/Male	Lizard meat ingestion	Headache, arthralgia and neurological deficit	CSF sample PCR	Not mentioned	steroid and albendazole	Improvement of symptoms
Yang et al. (2021)	Vietnam/2021	24 years old/Male	Lizard meat ingestion	Headache, weakness and numbness in limbs	CSF sample PCR	Not mentioned	Albendazole and steroid	Improvement of symptoms
Yang et al. (2021)	Vietnam/2021	31 years old/Male	Lizard meat ingestion	Nausea, vomiting and arthralgia	CSF sample PCR	Not mentioned	Albendazole and steroids	Improvement of symptoms
Yang et al. (2021)	Vietnam/2021	36 years old/Male	Lizard meat ingestion	Not mentioned	CSF sample PCR	Not mentioned	Herbal remedies	Not mentioned
Yang et al. (2021)	Vietnam/2021	32 years old/Male	Lizard meat ingestion	Not mentioned	CSF sample PCR	Not mentioned	Herbal remedies	Not mentioned

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