Detecting Angiostrongylus cantonensis Eosinophilic Meningitis with Highly Sensitive Quantitative Polymerase Chain Reaction—Report of Five Cases in Southern India

Although more than 30 case reports of eosinophilic meningitis have been attributed to Angiostrongylus cantonensis (A. cantonensis) in India, only three have been microbiologically confirmed (via polymerase chain reaction [PCR] or immunoblot testing). In seven ocular infections and two brain abscesses reported, A. cantonensis was identified on the basis of the morphology of recovered worms. Here, five cases of Angiostrongylus eosinophilic meningitis (AEM) in children and adults are reported, diagnosed via the detection of A. cantonensis DNA in cerebrospinal fluid using the AcanR3990 quantitative PCR (National Institutes of Health, Bethesda, MD). All patients responded to management with steroids and albendazole. When AEM cases reported from India were reviewed and mapped, the majority were reported from southern Indian states. Managing and preventing this emerging zoonosis in these areas requires 1) access to accurate and timely diagnostics, 2) increasing awareness among clinicians, and 3) risk assessment with public health officials on acquiring infections from water and food contaminated by gastropods and other paratenic hosts.