Human eosinophilic meningitis is most commonly caused by -
Ans. is 'a' i.e., Angiostrongyliasis Angiostrongyliasis* Angiostrongyliasis is the most common cause of human eosinophilic meningitis.* It is caused by Angiostrogylus cantonensis (rat lung worm).Life Cycle* Cantonensis larvae produced by adult worms in the rat lung migrate to the gastrointestinal tract and are expelled with the feces.* They develop into infective larvae in land snails and slugs.* Humans acquire the infection by ingesting raw infected mollusks; vegetables contaminated by mollusk slime; or crabs, freshwater shrimp, and certain marine fish that have themselves eaten infected mollusks. The larvae then migrate to the brain.* The parasites eventually die in the CNS, but not before initiating pathologic consequences that, in heavy infections, can result in permanent neurologic sequelae or death.* Migrating larvae cause marked local eosinophilic inflammation and hemorrhage, with sub- sequent necrosis and granuloma formation around dying worms.Clinical features & management* Clinical symptoms develop 2-35 days after the ingestion of larvae.* Patients usually present with an insidious or abrupt excruciating frontal, occipital, or bitemporal headache. Neck stiffness, nausea and vomiting, and paresthesias are also common. Fever, cranial and extraocular nerve palsies, seizures, paralysis, and lethargy are uncommon.* Examination of cerebrospinal fluid (CSF) is mandatory in suspected cases and usually reveals an elevated opening pressure, a white blood cell count of 150-2000/mL, and an eosinophilic pleocytosis of >20* The diagnosis is generally based on the clinical presentation of eosinophilic meningitis together with a compatible epidemiologic history.* Specific chemotherapy is not of benefit in angiostrongyliasis; larvicidal agents may exacerbate inflammatory brain lesions.* Management consists of supportive measures, including the administration of analgesics, sedatives, and--in severe cases-- glucocorticoids.* Repeated lumbar punctures with removal of CSF can relieve symptoms.* In most patients, cerebral angiostrongyliasis has a self-limited course, and recovery is complete.* The infection may be prevented by adequately cooking snails, crabs, and prawns and inspecting vegetables for mollusk infestation.Note:* Other parasitic or fungal causes of eosinophilic meningitis in endemic areas may include.# Gnathostomiasis# Paragonimiasis# Schistosomiasis# Neurocysticercosis# Coccidioidomycosis
Angiostrongyliasis
Neurocysticercosis
Coccidiodomycosis
Schistosomiasis
C.N.S.