Angiostrongylus costaricensis is a filariform nematode normally living within the mesenteric arteries of the definitive host—a rodent. The female is 33 mm long. Keywords: Angiostrongylus costaricensis, Abdominal angiostrongyliasis, helminth, intestinal parasitosis, eosinophilic ileocolitis, Martinique. Angiostrongylus costaricensis was discovered by Morera and Céspedes in , in a man suffering from an abdominal syndrome. Upon surgery, worms were.
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Human abdominal angiostrongyliasis HAA is a parasitic disease caused by the accidental ingestion of the nematode Angiostrongylus costaricensis in its larval form. Human infection can lead to severe ischemic and inflammatory intestinal lesions, sometimes complicated by life-threatening ileal perforations.
Only one case had been reported in Martinique, an Island in the French Antilles, in We retrospectively reviewed the medical charts of patients diagnosed with abdominal angiostrongyliasis at the University Hospital of Martinique between and The objectives of this study were to evaluate the incidence and perform a descriptive analysis of the clinical, biological, radiological, and histopathological features of HAA in Martinique.
All patients presented with abdominal pain associated with high blood eosinophilia median: Two developed ileal perforation and were managed by surgery, with diagnostic confirmation based on histopathological findings on surgical specimens. The other two cases were probable, with serum specimens reactive to Angiostrongylus sp. All cases improved without sequelae. The description of this case series highlights the need to increase awareness of this life-threatening disease in the medical community costarciensis to facilitate access to specific diagnostic tools in Martinique.
Environmental and epidemiological studies are needed to broaden our knowledge of the burden of this disease. The definitive hosts are rodents of the Cricetidae, Heteromyidae, and Muridae families [ 19406062 ].
Adult nematodes reside in the mesenteric arterial system cosgaricensis wild rodents, in which females lay eggs that generate first-stage larvae Clstaricensiswhich are shed in the rodents’ feces.
Larval maturation to the third-stage L3 occurs in intermediate hosts, mainly slugs from the families Veronicellidae and Limacidae [ 11214662 ]. Human infection is accidental and occurs by ingesting third-stage larvae L3 from mollusks or anyiostrongylus contaminated with their slime [ 43 ]. Once ingested, the larvae invade intestinal tissues, reach sexual maturity, and release eggs in the ileo-cecal mesenteric arteries, causing eosinophilic enteritis in humans [ 66 ].
Some sero-epidemiological studies in South America have shown strong seroprevalence rates in humans, i. This implies numerous asymptomatic infections [ 17 ] and a far broader distribution of the parasite in the Americas than previously believed [ 34 ].
In contrast, Costaricenzis is rarely reported in the Antilles and only six sporadic cases have been described since Table 2.
Among them, one was reported in Martinique, an island in the French Antilles. Abdominal angiostrongyliasis in the Antilles. The main objective of this study was to evaluate the incidence of symptomatic HAA cases in Martinique. The secondary objective was to perform a descriptive analysis of the clinical, biological, radiological, and histopathological features of these cases.
It has a tropical climate, with a rainy season from June to November and a dry season from December to May. A retrospective monocentric observational study was performed in the University Hospital of Martinique between January 1, and December 31, Demographic data, abdominal imaging, biological results, clinical features, and outcomes were anonymously and retrospectively collected from the medical charts according to the legal and ethical guidelines of the French National Committee on Data Protection CNIL.
Serological assays to detect IgG against Angiostrongylus sp. We defined a confirmed case as a patient with clinical symptoms and biological results consistent with HAA fever, abdominal tenderness, and blood eosinophilia and histopathological findings of HAA identification of worms, eggs, or larvae in the intestinal wall.
A probable case was defined as a patient with clinical symptoms consistent with HAA and a serum specimen with IgG reactive to Angiostrongylus sp.
The variables were secondarily anonymized and retrospectively collected from medical charts. During the year period of the study, two confirmed and two probable cases of HAA were identified male: The annual incidence rate was 0. All cases presented abdominal pain associated with high blood eosinophilia median: The eosinophilia rate was not related to the severity of the disease.
Cases 1 and 2, diagnosed in month old children, were particularly severe and required surgical procedures with diagnostic confirmation by histological findings. These cases were characterized by anemia, a marked loss of weight and the presence of Charcot Leyden crystals in feces. Cases 3 and 4, probable, were diagnosed in a teenager and an adult with serum specimens reactive to Angiostrongylus sp.
The length of hospitalization was variable median The clinical presentation along with the biological, imaging, histopathological, and epidemiological features are described in Table 1.
Clinical characteristics of the four patients with confirmed cases 1 and 2 and probable cases 3 and 4 Angiostrongylus costaricensis infection in Martinique. Achatina fulicaCRP: Cerebrospinal fluid, CT scan: Computerized axial tomography, Dx: Limicolaria auroraND: Imagery was performed two days following hospitalization and revealed a distended left colic flexure.
Pneumoperitoneum under the right hypochondria white arrow. Focus on the pneumoperitoneum white arrow. Section of the intestine showing two thin-shelled eggs darts surrounded by a granulomatous reaction with giant cells HES, x.
Section of the intestine showing two A. Transversal section of a mesenteric artery showing A. Transversal section of a mesenteric small artery showing three sections of adult worms darts HES, x.
Indeed, only six sporadic cases of HAA have been reported in the Antilles over the last two decades. Two cases were diagnosed in travelers returning from the Greater Antilles, one from Puerto Rico [ 47 ], and the other from the Dominican Republic [ 59 ].
In the Lesser Antilles, one case was reported in Martinique in in a month-old boy [ 24 ], followed by two cases in Guadeloupe in and in a month-old and a five year-old, respectively [ 26 ], and a presumed case in the Commonwealth of Dominica in a North-American student in [ 50 ]. Clinical and biological features of these cases are summarized in Table 2. In our case series, the diagnosis of angiostrongyliasis was considered after admission to hospital because of the nonspecific clinical presentation of the disease [ 33 ].
The disease is generally mild and self-limiting, but some cases can be complicated by intestinal infarction, pseudo-tumor, acute appendicitis, or digestive perforation, requiring emergency laparotomy and surgical care with an unpredictable prognosis [ 33 ].
Typically, diagnosis occurs unexpectedly when an exploratory laparotomy or laparoscopy is required with histological examination of unhealthy tissues. Definitive diagnosis is established when histological examination of resected specimens shows eggs, larvae, or adult parasitic forms in mesenteric arteries [ 19 ]. In subclinical forms not requiring laparotomy or surgery, diagnosis may be established when IgG anti-crude adult worm antigens are found by ELISA-based serological analysis, but such analyses are available in only a few laboratories worldwide [ 13154867 ].
Better specificity is observed when antigens are derived from A. Unfortunately, such biological tools are not yet available in the French territories.
First report of a naturally patent infection of Angiostrongylus costaricensis in a dog.
In our study, the pediatric cases cases 1 and 2 illustrate the severe costraicensis chronic costarixensis of the disease, with necrotizing intestinal inflammation, requiring laparotomy and partial intestinal resection. These two cases were characterized by weight loss, anemia, and a long hospital stay Table 1consistent with the results observed in the three reported pediatric cases in Martinique and Guadeloupe in the ‘s [ 2426 ].
In both of our pediatric cases, examination of the ileo-cecal surgical specimen unexpectedly led to the diagnosis of HAA through microscopic identification of A.
Case 1 was particularly intriguing due to the presence of degenerated helminth eggs in the feces after surgery Fig. We could not confirm them as A. Indeed, detection of A. Cosstaricensis, in this case, surgery may have liberated the eggs in the digestive tract. Cases 3 and 4 illustrate the presumptive and probable diagnoses of less severe forms of HAA, based solely on abdominal symptoms and marked eosinophilia.
[Human angiostrongyliasis caused by Angiostrongylus costaricensis].
The absence of histopathological examination of digestive specimens and specific A. The main elements supporting the diagnosis of HAA were the positive results to A. Several negative parasitological examinations of feces and the absence of headaches and neurological costaricenais, respectively ruled out a possible differential diagnosis of strongyloidiasis and angiostrongyliasis due to A.
All patients recovered without sequelae. Microscopical aspects of the ileal specimen and parasitic stools examination of case No.
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Longitudinal section of a mesenteric artery with an A. Cross section of intra-mesenteric arterial adult nematodes darts with an eosinophilic inflammatory infiltrate in the surrounding tissues. Impaired embryonated egg of nematode maybe A. There is no consensus concerning the treatment of HAA [ 38 ]. It is mainly supportive, costaricensix on analgesia, hydration, and nutrition. Surgery can solve ischemia-related intestinal damage and perforation.
Anthelmintic treatment using benzimidazole-derived compounds is debatable because their larvicidal effect aggravates the inflammatory response, leading to more severe lesions, and may favor the erratic migration of adult parasites and larvae [ 39 ]. Recent studies in mouse models showed that prophylactic enoxaparin treatment does not prevent tissue damage and mortality related to abdominal angiostrongyliasis [ 5455 ]. The four patients in our case series were treated with an anthelmintic as standard treatment for cases of high eosinophilia before diagnostic confirmation.
The angiosgrongylus of transmission of HAA varies depending on the geographical area, generally through the slime of mollusks i.
The mode of transmission for the two confirmed cases is unclear, as no evident contact with mollusks was reported for either patient. However, environmental investigation in one case found the frequent presence of slugs und. In the other case, the parents did not exclude contact between their child and mollusks, but no specific event was reported.
The modest family house was in a district infested with slugs and snails during the rainy season, including Limicolaria aurora and A. These mollusks were not examined to ascertain the presence of A. Aside from the adult case diagnosed during the dry season in Februaryall diagnoses in children were made during the rainy season, when slugs and snails are abundant.
Environmental studies are needed to better understand the routes of HAA costaricensid and evaluate the infection rate and dissemination in mollusks and rodents in Martinique. The only environmental investigation in the French Antilles was conducted on Rattus rattus and Rattus norvegicus in Guadeloupe an island close to Martinique in and showed that 7.
These rat species are also found in Martinique and may be the main definitive hosts there [ 49 ] Table 3. Among the most common definitive hosts in South America, the rodent families Cricetidae and Heteromyidae are absent in Martinique [ 526163 ]. Slugs, acting as intermediate hosts for A. The aquatic snails Biomphalaria glabrata and B. This invasive species, first described in in Martinique, is responsible for the emergence of central nervous system angiostrongyliasis due to Angiostrongylus cantonensis in the Lesser Antilles angiosstrongylus 9 ].
The definitive hosts of A.