Neuroangiostrongyliasis: Global Spread of an Emerging Tropical Disease

Neuroangiostrongyliasis (NAS) is an emerging parasitic disease caused by the neurotropic nematode Angiostrongylus cantonensis. Since it was first discovered, in rats in southern China in the 1930s, this tropical to subtropical parasite has spread to much of Southeast Asia, the Pacific Islands (inclu...

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Bibliographic Details
Published in:The American journal of tropical medicine and hygiene 2022-12, Vol.107 (6), p.1166-1172
Main Authors: Cowie, Robert H, Ansdell, Vernon, Panosian Dunavan, Claire, Rollins, Randi L
Format: Article
Language:English
Subjects:
Angiostrongylus cantonensis
Animals
Humans
Life Cycle Stages
Meningitis - diagnosis
Parasites
Parasitic diseases
Rats
Review
Snails - parasitology
Strongylida Infections - complications
Strongylida Infections - drug therapy
Strongylida Infections - epidemiology
Zoonoses
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Summary:Neuroangiostrongyliasis (NAS) is an emerging parasitic disease caused by the neurotropic nematode Angiostrongylus cantonensis. Since it was first discovered, in rats in southern China in the 1930s, this tropical to subtropical parasite has spread to much of Southeast Asia, the Pacific Islands (including Hawaii), Australia, Japan, South America, the southeastern United States, the Caribbean, Africa, the Canary Islands, and the Balearic Islands. The parasite completes its natural life cycle in snails and slugs (intermediate hosts), and rats (definitive hosts). Humans become accidental hosts after ingesting infective third-stage larvae contained within uncooked or undercooked intermediate or paratenic hosts, an event that sometimes results in NAS, also known as rat lungworm disease. Although A. cantonensis larvae cannot complete their life cycle in humans, their migration into the brain and spinal cord combined with a powerful inflammatory reaction often leads to eosinophilic meningitis and can, in rare instances, lead to coma, paralysis, and death or, in other cases, chronic, disabling neurologic sequelae. Symptoms of NAS are diverse, which often makes it difficult to diagnose. Treatment may include administration of analgesics, corticosteroids, anthelminthics, and repeat lumbar punctures to reduce intracranial pressure. Unfortunately, few medical providers, even in endemic areas, are familiar with A. cantonensis or its epidemiology, diagnosis, and treatment. As the parasite continues to spread and NAS affects more people, medical practitioners, as well as the general public, must become more aware of this emerging zoonosis and the potentially devastating harm it can cause.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.22-0360