Eosinophilic meningitis

Eosinophilic meningitis is usually caused by Angiostrongylus cantonensis and sometimes by Gnathostoma species. Confirm the presence of eosinophils in the cerebrospinal fluid (CSF) by Giemsa stain – standard CSF stains cannot distinguish eosinophils from neutrophils.

Eosinophilic meningitis caused by A. cantonensis can occur following ingestion of snails and slugsBarratt 2016. Some authorities recommend postexposure prophylaxis with albendazole (20 mg/kg up to 400 mg orally with fatty food, daily for 7 daysProciv 2018) for people in endemic areas who have ingested snails or slugs; however, evidence to support the effectiveness of this approach is limited.

There is conflicting evidence about the treatment of A. cantonensis meningoencephalitis – seek expert advice. Corticosteroid therapy improves symptoms. In most cases, the benefits of anthelmintic treatment (usually in combination with corticosteroids) are thought to outweigh the risksProciv 2018.