Eosinophilic meningitis in Thailand. Clinical and epidemiological characteristics of 162 patients with myeloencephalitis probably caused by Gnathostoma spinigerum

Abstract

The clinical and epidemiological characteristics of 162 patients with eosinophilic myeloencephalitis, believed to be caused by invasion of the central nervous system by Gnathostoma spinigerum, are described. The case mortality rate was at least 12%, and probably higher. Single live young adult G. spinigerum were recovered from the brains of 2 patients at autopsy and from the eye lids of 2 other living patients. The disease caused by this parasite can be distinguished from that caused by Angiostrongylus cantonensis by characteristic acute nerve root pain, signs of spinal cord and cerebral involvement, and the presence of bloody or xanthochromic cerebrospinal fluid. As judged by its prevalence and mortality, central nervous system disease caused by G. spinigerum is the most important parasitic disease of the central nervous system in Thailand. Since invasion of the nervous system by this parasite is a significant cause of intracranial hemorrhage in Thailand, it should be kept in mind by internists, neurologists, neurosurgeons, and pathologists who care for patients residing in, or who have visited, areas where G. spinigerum occurs.