Abstract
A subcommittee of the Hawaii Governor's Joint Task Force on Rat Lungworm Disease developed preliminary guidelines for the diagnosis and treatment of neuroangiostrongyliasis (NAS) in 2018 (Guidelines, 2018). This paper reviews the main points of those guidelines and provides updates in areas where our understanding of the disease has increased. The diagnosis of NAS is described, including confirmation of infection by real-time polymerase chain reaction (RTi-PCR) to detect parasite DNA in the central nervous system (CNS). The treatment literature is reviewed with recommendations for the use of corticosteroids and the anthelminthic drug albendazole. Long-term sequelae of NAS are discussed and recommendations for future research are proposed.
Highlights
Neuroangiostrongyliasis is a parasitic infection of the central nervous system caused by larvae of the rat lungworm, Angiostrongylus cantonensis
Rats in the genus Rattus are the definitive host for A. cantonensis and numerous species of gastropods serve as the intermediate host (Cowie, 2013a)
A positive real-time polymerase chain reaction (RTi-PCR) test for A. cantonensis DNA in the cerebrospinal fluid (CSF) is valuable for confirmation of NAS (Qvarnstrom et al, 2016), it is not necessary prior to starting treatment provided that Eosinophilic meningitis (EOM) has been documented, there is a potential exposure history, and there are no other obvious causes of the illness
Summary
Neuroangiostrongyliasis is a parasitic infection of the central nervous system caused by larvae of the rat lungworm, Angiostrongylus cantonensis. A positive RTi-PCR test for A. cantonensis DNA in the CSF is valuable for confirmation of NAS (Qvarnstrom et al, 2016), it is not necessary prior to starting treatment provided that EOM has been documented, there is a potential exposure history, and there are no other obvious causes of the illness.
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