Costaricensis angiostrongyliasis B81.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Nematode infection, which causes abdominal angiostrongyliasis with severe abdominal pain and hemophilia.

Pathogen
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  • Angiostrongylus costaricensis (nematode, threadworm). Infection in rodents and humans.
  • Infection through contaminated and raw foods such as salads and water.
  • A. costaricensis is the only nematode that infects mesenteric arteries of hosts. The adult worms parasitize in the mesenteric vessels of rats, larvae hatch from the deposited eggs, which penetrate the intestinal wall, are excreted with the stool and enter snails for further development. From the snails the 3rd larvae are excreted, which infect soil, plants and water.

Occurrence/Epidemiology
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Occurrence in South and Central America and in the south of the USA.

Clinical features
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  • The exact incubation period is not known.
  • In the foreground is the picture of an acute appendicitis, strong abdominal pain preferably in the ileocecal region, fever, vomiting, nausea. Asymmetrical paresthesias of the extremities and trunk with burning pain and pronounced sensitivity to touch over several dermatomes. Photophobia is often present.
  • Symptoms usually subside after 1-2 weeks, recurrences are possible.

Laboratory
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Eosinophilia.

Diagnosis
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  • Microscopy of stool and intestinal biopsies is only occasionally successful.
  • Antibody test (ELISA), diagnostic value is questionable.

Differential diagnosis
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Complication(s)
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  • Ileus, intestinal infarcts, perforations.
  • Granuloma formation in organs such as liver and spermatic artery with image of an acute testicle.

Therapy
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  • No specific therapy established so far.
  • In individual cases success with mebendazole and albendazole.
  • Surgical intervention required in case of complications.

Progression/forecast
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  • Good for mild cases.
  • In complications, deaths have been described.

Prophylaxis
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Avoidance of contaminated food and water.

Literature
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  1. Terada M, cinema H (1993) Effects of mebendazole on Angiostrongylus costaricensis in mice, with special reference to the timing of treatment. Parasitol Res 79: 441-443
  2. Mentz MB, Graeff-Teixeira C (2004) Treatment with mebendazole is not associated with distal migration of adult Angiostrongylus costaricensis in the murine experimental infection. Rev Inst Med Trop Sao Paulo 46: 73-75

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Last updated on: 29.10.2020