Eosinophilic meningitis in Prapokklao Hospital.

Abstract

Background : Eosinophilic meningitis is mainly caused by helminthic infection. Angiostrongylus cantonensis and Gnathostoma spinigerum are major causative agents. Incidence of this disease is high in Thailand especially in northeastern area. In Chanthaburi,there was no previous study about eosinophilic meningitis. We review cases of eosinophilic meningitis in Prapokklao Hospital to evaluate manifestrations and outcome.

Method : Descriptive retrospective study. All in-patient medical record of eosinophilic meningitis in medicine department form January 2003 to December 2005 were reviewed and evaluated the clinical presentation, laboratory investigation and outcome.

Results : There were 37 cases of eosinophilic meningitis in past 3 years. All cases were clinically caused by Angiostrongylous cantonensis. Manifestrations included headache(97.3 percent), vomiting(75.7 percent), stiffneck(49.5 percent),fever(13.5 percent), cranial nerves palsy(13.5 percent), myalgia(10.8 percent),fatigue(8.1 percent) and photophobia(2.7 percent). Laboratory findings included peripheral blood eosinophilia(89.2 percent), increase CSF pressure>200mmH2O (73 percent), CSF pleocytosis (mean=1104 cell/cu.mm3,eosinophil 58.8 percent),protein 90mg/dl and CSF/blood glucose ratio=46. Level of cosciousness was not correlated with peripheral blood eosinophilia, CSF eosinophil, CSF protein and CSF/blood glucose ratio. The patients who presented with altered mental status had unfavorable outcome.

Conclusion : Eosinophilic meningitis caused by Angiostrongylous cantonensis should be considered in patient who have headache after eating raw snail especially between October to November.