广州管圆线虫病所致嗜酸粒细胞性脑膜脑炎18例临床分析

A clinical research for eosinophilic meningoencephalitis caused by angiostrongyliasis

目的提高临床医师对广州管圆线虫病的认识。方法分析１８例广州管圆线虫病所致嗜酸粒细胞性脑膜脑炎的临床特征及实验室、流行病学调查资料。结果发病前均有生食淡水螺肉史，潜伏期１～２５天。以头痛、躯体痛为主要表现，头痛剧烈而脑膜刺激征不明显。周围血象、脑脊液中嗜酸粒细胞明显增高，血清广州管圆线虫抗体阳性（ＥＬＩＳＡ法）。头颅ＣＴ正常，２例头颅磁共振（ＭＲ）检查呈斑片状异常信号，脑电图α波变慢。用阿苯哒唑、氟美松治疗效果好，预后佳。结论广州管圆线虫病是嗜酸粒细胞性脑膜脑炎的主要病因之一。

Objective To improve the awareness of angiostrongyliasis. Methods The clinical and laboratory data as well as the epidemiological informations of 18 patients with eosinpphilic meningoencephalitis caused by Angiostrongylus cantonensis were analyzed. Results All the patients had a history of eating raw fresh water snail (Ampularium canaliculatus) before the onset of the disease. Incubation period ranged from 1 to 25 days. The major symptoms of the patients were severe headache and pain in the trunk and limbs. Peripheral blood eosinophilia was noted together with increased eosinophiic count in cerebrospinal fluid. With ELISA sera from patients were specifically IgGantibody positive against Angiostrougylus cantonensis antigen, but were negative against other parasitic antigens such as Paragonimus westermani, Cysticercus, Cellulosae hominis, Echinococcus granulosus and Trichinella spiralis. Abnormal spot signal was found in 2 cases with brain magnetic resonance imaging. Electroen cephalogram showed slow alpha rhythm. All the patients were effectively treated with good combined administration of albendazole and dexamethazone. Conclusion Angiostrongyliasis is one of the common causes leading to eosinophilic meningoencephalitis. To our knowldege, Wenzhou is the first small outbreak site discovered of angiostrongyliasis in China's Mainland.