Abstract:

Objective To summarize the clinical features and treatment experience in the moderate to severe angiostrongyliasis cantonensis in children for improving the understanding of this infection. Methods The clinical data, including the general information, findings of laboratory studies, imaging and neuroelectrophysiological examinations as well as treatment and prognosis, were retrospectively analyzed in the patients of pediatric angiostrongyliasis admitted to the Women and Children′s Medical Center Affiliated to Guangzhou Medical University between September 1, 2018 and March 30, 2024. Results A total of 18 cases were included, including 11 males and 7 females, with a median age of 2.2 (1.3, 4.4) years. The 18 children had fever and neurological symptoms, in whom 5 were accompanied by respiratory symptoms such as cough and expectoration. Fundus examination failed to reveal any larvae of Angiostrongylus cantonensis. Elevated count and percentage of eosinophil in peripheral blood were found in all children, with a median count of eosinophils being 22.7 (14.7, 36.0)×10⁹/L and the median percentage of eosinophils being 2.3 (0.9, 4.0)%, respectively. Cerebrospinal fluid pressure and white blood cell count in the cerebrospinal fluid were elevated. The median cerebrospinal fluid pressure arrived at 220.0 (205.0, 272.5) mm H₂O, and the median white blood cell count in the cerebrospinal fluid was 404.0 (230.0, 841.5)×10⁶/L. Twelve of the 14 children undergone detection of the serum antibody were positive for Angiostrongylus cantonensis, and 5 were positive for Angiostrongylus cantonensis in the 11 cases undergone antibody test of the cerebrospinal fluid. Fifteen children received metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid, positive results were seen in 14. Four children underwent blood mNGS, positive findings were found in 2. Abnormalities were found in 16 of the 18 children undergone cranial MRI examination. Twelve children underwent chest CT examination, and their results were all abnormal. After definitive diagnosis, all the 18 children received deworming with albendazole, 16 were treated with combined use of glucocorticoids. One child died of pulmonary haemorrhage, and another one was complicated with bilateral ocular cohesion and limited abduction. The remaining 16 cases were cured, without sequelae during 1 and 15 months of follow-up. Conclusion For pediatric patients with fever and neurological symptoms, peripheral blood eosinophilia, abnormalites indicated by cranial MRI or chest CT, anti-parasitic antibody detection and cerebrospinal fluid mNGS should be done as soon as possible. Early diagnosis and treatment of Angiostrongyliasis cantonensis can effectively improve the neurological symptoms and prognosis of patients.

Key words: Angiostrongyliasis cantonensis, Children, Eosinophilic meningitis, Albendazole, Glucocorticoids