Angiostrongyliasis in the Americas.

To the Editor: We read with special interest the article by Hochberg et al. about angiostrongyliasis in Hawaii (1). Angiostrongylus cantonensis meningitis in the Americas was reported by Aguiar et al. in Cuba in 1981 (2), and we have studied this zoonosis during the ensuing 25 years. We agree with the authors about the difficulty in obtaining a specific immunoassay for detection of antibodies to A. cantonensis antigens. In Cuba, as in Hawaii, no other cause of eosinophilic meningitis was identified.

To improve accuracy of the diagnosis we investigated immunoglobulin (Ig) E intrathecal synthesis during the first diagnostic lumbar puncture. We also confirmed this synthesis as either a 2-class response (IgG + IgA) or a 3-class response (IgG + IgA + IgM) that appeared 8 days later in cerebrospinal fluid (3).

Since 1991, our records show that the major incidence of the disease is during the second quarter of the year. We detected 32% of the cases during the rainy season when rats come into houses in rural and semirural areas and snails and slugs appear more often in gardens and yards where children play. Ethnicity data show that 52% of those affected were Caucasian and 32% were African. The median interval from onset of symptoms to lumbar puncture was 1-3 days. Although no children died, 6 (23%) of 26 adult patients died. The clinical signs and symptoms of the Cuban patients are similar to those in Hawaii (4,5). We congratulate the authors for systematically determining incidence rates of A. cantonensis meningoencephalitis, a severe but preventable infection.

References

(1.) Hochberg NS, Park SY, Blackburn BG, Sejvar JJ, Gaynor K, Chung H, et al. Distribution of eosinophilic meningitis cases attributable to Angiostrongylus cantonensis, Hawaii. Emerg Infect Dis. 2007;13:1675-80.

(2.) Aguiar PH, Morera P, Pascual J. First record of Angiostrongylus cantonensis in Cuba. Am J Trop Med Hyg. 1981;30:963-5.

(3.) Dorta-Contreras AJ, Noris-Garcia E, Escobar-Perez X, Padilla Docal B. IgG1, IgG2 and IgE intrathecal synthesis in Angiostrongylus cantonensis meningoencephalitis. J Neurol Sci. 2005;238:65-70. DOI: 10.1016/j.jns.2005.06.014

(4.) Dorta-Contreras AJ, Nunez-Fernandez FA, Perez-Martin O, Lastre-Gonzalez M, Magraner-Tarrau ME, Bu-Coifiu Fanego R, et al. Peculiaridades de la meningoencefalitis por Angiostrongylus cantonensis en America. Rev Neurol. 2007;45:755-63.

(5.) Dorta-Contreras A, Noris-Garcia E, Padilla-Docal B, Rodriguez-Rey A, Gonzalez-Hernandez M, Magraner-Tarrau ME, et al. Aportes cubanos al estudio del Angiostrongylus cantonensis. Ciudad de la Habana (Cuba): Editorial Academia; 2006.

DOI: 10.3201/eid1506.071708

Alberto Juan Dorta-Contreras, Maria Esther Magraner-Tarrau, and Eduardo Sanchez-Zulueta

Address for correspondence: Alberto Juan Dorta-Contreras, Hospital Pediatrico San Miguel, Apartado Postal 10049 CP 11000, Laboratorio Central de Liiquido Cefalorraquiideo, Ciudad de la Habana 11000, Cuba; email: [e-mail]

Author affiliation: Facultad de Ciencias Medicas "Dr. Miguel Enriquez," Ciudad Habana, Cuba