Angiostrongylus Cantonensis Infections and Eosinophilic Meningitis

Angiostrongylus cantonensis, the rat lungworm, is a parasitic nematode widely recognised as the principal cause of human eosinophilic meningitis. The parasite’s lifecycle involves definitive hosts—commonly Rattus spp.—in which adult worms reside in the pulmonary arteries, and intermediate hosts, primarily gastropods such as snails and slugs. Humans become accidental hosts through ingestion of infective third-stage larvae, either via undercooked intermediate hosts or contaminated produce. Following larval migration across the blood–brain barrier, the host immune response is characterised by eosinophilic pleocytosis within the cerebrospinal fluid, leading to the clinical syndrome of eosinophilic meningitis. Symptoms range from severe headache, neck stiffness and photophobia to more fulminant neurological manifestations including ataxia and cranial neuropathies. Diagnostic challenges arise from variable presentation and low parasite loads; conventional techniques include eosinophil counts in cerebrospinal fluid and serological assays, while advanced molecular methods offer greater sensitivity. Geographically, A. cantonensis has expanded beyond its origins in Southeast Asia and the Pacific to tropical and subtropical regions worldwide, with emerging foci in the Americas, including the southern United States. Public health measures emphasise food safety, control of rodent and gastropod populations, and community education to mitigate transmission risk. The global spread of A. cantonensis and its clinical burden underscore the need for enhanced surveillance, standardised diagnostics, and novel therapeutic strategies.

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Angiostrongylus Cantonensis Infections and Eosinophilic Meningitis publication trend

The graph below shows the total number of articles in angiostrongylus cantonensis infections and eosinophilic meningitis across all publications each year (not limited to Nature Index journals).

Technical terms

Eosinophilic meningitis: Inflammation of the meninges accompanied by elevated eosinophil counts in cerebrospinal fluid.

Paratenic host: An organism in which a parasite survives without further development, facilitating transmission to the definitive host.

Pleocytosis: An increased cell count in cerebrospinal fluid, often reflecting an inflammatory response.

Next-generation sequencing (NGS): High-throughput DNA sequencing techniques enabling rapid identification of pathogen genetic material.

Anthelmintics: Medicinal agents that expel or destroy parasitic worms.

References

1. Angiostrongylus cantonensis Infection in Brown Rats (Rattus norvegicus), Atlanta, Georgia, USA, 2019–2022 - Volume 29, Number 10—October 2023 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2023).
2. Severe angiostrongyliasis with neuropsychiatric symptoms in vulnerable adults: Early diagnosis via next-generation sequencing and successful treatment. Journal of Infection and Public Health (2025).
3. Geographic distribution of Angiostrongylus cantonensis in wild rats (Rattus rattus) and terrestrial snails in Florida, USA. PLOS ONE (2017).