Angiostrongylus costaricensis infection
Angiostrongyliasis costaricensis has been reported mostly in South and Central America, the Caribbean, and Africa.
The life cycle is similar for both species. In the definite host (rats), adult worms lay eggs, and larvae hatch from them, migrate, and get excreted in the rat's feces. These larvae are then swallowed by snails and slugs. These slugs may then be eaten by a variety of creatures including frogs, crabs, fish, etc. The predominant manner in which humans become infected is ingestion of raw snails that are harboring the larva. Similarly, ingestion of other uncooked or undercooked freshwater species that have consumed infected snails or slugs such as frogs, shrimp, crabs, and fish can also lead to disease. Fruits and vegetables can also carry larvae and cause infection. Children may infect themselves by putting their hands in their mouth after playing with affected creatures.
Angiostrongylus costaricensis causes eosinophilic enteritis, usually in children. Since the worms often reside in the arterioles of the ileocecal region, the infection is often discovered during surgery in cases of suspected appendicitis. The worms are typically removed at the time of surgery.
B81.3 – Intestinal angiostrongyliasis
72966005 – Angiostrongylus costaricensis
Differential Diagnosis & Pitfalls
- Strongyloides stercoralis – may persist for years because of autoinfection; life-threatening hyperinfection (dissemination) may occur in immunocompromised hosts. May occur after exposure abroad (veterans), but also endemic in parts of Southeastern US.
- Ascaris lumbricoides – occasionally associated with eosinophilia. Symptoms usually due to intestinal obstruction with very large worm burdens.
- Toxocara canis – causative agent of visceral larval migrans. Usually occurs in young children with tender hepatomegaly and marked eosinophilia with or without pneumonitis.
- Trichinella spiralis – increasingly associated with eating wild game meat. The syndrome may include diarrhea, myalgias, eosinophilia, periorbital edema, and myocarditis.
- Anisakiasis – an acute illness obtained from eating raw or undercooked fish; most commonly reported in Japan and the Netherlands. Causes regional enteritis with a systemic eosinophilia.
- Capillaria philippinensis – mostly reported in the Philippines; causes eosinophilia with a malabsorptive diarrhea.
- Early trematode (fluke) infection – often presents with an acute gastrointestinal syndrome with eosinophilia. These include acute schistosomiasis (Katayama fever), fascioliasis, clonorchiasis, paragonimiasis, and fasciolopsiasis.
- Cystoisospora belli – a protozoan that causes acute diarrhea in immunocompetent patients but can cause a chronic wasting syndrome in immunocompromised patients.
- Eosinophilic gastroenteritis – an idiopathic syndrome more common in atopic persons.
- Vasculitis – polyarteritis nodosa may present with abdominal pain and eosinophilia.