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Angiostrongylus costaricensis infection
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Angiostrongylus costaricensis infection

Contributors: David L. McCollum MD, J. Martin Rodriguez MD, James H. Willig MD, MSPH
Other Resources UpToDate PubMed


Angiostrongyliasis is a zoonotic disease resulting from infection with two species of a parasitic nematode (roundworm), Angiostrongylus cantonensis (also known as rat lungworm) and Angiostrongylus costaricensis. The predominant clinical manifestations in humans are eosinophilic meningitis for A. cantonensis and enteritis for A. costaricensis. This summary focuses on angiostrongyliasis resulting from infection with A. costaricensis.

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

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Differential Diagnosis & Pitfalls

Other causes of eosinophilic enteritis include:
  • Strongyloidiasis – 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.
  • Ascariasis – occasionally associated with eosinophilia. Symptoms usually due to intestinal obstruction with very large worm burdens.
  • Toxocariasis – causative agent of visceral larval migrans. Usually occurs in young children with tender hepatomegaly and marked eosinophilia with or without pneumonitis.
  • Trichinellosis – 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.
  • Cystoisosporiasis – 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.

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Last Updated:04/19/2018
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Angiostrongylus costaricensis infection
A medical illustration showing key findings of Angiostrongylus costaricensis infection : Abdominal pain, Fever, Nausea, Vomiting, Anorexia, EOS increased, RLQ abdominal mass
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