Eosinophilic radiculomyeloencephalitis: an angiostrongyliasis outbreak in American Samoa related to ingestion of Achatina fulica snails
Kliks, M.M.; Kroenke, K.; Hardman, J.M.
American Journal of Tropical Medicine and Hygiene 31(6): 1114-1122
1982
ISSN/ISBN: 0002-9637 PMID: 7149098 Document Number: 186088
An outbreak of eosinophilic radiculomyeloencephalitis in American Samoa was related to eating local A. fulica infected with Angiostrongylus cantonensis. Of 24 Korean fishermen who shared the same infective meal, 16 who ate raw or partially cooked snails became ill; 5 who ate boiled snails and 3 who ate none remained well. Illness began within one to 6 days, persisted up to 10 weeks and was characterized by both peripheral blood and spinal fluid eosinophilia, severe pains, weakness and hyporeflexia of the legs and dysfunction of the bladder and bowels. One man died 17 days after eating the snails and maturing larvae were found in his spinal cord. ELISA titres for A. cantonensis antigens were 1:64 or higher in all 10 patients tested. Treatment with thiabendazole (50 mg/kg daily for 3 days) had no appreciable effect on the clinical course of the illness. All surviving patients completely recovered (after being returned to Korea) except one who had persistent paresthesias of the foot. Sixteen Korean fishermen ate raw or partially-cooked Achatina fulica. Their ensuing illnesses began 1-6 days later and lasted for up to 10 weeks, and were characterized by peripheral-blood and spinal-fluid eosinophilia, severe pains, weakness of the legs and dysfunction of the bladder and bowels. Three men became comatose; 1 died 17 days after eating the snails, and maturing larvae of Angiostrongylus cantonensis were found in his spinal cord. Treatment with thiabendazole had no appreciable effect on the clinical course of the illness.W. Crewe.