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Table 1

Description of the probable cases (numbers 1–4) and confirmed cases (numbers 5–8) of Angiostrongylus cantonensis infection in Martinique, including clinical, biological, imaging, and epidemiological features.

Case 1 2 3 4 5 6 7 8
Demographic characteristics
 Year 2002 2002 2006 2008 2013 2015 2015 2015
 Season Dry Rainy Rainy Rainy Rainy Dry Rainy Rainy
 Sex F M F M M M M M
 Age 10.5 months 11 months 13 months 37 years 64 years 61 years 58 years 11.5 years
 Residential locality Fort-de-France Le Lamentin Cap Ferré, Saint-Anne Le Diamant ND Fort-de-France Quartier Morne Etoile, le Lorrain Quartier Petit Versailles, Saint-Anne
 Medical history None None None Substance addiction, bipolar Intellectual disability Diogenes syndrome Schizophrenia Autism, stunted growth
 Risky behaviour Playing on soil Accidental slug ingestion Unknown Undercooked snail consumption Stays in forest several days Unknown Pica disorder Pica disorder
Clinical presentation
 Fever Yes Yes Yes No Yes No No Yes
 Neurological signs and symptoms Strabismus, cranial nerves VI palsy Seizures Hypotonia, tetraplegia Radiculalgia, cranial nerves VI palsy Headaches, coma Headaches, Neck stiffness, cranial nerves VI palsy Extrapyramidal syndrome, seizures, left hemiparesis, coma Difficult examination because of autism
 Digestive signs and symptoms Anorexia None None Nausea, vomiting None Loss of appetite None Loss of appetite, constipation
 Others ND ND ND ND ND ND ND Itching
Laboratory tests
 CRP (mg/L) <5 <5 <5 11.6 74 <5 <5 <5
 Total WBC count (G/L) D0 8.24 15.09 10.03 10.00 12.20 16.35 6.61 20.75
 Eosinophils in blood G/L (%) D0/max value 0.49 (5)/5.46 (32) 2.23 (14)/3.23 (26) 2.11 (21)/3.66 (17) 0.62 (8)/0.89 (10) 1.40 (11)/2.49 (21) 1.77 (11)/2.76 (13) 1.67 (25)/1.98 (36) 6.43 (31)/6.43 (31)
 WBC count in CSF 1st LP 170 600 0 389 1040 410 2280 1080
 Eosinophils in CSF/mm3(%) 1st LP/max value 59 (35)/355 (48) 90 (15)/392 (49) 0 (0)/220 (38) 0 (0)/59 (62) 600 (60)/600 (60) 16 (4)/45 (18) 1550 (68)/1550 (68) 691 (64)
 Proteinorachia g/L D0/max value 1.25/1.25 0.52/0.85 0.33/0.83 1.17/1.17 1.10/1.10 1.71/1.71 1.50/3.70 0.63
 Glycorachia mmol/L D0/min value 0.1/0.1 1.7/1.0 3.5/0.2 2.3/1.8 4.3/4.3 1.0/1.0 3.3/0.9 3.4
 Intracranial Hypertension ND ND No Yes, 37 No Yes ND ND
 Angiostrongylus serodiagnosis Positivea (D13, D28, D49) Negativea (D9) Negativea (D9) Negativea D24 Positive D3, D19b Positivec Positivec Positivec
Positivea (D38) Positivea (D19)
 Cross-reactions (sera) Cysticercosis (1/2048e) None None Echinococcus Toxocara Toxocara, Filaria, Strongyloides Toxocara, Strongyloides Toxocara, Echinococcus, Strongyloides
 Specific antibodies in CSF Positivea (D49) Positivea (D38) Positivea Positivea (D24) ND ND Positiveb (D8) Positiveb
 Parasitological examination of faeces Negative Negative Negative Negative Negative Negative Negative Negative
 Brain CT-scan Subnormal None None ND Normal Normal ND Normal
 Brain MRI Ventricular dilatation Normal Hydrocephalus, ventricular dilatation, myelitis Normal Leukoaraiosis, cortico – subcortical atrophy Normal Ventricular dilatation Abnormal(no precisions)
Management & outcome
 Treatment Thiabendazole, albendazole Albendazole Albendazole, prednisone Subtractive LP Albendazole, prednisone Albendazole + MPS Albendazole + MPS Albendazole + MPS
Subtractive LP Subtractive LP Subtractive LP Subtractive LP
 Hospitalization time (days) 55 15 34 19 49 66 + 90 days of physiotherapy 20 16
 Clinical outcome, sequelae Strabismus Recovery Psychomotor retardation Strabismus Recovery Memory disorders, cranial nerves VI palsy D20: death Vision disorders

Abbreviations: CSF, cerebrospinal fluid; CT-scan, computerised tomography scan; CRP, C-reactive protein; Dx, day x after admission to hospital; LP, lumbar puncture; MPS, methylprednisolone; ND, not determined.

Normal values: CRP: <5 mg/L; protein level in CSF: 0.15–0.40 g/L; glucose level in CSF: 2.8–4.5 mmol/L; intracranial tension: <20.

a

Serology performed by indirect immunofluorescence in the Medical Center of Gonesse, France.

b

Serology performed by western-blot analysis in the Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand.

c

Serology performed by western-blot analysis in the Swiss Tropical and Public Health Institute, Basel, Switzerland.

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