First cases of Angiostrongylus cantonensis infection reported in Martinique, 2002–2017

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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	Positive^a (D_13, D₂₈, D₄₉)	Negative^a (D₉)	Negative^a (D₉)	Negative^a D₂₄	Positive D₃, D₁₉^b	Positive^c	Positive^c	Positive^c
Angiostrongylus serodiagnosis	Positive^a (D_13, D₂₈, D₄₉)	Positive^a (D₃₈)	Positive^a (D₁₉)	Negative^a D₂₄	Positive D₃, D₁₉^b	Positive^c	Positive^c	Positive^c
Cross-reactions (sera)	Cysticercosis (1/2048e)	None	None	Echinococcus	Toxocara	Toxocara, Filaria, Strongyloides	Toxocara, Strongyloides	Toxocara, Echinococcus, Strongyloides
Specific antibodies in CSF	Positive^a (D₄₉)	Positive^a (D₃₈)	Positive^a	Positive^a (D₂₄)	ND	ND	Positive^b (D₈)	Positive^b
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
Treatment	Subtractive LP	Subtractive LP	Subtractive LP	Subtractive LP	Subtractive LP	Albendazole + MPS	Albendazole + MPS	Albendazole + MPS
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.

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

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

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

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