Angiostrongylus costaricensis infection

CASES/YEAR
5 (US); 100 (Global)
CATEGORY
Intestinal Nematodes
AGENT TYPE
Helminths
OTHER NAMES
Abdominal angiostrongyliasis; Intestinal angiostrongyliasis;
ACUITY
Acute-Severe
INCUBATION
2-4 weeks; [CCDM]
INITIAL SYMPTOMS
Abdominal pain and mass in right lower quadrant, anorexia, fever, vomiting, and diarrhea or constipation; [CCDM]
PRECAUTIONS
"The manner of human infection is not usually known, but it may occur after accidental ingestion of infected slugs or of foods contaminated with larvae deposited in the mucous slime trail of slugs." [PPID, p. 3477]
COMMENTS
This disease may mimic appendicitis or Crohn's disease. Adult worms live in small arteries, usually in the ileocecal area. Eggs and larvae are found in lymph nodes, intestinal wall, and omentum. Lab findings include eosinophilia of 20%-60% and leukocytosis. Cotton rats are reservoirs, and slugs are intermediate hosts. The value of drug therapy is debated. [CCDM, p. 12-14] Abdominal angiostrongyliasis is characterized by fever, vomiting, and abdominal pain. A right lower quadrant mass is present in about 50% of cases. Infection may occur from ingestion of slugs or plants contaminated with their slime. [PPID, p. 3477]
DIAGNOSTIC
Identify eggs or worms in tissue biopsy of ileum or colon; Serological tests are not commonly available; [PPID, p. 3477]
SCOPE
A. costaricensis: Central and South America [ID, p. 2375] Central and South America; Rarely in Africa (Democratic Republic of the Congo); [Guerrant, p. 776]
SIGNS & SYMPTOMS
  • >fever
  • G abdominal mass
  • G abdominal pain
  • G blood in stool
  • G constipation
  • G diarrhea
  • G nausea, vomiting
  • H eosinophilia
  • H leukocytosis
  • *bowel obstruction
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Ingestion
SOURCE
Eating Contaminated Food, Eating Contaminated Produce
RESERVOIR
Rodents, Wild Animals
RISK FACTORS
  • Ingest infectious agents in food/water
  • Travel to endemic area
TREATMENT
A few reports of benefit from albendazole and mebendazole; Infections are generally self-limited within 2 weeks. [Cecil, p. 2135] "Careful observation and surgical resection for severe symptoms are the mainstays of treatment." [Harrison ID, p. 1136]
DRUG LINK
REFERENCES FOR CASES/YEAR
1. (US) A few cases suspected in the US; Infected animals found in Texas; [CDC website]
2. (Global) Most cases in Costa Rica, but also reported in other Latin American countries and Texas; [Cohen] Reported in Latin America, mainly in young children; [Cecil, p. 2135] A case reported in Los Angeles may have been anisakiasis. A few deaths have been reported. [Guerrant, p. 776] Guesstimate: 100 cases/year;