{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T14:33:58Z","timestamp":1762353238407,"version":"build-2065373602"},"reference-count":11,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Angiostrongylus cantonensis<\/jats:italic>\n                    , or rat lungworm, is a neurotropic parasite that causes eosinophilic meningitis. Although classically transmitted through ingestion of contaminated produce or undercooked snails or slugs, ritual ingestion of slugs as part of spiritual ceremonies has not been well described as a transmission route. We report two cases of eosinophilic meningitis in previously healthy adult men in south Brazil who developed subacute neurological symptoms, including progressive lower limb weakness, hyperesthesia, and severe neuropathic pain. Cerebrospinal fluid (CSF) analysis revealed marked eosinophilia (27\u201335%) and elevated protein levels. One patient showed subtle leptomeningeal enhancement on magnetic resonance imaging (MRI). Both cases were serologically confirmed by ELISA and western blot for\n                    <jats:italic>A. cantonensis<\/jats:italic>\n                    in CSF. History-taking revealed a shared exposure event: the ingestion of raw slugs during a religious ritual. Both patients were treated with albendazole, ivermectin, and corticosteroids for 2 weeks, as well as gabapentin for neuropathic pain. Both patients demonstrated neurological recovery and were discharged with outpatient follow-up. Both patients had normal CSF parameters within 2 weeks. These cases highlight a culturally linked exposure route for\n                    <jats:italic>A. cantonensis<\/jats:italic>\n                    . Clinicians should consider eosinophilic meningitis in the differential diagnosis of subacute neurological syndromes in endemic areas, particularly when initial diagnoses (e.g., urinary tract infection, gout) do not explain the full clinical picture. Culturally sensitive history-taking and communication, especially when considering communities that are vulnerable to stigma and violence, is critical to help obtain relevant exposure history.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0364","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T15:05:28Z","timestamp":1758207928000},"page":"1048-1051","source":"Crossref","is-referenced-by-count":0,"title":["Cultural and Clinical Insights from an Outbreak of Eosinophilic Meningitis Caused by the Rat Lungworm (Angiostrongylus cantonensis) in South Brazil"],"prefix":"10.4269","volume":"113","author":[{"given":"Christopher J.","family":"Hernandez","sequence":"first","affiliation":[{"name":"David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro M.","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Nossa Senhora da Concei\u00e7\u00e3o, Porto Alegre, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andressa","family":"Noal","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Nossa Senhora da Concei\u00e7\u00e3o, Porto Alegre, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Catherine","family":"Cambou","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivana Ros\u00e2ngela","family":"dos Santos Varella","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Nossa Senhora da Concei\u00e7\u00e3o, Porto Alegre, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Breno R.","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Nossa Senhora da Concei\u00e7\u00e3o, Porto Alegre, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marineide","family":"Gon\u00e7alves de Melo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Nossa Senhora da Concei\u00e7\u00e3o, Porto Alegre, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Nielsen-Saines","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"article-title":"Candombl\u00e9, Macumba Ritual and Jar\u00e9 in Brazil.","year":"2015","author":"Turner","key":"b1"},{"key":"b2","series-title":"J Ethnobiol Ethnomed","first-page":"23","article-title":"From Eshu to Obatala: Animals used in sacrificial rituals at Candombl\u00e9 \u201cterreiros\u201d in Brazil","volume":"5","author":"L\u00e9o Neto","year":"2009"},{"key":"b3","series-title":"Rev Soc Bras Med Trop","first-page":"664","article-title":"First report of Angiostrongylus cantonensis in Porto Alegre, State of Rio Grande do Sul, Southern Brazil","volume":"46","author":"Cognato","year":"2013"},{"key":"b4","series-title":"Mem Inst Oswaldo Cruz","first-page":"399","article-title":"Eosinophilic meningitis caused by Angiostrongylus cantonensis: An emergent disease in Brazil","volume":"109","author":"Morassutti","year":"2014"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"335","article-title":"Immunodiagnostic detection of Angiostrongylus cantonensis exposure on Hawaii Island using isogeographic 31-kDa antigen","volume":"109","author":"Jarvi","year":"2023"},{"key":"b6","series-title":"Hawaii J Health Soc Welf","first-page":"107","article-title":"Clinical characteristics of long-term complications of severe rat lung worm disease in Hawai\u2019i: A survey of 4 cases","volume":"82","author":"Khamsai","year":"2023"},{"key":"b7","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"389","article-title":"Human Angiostrongylus cantonensis: An update","volume":"31","author":"Wang","year":"2012"},{"key":"b8","series-title":"J Infect Dis","first-page":"860","article-title":"Interleukin 33 mediates type 2 immunity and inflammation in the central nervous system of mice infected with Angiostrongylus cantonensis.","volume":"207","author":"Peng","year":"2013"},{"key":"b9","series-title":"Hawaii J Med Public Health","first-page":"83","article-title":"Effects of washing produce contaminated with the snail and slug hosts of Angiostrongylus cantonensis with three common household solutions","volume":"72","author":"Yeung","year":"2013"},{"key":"b10","series-title":"Lat Am Res Rev","first-page":"858","article-title":"Pursuing racial order and social progress: Violence, Afrophobia and \u201creligious racism\u201d in Brazil","volume":"59","author":"Cantave","year":"2024"},{"year":"2016","series-title":"Report on Religious Intolerance and Violence in Brazil (2011\u20132015): Preliminary Results","author":"Fonseca","key":"b11"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/5\/article-p1048.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/5\/article-p1048.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/5\/article-p1048.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T14:22:03Z","timestamp":1762352523000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/5\/article-p1048.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":11,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0364","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2025,11,5]]}}}