Angiostrongyliasis is infection with larvae of worms of the genus Angiostrongylus. Depending on the infecting species, abdominal symptoms (Angiostrongylus costaricensis) or neural involvement with eosinophilic meningitis (A. cantonensis) result. Diagnosis is suspected by history and presence of eosinophilia in cerebrospinal fluid (CSF) and/or blood. Anthelmintics are either ineffective or deleterious.
(See also Approach to Parasitic Infections.)
Angiostrongylus are parasites of rats (rat lung worms). Excreted larvae are taken up by intermediate hosts (land snails and slugs) and paratenic or transport hosts (hosts that are not required for the parasite#39;s development but that can transmit infection to humans). Human infection is acquired by ingestion of raw or undercooked snails or slugs or transport hosts (certain land crabs, freshwater shrimp and prawns, frogs, or toads); it is unclear whether larval contamination of vegetables (eg, in slime from snails or slugs that crawl on the food) can cause infection.
A. cantonensis infection (neural angiostrongyliasis) occurs predominantly in Southeast Asia and the Pacific Basin, although infection has been reported elsewhere, including the Caribbean, Hawaii, Louisiana, Florida, and other southern states. The larvae migrate from the gastrointestinal (GI) tract to the meninges, where they cause eosinophilic meningitis, with fever, headache, and meningismus, accompanied by eosinophilia. Occasionally, ocular invasion occurs.
A. costaricensis infection (abdominal angiostrongyliasis) occurs in the Americas, predominantly in Latin America and the Caribbean. Adult worms reside in arterioles of the ileocecal area, and eggs can be released into the intestinal tissues, resulting in local inflammation with abdominal pain, vomiting, and fever; this infection can mimic appendicitis. Abdominal angiostrongyliasis is often accompanied by eosinophilia, and a painful right lower quadrant mass may develop.

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