ANGIOSTRONGYLUS EOSINOPHILIC MENINGITIS I N REUNION AND MAYOTTE ISLANDS - REPORT OF 3 CASES IN INFANTS INCLUDING 1 FATAL RADICULOMYELOENCEPHALITIS WITH HYDROCEPHALUS

Back ground. Eosinophilic meningitis caused by Angiostrongylus cantone nsis is widespread in Southeast Asia and Pacific islands. Adults devel op a transient meningitis with a benign course but severe or fatal dis ease may occur in pediatric patients. Case report 1. A 11 months old b oy living in Mayotte island was hospitalized some days after fever and skin rash with seizure status, coma, flaccid quadriplegia, absence of deep tendon reflexes, urinary retention and anal incontinence. Eosino philia was observed in peripheral blood and in the cerebrospinal fluid Secondary he developed a triventricular hydrocephalus treated by a ve ntriculoperitoneal shunt. After 3 weeks, the child died. Retrospective ly the diagnosis of angiostrongylus infection was established with the help of serology. Case reports 2 and 3, Two infants, 10 and 11 months old boys, living in Reunion island, developed fever and vomitings, ir ritability and, for one of them a unilateral sixth cranial nerve palsy There was eosinophilia in the peripheral blood and in the cerebrospin al fluid. All symptoms progressively disappeared with complete recover y. The suspected diagnosis of angiostrongylus infection was confirmed by the serology. Conclusion, We report the first case of Angiostrongyl us cantonensis infection in the French island of Mayotte (Comoro Islan ds) and we confirm the presence of this disease in Reunion island. In this Indian Ocean area, eosinophilic meningitis occurs most of the tim e in infants with sometimes severe radiculomyeloencephalitic forms. Th e origin of these occasionally massive infections is the giant African snail Achatina fulica. For a child with meningitis living in Reunion or Mayotte, or coming back from these 2 islands, Angiostrongylus canto nensis infection must be evoked, especially ii there is a blood eosino philia. Since efficiency of antiparasitic treatment is nowadays not pr oved, information must be given to people living in exposed areas in v iew to limit incidence of this disease.