Abstract:

Retrospective analysis of laboratory tests and imaging examination of 12 children hospitalized for angiostrongyliasis cantonensis infection in Guangzhou Women and Children’s Medical Center from January 2018 to December 2020. Nine cases came from Guangdong, 2 cases came from Guangxi and 1 case came from Yunnan. There were 6 males and 6 females. The age ranged from 1 year and 3 months to 12 years old. There were 4 children with epidemiological histories (1 case of eating river snails, 1 case of eating snails, 1 case had contacted golden apple snail, 1 case of contacting slugs). The most common symptoms were fever (12 cases, all infants have high fever), followed by vomiting (9 cases), and fatigue (7 cases). The peripheral white blood cell count increased in 12 cases [(18.4 ± 4.1) × 10⁹/L], the eosinophil percentage (EOS%) increased in 12 cases [(26.9 ± 10.5)%], the eosinophils absolute count increased in 12 cases [(3.4 ± 2.0) × 10⁹/L]. CSF WBC count increased in 12 cases [(656 ± 424) × 10⁶/L], CSF protein increased in 12 cases [(1.1 ± 0.59) g/L], CSF EOS% increased in 12 cases [(25.7 ± 15.5)%], of which 8 cases were higher than that in peripheral blood. Seven of the 9 children were positive for serum angiostrongyliasis cantonensis antibodies. Three of the 9 children were positive for Angiostrongylus cantonensis antibodies in CSF. Metagenomic next-generation sequencing (mNGS) of the CSF was performed in 11 cases, and Angiostrongylus cantonensis DNA sequence was detected in 10 cases. Imaging examination revealed abnormal head MRI in 8 cases. The main findings were enhancement in leptonmeninges and multiple nodular enhancement in brain. Chest CT showed abnormality in 9 cases, suggesting that ground-glass opacity lesions and multiple small nodular lesions located in the subpleural area were the main manifestations. One child was in coma at admission and died. The other 11 cases were treated with albendazole, and steroids were administrated for 10 cases. The 11 cases were cured after treatment, and there were no sequelae after being followed-up for 2-6 months. The epidemiological history and clinical symptoms of Angiostrongyliasis cantonensis in children were atypical. It should be comprehensively diagnosed by combining laboratory tests, imaging findings, and high-throughput sequencing technology can assist the early diagnosis.

Key words: Child, Angiostrongyliasis cantonensis, Eosinophilic meningitis, Albendazole