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Volume 13, Number 11—November 2007


Distribution of Eosinophilic Meningitis Cases Attributable to Angiostrongylus cantonensis, Hawaii

Natasha S. Hochberg*1Comments to Author , Sarah Y. Park†, Brian G. Blackburn*2, James J. Sejvar*, Kate Gaynor‡, Heath Chung§, Karyn Leniek*, Barbara L. Herwaldt*, and Paul V. Effler†
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Hawaii State Department of Health, Honolulu, Hawaii, USA; ‡Centers for Disease Control and Prevention, Honolulu, Hawaii, USA; §University of Hawaii School of Medicine, Honolulu, Hawaii, USA;

Main Article

Table 2

Classification of cases of eosinophilic meningitis (EM; 
n = 83) and Angiostrongylus cantonensis infection by cause or category, Hawaii, January 2001–February 2005

Cause or category No. (%)
Cases attributed to causes other than 
A. cantonensis infection* 59 (71)
Presence of intracranial hardware 35 (42)
No intracranial hardware 24 (29)
Patient <2 mo of age
No microbial etiologic agent identified 10
Bacterial meningitis† 3
Enteroviral meningoencephalitis 2
Patient ≥2 mo of age
Streptococcal meningitis‡ 2
Viral meningoencephalitis§ 2
Presumptive viral encephalomyelitis 1
Encephalitis not otherwise specified 1
Suspected vertebral artery dissection 1
Cancer 1
Not otherwise specified¶
Cases attributed to A. cantonensis infection 24 (29)
Clinically defined 23
Parasitologically confirmed 1

*The 59 cases include 35 (42%) in patients with intracranial hardware and 24 (29%) in patients without intracranial hardware. All cases of EM in patients with intracranial hardware when the lumbar puncture was done were attributed to the hardware (Table 1), regardless of the reason for implantation. Two of the 35 such cases were in patients <2 mo of age.
†Etiologic agents were Escherichia coli, Klebsiella sp., and α-hemolytic Streptococcus.
‡Etiologic agents were S. agalactiae (group B Streptococcus) and S. pneumoniae, in 87-y-old and 5-mo-old patients, respectively.
§Etiologic agents were herpes simplex virus and an enterovirus, in 20-y-old and 3-mo-old patients, respectively.
¶Did not meet criteria for A. cantonensis infection (Table 1).

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1Current affiliation: Emory University, Atlanta, Georgia, USA

2Current affiliation: Stanford University School of Medicine, Stanford, California, USA