First report of eosinophilic meningitis caused by Angiostrongylus cantonensis in the State of Amazonas, Brazil: a case report

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Abstract Background Eosinophilic meningitis is a clinical syndrome characterized by eosinophilic inflammation of the central nervous system and has multiple etiologies, including infection with Angiostrongylus cantonensis. While this parasitic infection has been previously reported in various tropical and subtropical regions, no documented cases have been reported in the State of Amazonas, Brazil. This case represents the first confirmed human infection in this region, raising concerns about the potential expansion of the parasite's endemic range and the need for enhanced public health surveillance. Case presentation A 1-year-old Brazilian female child of mixed-race (parda) ethnicity from the state of Amazonas, Brazil, who was admitted to the hospital with persistent fever, irritability, drowsiness, vomiting, and asthenia. Laboratory investigations revealed elevated eosinophils (15%) in peripheral blood and cerebrospinal fluid pleocytosis with eosinophils (31%), strongly suggesting eosinophilic meningitis. Polymerase chain reaction (PCR) testing ruled out viral causes, while ELISA and Western blot analysis confirmed infection with A. cantonensis . The patient was treated with prednisolone, albendazole, and supportive therapy and showed significant clinical improvement after 30 days of hospitalization, with no residual neurological deficits. Conclusions This case represents the first confirmed report of eosinophilic meningitis caused by A. cantonensis in Amazonas, Brazil, suggesting a possible expansion of endemic transmission. The findings emphasize the importance of clinical awareness, early diagnosis, and vector control strategies to prevent further cases. Increased public health efforts, surveillance of intermediate hosts, and preventive measures are essential to mitigate the potential spread of angiostrongyliasis in the region.