Intrathecal synthesis of IgE in children with eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis

Thirteen patients, mean age 4.5 years were studied; a diagnostic lumbar puncture was performed and serum samples taken. Immunoglobulin E (IgE) in serum and in cerebrospinal fluid (CSF) was quantified by nephelometry. Control patients had other infections or other neurological diseases.The mean cell count in the CSF was 500 × 10-6 cells/L and of these 23% were eosinophils. In blood the eosinophils were 13%. The chief symptoms of the patients were migraine, vomiting and fever and 50% presented some meningeal signs. IgE intrathecal synthesis analyzed by the corresponding quotient diagram (Reibergram) was observed in all patients. No intrathecal IgE synthesis was seen in control patients.Intrathecal synthesis of IgE demonstrates the participation of this immunoglobulin in the destruction of the third stage larvae of the parasite in the CSF. The test should be considered in our environment as a tool to aid diagnosis.Eosinophilic meningoencephalitis is a disease caused by the helminth Angiostrongylus cantonensis. The definitive hosts of this parasite are rats, Rattus rattus and Rattus norvegicus [1-3]. Many species of mollusc constitute intermediary hosts [4] and are responsible for the transmission of this zoonosis. Eosinophilic meningoencephalitis described for the first time in Southeast Asia and later in Asia, Africa and the Caribbean [5-8], is considered an important and sometimes fatal human disease. In Cuba this disease is primarily observed in children with a mild course, because the number of larvae accidentally ingested is small. Since 1981, when in the Paediatric Hospital of San Miguel del Padron, the first case was observed in the Americas, an average of 3 cases per year have been reported.IgE plays an important role in anaphylactic type 1-hypersensitivity mechanisms, with high values in patients with parasitic infectious diseases accompanied by eosinophilia [5].In an earlier study [9] on four patients diagnosed with eosinophilic meningoencephalitis caused by