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Eosinophilic myelitis, a souvenir from South East Asia
  1. Erich Schmutzhard
  1. Correspondence to:
 E Schmutzhard
 Professor of Critical Care Medical University Hospital Innsbruck, Department of Neurology, Anichstrasse 35, A-6020 Innsbruck, Austria; erich.schmutzhard{at}uibk.ac.at

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Third stage larva of Gnathostoma spinigerum (courtesy of Professor Athasit Vejjajiva, Bangkok, Thailand).

The term eosinophilic meningitis and myelitis theoretically encompasses all the conditions causing meningitis and/or myelitis associated with eosinophilia in the cerebrospinal fluid (CSF) (table 1). But when imported from South East Asia it refers more specifically to the neurological complications of infestation with the nematode worms Angiostrongylus cantonensis and Gnathostoma spinigerum. Humans are accidental hosts of these tissue nematodes, they become infected by ingesting undercooked fish or poultry, or raw snails. The third stage larvae of these parasites migrate through various tissues of the host, including the eye and the central nervous system (CNS), Gnathostoma spinigerum larvae showing a particular neurotropism.2

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Table 1

Causes of an acute eosinophilic meningitis and/or myelitis

A CASE

A 22 year old female student spent her three month summer vacation travelling, on a low budget, through Thailand and Myanmar. Apart from two short episodes of “traveller’s diarrhoea” she remained healthy throughout the entire period. Two weeks after her return to Austria she developed neurogenic disturbance of micturition and dysaesthesia in the left leg, two weeks later dysaesthesia in the mid-thoracic area, and finally painful dysaesthesia in the …

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