Research for Angiostrongylus Cantonensis and Costaricensis in French West Indies and French Guiana
NCT ID: NCT03378882
Last Updated: 2020-12-11
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
20 participants
OBSERVATIONAL
2018-04-03
2021-08-01
Brief Summary
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In 2013, the investigation of an eosinophilic meningitis case by the Basse-Terre hospital team with a positive specific PCR in the CSF (CDC, Atlanta, USA) showed the first case of neuromeningeal angiostrongylosis in Guadeloupe. A similar case was diagnosed by serology at Pointe-à-Pitre University Hospital a few years earlier without having been published, and another serious case diagnosed also at Pointe-à-Pitre University Hospital Center in January 2017. The team at the Martinique University Hospital Center also reported several cases of eosinophilic meningitis with positive serologies for A. cantonensis carried out in laboratories outside Martinique (Laboratory of Parasitology, Gonesse, France; Thailand; and Tropical Institute and Public Health, Switzerland) in recent years.
The emergence of this parasitosis is related to the introduction of the intermediate host Achatina fulica on the American continent and the geographical evolution of the angiostrongylosis cases is intrinsically linked to that of the Achatins. To date, only two studies report the environmental presence of Angiostrongylus cantonensis in the Lesser Antilles. One proved the presence in rats (23.4%) on the island of Grenada, and the other in Guadeloupe, showing that 32.4% of Achatina fulica collected carried the parasite by specific PCR. In Martinique, where the number of cases is increasing, and in French Guiana, where there is an increase in the number of cases in neighboring countries, especially Brazil, no study has been conducted on this parasite.
In parallel with this finding, several serious digestive tables associated with strong hypereosinophilia were reported in Martinique and Guadeloupe in the 90s but also in recent years, the last case in December 2016. Etiological diagnoses were established by the discovery of Angiostrongylus costaricensis parasite in ileal pathological specimens. However, these cases could never be investigated by serology or specific PCR due to lack of diagnostic tools available in the French West Indies and Guiana region, and more broadly in metropolitan France.
Detailed Description
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The mode of contamination in humans is by ingestion of stage 3 parasitic larvae according to various modes: accidental ingestion of molluscs or salads soiled by "molluscan slime" (example: by consumption of salad, vegetables, non-washed fruits), voluntary ingestion of molluscs, manipulation of molluscs (children or fishermen), use of drinking water drawn from natural and non-disinfected water bodies. Hand-carried transmission after handling of Achatines is most often reported in young children.
In humans, these larvae have a different preferential tropism depending on the species of Angiostrongylus. The two main pathogenic species for humans are Angiostrongylus cantonensis and Angiostrongylus costaricensis.
Angiostrongylus cantonensis:
After ingestion by man, the larvae of Angiostrongylus cantonensis migrate to the central nervous system. They cause eosinophilic angiostrongyl meningitis and meningoencephalitis, which can lead to severe neurological sequelae (paralysis) or even death.
These clinical features are associated with eosinophilic pleocytosis in CSF (eosinophilic meningitis) and blood eosinophilia.
Angiostrongylus cantonensis was first described in Canton, China in 1935. To date, it is present in the Pacific Islands, Australia, Africa and recently on the American continent.
Angiostrongylus costaricensis:
After ingestion, the larvae of Angiostrongylus costaricensis migrate intestines and into the abdominal cavity. They cause severe abdominal pain mimicking those of appendicitis, haemorrhage and perforation digestive that can lead to death (2 to 8% of cases).
A major eosinophilia usually accompanies these unspecific clinical pictures. Angiostrongylus costaricensis does not have the same geographical distribution as Angiostrongylus cantonensis. It was first described in Costa Rica in 1967 and is endemic on the American continent, where it is at the origin of many human cases.
Conditions
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Keywords
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Study Design
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COHORT
PROSPECTIVE
Interventions
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Parasitic serologies
Suspected angiostrongylosis - Angiostrongylus cantonensis:
* An aliquot of CSF and an aliquot of serum will be sent to the laboratory of tropical medicine in Switzerland for research of specific antibodies.
* A CSF aliquot will be sent to the CDC for PCR.
Suspected angiostrongylosis- Angiostrongylus costaricensis:
\- An aliquot of serum will be sent to the laboratory of tropical medicine in Switzerland for research of specific antibodies.
Biopsy
Suspected angiostrongylosis - Angiostrongylus costaricensis:
\- A piece of biopsy or intestinal resection will be sent to the pathology laboratory for parasitic elements suggestive of Angiostrongylus costaricensis infection
Eligibility Criteria
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Inclusion Criteria
* Hypereosinophilia associated with a severe gastrointestinal table(= suspicion of intestinal angiostrongylosis)
Exclusion Criteria
* Angiostrongylosis of importation (contracted outside the French West Indies - French Guiana region)
* Absence of hypereosinophilia
* Hypereosinophilia in the context of an other parasitosis
* Non-parasitic hypereosinophilia
ALL
No
Sponsors
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University Hospital Center of Pointe-à-Pitre/Abymes (Guadeloupe)
UNKNOWN
Hospital Center of Basse-Terre (Guadeloupe)
UNKNOWN
Hospital Center of Cayenne (French Guiana)
UNKNOWN
Hospital Center of Saint-Laurent du Maroni (French Guiana)
UNKNOWN
University Hospital Center of Martinique
OTHER
Responsible Party
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Principal Investigators
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Nicole DESBOIS, MD
Role: PRINCIPAL_INVESTIGATOR
CHU of Martinique
Locations
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CHU of Martinique
Fort-de-France, , France
Countries
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Central Contacts
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Facility Contacts
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Nicole DESBOIS, MD
Role: primary
Other Identifiers
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17/E/05
Identifier Type: -
Identifier Source: org_study_id