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Corticosteroids for parasitic eosinophilic meningitis


Thanaviratananich, S., et al

Subject Keywords: Corticosteroids, Eosinophilic meningitis
Type: Article
Region: International (other)

Eosinophilic meningitis is an inflammation of the membrane covering the brain which can be broadly categorised into infectious and non-infectious causes. Among infectious aetiologies, Angiostrongylus cantonensis, a rat lung worm, is the major cause of eosinophilic meningitis. It occurs principally in South-East Asia and throughout the Pacific basin. However, this parasite has spread progressively beyond the Pacific basin and is now found in regions of North America due to intercontinental dissemination of infected ship rats. Severe headache, which is self-limiting, is the main complaint. The headache is probably due to an immune response to the dead parasites. Other signs and symptoms include neck stiffness and pain, visual disturbances, nausea, vomiting, paraesthesia and hyperaesthesia.

Corticosteroids are drugs that reduce inflammation, which can occur in eosinophilic meningitis from dead larvae. Our review found only one randomised controlled trial that matched our criteria. This trial included 129 patients (63 in the treatment group, prednisolone 60 mg/day, divided into three doses for two weeks and 66 in the control group, placebo). However,19 patients were lost to follow-up. It showed that the median time of resolution of headaches was lower in the group treated with prednisolone (10.5 days versus 25 days) and the number of patients who still had headaches after 14 days was lower in the prednisolone group compared to the control (9.1% versus 45.5%).

There were statistically significant differences, which favoured the treatment group in other outcomes including the frequency of acetaminophen use (median of number of times used) amongst those who still had headaches after 14 days of prednisolone treatment; mean time until complete disappearance of headache; the number of patients who needed repeat lumbar puncture was smaller in the treatment group; and the frequency of acetaminophen use (median of number of times) was lower in the treatment group. There were no reported adverse effects from prednisolone in the treatment group. However the trial authors did not report on allocation concealment which is one of the important issues when considering selection bias.



Rights: © The Cochrane Collaboration
Suggested citation:

Thanaviratananich, S., et al. (2012) Corticosteroids for parasitic eosinophilic meningitis [Online]. Available from: [Accessed: 23rd April 2019].


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