Treatment of a rare and severe infection of central nervous system by Angiostrongylus cantonensis: A case report

Table 1 Summary of blood test results on admission

Item	Result	Trend
White blood cell count (109/L)	11.46	Indicates an increase
Neutrophils	0.660	No significant change or not mentioned
Lymphocytes (109/L)	0.196	Indicates a decrease
Monocytes (109/L)	0.089	Indicates an increase
Eosinophils (109/L)	0.049	No significant change or not mentioned
D-dimer (ng/mL)	2209	No significant change or not mentioned
International normalized ratio	1.43	Indicates an increase
Plasma prothrombin time (second)	15.4	Indicates an increase
Plasma prothrombin activity (%)	60	Indicates a decrease
Inflammatory indicators	Normal	No significant change or not mentioned
Electrolytes	Normal	No significant change or not mentioned

Table 2 Summary of cerebrospinal fluid test results

Item	October 23, 2023	October 27, 2023	October 29, 2023	November 06, 2023	November 08, 2023
Routine	Colorless and transparent; total cell count: 1254 × 106/L; total WBC: 954 × 106/L; multinucleated to mononucleated cell ratio: 1:1; qualitative protein test: Positive	Colorless and transparent; total cell count: 187 × 106/L; total WBC: 182 × 106/L; multinucleated to mononucleated cell ratio: 0.85; qualitative protein test: Positive	Colorless and transparent; total cell count: 147 × 106/L; total WBC: 108 × 106/L; multinucleated to mononucleated cell ratio: 1:9; qualitative protein test: Positive	Light yellow and slightly turbid; total cell count: 82 × 106/L; total WBC: 79 × 106/L; multinucleated to mononucleated cell ratio: 0.47; qualitative protein test: Positive	Light yellow and transparent; total cell count: 142 × 106/L; total WBC: 142 × 106/L; multinucleated to mononucleated cell ratio: 0.45; qualitative protein test: Positive
Biochemical test	Glu 2.71 mmol/L (decrease); chloride 1134 mmol/L (decrease); protein 790 mmol/L (increase)	Glu 2.08 mmol/L (decrease); chloride 116 mmol/L (decrease); protein 685 mmol/L (increase)	Glu 3.51 mmol/L; chloride 121 mmol/L; protein 412 mmol/L (increase)	Glu 2.49 mmol/L (decrease); chloride 1155 mmol/L (decrease); protein 1000 mmol/L (increase)	Glu 2.9 mmol/L; chloride 113 mmol/L (decrease); protein 936 mmol/L (increase)
Ig determination	IgA 1.0 mg/dL (increase); IgG 10.2 mg/dL (increase); IgM 4.7 mg/dL (increase)	IgA 4.0 mg/dL (increase); IgG 22.5 mg/dL (increase); IgM 8.4 mg/dL (increase)	IgA 4.0 mg/dL (increase); IgG 15 mg/dL (increase); IgM 5.8 mg/dL (increase)	IgA 2.4 mg/dL (increase); IgG 32.7 mg/dL (increase); IgM 0.3 mg/dL (increase)	IgA 2.0 mg/dL (increase); IgG 33.2 mg/dL (increase); IgM 0.2 mg/dL (increase)
TORCH	Negative	Negative	Negative	Negative	Negative
Pathogen detection	Negative	Negative	Negative	Negative	Negative
Bedside ROSE	Absent	Absent	No bacteria, fungi, or parasites found. Predominantly mononuclear cells	No bacteria, fungi, or parasites found. Predominantly mononuclear cells with a few eosinophils	No bacteria, fungi, or parasites found. Predominantly mononuclear cells with a few eosinophils
M. tuberculosis nucleic acid PCR test	Absent	Absent	Absent	Negative	Negative
M. tuberculosis and rifampicin resistance gene testing	Absent	Absent	Negative	Negative	Absent
NGS test in this hospital	Negative	Negative	Negative	Negative	Absent
KingMed NGS test	Absent	Absent	Absent	Absent	Angiostrongylus cantonensis (sequences 4643)

Glu: Glucose; Ig: Immunoglobulin; TORCH: Toxoplasma, other pathogens, rubella virus, cytomegalovirus, and herpes simplex virus; NGS: Next-generation sequencing; M. tuberculosis: Mycobacterium tuberculosis; PCR: Polymerase chain reaction; ROSE: Rapid on site evaluation; WBC: White blood cell.

Table 3 Summary of cerebrospinal fluid test results

Item	November 11, 2023	November 16, 2023	November 22, 2023	November 30, 2023	December 19, 2023
Routine	Colorless and slightly turbid; total cell count: 506 × 106/L; total WBC: 491 × 106/L; multinucleated to mononucleated cell ratio: 0.75; qualitative protein test: Positive	Colorless and transparent; total cell count: 171 × 106/L; total WBC: 145 × 106/L; multinucleated to mononucleated cell ratio: 0.27; qualitative protein test: Positive	Colorless and transparent; total cell count: 90 × 106/L; total WBC: 88 × 106/L; multinucleated to mononucleated cell ratio: 0.45; qualitative protein test: Positive	Colorless and transparent; total cell count: 65 × 106/L; total WBC: 59 × 106/L; multinucleated to mononucleated cell ratio: 0.08; qualitative protein test: Positive	Colorless and transparent; total cell count: 252 × 106/L; total WBC: 88 × 106/L; multinucleated to mononucleated cell ratio: 0.08; qualitative protein test: Positive
Biochemical test	Glu 2.36 mmol/L (decrease); chloride 1183 mmol/L (decrease); protein 980 mmol/L (increase)	Glu 2.51 mmol/L (decrease); chloride 1195 mmol/L; protein 1023 mmol/L (increase)	Glu 3.22 mmol/L (decrease); chloride 1209 mmol/L; protein 574 mmol/L (increase)	Glu 2.87 mmol/L; chloride 121 mmol/L; protein 604 mmol/L (increase)	Glu 3.02 mmol/L; chloride 1233 mmol/L; protein 412 mmol/L (increase)
Ig determination	IgA 1.8 mg/dL (increase); IgG 33.5 mg/dL (increase); IgM 9.8 mg/dL (increase)	IgA 1.0 mg/dL (increase); IgG 32.1 mg/dL (increase); IgM 16.8 mg/dL (increase)	IgA 0.5 mg/dL; IgG 19.2 mg/dL (increase); IgM 5.2 mg/dL (increase)	IgA 2.4 mg/dL (increase); IgG 17.9 mg/dL (increase); IgM 0.3 mg/dL (increase)	IgA 1.2 mg/dL (increase); IgG 10 mg/dL (increase); IgM 1.7 mg/dL (increase)
TORCH	Absent	Absent	Absent	Absent	Absent
Pathogen detection	Negative	Negative	Negative	Negative	Negative
Bedside ROSE	No bacteria, fungi, or parasites found. Predominantly mononuclear cells with eosinophils being approximately 40%	No bacteria, fungi, or parasites found. Predominantly mononuclear cells with eosinophils being approximately 11.1%	Absent	Absent	Absent
M. tuberculosis nucleic acid PCR test	Absent	Absent	Absent	Absent	Absent
M. tuberculosis and rifampicin resistance gene testing	Absent	Absent	Absent	Absent	Absent
NGS test in this hospital	Absent	Negative	Absent	Absent	Absent
KingMed NGS test	Absent	Absent	Absent	Angiostrongylus cantonensis (sequences 10429)	Angiostrongylus cantonensis (sequences 1003)

Glu: Glucose; Ig: Immunoglobulin; TORCH: Toxoplasma, other pathogens, rubella virus, cytomegalovirus, and herpes simplex virus; NGS: Next-generation sequencing; M. tuberculosis: Mycobacterium tuberculosis; PCR: Polymerase chain reaction; ROSE: Rapid on site evaluation; WBC: White blood cell.