Introduction

Angiostrongylus cantonensis (the rat lungworm), the primary causative agent for several outbreaks of eosinophilic meningitis in humans (Tseng et al., 2011), was first described by Chen (1935) based on the worms collected from the pulmonary arteries of infected rats in Guangzhou, China. The first human infection by this nematode was reported in Taiwan, by Nomura and Lin, 10 years later (Beaver and Rosen, 1964). Angiostrongylus cantonensis infection typically presents as eosinophilic meningitis; however, other manifestations in the form of ocular angiostrongyliasis, encephalitis, and radiculomyelitis have also been reported. Primary symptoms include acute headaches, eosinophilia in the blood and cerebrospinal fluid (CSF), and other symptoms ranging from fever, hyperesthesia, paresthesia, nausea, vomiting and in some rare cases even coma and death (Cowie et al., 2022). There is an additional risk of developing chronic sequelae, which is majorly debilitating. Definitive diagnosis of this infection has proved to be challenging; given visual detection of parasite in patient samples is rare; and the amplification of the ITS1 region of the parasite DNA from the patient’s CSF has a detection rate of merely 65.3% (Jarvi et al., 2023). Hence, spreading awareness for prevention is just as important as finding a cure.
Angiostrongylus cantonensis nematode is a parasite, its synanthropic definitive and intermediate hosts being rodents (particularly Rattus spp.) and a diverse range of gastropods, respectively; however, animals such as shrimp, frogs, and lizards can act as paratenic hosts (Turck et al., 2022) (Figure 1). Consumption of such hosts have given rise to further cases and outbreaks ofAngiostrongylus cantonensis infection in humans in several countries, including Taiwan (Tseng et al., 2011), Thailand (Eamsobhana, 2014), China (Lv et al., 2009), Brazil (Morassutti et al., 2014), USA (Cowie et al., 2017), Vietnam (McBride et al., 2017), Australia (Barratt et al., 2016), and India (Pandian et al., 2023). A number of cases have occurred in travelers to endemic areas, where consumption of exotic dishes and contaminated foodstuffs result in infection (Federspiel et al., 2020), which highlights the necessity for further awareness about this disease and its causative agent. Indeed, there are concerns as to the extent of infection the rat lungworm can inflict upon humans, where cases have shown presence of the parasite in the lungs of human patients (Prociv et al., 2000). Nevertheless, as the presence ofAngiostrongylus cantonensis in human feces have not yet been identified, hence the spread of Angiostrongylus cantonensisdepends largely on its natural hosts; rats and gastropods.