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Angiostrongylus cantonensis and neuroangiostrongyliasis (rat lungworm disease): 2020

Neuroangiostrongyliasis (NAS), infection with the rat lungworm, Angiostrongylus cantonensis, is the leading cause of human eosinophilic meningoencephalitis globally. For various reasons, its geographical range continues extending, from a presumed origin in Southeast Asia. A wide range of other vertebrate accidental hosts can also be affected, including non-human primates, dogs, fruit bats, horses, marsupials and some species of birds. The definitive hosts include several species of rats, in whose pulmonary vasculature the adult worms reside (reviewed in Barratt et al., 2016). Each female worm releases thousands of eggs daily, which lodge to embryonate in alveolar capillaries (Fig. 1). First-stage larvae (L1s) hatch and escape via the airways, then passing through the gut to the outside world. To infect the next definitive host, these must develop to the third stage (L3) (Fig. 2) which can occur only within the tissues of intermediate hosts, a wide range of slug and snail species (Fig. 3). These gastropod molluscs usually acquire L1s by ingesting rat feces, although some might also be invaded percutaneously. The life cycle is completed when a rat eats the infected gastropod; L3s are released in the gut, then develop through the L4 and L5 stages in the central nervous system (CNS), before returning to the right ventricle and pulmonary arteries, where they mature and copulate, potentially surviving for the life of the host.