Emergence of Neural Angiostrongyliasis in Eastern Australia Mahdis Aghazadeh, 1,2 Malcolm K. Jones, 1,2 Kieran V. Aland, 3 Simon A. Reid, 4 Rebecca J. Traub, 5 James S. McCarthy, 1,2 and Rogan Lee 6 Abstract Despite an apparent increase in cases of angiostrongyliasis in humans and animals in Australia, the epidemiology of infection with the two species of Angiostrongylus that co-exist in this country, namely A. cantonensis and A. mackerrasae, is poorly understood. This knowledge gap is particularly important with respect to A. mack- errasae, a species evidently native to Australia, as its ability to cause disease in humans is unknown. Likewise, there is little information on the roles of native and introduced species of rodents and molluscs as hosts of Angiostrongylus species in Australia. This review focuses on the gaps in the knowledge about the two species, highlighting the need for epidemiological and pathogenesis studies on the native lungworm A. mackerrasae. Key Words: Angiostrongylus mackerrasae—Angiostrongylus cantonensis—Australia—Rat lungworm. Introduction N eural angiostrongyliasis, the cause of eosinophilic meningitis, is a consequence of the migration of larvae of the rat lungworm Angiostrongylus cantonensis in humans and animals. First discovered in 1935 in China, A. cantonensis has been reported to be the most common species causing eosinophilic meningitis around the globe (Qvarnstrom et al. 2010). Accidental infection in humans may cause severe headache, nuchal rigidity, and paralysis of cranial nerves (Graeff-Teixeira et al. 2009), whereas lumbar hyperesthesia and hind limb paresis are predominant signs observed in dogs (Mason et al. 1976). Eosinophilic meningitis is not the only clinical manifestation of A. cantonensis. Lung pathology caused by A. cantonensis larvae has been reported from computed tomography (CT) scan images of patients with neural angio- strongyliasis in China (Cui et al. 2011) and in Australia (Morton et al. 2013). Ocular angiostrongyliasis has also been reported in 42 patients from 13 countries, in which the most common sign is loss of vision (Diao et al. 2011, Feng et al. 2013). Fatal cases of encephalitis due to Angiostrongylus have also been reported in humans (Sawanyawisuth and Kitthaweesin 2008, Lv et al. 2009, Sawanyawisuth et al. 2009, Morton et al. 2013). Between 1994 and 2006, more than 300 cases of human angiostrongyliasis were reported in China (He et al. 2009). To date, over 2800 human cases have been reported worldwide, of which 28 were in Australia (Wang et al. 2008, Morton et al. 2013). Outbreaks of the disease have been reported in Tahiti (Rosen et al. 1961), American Samoa (Kliks and Palumbo 1992), Taiwan (Tsai et al. 2001), the Caribbean region (Lindo et al. 2002, Slom et al. 2002), Japan (Asato et al. 2004), China (Wang et al. 2008, Deng et al. 2011, Chen et al. 2011), and Ecuador (Dorta-Contreras et al. 2010). In such outbreaks, groups of people are usually affected by the disease in a single geographical location owing to a point source exposure attributed to contaminated foods. In contrast, re- ported cases from Australia have mostly been isolated inci- dents caused by ingestion of infected snail or slug tissues by children (Morton et al. 2013) or by misadventure, including ‘‘dares’’ by peers to ingest molluscs (Senanayake et al. 2003, Blair et al. 2013). A. cantonensis causes significant pathol- ogy, especially in infected children, and the prognosis of the disease is usually poor when considerable numbers of larvae are ingested (Li et al. 2001). Other Angiostrongylus species known to cause pathology in animals and humans are A. vasorum, A. costaricensis, and A. malaysiensis. As with A. cantonensis, all three species use terrestrial and aquatic molluscs as their intermediate hosts. A. vasorum is found in Europe, northern Asia, North America, and Africa. Adults of this species infect the pulmonary 1 School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia. 2 QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. 3 Queensland Museum and Sciencentre, Queensland, Australia 4 School of Population Health, The University of Queensland, Herston, Queensland, Australia. 5 Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia. 6 Institute for Clinical Pathology and Medical Research, Westmead Hospital, the University of Sydney, New South Wales, Australia. VECTOR-BORNE AND ZOONOTIC DISEASES Volume 15, Number 3, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/vbz.2014.1622 184