Diagnostic criteria for neurognathostomiasis - all of the following:
(1) both of the following epidemiologic criteria:
(1a) travel or residence in an area where neurognathostomiasis is endemic
(1b) exposure to raw or undercooke freshwater fish, frogs, poultry or shellfish
(2) one or more of the following clinical findings:
(2a) painful radiculomyelitis or radiculomyeloencephalitis
(2b) meningitis or meningoencephalitis
(2c) intracerebral hemorrhage
(2d) subarachnoid hemorrhage
(3) one of the following giving indirect evidence of CNS invasion
(3a) parenchymal hemorrhagic tracts (>= 3 mm) on neuroimaging
(3b) eosinophilic pleocytosis in the CSF
(4) both of the following findings on immunoblot testing:
(4a) positive reaction with 24-kDa component of Gnathostoma spinigerum
(4b) negative reaction to 29-31-kDa component of Angiostrongylus cantonensis
where:
• A patient with a negative reaction on the Gnathostoma immunoblot should have repeat testing in 4 weeks to detect seroconversion.
