Eosinophilic Meningitis on Hawai'i

Angiostrongyliasis, or human infection due to snail or slug ingestion with rat lungworm. 

It's an uncommon but potentially devastating disease here on the Big Island.  Typically, we see a GI  symptom prodrome, followed by an acute or subacute febrile meningitis with prominent radicular irritation, including an unusually high incidence of hyperesthesia.

Note that in Hawaii, CSF and CBC will always show increasing eosinophilia within a week, but NOT always on the CBC and LP at the time of presentation.

Most survive, but the residual cranial nerve and radicular symptoms seem much more common than with other types of meningitis. Is this because the milder cases typically have been  underdiagnosed here?  One wonders. There is a diagnostic antibody test, on CSF or blood.
See review here, courtesy of Intech.