First Reported Outbreak of Abdominal Angiostrongyliasis

Human abdominal angiostrongyliasis is a potentially fatal disease caused by Angiostrongylus costaricensis, a nematode found in the Americas. During the period of December 1994 through August 1995, an outbreak of this disease occurred in Guatemala. We identified 22 cases of abdominal angiostrongyliasis and conducted a matched case-control study to identify risk factors for illness. The median age of the 18 cases enrolled in the study was 37 years (range, 9–68 years), and 11 (61.1%) were male. Consumption of the following six raw food items was associated with angiostrongyliasis: mint (odds ratio [OR], 6.9; 95% confidence interval [CI], 1.5–66.0), shrimp (OR, infinite; 95% CI, 1.4 to infinite), and four kinds of ceviche that reportedly contained raw mint (OR for consumption of mint or ceviche that contained mint, 7.0; 95% CI, 1.0–315). We conclude that raw mint was the likely vehicle of infection for this outbreak. To our knowledge, this is the first reported outbreak of abdominal angiostrongyliasis and the first time that a specific food item has been epidemiologically linked to the disease.