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Nematodes of rats of the genus Angiostrongylus cause two distinct syndromes in humans Angiostrongylus cantonensis, the rat lungworm, causes eosinophilic meningoencephalitis, primarily in southeast Asia and some Pacific islands Angiostrongylus costaricensis causes gastrointestinal inflammation In both diseases, human infection follows ingestion of larvae within slugs or snails (and also crabs or prawns for A cantonensis) or on material contaminated by these organisms Since the parasites are not in their natural hosts, they cannot complete their life cycles, but they can cause disease after migrating to the brain or gastrointestinal tract In A cantonensis infection, disease appears to be caused primarily by worm larvae migrating through the CNS and an inflammatory response to dying worms After an incubation period of 1 day to 2 weeks, presenting symptoms and signs include headache, stiff neck, nausea, vomiting, cranial nerve abnormalities, and paresthesias Most cases resolve spontaneously after 2 8 weeks, but serious sequelae and death have been reported The diagnosis is strongly suggested by the finding of eosinophilic CSF pleocytosis (leukocytosis with over 10% eosinophils) in a patient with a history of travel to an endemic area Peripheral eosinophilia may not be present A cantonensis larvae have rarely been recovered from the CSF and the eyes There is no specific treatment Antihelminthic therapy is probably not indicated, since responses to dying worms may worsen with therapy Corticosteroids have been used in severe cases In A costaricensis infection, parasites penetrate ileocecal vasculature and develop into adults, which lay eggs, but do not complete their life cycle Disease is due to an inflammatory response to dying worms in the intestinal tract, with an eosinophilic granulomatous response, at times including vasculitis and ischemic necrosis Common findings are abdominal pain, vomiting, and fever Pain is most commonly localized to the right lower quadrant, and a mass may be appreciated, all mimicking appendicitis Symptoms may recur over months Uncommon findings are intestinal perforation or obstruction, or disease due to migration of worms to other sites Many cases are managed surgically, usually for suspected appendicitis Biopsy of inflamed intestinal tissue may show worms localized to mesenteric arteries.

The clinical diagnosis is supported by findings of elevated serum muscle enzymes (creatine kinase, lactate dehydrogenase, aspartate aminotransferase) Serologic tests become positive 3 or more weeks after infection; a variety of techniques are used, including ELISA, immunofluorescence, indirect hemagglutinin, precipitin, and bentonite flocculation assays Rising antibody titers are highly suggestive of the diagnosis Muscle biopsy can usually be avoided, but if the diagnosis is uncertain, biopsy of a tender, swollen muscle may identify Trichinella larvae For maximal yield, biopsy material should be examined histologically, and a portion should be enzymatically digested to release larvae, but evaluation before about 3 weeks after infection may not show muscle larvae

No effective specific therapy for full-blown trichinosis has been identified However, if infection is suspected early in the course of illness, treatment with mebendazole (25 mg/kg twice daily) or albendazole (5 75 mg/kg twice daily) will kill

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Traditionally, Macintosh development tools are centered on an Integrated Development Environment (IDE). An IDE is commonly composed of an integrated editor, compiler, linker, and debugger, all within one program. To develop a new application, you launch the IDE and create a new project file. The project file acts as a repository for all files that make up the project, including source files, libraries, and any support files. You write your program using the integrated editor, build the program by selecting a build command, and execute the program with a run command. Typically commands are accessible from menu items, and customization takes place through standard dialog boxes. Debugging a program is as simple as building the program in debugging mode and stepping through the program within the IDE. When encountering an error, you simply edit the code (in place), rebuild, and continue debugging the program. The strength of this approach is that all tools and commands are accessible through a consistent user interface. Also, you can easily access hard-to-remember commands and options from menus and dialog boxes. UNIX, on the other hand, has always offered a more segregated development environment. To create a new project, you first create a makefile, specifying what files compose the project, as well as the build tools, their options, and any numbers of build commands. You write the program using your favorite editor, and build and run the program from a shell. To debug the program, you run it within a commandline debugger (gdb), run it within a debugger in emacs, or use print statements.

and eosinophilic granulomas It is not known if antihelminthic therapy is helpful, but diethylcarbamazine, thiabendazole, and mebendazole have been used

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