Re: “Severe angiostrongyliasis with neuropsychiatric symptoms in vulnerable adults: Early diagnosis via next-generation sequencing and successful treatment”

Tang et al. (2025) report on two cases of neuroangiostrongyliasis in vulnerable adults, diagnosed via metagenomic next-generation sequencing (mNGS). We highlight the clinical value of mNGS in detecting atypical presentations, particularly in patients without eosinophilia or classic meningitic signs. While mNGS demonstrates diagnostic potential, its limitations and feasibility in low-resource settings must be acknowledged. We propose a contextualized approach integrating mNGS with cost-effective tools like LAMP and rapid antigen tests, especially for underserved populations.The commentary also calls attention to the risk of underdiagnosed parasitic CNS infections in socioeconomically vulnerable groups and urges broader diagnostic preparedness and targeted surveillance.