Diagnosis and Management of Baylisascaris procyonis Infection in an Infant with Nonfatal Meningoencephalitis

Eosinophil-Associated Inflammation and Elaboration of Eosinophil-Derived Proteins in 2 Children With Raccoon Roundworm (Baylisascaris procyonis)Encephalitis

“…23 In our patients, and other previously described cases of human B procyonis infection, ataxia and related CNS signs were early manifestations. [3][4][5][6][7] Severe white matter changes were also observed by MRI in our patients (Fig 1).…”

“…One nonfatal case was treated with thiabendazole, prednisone, and ivermectin, but without obvious improvement. 5 Ivermectin does not cross the blood-brain barrier, except perhaps through hemorrhage, and was undetectable in the CSF of the patient. Another child was treated with high-dose albendazole (40mg/kg x 28 days) and steroids, again without obvious clinical improvement but with apparent stabilization.…”

“…1,2 Neural larva migrans and eosinophilic meningoencephalitis attributable to B procyonis have now been identified in 7 young children, including the 2 reported here. [3][4][5][6][7] We specifically note a novel correlation with elevated cerebrospinal fluid (CSF) levels of major basic protein and the neurotoxic protein eosinophil-derived neurotoxin associated with eosinophilic inflammation in these 2 cases. We hypothesize that the severe neurologic consequences of Baylisascaris encephalitis are attributable, in part, to marked eosinophil degranulation and release of these toxic eosinophil proteins in the central nervous system (CNS) of patients with this disease.…”

Interlaboratory Optimization and Evaluation of a Serological Assay for Diagnosis of Human Baylisascariasis

“…Covert infections with B. procyonis, showing mild or no symptoms, may be expected based on the widespread distribution of raccoons in North America, the prevalence of B. procyonis in raccoons (68 to 90%), and the level of human exposure to B. procyonis eggs (2,4,5). Covert infections have been shown in previous reports, e.g., one study showed 8% seroprevalence in children in the Chicago, Illinois, area (9), and the parents of a child with severe NLM symptoms tested positive for B. procyonis-specific antibodies without showing signs or symptoms of infection (10). Although an assay with an ELISA platform would be more efficient for service diagnostic laboratories and for serosurveys, several bands are seen in Western blots that seem to be reactive when any human serum sample, including normal human serum and Toxocara-positive serum, is tested (Fig.…”

Zoonosis Caused by Baylisascaris procyonis

“…Protein epitopes of 33-kDa to 45-kDa antigens appear to be recognized selectively by antibodies from B. procyonis-infected humans and animals but not by normal human or T. canis antibody-positive sera . In addition, children with clinical B. procyonis NLM are strongly positive for anti-Baylisascaris antibodies in CSF and serum and have consistently been negative for anti-Toxocara antibodies (Cunningham et al, 1994;Fox et al, 1985;Gavin et al, 2002;Kazacos, 2001;Moertel et al, 2001;Murray, 2002;Park et al, 2000;Rowley et al, 2000). In several of these cases, positive B. procyonis serology was confirmed by brain biopsy or at autopsy (CDC, 2002;Fox et al, 1985;Huff et al, 1984;Rowley et al, 2000).…”