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For the full report and more information click here http://cid.oxfordjournals.org/content/39/10/1484.full

Zoonoses caused by metazoan parasites are intriguing and diagnostically challenging entities for clinicians. Until recently, few physicians were even aware of human infections caused by the raccoon roundworm,Baylisascaris procyonis. A nematode parasite that has produced neurologic disease in over 100 species of animals, B. procyonis epitomizes the ecologic complexity of infectious diseases. More than 25 years have passed since the first report of human visceral larva migrans (LM) and neural LM likely caused by B. procyonis. Reports of the first histologically confirmed cases were published in 1984 and 1985, and since then, 12 other cases have been reported, and several more are known or suspected (table 1). The parasite is also a well-known cause of ocular LM and diffuse unilateral subacute neuroretinitis (DUSN) in humans, with probable cases dating to 1952. There is a likelihood of human exposure to this parasite in the United States and elsewhere wherever raccoons exist.

The raccoon roundworm, Baylisascaris procyonis, is increasingly recognized as a cause of zoonotic visceral, ocular, and neural larva migrans and, in particular, of devastating encephalitis in young children. Exposure occurs mainly at raccoon latrines, where large numbers of infective eggs may be accidentally ingested. Risk factors for infection include contact with raccoon latrines, pica/geophagia, age of <4 years, and male sex. The severity of central nervous system (CNS) disease depends on the number of eggs ingested, the extent and location of larval migration, and the severity of ensuing inflammation and necrosis. Diagnosis of Baylisascaris encephalitis is based on clinical CNS disease, peripheral and cerebrospinal fluid eosinophilia, deep white matter lesions visible by magnetic resonance imaging, and positive results of serologic tests. Treatment efficacy in clinical cases is poor, but albendazole prevents disease if given promptly after infection. Considering the seriousness of this disease and limitations of diagnosis and treatment, prevention of infection with eggs is of utmost importance.

Raccoon Roundworm Encephalitis

Typical raccoon latrines found in urban/suburban environments. A, Latrine on a chimney ledge,  B, Large latrine in the crotch of an oak tree  C, Large latrine on a house roof, D, Latrine site on the ground near downed timber and rocks in a suburban yard. E, Latrine on a stump in a suburban park with plants sprouting from seeds in the feces.  F, Raccoon feces hidden in leaf litter in a suburban back yard.

B. procyonis has emerged in recent years as one of the most serious causes of LM in humans. The larvae have a noted tendency to invade the brain and eye, where they cause their most serious pathology. Transmitted by the accidental ingestion of infective eggs in raccoon feces or contaminated materials, most cases have involved very young children. Serologic evidence indicates that the parasite produces a full spectrum of infection and disease, from asymptomatic to fatal, in human populations. It is likely that many infections go undiagnosed or are misdiagnosed as other conditions. How such an infection could occur in humans becomes clear once the natural history of B. procyonis in raccoons and their behavior around humans are understood.

Adult Baylisascaris procyonisin situ in the small intestine of a raccoon. Adults are large, tan-colored nematodes. Females reach 20–22 cm in length and males reach 9–11 cm in length. (Photograph copyright 1999 by William J. Murray).

Raccoon And Diseases

Zoonoses caused by metazoan parasites are intriguing and diagnostically challenging entities for clinicians. Until recently, few physicians were even aware of human infections caused by the raccoon roundworm,Baylisascaris procyonis. A nematode parasite that has produced neurologic disease in over 100 species of animals, B. procyonis epitomizes the ecologic complexity of infectious diseases. More than 25 years have passed since the first report of human visceral larva migrans (LM) and neural LM likely caused by B. procyonis. Reports of the first histologically confirmed cases were published in 1984 and 1985, and since then, 12 other cases have been reported, and several more are known or suspected (table 1). The parasite is also a well-known cause of ocular LM and diffuse unilateral subacute neuroretinitis (DUSN) in humans, with probable cases dating to 1952. There is a likelihood of human exposure to this parasite in the United States and elsewhere wherever raccoons exist.

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