Rapid Therapeutic Response of Eosinophilic Meningoencephalitis in a Toddler With Baylisascaris procyonis Infection.

INTRODUCTION: Eosinophilic meningitis is an infrequently encountered condition. Baylisascaris procyonis (raccoon roundworm) infection, rarely diagnosed in North America, is a known cause of eosinophilic meningitis, often producing death or permanent neurologic damage. CASE REPORT: We recently encountered a toddler with geophagia and probable exposure to raccoon feces, who presented with eosinophilic meningitis and encephalitis, and was diagnosed with B procyonis infection and possible Toxocara co-infection. His marked peripheral eosinophilia and neurologic symptoms rapidly responded to corticosteroid and albendazole therapy. DISCUSSION: Since B procyonis infection is infrequently encountered, its diagnosis in the proper clinical and epidemiologic setting may not always be considered, resulting in a delay of appropriate therapy. Our patient, diagnosed and treated early in his course, demonstrated rapid clinical and laboratory improvement with anti-inflammatory and antiparasitic therapy. CONCLUSION: In cases of eosinophilic meningitis, infection with B procyonis should be routinely considered to allow timely institution of effective therapy for this unusual but potentially fatal or debilitating infection.

Molecular Identification of Hysterothylacium spp. In Fishes From the Southern Mediterranean Sea (Southern Italy).

Samples obtained from 11 teleost fish species collected in waters off of the Mediterranean coasts of Sicily, Italy, were examined for the presence of Hysterothylacium spp. larvae. In total, 3,017 fish samples were examined, and the larvae recovered were used in subsequent phylogenetic studies. Fifty-eight raphidascaridid parasitic nematodes were found in the examined fish, with prevalence values ranging from 0.2% in anchovies to 60% in forkbeard samples. Twenty-seven parasites were identified as Hysterothylacium fabri and Hysterothylacium aduncum by sequencing the following regions: the nuclear ribosomal internal transcribed spacer ( ITS) and the mitochondrial cytochrome c oxidase subunit II ( COXII). Two other larvae collected from Lophius piscatorius had very low identity scores, with ITS and COXII sequences reported in GenBank and high genetic distances (AY603539). Pairwise comparisons between the ITS region of the H. fabri isolated from fishes from Sicilian coastal waters and those isolated from the Mediterranean Sea, Turkey (KC852206), revealed genetic differences ranging from 0.015 to 0.018. Our H. aduncum samples had very low genetic differences to H. aduncum from the Adriatic Sea (KP979763, 0.00-0.003). The concatenated phylogenetic examination of the ITS- COXII sequences by using maximum likelihood analyses indicated 3 distinct clades supported by high bootstrap values. Further molecular identification and detailed morphological analyses are needed to clarify these results and confirm the diversity and relationships within Hysterothylacium.

Baylisascaris procyonis and Herpes Simplex Virus 2 Coinfection Presenting as Ocular Larva Migrans with Granuloma Formation in a Child.

Ocular Baylisascaris procyonis infection results from ingestion of infective eggs of B. procyonis, the raccoon ascarid. Herpes simplex virus type 2 (HSV-2) infection of the retina is the result of either primary infection or reactivated disease. Herein, we report a case of a 12-year-old female resident of the Bronx in New York City, who presented with pan-uveitis and vision loss. Initial evaluation for etiologic causes was nondiagnostic. Serology for anti-Baylisascaris procyonis antibodies in serum and vitreous fluid were both positive. Polymerase chain reaction (PCR) of vitreous fluid was positive for HSV-2. Treatment with vitrectomy, albendazole, and acyclovir resulted in mild improvement of visual acuity. The atypical presentation of B. procyonis in this case, as ocular larva migrans with a peripheral granuloma and retinal detachment, underscores the importance of maintaining a high degree of suspicion for this pathogen even in non-diffuse unilateral subacute neuroretinitis (DUSN) patients in urban areas. This case further illustrates that it is possible to have coexisting infections in cases of posterior uveitis.

Granulomatous peritonitis in a European brown bear caused by Baylisascaris transfuga.

We report a case of granulomatous peritonitis due to Baylisascaris transfuga in a young male European brown bear (Ursus arctus). At necropsy, there were extensive abdominal adhesions and extensive granulomatous tissue on the peritoneum and liver capsule. In the gastrointestinal tract, there were 58 nematodes that were identified as Baylisascaris transfuga using light and scanning electron microscopy.

Global neurologic deficits with baylisascaris encephalitis in a previously healthy teenager.

We present a case of acute eosinophilic meningoencephalitis caused by Baylisascaris procyonis in a previously healthy teenager with a history of substance abuse. Treatment included methylprednisolone; no anthelmintic drugs were administered. This case identifies a new risk factor, altered behavior related to substance abuse, and a newly described outcome of cognitive deficits for B. procyonis disease in older children.

Visceral and presumptive neural baylisascariasis in an orangutan (Pongo pygmaeus).

A 32.5-year-old female hybrid orangutan (Pongo pygmaeus) developed hind-limb stiffness that progressed to tetraparesis over 2 wk. Repeated diagnostic evaluations, including serial magnetic resonance imaging of the central nervous system, revealed nonspecific lesions involving both the deep white and gray matter with an intact blood-brain barrier. Multiple empirical treatments failed to produce improvement and the animal was humanely euthanized. Histology of a granuloma in the ileum contained a nematode parasite, most consistent with Baylisascaris procyonis. Additionally, neuropil vacuolization, rarefaction, astrocytic scarring, and an eosinophilic granuloma and lymphoeosinophilic perivascular cuffing in the brain were suggestive of nematode migration. These findings confirm the presence of visceral larval migrans and support the presence of neural larval migrans. This case report of Baylisascaris procyonis confirms the presentation for the first time in an ape and documents the difficulty in antemortem diagnosis of neural larval migrans.

Baylisascariasis.

The raccoon roundworm, Baylisascaris procyonis, is the most common and widespread cause of clinical larva migrans in animals. In addition, it is increasingly recognized as a cause of devastating or fatal neural larva migrans in infants and young children and ocular larva migrans in adults. Humans become infected by accidentally ingesting infective B. procyonis eggs from raccoon latrines or articles contaminated with their feces. Two features distinguish B. procyonis from other helminthes that cause larva migrans: (i) its aggressive somatic migration and invasion of the central nervous system and (ii) the continued growth of larvae to a large size within the central nervous system. Typically, B. procyonis neural larva migrans presents as acute fulminant eosinophilic meningoencephalitis. Once invasion of the central nervous system has occurred, the prognosis is grave with or without treatment. To date, despite anthelmintic treatment of cases of B. procyonis neural larva migrans, there are no documented neurologically intact survivors. Epidemiologic study of human cases of neural larva migrans demonstrate that contact with raccoon feces or an environment contaminated by infective eggs and geophagia or pica are the most important risk factors for infection. In many regions of the United States, increasingly large populations of raccoons, with high rates of B. procyonis infection, live in close proximity to humans. Although documented cases of human baylisascariasis remain relatively uncommon, widespread contamination of the domestic environment by infected raccoons suggests that the risk of exposure and human infection is probably substantial. In the absence of early diagnosis or effective treatment, prevention of infection is the most important public health measure.

Eosinophil-associated inflammation and elaboration of eosinophil-derived proteins in 2 children with raccoon roundworm (Baylisascaris procyonis) encephalitis.

OBJECTIVE: Eosinophil-associated proteins, especially eosinophil-derived neurotoxin, may be important contributors to the neurologic pathology and symptoms caused by Baylisascaris procyonis infection. METHODS: Two cases of severe B procyonis encephalitis with evidence of marked eosinophil degranulation in the central nervous system are presented. Serial cerebrospinal fluid (CSF) specimens were collected from each patient during the course of their illness. Antibodies against B procyonis were measured in the patients' serum and CSF. Levels of the eosinophilopoietin interleukin-5 (IL-5) and 2 important eosinophil proteins, eosinophil-derived neurotoxin and major basic protein, were assayed in the CSF. RESULTS: Both patients had rapidly progressive central nervous system disease with evidence of eosinophilic meningoencephalitis. Both tested positive for antibodies to B procyonis in serum and CSF and had progressively worsening deep white matter changes on magnetic resonance images of the brain. CSF levels of IL-5, eosinophil-derived neurotoxin, and major basic protein were markedly elevated over controls. CONCLUSIONS: This is the first report of the measurement of IL-5, eosinophil-derived neurotoxin, and major basic protein in human CSF. In addition to traumatic damage and necrosis caused by migrating larvae, eosinophil-derived neurotoxin from associated eosinophilic inflammation may be an important contributory factor in the pathogenesis of B procyonis encephalitis. parasite, eosinophil-derived-neurotoxin, major basic protein, eosinophilia, hypereosinophilia, interleukin-5, encephalitis, child.