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Baylisascaris Procyonis


Presentation

  • Large numbers of intact eosinophils were present in the brain around blood vessels and necrotic migration tracks and in mesenteric granulomata.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • He presented with fever, meningismus, lethargy, irritability and asymmetric spastic extremity weakness.[ncbi.nlm.nih.gov]
  • Two cases of severe B procyonis encephalitis with evidence of marked eosinophil degranulation in the central nervous system are presented.[ncbi.nlm.nih.gov]
  • Adult worms were present in animals as young as 10 wk and 100% of 4-mo-old raccoons were infected. Although 80% of sampled raccoons hosted adult B. procyonis , prevalence and abundance were lower in older animals.[ncbi.nlm.nih.gov]
Weakness
  • He presented with fever, meningismus, lethargy, irritability and asymmetric spastic extremity weakness.[ncbi.nlm.nih.gov]
Pathologist
  • Chicago: American Society of Clinical Pathologists; 1995. Boyce WM, Asai DJ, Wilder JK, Kazacos KR. Physicochemical characterization and monoclonal and polyclonal antibody recognition of Baylisascaris procyonis larval excretory-secretory antigens.[wwwnc.cdc.gov]
Respiratory Distress
  • Clinical findings Skin irritation, respiratory distress, hepatomegaly and fever due to larval migration, nausea, lethargy, incoordination, blindness, encephalitis, blindness, death.[medical-dictionary.thefreedictionary.com]
Strabismus
  • J Pediatr Ophthalmol Strabismus. 2011 ; 48 : 204 – 12. DOI PubMed Hung T, Neafie RC, Mackenzie IR. Baylisascaris procyonis infection in elderly person, British Columbia, Canada. Emerg Infect Dis. 2012 ; 18 : 341 – 2.[wwwnc.cdc.gov]
Retinal Lesion
  • […] neuroretinitis Baylisascaris procyonis Diffuse unilateral subacute neuroretinitis (DUSN) is a clinical syndrome first described by Gass and associates in 1978, characterised early by visual loss, vitritis, papillitis, and recurrent crops of grey-white retinal[bjo.bmj.com]
Suggestibility
  • We tested 150 adults from California, USA, for B. procyonis antibodies; 11 were seropositive, suggesting that subclinical infection does occur.[ncbi.nlm.nih.gov]
  • We tested 347 asymptomatic adult wildlife rehabilitators for B. procyonis antibodies; 24 were positive, suggesting that subclinical baylisascariasis is occurring among this population.[ncbi.nlm.nih.gov]
  • Early findings of marked blood and cerebrospinal fluid eosinophilia and of diffuse white matter signal abnormality in the brain and spinal cord on MRI suggested a parasitic encephalomyelitis.[ncbi.nlm.nih.gov]
  • In many regions of North America, large populations of raccoons with high rates of endemic B. procyonis infection live in proximity to humans, which suggests that the risk of human infection is probably substantial.[ncbi.nlm.nih.gov]
  • Less than 5% of migrating larvae reach the brain, and experimental studies suggest that host size, infection site, and inoculating dose drive pathology ( 1 ).[wwwnc.cdc.gov]
Paresis
  • Ultimately, loss of milestones and regression develop, leading to posturing, spasticity, paresis, seizures, and ocular or cranial nerve involvement. Mortality is high, and survivors almost always are severely disabled.[cancertherapyadvisor.com]
Language Delays
  • At 10 months, residual neurologic deficits included subtle paraparesis and moderate language delay. This case is the first in which spinal involvement in human Baylisascaris infection was clinically suspected and confirmed by neuroimaging.[ncbi.nlm.nih.gov]

Workup

  • Epidemiologic Field Studies Field studies have played an important part in the diagnostic workup of several of the documented cases of B. procyonis NLM, have contributed greatly to our understanding of the epidemiology and pathogenesis of the condition[doi.org]
Pulmonary Infiltrate
  • Pulmonary infiltrates, asthma and eosinophilia due to Ascaris suum infestation in man. N Engl J Med. 1972 ; 286 : 965 – 70.[wwwnc.cdc.gov]
Herpes Simplex Virus Type 2
  • Herpes simplex virus type 2 (HSV-2) infection of the retina is the result of either primary infection or reactivated disease.[ajtmh.org]

Treatment

  • Rapid presumptive treatment with albendazole and high-dose steroids halted progression of clinical signs.[ncbi.nlm.nih.gov]
  • Also, additional monthly treatments are highly likely to clear dogs of any worms not killed with the initial treatment.[ncbi.nlm.nih.gov]
  • Despite treatment with albendazole and high dose corticosteroids, both patients are neurologically devastated.[ncbi.nlm.nih.gov]
  • Prevention efforts are critical due to the lack of effective treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis Poor, profound neurologic impairment, partial paralysis, cotical blindness, developmental delay, etc. Management Deworming; possibly albendazole.[medical-dictionary.thefreedictionary.com]
  • Prognosis is very poor with or without treatment. The usual therapy includes antihelminthic agents plus steroids.[cancertherapyadvisor.com]
  • Once invasion of the central nervous system has occurred, the prognosis is grave with or without treatment.[doi.org]

Etiology

  • It was concluded that B. procyonis larvae have marked ability to produce OLM in subhuman primates following oral infection and should be considered as a possible etiology in human ocular disease.[iovs.arvojournals.org]
  • 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.[ajtmh.org]
  • Eosinophils are not normally present in CSF; their presence narrows the differential diagnosis of CNS disease and provides an early or the only etiologic clue.[doi.org]

Epidemiology

  • The pathologic, epidemiologic, and imaging features of this disease are herein reviewed.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • Sorvillo is Associate Professor, Department of Epidemiology, UCLA School of Public Health. His research interests include the epidemiology and control of infectious diseases, particularly parasitic agents.[wwwnc.cdc.gov]
  • Although the assay we used has a sensitivity of 88% and specificity of 98%, it is time-consuming and not ideal for large-scale epidemiologic studies ( 7 ).[wwwnc.cdc.gov]
  • Contact your doctor or the Southern Nevada Health District, Office of Epidemiology at (702) 759-1300.[southernnevadahealthdistrict.org]
Sex distribution
Age distribution

Prevention

  • Prevention efforts are critical due to the lack of effective treatment.[ncbi.nlm.nih.gov]
  • The public should be made aware of the hazards associated with raccoons and B procyonis to hopefully prevent future cases of B procyonis infection.[ncbi.nlm.nih.gov]
  • In the absence of effective treatment, prevention of infection remains the most important public health strategy.[ncbi.nlm.nih.gov]
  • Investigating Potential Human Risk and Potential Preventive Measures of Exposure to Baylisascaris procyonis in Texas EPA Grant Number: U916239 Title: Investigating Potential Human Risk and Potential Preventive Measures of Exposure to Baylisascaris procyonis[cfpub.epa.gov]
  • Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.[wwwnc.cdc.gov]

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