Kevin R. Kazacos

Epidemiologic and zoonotic aspects of ascarid infections in dogs and cats.

Toxocaracanis and Toxocara cati of dogs and cats, respectively, can cause significant disease in people. Human seroprevalence for Toxocara antibodies varies with factors such as geographic location, socio-economic status, and dietary habits. Risk factors for infection include geophagia and low-level education. Toxocara canis is better recognized as a cause of human toxocariasis, but Toxocara cati should not be overlooked. In addition, patent infections with Baylisascaris procyonis, the raccoon ascarid, have been increasingly recognized in dogs. Pet owners need to be properly educated about zoonotic risks, and veterinarians should institute regular parasite screening and treatment for all pets. Establishment of national surveillance programs to determine the incidence and specific etiological agent in human larva migrans patients would aid in the development of targeted intervention strategies.

Hookworms of dogs and cats as agents of cutaneous larva migrans

Dogs and cats are hosts to hookworms that may cause zoonotic disease, most notably, cutaneous larva migrans. Ancylostoma braziliense is most often implicated in dermatological lesions, and Ancylostoma caninum has been associated with eosinophilic enteritis and suggested as a possible cause of diffuse unilateral subacute neuroretinitis in humans. Other manifestations include eosinophilic pneumonitis, localized myositis, folliculitis, erythema multiforme, or ophthalmological manifestations. Ancylostoma eggs are morphologically indistinguishable, which complicates epidemiological studies. Surveys of dermatologists, gastroenterologists, and ophthalmologists would help to define the incidence of these zoonotic infections. Improved diagnostic tests are needed to identify the causative species involved and understand the epidemiology of hookworm disease. This review describes the discovery of the disease, the biology of the agents, and how that biology may impact disease.

Baylisascaris larva migrans

Baylisascaris procyonis is a roundworm of the raccoon found primarily in North America but also known to occur in other parts of the world including South America, Europe, and Japan. Migration of the larvae of this parasite is recognized as a cause of clinical neural larva migrans (NLM) in humans, primarily children. It is manifested as meningoencephalitis associated with marked eosinophilia of the cerebrospinal fluid and peripheral blood. Diagnosis is made by recovering and identifying larvae in or from the tissues, epidemiological history, serology, and imaging of the central nervous system. Treatment is with albendazole and steroids, although the prognosis is generally poor. This parasite can also cause ocular larva migrans (OLM) which usually presents as diffuse unilateral subacute neuroretinitis (DUSN). The ocular diagnosis can be made by visualizing the larva in the eye and by serology. Intraocular larvae can be destroyed by photocoagulation although albendazole and steroids may also be used. However, once visual disturbance is established the prognosis for improved vision is poor. Related Baylisascaris species occur in skunks, badgers, and certain other carnivores, although most cases of NLM are caused by B. procyonis. Baylisascaris procyonis has also been found in kinkajous in the USA and South America and may also occur in related procyonids (coatis, olingos, etc.).

Diffuse Unilateral Subacute Neuroretinitis: Morphometric, Serologic, and Epidemiologic Support for Baylisascaris as a Causative Agent

PURPOSE Several nematodes have been postulated as etiologic agents in diffuse unilateral subacute neuroretinitis (DUSN), but the cause of this condition remains uncertain. The authors report the first case of DUSN from the western United States (northern California), along with morphometric, serologic, and epidemiologic evidence supporting Baylisascaris procyonis as its cause. METHODS One patient was examined and evaluated for disc edema and transient obscurations of vision. A diagnosis of DUSN was confirmed when a motile nematode was identified within the substance of the patients retina. Morphometric analysis of the nematode was done from projected fundus photographs. Serologic evidence of Baylisascaris infection was suggested by Western blot analysis. A necropsy was done on 12 raccoons from the area. They were examined for evidence of Baylisascaris infection, previously believed to be nonendemic in the region. RESULTS The intraocular nematode measured 1727 x 67 microns, most consistent with Baylisascaris. The patient had considerable exposure to raccoons, and was seropositive for B. procyonis infection on Western blot analysis. Necropsy evaluation showed B. procyonis infection in 8 of 12 raccoons examined from the area. CONCLUSIONS The morphometric, serologic, and epidemiologic findings in this case provide evidence that the raccoon ascarid, B. procyonis, is a cause of the large nematode variant of DUSN.

IMPLICATIONS OF RACCOON LATRINES IN THE EPIZOOTIOLOGY OF BAYLISASCARIASIS

Raccoons (Procyon lotor) frequently establish defecation sites, termed latrines, on large logs, stumps, rocks, and other horizontally oriented structures/surfaces. These latrines are important foci of infective eggs of Baylisascaris procyonis, a nematode parasite of raccoons which is pathogenic to numerous species of mammals and birds. To examine the role of raccoon latrines in this animal-parasite interaction, we documented animal visitations to raccoon latrines in two large forested tracts and two woodlots in Indiana (USA) during 1994 and 1995. Species richness of vertebrate visitors did not differ between sites or years, but species composition differed by site and year. Fourteen mammal and 15 bird species were documented visiting raccoon latrines. Small granivorous mammals, including white-footed mice (Peromyscus leucopus), eastern chipmunks (Tamias striatus), and tree squirrels (Sciurus carolinensis, S. niger, Tamiasciurus hudsonicus) were the most common visitors to latrine sites. White-footed mice, chipmunks, white-breasted nuthatches (Sitta carolinensis), and opossums (Didelphis virginiana) were photographed foraging on undigested seeds in raccoon feces. Active foraging at latrines also was shown experimentally; seeds embedded in raccoon feces were removed at a greater rate at latrine sites than at nonlatrines. We conclude that raccoon latrines are visited routinely by a variety of vertebrates, especially small granivorous rodents and birds which forage for seeds in raccoon feces, and that raccoon latrines are probable sites of transmission of B. procyonis to susceptible mammals and birds.

Raccoon Roundworm Encephalitis

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.

Case 4. The first fatal Baylisascaris infection in humans: an infant with eosinophilic meningoencephalitis.

Baylisascaris procyonis, the ascarid of raccoons, causes a characteristic, rapidly fatal eosinophilic meningoencephalitis with ocular involvement in many naturally and experimentally infected aberrant hosts, including monkeys. Warnings that humans are potentially susceptible to the devastating infection have been issued, but an instance in humans has not been recognized. This report describes a boy who died from an eosinophilic meningoencephalitis, which mimicked B. procyonis infection in monkeys. The causative agent was not identified during life. Autopsy showed a systemic larval ascarid infection with massive involvement of the brain. The size and anatomy of the larvae in histologic sections were identical to those recorded for B. procyonis. The larvae were indistinguishable from the B. procyonis larvae observed in histologic sections of experimentally infected monkeys. An indirect immunofluorescence test was positive for B. procyonis. Exposure to raccoon feces was highly likely. The evidence suggests that this is the first recognized B. procyonis infection in humans. Prudent avoidance of exposure to raccoon feces is indicated.

Raccoon Roundworm (Baylisascaris procyonis) Encephalitis: Case Report and Field Investigation

Baylisascaris procyonis is a common and widespread parasite of raccoons in the United States and Canada. With large raccoon populations occurring in many areas, the potential risk of human infection with B procyonis is high. We report a case of severe raccoon roundworm (B procyonis) encephalitis in a young child to illustrate the unique clinical, diagnostic, and treatment aspects, as well as public health concerns ofB procyonis infection. Acute and convalescent serum and cerebrospinal fluid samples from the patient were tested for antibodies against B procyonis to assist in documenting infection. An extensive field survey of the patients residence and the surrounding community was performed to investigate raccoon abundance and to determine the extent of raccoon fecal contamination and B procyonis eggs in the environment. The patient evidenced serologic conversion, and the field investigation demonstrated a raccoon population far in excess of anything previously reported. There was abundant evidence of B procyonis eggs associated with numerous sites of raccoon defecation around the patients residence and elsewhere in the community. Because B procyonis can produce such severe central nervous system disease in young children, it is important that pediatricians are familiar with this infection. The public should be made aware of the hazards associated with raccoons and B procyonis to hopefully prevent future cases of B procyonisinfection.

The raccoon ascarid. A probable cause of human ocular larva migrans.

The ability of raccoon roundworm larvae, Baylisascaris procyonis, to produce ocular larva migrans (OLM) was studied in various experimental animals. In addition, the clinical and pathologic lesions were compared to those in suspected cases of human ocular baylisascariasis, in patients with diffuse unilateral subacute neuroretinitis (DUSN). Ocular larva migrans was produced in squirrel monkeys, cynomolgus monkeys, mice, hamsters, grey squirrels, and woodchucks orally infected with B. procyonis eggs. The clinical and histologic lesions were primarily those of retinitis, retinal hemorrhages, retinal tracks, disruption, and vasculitis; pigment migration; choroiditis; vitritis; and free or encysted larvae in ocular and extraocular tissues. The lesions of experimental OLM correlated well with those of suspected cases of human ocular baylisascariasis and DUSN. Based on these studies, B. procyonis of raccoons should be considered as a probable cause of OLM and DUSN in humans.

Raccoon Latrine Structure and Its Potential Role in Transmission of Baylisascaris procyonis to Vertebrates

Abstract Baylisascaris procyonis, the common large roundworm of raccoons (Procyon lotor), causes clinical neurologic disease in many species of mammals and birds. Infective eggs of B. procyonis are present at raccoon latrine sites, and these sites may be important in the transmission of this parasite to syntopic small vertebrates in forested areas. We located raccoon latrines in forested sites in Indiana, sampled soil and fecal material from these locations, and examined these samples for the presence of Baylisascaris procyonis eggs. We also quantified the structural characteristics of raccoon latrines in wooded areas, compared their characteristics with randomly located sites, and classified sites based on structural features using stepwise discriminant function analysis. B. procyonis eggs were present at 14% of the raccoon latrines sampled. Latrine sites differed from randomly located sites and exhibited characteristics generally associated with treefall gaps. Most latrines were located either on logs (49%) or at the base of large trees (37%). Structural features surrounding latrines often are important travel routes or foraging areas for various small vertebrates. The visitation of mammals and birds to sites exhibiting these structural features may result in infection with B. procyonis. In this way, Baylisascaris procyonis could have long-term impacts on populations of native mammals and birds.