Baylisascaris Procyonis Neural Larva Migrans in an Infant in New York City.

Jason E Perlman,Jon Edwards,Susan K Schulman,Fabiana S Machado,Rajen U Desai,Gavin H Imperato,Norman A Saffra,Kevin R Kazacos,Lucy R Pontrelli,Herbert B Tanowitz

doi:10.4303/jnp/n100502

Abstract

Neural larva migrans (NLM) with eosinophilic meningoencephalitis secondary to raccoon roundworm (Baylisascaris procyonis) infection has been reported in rural and suburban areas of North America and Europe with extant raccoon populations. Most cases have occurred in infants less than two years of age exposed to areas of raccoon fecal contamination. Here, we present a case of Baylisascaris-induced NLM from the densely populated borough of Brooklyn in New York City and alert urban pediatricians to consider this cause of clinical neurologic disease even in areas not typically thought to be associated with endemic risk factors. Infected raccoons also occur in urban settings, and urban children may be exposed to environmental areas or materials contaminated with their feces and the parasite's eggs.

Highlights

Neural larva migrans (NLM) is invasion of the brain and/or spinal cord by migrating larvae of helminth parasites, most commonly ascarids of carnivores [11,13]
Because of its high prevalence and widespread distribution, B. procyonis is being increasingly recognized as a cause of eosinophilic meningoencephalitis in humans, primarily children with significant environmental contact [8, 20]
Eosinophilia may be secondary to infectious organisms such as Ascaris lumbricoides, Toxocara canis, Trichinella spiralis, Angiostrongylus cantonensis, Baylisascaris procyonis, Strongyloides stercoralis, filarial worms, Schistosoma species, liver and lung flukes, Cryptococcus neoformans, and Coccidioides immitis [16]

Summary

Introduction

Neural larva migrans (NLM) is invasion of the brain and/or spinal cord by migrating larvae of helminth parasites, most commonly ascarids of carnivores [11,13]. NLM has been less often reported within densely urban communities, even though raccoons are known to occur in this setting [8] This geographical bias may obscure consideration of this etiology and lead to delayed diagnosis and poor neurological outcomes. We present a case of an infant in New York City in order to alert pediatricians in urban settings to consider NLM as well as B. procyonis in patients with eosinophilic meningoencephalitis. A New York City Department of Health public health advisory was released, in response to this case as well as another of our urban patients, a teenager with B. procyonis-induced ocular larva migrans (OLM), who suffered permanent severe vision impairment [21]

Case report

Discussion