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Clinical Microbiology Reviews, October 2005, p. 703-718, Vol. 18, No. 4
0893-8512/05/$08.00+0     doi:10.1128/CMR.18.4.703-718.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Baylisascariasis

Microbiology and Infectious Diseases Research, Department of Pathology and Laboratory Medicine, Evanston Northwestern Healthcare, Evanston,¹ Department of Veterinary Pathobiology, Purdue University School of Veterinary Medicine, West Lafayette, Indiana,² Division of Infectious Diseases, Department of Pediatrics, Children's Memorial Hospital, and Northwestern University Feinberg School of Medicine, Chicago, Illinois³

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.

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