Baylisascariasis infection with severe outcome in two New York City Children, 2008-2009

Baylisascariasis, a rare parasitic infection caused by Baylisascaris procyonis, the raccoon roundworm, can result in severe neurologic sequelae and death in humans. While fewer than 30 cases have been reported in the literature; the disease is likely under recognized. Raccoons have a high prevalence of infection, shedding more than 40 million eggs per day. Human infection occurs upon ingestion of viable eggs. Children are at particular risk because geophagia is more common in this agegroup.

The Health Department investigated two pediatric cases from a tradition-observant religious community, living in close proximity and reported by one clinician. The first case, a 12 month-old, was diagnosed with eosinophilic meningoencephalitis following acute onset of developmental regression, irritability, postural deficits and seizures in October 2008. Serologic testing for B. procyonis was positive. The child did not improve despite anti-helminthic and steroid therapy, sustaining permanent brain damage. The second case, a 14 year-old, developed acute onset blindness in the right eye in January 2009. Ocular examination revealed a larva and lesions consistent with ocular larva migrans from B. procyonis resulting in permanent blindness. The source of infection was not identified in either case. Raccoons were seen in the neighborhoods of both children but environmental sampling failed to identify B. procyonis. Both had history of travel to upstate New York.

The Health Department plans to create educational materials for the general public as well as targeting the tradition-observant religious community. Additionally, plans to sample raccoons for B. procyonis will help determine the prevalence among NYC raccoons.