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Key Features

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  • Eosinophilic meningoencephalitis or encephalopathy

  • Ocular larva migrans

  • Human infections with Baylisascaris procyonis, the raccoon roundworm, are increasingly recognized, particularly in children

  • Young age, pica, and exposure to raccoon feces represent the main risk factors

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Clinical Findings

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  • Most are asymptomatic

  • Severe encephalitis (neural larva migrans) and endophthalmitis (ocular larva migrans) occur

  • Symptoms typically begin 2–4 weeks after inoculation

  • CNS infections characteristically present as acute, rapidly progressive encephalitis with eosinophilic pleocytosis of the CSF (varies from 4% to 68% eosinophils in mild pleocytosis)

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Diagnosis

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  • Observation of larvae on examination of tissue biopsies or by serology (of serum or CSF)

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Treatment

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  • Antihelminthic drugs have not been shown to have any beneficial effect

  • Nevertheless, albendazole (20–40 mg/kg/d for 1–4 weeks) has been used to treat most cases, together with anti-inflammatory drugs

  • Complete resolution of symptoms has not been achieved thus far

  • Immediate prophylactic treatment with albendazole (25 mg/kg daily for 20 days) should be considered for those with known ingestion of raccoon feces

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