ABSTRACT. Objective. Eosinophil-associated proteins, especially eosinophil-derived neurotoxin, may be important contributors to the neurologic pathology and symptoms caused by Baylisascaris procyonis infection.Methods. Two cases of severe B procyonis encephalitis with evidence of marked eosinophil degranulation in the central nervous system are presented. Serial cerebrospinal fluid (CSF) specimens were collected from each patient during the course of their illness. Antibodies against B procyonis were measured in the patients' serum and CSF. Levels of the eosinophilopoietin interleukin-5 (IL-5) and 2 important eosinophil proteins, eosinophilderived neurotoxin and major basic protein, were assayed in the CSF.Results. Both patients had rapidly progressive central nervous system disease with evidence of eosinophilic meningoencephalitis. Both tested positive for antibodies to B procyonis in serum and CSF and had progressively worsening deep white matter changes on magnetic resonance images of the brain. CSF levels of IL-5, eosinophilderived neurotoxin, and major basic protein were markedly elevated over controls.Conclusions. This is the first report of the measurement of IL-5, eosinophil-derived neurotoxin, and major basic protein in human CSF. In addition to traumatic damage and necrosis caused by migrating larvae, eosinophil-derived neurotoxin from associated eosinophilic inflammation may be an important contributory factor in the pathogenesis of B procyonis encephalitis. Pediatrics 2001;108(5). URL: http://www.pediatrics.org/cgi/content/ full/108/5/e93; parasite, eosinophil-derived-neurotoxin, major basic protein, eosinophilia, hypereosinophilia, interleukin-5, encephalitis, child.ABBREVIATIONS. CSF, cerebrospinal fluid; CNS, central nervous system; MRI, magnetic resonance imaging; IL-5, interleukin-5; PBS, phosphate-buffered saline.B aylisascaris procyonis, the common raccoon ascarid, is a well-known cause of severe neurologic disease (neural larva migrans) in animals, with cases identified in Ͼ90 species of mammals and birds in North America. 1,2 Neural larva migrans and eosinophilic meningoencephalitis attributable to B procyonis have now been identified in 7 young children, including the 2 reported here. [3][4][5][6][7] We specifically note a novel correlation with elevated cerebrospinal fluid (CSF) levels of major basic protein and the neurotoxic protein eosinophil-derived neurotoxin associated with eosinophilic inflammation in these 2 cases. We hypothesize that the severe neurologic consequences of Baylisascaris encephalitis are attributable, in part, to marked eosinophil degranulation and release of these toxic eosinophil proteins in the central nervous system (CNS) of patients with this disease.
CASE REPORTS Case 1A 13-month-old boy became irritable 3 weeks before hospital admission, then became progressively irritable, ataxic, and weak. Three days before admission, he was unable to cruise, sit up, or walk, and exhibited dysmetria. He then had an episode of limb twitching followed by rigidity and decreased...