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Potential
The introduction of Salmonella typhimurium into foods The ubiquitous raccoon can carry Baylisascaris
procyonis, a parasite that can cause life-threatening
being served in restaurants in and around Dalles, Ore., in
infections. (U. S. Fish and Wildlife Service/photo by John
September 1984 by the Bhagwan Shree Rajneesh cult is and Karen Hollingsworth.)
often called the first modern act of bioterrorism in North
America. It was not.
Fourteen years earlier, on 1 February 1970, four university students in Montreal, Quebec,
Canada, were infected—deliberately—with a massive dose of roundworm eggs from the parasite
Ascaris suum. The students became acutely ill with pulmonary infiltrates, asthma, and
eosinophilia. After being treated with prednisone and piperazine, all four recovered. A
parasitology graduate student was later identified as the attacker. This unusual assault with a
common pig parasite, although reported two years later in the New England Journal of Medicine
(286:965-970, 1972), has largely faded from view. "It happened so many years ago that I forgot
about it," recently noted one of the original investigators, Lewis Perelmutter, formerly of Queen
Elizabeth Hospital, McGill University, Montreal.
Yet the incident is worth reexamining, particularly for the ease of the attack and the unusual
choice of pathogen. Two more recent reports about a similar parasitic roundworm, Baylisascaris
procyonis, reinforce the notion that we remain especially vulnerable to such obscure, but readily
accessible pathogens. This latter roundworm is responsible for 12 scattered cases of infection in
the United States since 1981, including two deaths, according to a report in Morbidity and
Mortality Weekly Report early this year (50:1153-1155, 2002).
Although the case numbers are few, Frank Sorvillo of the University of California Los Angeles
School of Public Health and coworkers state in Emerging Infectious Diseases (8:355-359, 2002)
that B. procyonis is an underrecognized, emerging helminthic zoonotic that is a potential
bioterrorism agent. Of particular note, human infections can lead to devastating neurologic
sequelae or death.
B. procyonis is a nematode that parasitizes the intestinal tracts of North American raccoons,
whose droppings release huge quantities of infectious B. procyonis eggs. Raccoons are unusual
in that they tend to defecate in specific sites, including fallen trees, rocks, and stumps in the wild,
and on woodpiles, decks, walls, steps, and flat rooftops, in suburban settings. Such sites provide
likely points of human contact with B. procyonis.
The worm eggs are extremely hardy and, provided with moisture, will remain infectious for
years. They are resistant to most disinfectants, including sodium hypochlorite and quaternary
ammonium solutions. Raccoons shed as many as 250,000 eggs per gram of feces, and as few as
5,000 eggs may serve as an infective dose. In effect, raccoon droppings may be as dangerous as
the often rabies-infected animals themselves.
The full spectrum of B. procyonis disease is unknown. Eggs ingested by humans and other
intermediate hosts escape from the intestine, and the larvae migrate to other tissues, including the
brain and eyes. Host inflammatory responses likely contribute to the subsequent neurologic and
ocular damage. There is no effective therapy. Various antihelminthic drugs, including
ivermectin, and antiinflammatory agents have been used to treat the infection, but with little
obvious success. There is also no vaccine, no standardized diagnostic reagents, and no active
federal research on this emerging pathogen, with which few practicing physicians are familiar.
Edward McSweegan
Edward McSweegan is a microbiologist in the Washington, D.C., area.
November 2002.