LETTERS

DOI: 10.3201/eid1509.090459 Backyard Page County). Yards were selected on the basis of proximity to forest pre- References Latrines and Risk serves and willingness of homeowners for to participate in the study. We located 1. Tsurumi M, Kawabata H, Sato F. Present status and epidemiological investigation procyonis latrines by systematically search- of Carios (Ornithodoros) capensis in ing yards, giving special attention to the colony of the black-footed albatross Transmission to horizontal substrates, such as piles of Diomedea nigripes on Tori-shima, Izu Humans wood and the bases of large trees (6). Islands, Japan [in Japanese]. Journal of We removed all fecal material to test the Yamashina Institute for Ornithology. To the Editor: (Pro- 2002;10:250–6. for B. procyonis and stored it in plas- 2. Kawabata H, Ando S, Kishimoto T, Ku- cyon lotor) are abundant in urban en- tic bags at –20oC until analysis. Com- rane I, Takano A, Nogami S, et al. First vironments and carry a variety of dis- posite samples that were at least 2 g detection of Rickettsia in soft-bodied ticks eases that threaten domestic underwent fecal flotation in Sheather associated with seabirds, Japan. Microbiol (1) and humans (2,3). A ubiquitous Immunol. 2006;50:403–6. solution (7) (at least 1 g of every fe- 3. Sato Y, Konishi T, Hashimoto Y, Taka- parasite of raccoons, Baylisascaris cal deposit at a latrine) (n =131). We hashi H, Nakaya K, Fukunaga M, et al. procyonis causes a widely recognized identified B. procyonis eggs by mi- Rapid diagnosis of Lyme disease: flagellin emerging , baylisascariasis croscopic examination on the basis of gene–based nested polymerase chain reac- (3). Although only 14 human cases tion for identification of causative Borre- their size and morphologic appearance lia . Int J Infect Dis. 1997;2:64–73. of severe B. procyonis encephalitis (2). Multiple slides were examined for DOI: 10.1016/S1201-9712(97)90084-9 have been reported over 30 years (4), ≈10% of the samples (randomly se- 4. Loftis AD, Gill JS, Schriefer ME, Levin prevention is still a priority for public lected) to validate our results. Preva- ML, Eremeeva ME, Gilchrist MJ, et al. health and wildlife officials because of Detection of Rickettsia, Borrelia, and lence was considered the proportion Bartonella in Carios kelleyi (Acari: Ar- the seriousness of the resulting neuro- of positive samples from all sampled gasidae). J Med Entomol. 2005;42:473– logic disease (5). yards. 80. DOI: 10.1603/0022-2585(2005)042 Raccoons prefer to defecate at Each yard was additionally sur- [0473:DORBAB]2.0.CO;2 latrines they create. Infected animals 5. Gill JS, Ullmann AJ, Loftis AD, Schwan veyed for potential latrine substrates TG, Raffel SJ, Schrumpf ME, et al. Novel shed ≈20,000 eggs/g of feces (3), so (8) and factors believed to attract or relapsing fever spirochete in bat tick. latrines serve as the foci of parasite deter raccoons. The distance of each Emerg Infect Dis. 2008;14:522–3. DOI: transmission (6). When latrines occur yard from the nearest forested habitat 10.3201/eid1403.070766 in close proximity to humans, the risk 6. MA, Grimm D, Henion AK, Elias was calculated by using ArcGIS 9.0 AF, Stewart PE, Rosa PA, et al. Borrelia for zoonotic transmission increases (Geographic Information Systems, burgdorferi sigma54 is required for mam- (2). Because B. procyonis are transmit- Redlands, CA, USA). We used homo- malian infection and vector transmission ted by the fecal–oral route, young chil- geneity tests to identify differences in but not for tick colonization. Proc Natl dren have the greatest risk for zoonot- Acad Sci U S A. 2005;102:5162–7. DOI: the proportion of yards with latrines 10.1073/pnas.0408536102 ic infection because of their tendency present and to compare the prevalence 7. Barbour AG. Isolation and cultivation to put objects into their mouths (1,2). of B. procyonis between study areas. of Lyme disease spirochetes. Yale J Biol Many human cases have occurred in Logistic regression and odds ratios Med. 1984;57:521–5. environments where latrines were near 8. Barbour AG. Relapsing fever. In: Goodman were used to evaluate a main effect JL, Dennis DT, Sonenshine DE, editors. children’s play areas. Our objective model composed of 10 yard attributes, Tick-borne diseases of humans. Washing- was to determine which factors en- including the presence of a pet, bird- ton: ASM Press; 2005. p. 268–91. courage raccoons to create latrines in feeders, garbage cans, and sandboxes, 9. Thomas NJ, Bunikis J, Barbour AG, Wol- human habitats. This information will cott MJ. Fatal spirochetosis due to a relaps- and to evaluate a simplified model in ing fever-like Borrelia sp. in a northern allow public health officials and wild- which attributes were combined to re- spotted owl. J Wildl Dis. 2002;38:187–93. life managers to develop strategies to flect the presence of food and latrine 10. Ministry of Health, Labour and Welfare, educate the public and to ultimately substrates, such as pet food, birdfeed, Japan. MHLW statistical database; 1998 prevent zoonotic transmission. [in Japanese] [cited 2009 Jun 23]. Available garbage and piles of wood or logs, from http://wwwdbtk.mhlw.go.jp/toukei/ We surveyed 119 backyards respectively. data/210/1998/toukeihyou/0002222/ for raccoon latrines in the suburbs Latrines occurred in 61/119 yards t0033267/hyo02_001.html of Chicago, Illinois, USA, near the (51%; 95% confidence interval [CI] Ned Brown Forest Preserve (n = 38; 0.42%–0.60%). There was no signifi- Address for correspondence: Hiroki Kawabata, 42°01′55.05′′N, 88°00′00.62′′W, Cook National Institute of infectious Diseases, cant difference in the proportion of County) and Lincoln Marsh (n = 81; backyards with latrines in proximity Bacteriology, Toyama 1-23-1 Shinjukuku 41°51′4.54′′N, 88°5′39.019′′W, Du- Tokyo 162-8640, Japan; email: [email protected] to Ned Brown (23/38, 82%) and Lin-

1530 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 15, No. 9, September 2009 LETTERS coln Marsh (38/81, 46%). The number density, these attractants should be re- 5. Gavin PJ, Kazacos KR, Shulman of latrines per backyard ranged from 1 moved. Homeowners with small chil- ST. Baylisascariasis. Clin Microbiol Rev. 2005;18:703–18. DOI: 10.1128/ to 6 (χ = 2.15). B. procyonis eggs were dren should remove latrines as quickly CMR.18.4.703-718.2005 found at 14/61 latrines sampled (23%; as they are discovered (2). The risk 6. Page LK, Swihart RK, Kazacos KR. 95% CI 12%–34%), and no significant of children acquiring potentially fa- Raccoon latrine structure and its poten- difference in prevalence was found tal baylisascariasis can be reduced if tial role in transmission of to vertebrates. Am Midl Nat. between the Ned Brown (6/23, 26%; parents understand how to reduce the 1998;140:180–5. DOI: 10.1674/0003- 95% CI 8%–44%) and Lincoln Marsh likelihood that children will come into 0031(1998)140[0180:RLSAIP]2.0.CO;2 areas (8/38, 21%; 95% CI 8%–34%). contact with raccoon latrines. 7. Sloss MW, Kemp RL, Zajac AM. Vet- Evaluation of the main effect erinary clinical parasitology. Ames (IA): Iowa State University Press; 1994. model identified a decreasing prob- Acknowledgments 8. Page LK, Swihart RK, Kazacos KR. Im- ability of latrine occurrence with in- The authors thank the Cook County plications of raccoon latrines in the epi- creasing distance from the nearest Forest Preserve District, the Elk Grove Vil- zootiology of baylisascariasis. J Wildl Dis. 1999 35 474 80 forested area and the presence of an lage, the Illinois Health Department, and the ; : – . outdoor pet, although these relation- numerous cooperating homeowners in both Address for correspondence: L. Kristen Page, ships were only marginally significant Elk Grove Village and Wheaton, Illinois. (p = 0.07 and 0.08, respectively). No Biology Department, Wheaton College, 501 other variables were closely associated This study was supported by the College Ave, Wheaton, IL 60187, USA; email: with the presence of raccoon latrines Wheaton College Alumni Association, the [email protected] (p>0.20). When evaluated alone, dis- Aldeen Fund, and the Science Division of tance from the forest preserve was sig- Wheaton College. nificantly related to latrine occurrence (p = 0.03); probability decreased with L. Kristen Page, Chris Anchor, increasing distance. Evaluation of the Ellen Luy, Sarah Kron, simplified model identified a weakly Grace Larson, Lauren Madsen, positive association with the pres- Kenneth Kellner, Reemergence of ence of a food source (p = 0.09) and and Timothy J. Smyser , no association with the presence of Author affiliations: Wheaton College, latrine substrate (p = 0.35). Although Wheaton, Illinois, USA (L.K. Page, E. Luy, Northern Italy the findings were not statistically sig- S. Kron, G. Larson, L. Madsen, K. Kellner); To the Editor: Strongyloidi- nificant, raccoon latrines did appear to Wildlife Division of the Forest Preserve asis is a helminth infection caused by be associated with the availability of District of Cook County, Elgin, Illinois, USA Strongyloides stercoralis, a a food source such as bird feed (odds (C. Anchor); and Purdue University, West ubiquitous in tropical and subtropical ratio [OR] 1.9, 95% CI 0.9–4.1); the Lafayette, Indiana, USA (T.J. Smyser) countries and occasionally reported in presence of an outdoor pet (OR 0.27, DOI: 10.3201/eid1509.090128 temperate countries, including Italy 95% CI 0.06–1.2) and increasing dis- (1). Sources of infection are filariform tance from the nearest forested area References strongyloid larvae present in soil con- reduced the likelihood of latrines. No taminated by infected feces; the larvae other variables were associated with 1. Kazacos KR. Protecting children from penetrate through the skin of a human the presence of raccoon latrines; how- helminthic zoonoses. Contemp Pediatr. 2000 17 1 24 . After the first life cycle, a process ever, low statistical power may have ; : – . 2. Kazacos KR. Baylisascaris procyonis and of autoinfection begins, which persists precluded adequate assessment. related species. In: Samuel WM, Pybus indefinitely in the host if the infection Our results suggest that when hu- MJ, Kocan AA, editors. Parasitic diseases is not effectively treated. The infec- mans live close to protected forests of wild mammals. Ames (IA): Iowa State 2001 tion can remain totally asymptomatic or natural areas, they are more likely University Press; . 3. Sorvillo F, Ash LR, Berlin OGW, Yatabe for many years or forever or cause cu- to attract raccoons into their yards. In J, Degiorgio C, Morse SA. Baylisascaris taneous (itching and rash), abdominal addition, anthropogenic food sources procyonis: an emerging helminthic zoono- (epigastric pain, pseudoappendicitis, such as pet food, garbage, and bird sis. Emerg Infect Dis. 2002;8:355–9. 4 Pai PJ Blackburn BG Kazacos KR War- diarrhea), respiratory (cough, recur- feed may increase the likelihood that . , , , rier RP, Begue RE. Full recovery from rent asthma), and systemic (weight a raccoon will create a latrine, and the Baylisascaris procyonis eosinophilic loss, cachexia) symptoms that can be presence of outdoor pets appears to be . Emerg Infect Dis. 2007;13: enervating. More importantly, when a deterrent. In areas of high raccoon 928–30. host immunity is impaired because of

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