Determination of the half-life of circulating leptin in the mouse.

BACKGROUND: The adipokine hormone, leptin, is a major component of body weight homeostasis. Numerous studies have been performed administering recombinant mouse leptin as an experimental reagent; however, the half-life of circulating leptin following exogenous administration of recombinant mouse leptin has not been carefully evaluated. METHODS: Exogenous leptin was administered (3 mg leptin per kg body weight) to 10-week-old fasted non-obese male mice and plasma was serially collected at seven time points; plasma leptin concentration was measured by enzyme-linked immunosorbent assay at each time point to estimate the circulating half-life of mouse leptin. RESULTS: Under the physiological circumstances tested, the half-life of mouse leptin was 40.2 (±2.2) min. Circulating leptin concentrations up to 1 h following exogenous leptin administration were 170-fold higher than endogenous levels at fasting. CONCLUSIONS: The half-life of mouse leptin was determined to be 40.2 min. These results should be useful in planning and interpreting experiments employing exogenous leptin. The unphysiological elevations in circulating leptin resulting from widely used dosing regimens for exogenous leptin are likely to confound inferences regarding some aspects of the hormone's clinical biology.

The effects of sex, age, and interval duration on the perception of time.

The present experiment examined the interactive effects of sex, age, and interval duration on individual's time perception accuracy. Participants engaged in the duration production task and subsequently completed questionnaires designed to elicit their temporal attitudes. The overall group of 100 individuals was divided evenly between the sexes. Five groups, each composed of 10 males and 10 females, were divided by decades of age ranging from 20 to 69 years old. The specific time estimation task was an empty interval production procedure composed of 50 trials on each of four different intervals of 1, 3, 7, and 20 s, respectively. The presentation orders of these intervals were randomized across participants but yoked across the sexes within each of the respective age groups. Analysis of the production results indicated significant influences for the sex of the participant while age did not appear to affect estimates of these short durations. Temporal attitudes, as reflected in responses to time questionnaire inquiries, did however exhibit significant differences across age. The contending theoretical accounts of such sex and age differences are considered and explanatory accounts that present a synthesis of endogenous and exogenous causal factors are discussed in light of the present pattern of findings.

Erroneous reports of the neotropical Echinococcus oligarthrus as a cause of echinococcosis in India.

Two cases of submandibular echinococcosis have been reported in adult residents of India (Kini et al., 1997; Sahni et al., 2000). It was stated in both publications that the cestode was E. oligarthrus, "a rare variety of E. granulosus", based on morphogical characteristics. It was also mentioned that 3 cases of E. granulosus with similar submandibular metacestode had been previously diagnosed in India. The metacestode is readily distinguishable from that of E. oligarthrus. The final hosts of E. oligarthrus are several neotropical species of wild cats and metacestode occurs in hystricognath, all of them absent in India. The larval stage of all 4 species of Echinococcus can be differentiated on the basis of the form and dimensions of rostellar hooks of protoescoleces. With the information provided in the two papers we concluded that the 2 cases of echinococcosis described in India were due to E. granulosus.

Early and late cognitive changes following temporal lobe surgery for epilepsy.

OBJECTIVE: To evaluate early and late postoperative cognitive changes in adult patients who had a standardized temporal lobe resection for control of intractable complex partial seizures and to relate quality of life measures at the long-term follow-up to seizure control and a verbal memory skill. METHODS: Patients in this longitudinal study had intractable epilepsy and had cognitive tests at the initial surgical evaluation, 1 year later, and at a long-term follow-up (at least >9 years later). Mean follow-up was 12.8 years. Participants were 44 patients who had an en bloc left (LTL) or right (RTL) temporal lobe resection and 8 nonsurgical patients with epilepsy. RESULTS: Patients with LTL surgery showed selective early decreases in verbal memory. At the long-term follow-up, further decreases in verbal memory and visual memory scores were seen for all patient groups. In general, the nonmemory scores remained stable over time. LTL surgery and initial high scores were predictors of verbal memory decreases seen at the early follow-up. Late memory declines were predicted by higher 1-year scores. LTL surgery was an additional predictor of late decline on a verbal memory task sensitive to the integrity of the left hippocampus. Higher quality of life scores of patients at the long-term follow-up were associated with both better seizure control and a higher everyday verbal memory skill: prose recall. CONCLUSIONS: Surgery-induced verbal memory deficits following LTL surgery continue 13 years after surgery. Late, possibly age-related, declines in multiple memory scores are seen in patients with temporal lobe surgery and nonsurgical patients with epilepsy. Patients with LTL surgery may be at risk for a more rapid decline in selective verbal memory skills. Evaluations of treatments for intractable epilepsy that compromise memory functions should consider the further quality of life impact of late age-related memory declines.

Cystic echinococcosis in the Arctic and Sub-Arctic.

The northern biotype of Echinococcus granulosus occurs throughout the holarctic zones of tundra and taiga, from eastern Fennoscandia to the Bering Strait in Eurasia and in North America from arctic Alaska approximately to the northern border of the United States. The cycle of the cestode is complex in taiga at lower latitudes, because of the greater diversity of potential hosts. In the Arctic and Subarctic, however, four patterns of predator/prey relationships may be discerned. Two natural cycles involve the wolf and wild reindeer and the wolf and elk (moose), respectively. Where deer of the two species coexist, both are prey of the wolf; the interactions of the wolf and elk are here described on the basis of long-term observations made on Isle Royale (in Lake Superior near the southern limit of taiga), where only the wolf and elk serve as hosts for E. granulosus. A synanthropic cycle involving herding-dogs and domesticated reindeer caused hyperendemicity of cystic echinococcosis in arctic Eurasia, mainly in northeastern Siberia. The 4th pattern, a semi-synanthropic cycle, formerly existed in Alaska, wherein sled-dogs of the indigenous hunters became infected by consuming the lungs of wild reindeer. The sequence of changes in life-style inherent in the process of acculturation affected the occurrence of cystic echinococcosis among nomadic Iñupiat in arctic Alaska. When those people became sedentary, the environs of their early villages soon became severely contaminated by faeces of dogs, and cases of cystic echinococcosis occurred. Compared to cystic echinococcosis caused by E. granulosus adapted to synanthropic hosts (dog and domestic ungulates), the infection produced by the northern biotype is relatively benign. Nearly all diagnosed cases of cystic echinococcosis (> 300) in Alaska have occurred in indigenous people; only one fatality has been recorded (in a non-indigenous person). After sled-dogs were replaced by machines, cases have become rare in Alaska. A similar effect has been observed in Fennoscandia, in the Saami and domesticated reindeer. Recent records indicate that the prevalence of cystic echinococcosis is increasing in Russia, suggesting that dogs are used there in herding.

Description of Paranoplocephala etholeni n. sp. (Cestoda: Anoplocephalidae) in the meadow vole Microtus pennsylvanicus, with a synopsis of Paranoplocephala s. l. in holarctic rodents.

Paranoplocephala etholeni n. sp., parasitizing the meadow vole Microtus pennsylvanicus in Alaska and Wisconsin, USA, is described. Paranoplocephala etholeni is morphologically most closely related to the Nearctic Paranoplocephala ondatrae (Rausch, 1948). Available data suggest that P. etholeni is a host-specific, locally rare species that may have a wide but sporadic geographical distribution in North America. The finding of P. ondatrae-like cestodes in Microtus spp. suggests that this poorly known species may actually be a parasite of voles rather than muskrat (type host). A tabular synopsis of all the known species of Paranoplocephala s. l. in the Holarctic region with their main morphological features is presented.

Characterization of the laminated layer of in vitro cultivated Echinococcus vogeli metacestodes.

The metacestode (larval) stages of the cestode parasites Echinococcus vogeli and E. multilocularis were isolated from the peritoneal cavity of experimentally infected C57BL/6 mice and were cultured in vitro for a period of up to 4 mo under conditions normally applied for the in vitro cultivation of E. multilocularis metacestodes. In contrast to E. multilocularis, E. vogeli did not exhibit extensive exogenous budding and proliferation but increased in size with a final diameter of up to 10 mm. Most metacestodes contained protoscoleces, singly or in groups, either associated with brood capsules or growing directly out of the germinal layer. Each individual metacestode was covered by an acellular translucent laminated layer that was considerably thicker than the laminated layer of E. multilocularis metacestodes. The ultrastructural characteristics, protein content, and carbohydrate composition of the laminated layer of in vitro cultivated E. vogeli and E. multilocularis were assessed using transmission electron microscopy, lectin fluorescence labeling, and lectin blotting assays. The laminated layer of E. vogeli is, as previously described for E. multilocularis metacestodes, largely composed of N-acetyl-beta-D-galactosaminyl residues and alpha- and beta-D-galactosyl residues, as well as of the core structure of O-linked carbohydrate chains, N-acetylgalactosamine-beta-1,3-galactose. However, in contrast to E. multilocularis, N-linked glycopeptides and alpha-D-mannosyl and/or glucosyl residues were also associated with the laminated layer of E. vogeli. The laminated layer from both species was isolated from in vitro cultivated metacestodes, and the purified fractions were comparatively analyzed. The protein:carbohydrate ratio (1:1) was similar in both parasites; however, the protein banding pattern obtained by silver staining following sodium dodecyl sulfate polyacrylamide gel electrophoresis suggested intrinsic differences in protein composition. A polyclonal antiserum raised against the E. multilocularis laminated layer and a monoclonal antibody, G11, directed against the major E. multilocularis laminated layer antigen Em2 did not cross-react with E. vogeli, indicating distinct compositional and antigenic differences between these 2 parasites.

Natural transfer of helminths of marine origin to freshwater fishes with observations on the development of Diphyllobothrium alascense.

Infective stages of helminths of 5 species that occur as adults in marine mammals were found in burbot, Lota lota (L.) (Gadidae), from the lower Kuskokwim River (southwestern Alaska): Diphyllobothrium alascense Rausch et Williamson, 1958; Pyramicocephalus phocarum (Fabricius, 1780); Corynosoma strumosum (Rudolphi, 1801); Corynosoma semerme (Forsell, 1904); and Pseudoterranova decipiens (Krabbe, 1878). Some larval stages were obtained also from smelt, Osmerus mordax dentex Steindachner, an anadromous fish important as prey of burbot. Burbot, which are freshwater fish, could become paratenic hosts of those helminths by means of at least 3 interactions: by consuming marine fishes in brackish waters at river mouths, by feeding on marine fishes that enter lower reaches of rivers, or by preying on anadromous fishes as they migrate up rivers. Consumption of burbot by people may result in infection by helminths of marine origin; of those recorded, only P. decipiens may be significantly pathogenic. Attempts to rear P. phocarum in dogs were unsuccessful. Plerocercoids of D. alascense, of very small size and found only in the gastric lumen of burbot, readily infected dogs. For study of their development, strobilae were obtained at intervals of 48 hr to 32 days postinfection. In heavy infections, some strobilae developed slowly, while others underwent rapid development.

A phylogenetic hypothesis for species of the genus Taenia (Eucestoda : Taeniidae).

Cladistic analysis of a numerical data matrix describing 27 characters for species of Taenia resulted in 4 most parsimonious phylogenetic trees (174 steps; consistency index = 0.28; homoplasy index = 0.72; retention index = 0.48). Monophyly for Taenia is diagnosed by the metacestode that is either a cysticercus or a form derived from a bladder-like larva; no other unequivocal synapomorphies are evident. Tree structure provides no support for recognition of a diversity of tribes or genera within the Taeniinae: Fimbriotaeniini and Taeniini have no phylogenetic basis. Hydatigera, Fimbriotaenia, Fossor, Monordotaenia, Multiceps, Taeniarhynchus, Tetratirotaenia must be subsumed within Taenia as synonyms. Taenia saginata and Taenia asiatica are sister species and distantly related to Taenia solium. Cospeciation with respect to carnivorous definitive hosts and Taenia appears to be limited. Although felids are putative ancestral hosts, contemporary associations appear to have resulted from extensive host-switching among felids, canids, hyaenids, and others. In contrast, relationships with herbivorous intermediate hosts are indicative of more pervasive coevolution; rodents as intermediate hosts are postulated as ancestral for the Taeniidae, Taenia + Echinococcus. Patterns appear consistent with rapid shifts between phylogenetically unrelated carnivores but among those that historically exploited a common prey resource within communities in specific biogeographic regions.

Effects of hypoxia, anoxia, and endogenous ethanol on thermoregulation in goldfish, Carassius auratus.

Effects of hypoxia, anoxia, and endogenous ethanol (EtOH) on selected temperature (T(sel)) and activity in goldfish were evaluated. Blood and brain EtOH concentrations ([EtOH]) and brain oxygen partial pressure (PO(2)) were quantified at crucial ambient oxygen pressures. Below a threshold value near 31 Torr, T(sel) decreased as a function of environmental PO(2). T(sel) of 15 degrees C-acclimated fish was approximately 10 degrees C at the onset of anoxia and changed little over 2 h. Activity showed a similar response pattern. Brain [EtOH] was significantly elevated above control levels after 1 h anoxia. In normoxic water, T(sel) remained different in previously anoxic and normoxic control fish for approximately 20 min. Blood [EtOH] of previously anoxic fish remained significantly elevated ([EtOH] >4.0 micromol/g blood), and activity was significantly depressed at 20 min. Brain PO(2) reached normal levels in <3 min. We conclude that [EtOH] (brain or blood) and brain PO(2) are not proximal causes of either behavioral anapyrexia (hypothermia) or inactivity in goldfish exposed to oxygen-depleted environments.

Temporal lobe epilepsy, temporal lobectomy, and major depression.

Sixty-two patients with medically intractable complex partial seizures who had either surgical or no surgical intervention were followed up at a mean of 10.9 years after surgery or initial evaluation. Of the 49 surgical patients, 45% had a life-time history of depression, versus 15% of the 13 patients in the nonsurgical comparison group. In the surgical group, 77% had prior history of depression; of these, 47% experienced no further episodes after surgery. Depression occurred de novo after lobectomy in 5 surgical patients (approximately 10%), 4 developing depression within 1 year. Presurgical presence of depressive episodes predicted continued postoperative depressive episodes. The significantly higher depression rate in patients with temporal lobe seizure foci suggests limbic system dysfunction in the increased risk for depression. Postsurgical resolution of episodes in almost 50% of these patients supports the tenet that depression per se is not a contraindication for surgery in patients with intractable seizures.

Karyological and dental identification of Microtus limnophilus in a large focus of alveolar echinococcosis (Gansu, China).

A study of voles (Arvicolidae, Rodentia) from Gansu (China) designed to identify a potential host of Echinococcus multilocularis, responsible for human alveolar echinococcosis, leads to a general analysis of Microtus limnophilus population karyotypes, M1 of M. oeconomus populations from all of Eurasia and of M. limnophilus of Mongolia. The Microtus of Gansu belonging to the nominal subspecies M. limnophilus limnophilus (2n = 38; NF = 58) differs markedly in size and shape of M1 from the M. limnophilus of Mongolia, which must therefore be considered as a new subspecies M. limnophilus of malygini nov. ssp. (2n = 38; NF = 60) and the M. oeconomus of Mongolia should be ranked as M. oeconomus kharanurensis nov. ssp. (2n = 30; NF = 60).

Histogenesis in the metacestode of Echinococcus vogeli and mechanism of pathogenesis in polycystic hydatid disease.

Histogenesis of the metacestode of Echinococcus vogeli was traced mainly in rodents inoculated intraperitoneally with finely minced infective vesicles. The fragments aggregated in the peritoneal cavity and coalesced, forming structures (plaques) from which primary vesicles arose. From primordia in their germinal tissue, exogenous vesicles developed, enlarged, and migrated outward to the surface of the laminated membrane, where they remained attached and proliferated. Each unit of vesicles so formed retained discrete identity and, within 6-8 mo, acquired an adventitia; thereafter, exogenous multiplication ceased and endogenous proliferation supervened. Large numbers of daughter cysts arose in the germinal tissue lining chambers within the units; endogenous proliferation also finally ceased, and the daughter cysts produced brood capsules containing protoscoleces. Primordia of exogenous vesicles were not observed in the walls of daughter cysts. Production of protoscoleces involved 3 processes: they developed in typical brood capsules, singly in minute brood capsules, or directly from germinal tissue. Exogenous proliferation is not characteristic in the natural intermediate host of E. vogeli, the paca. Evidently in primates, the initial proliferation in the liver is followed by extension of the metacestode into the peritoneal cavity and eventual invasion of abdominal and thoracic organs. Exogenous proliferation by a process unique to E. vogeli accounts for the clinical course of polycystic hydatid disease.

Limited range of genetic variation in Echinococcus multilocularis.

DNA sequencing of 1.3 kb of rDNA containing both internal transcribed spacers (ITS1, ITS2) and adjoining rRNA coding regions in each of 11 Echinococcus multilocularis isolates from Germany, Japan, and Alaska resulted in identical nucleotide sequences except for a single polymorphic locus 54 bp upstream of the 3' end of the 18S coding region, separating Eurasian isolates from an Alaskan isolate. The same base substitution was found in each of 2 additional isolates from Alaska. The distribution of the resulting genotypes with regard to their origin is highly significant (>99.9%) and corresponds to the traditional subspecies Echinococcus multilocularis multilocularis and Echinococcus multilocularis sibiricensis.

Effects of hemisphere speech dominance and seizure focus on patterns of behavioral response errors for three types of stimuli.

We used a protocol consisting of a continuous presentation of stimuli with associated response requests during an intracarotid sodium amobarbital procedure (IAP) to study the effects of hemisphere injected (speech dominant vs. nondominant) and seizure focus (left temporal lobe vs. right temporal lobe) on the pattern of behavioral response errors for three types of visual stimuli (pictures of common objects, words, and abstract forms). Injection of the left speech dominant hemisphere compared to the right nondominant hemisphere increased overall errors and affected the pattern of behavioral errors. The presence of a seizure focus in the contralateral hemisphere increased overall errors, particularly for the right temporal lobe seizure patients, but did not affect the pattern of behavioral errors. Left hemisphere injections disrupted both naming and reading responses at a rate similar to that of matching-to-sample performance. Also, a short-term memory deficit was observed with all three stimuli. Long-term memory testing following the left hemisphere injection indicated that only for pictures of common objects were there fewer errors during the early postinjection period than for the later long-term memory testing. Therefore, despite the inability to respond to picture stimuli, picture items, but not words or forms, could be sufficiently encoded for later recall. In contrast, right hemisphere injections resulted in few errors, with a pattern suggesting a mild general cognitive decrease. A selective weakness in learning unfamiliar forms was found. Our findings indicate that different patterns of behavioral deficits occur following the left vs. right hemisphere injections, with selective patterns specific to stimulus type.

Burhinotaenia colombiana n. sp. (Cestoda, Cyclophyllidea) from the double-striped stone curlew Burhinus bistriatus (Aves, Charadriiformes) in Colombia.

Burhinotaenia colombiana n. sp. (Dilepididae) is described from the small intestine of the double-striped stone curlew Burhinus bistriatus (Burhinidae) captured at Carimagua, Colombia. The new species is distinguished from the most similar Burhinotaenia delachauxi (Baer, 1925), a parasite of the Old World Burhinus spp., by the longer cirrus-sac (375-590, avg. 514 microns vs. 322-393, avg. 354 microns) and longer rostellar hooks (412-451, avg. 440 microns vs. 358-367, avg. 364 microns). The validity of the genus Burhinotaenia Spasskii and Spasskaya, 1965 and its generic diagnosis as proposed by Bona (1994) are confirmed. This is the first record of a species of Burhinotaenia in the New World.

Word-finding deficits persist after left anterotemporal lobectomy.

OBJECTIVE: To determine the incidence and extent of exacerbation of word-finding difficulty following anterotemporal lobectomy and to identify predictors of change. DESIGN: Case-series study of qualitative and quantitative changes in confrontation naming ability before surgery and 1 year after surgery. Stepwise multiple regression analysis of predictors of postoperative naming change. SETTING: A university epilepsy surgery program. PARTICIPANTS: Fifty-nine consecutive patients. INTERVENTION: Standard, en bloc anterotemporal lobectomy. MAIN OUTCOME MEASURE: Raw scores and types of errors on the 85-item Boston Naming Test. RESULTS: A significant exacerbation of word-finding difficulty was noted that persisted at least 1 year after surgery in 25% of patients with left, speech-dominant anterotemporal lobectomy (Laterality x Time interaction [F = 24.5; P < .0005]). "Tip-of-the-tongue"-type errors were most frequent (F = 54.66; P < .001), as opposed to paraphasic-type errors seen more frequently among patients with aphasia or dementia. Word-finding decline was worse among patients who underwent a left anterotemporal lobectomy and who were left-hemisphere speech dominant, older, or evaluated earlier in the postoperative course. CONCLUSIONS: Significant, persisting worsening of word-finding difficulties is not a rare consequence of a left anterotemporal lobectomy, as suggested by previous studies. Differences between these results and those of previous studies may reflect differences in extent of surgical resection and/or differential sensitivity of psychometric measures of naming to word-finding problems. Information regarding extent, frequency, and predictors of word-finding declines may be used in counseling surgical candidates about the potential cognitive side effects of anterotemporal lobectomy.

Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery.

Surgery for intractable epilepsy is a widely used treatment that is not readily assessed by randomised trials. We evaluated the impact of epilepsy surgery on seizures, medication use, employment, and the quality of life in 248 adults and adolescents consecutively referred to one medical centre between 1974 and 1990. Outcomes were determined through self-administered questionnaire and medical record review for 202 surgery and 46 non-surgery patients whose treatment was usually determined by the presence or absence of an epileptogenic focus. Surgery and non-surgery patients differed at baseline only in median monthly seizure frequency (surgery lower than non-surgery). After adjustment for baseline covariates, surgery patients at follow-up had greater decline in average monthly seizure frequency (-11.9 vs - 1.5; difference -10.4, 95% CI -20.5, -0.3) and took fewer antiepileptic medications (average number 1.4 vs 2.0; difference -0.67, 95% CI -0.94, -0.40). Although quality-of-life scores were higher (p < 0.05) with surgery on 5 of 11 scales that were administered only at follow-up, there were no significant differences in employment status or prospectively assessed quality of life. Relative to a non-surgery group, patients treated surgically had better seizure control with less antiepileptic medication. The impact of epilepsy surgery on quality of life and employment needs to be assessed in larger prospective studies.

Immunodiagnosis of polycystic hydatid disease/polycystic echinococcosis due to Echinococcus vogeli.

A crude antigenic metacestode extract from Echinococcus vogeli was assessed by enzyme-linked immunosorbent assay (ELISA) and showed strong binding activity with serum antibodies from patients with polycystic echinococcosis. Major cross-reactions occurred with serum antibodies from patients with cystic and alveolar echinococcosis and from patients infected with other species of helminths. An E. vogeli antigen fraction, Ev2, was subsequently purified by immunosorption. The respective Ev2 ELISA demonstrated improved specificity, allowing discrimination of non-Echinococcus infections from polycystic echinococcosis. Based upon the calculation of a comparative (Ev-crude ELISA versus Ev2 ELISA) reactivity index, it became possible to discriminate all cystic echinococcosis cases, but only some alveolar echinococcosis cases, from polycystic echinococcosis. Immunoblot analyses revealed an antibody banding pattern highly conserved among polycystic, cystic, and alveolar echinococcosis. However, immunoblotting reliably distinguished between echinococcosis and all non-Echinococcus infections.

Alveolar hydatid disease. Review of the surgical experience in 42 cases of active disease among Alaskan Eskimos.

OBJECTIVE: The authors reviewed the pathophysiology and clinical management of endemic alveolar hydatid disease in Alaskan Eskimos, incorporating recent developments in diagnosis and treatment. SUMMARY BACKGROUND DATA: Alveolar hydatid disease is a highly lethal zoonotic infection caused by the larval stage of Echinococcus multilocularis. This cestode is restricted geographically to northern climates, where foxes and small rodents represent the natural hosts. Domestic dogs also may serve as definitive hosts, and thus, transmit the parasite to humans. Human infection is characterized by the development of a cancer-like hepatic mass, which may extend to adjacent structures or metastasize to distant sites. If the infection goes untreated, mortality reaches 80%. METHODS: The medical records of all patients with alveolar hydatid disease diagnosed or treated at the Alaska Native Medical Center between 1951 and 1993 were reviewed. Forty-two cases of active disease are presented. RESULTS: Nine patients underwent resection of hepatic lesions with intent to cure, and each had a favorable result. Average post-diagnosis survival of those patients was 22 years; six still are living and free of disease. Partial resections or drainage procedures were performed in ten patients. Chemotherapy was used to augment the surgical treatment of eight patients, and four received chemotherapy alone, resulting in improved outcomes compared with historic controls. Late complications included hepatic abscess, biliary obstruction, and portal venous hypertension. CONCLUSIONS: Whereas alveolar hydatid disease rarely is encountered in other areas of North America, the biologic potential for spread of the disease may be increasing because of illegal importation of infected foxes to the Eastern seaboard. Therefore, the surgical community should maintain an awareness of the diagnosis and management of this potentially devastating parasitic infection.