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Zhao YM, Zhang HC, Li ZR, Zhang HY. Scrotal sparganosis mimicking scrotal teratoma in an infant: a case report and literature review. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:545-9. [PMID: 25352706 PMCID: PMC4210740 DOI: 10.3347/kjp.2014.52.5.545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 07/05/2014] [Accepted: 08/03/2014] [Indexed: 12/05/2022]
Abstract
Sparganosis is an infection with a parasitic tapeworm larva that occurs by eating infected foods or drinking contaminated water. The larvae can migrate to a tissue or muscle in the chest, abdominal wall, extremities, eyes, brain, urinary tract, pleura, pericardium, spinal canal, or scrotum. Herein, we report a 5-month old infant with scrotal sparganosis who was initially suspected to have a scrotal inflammatory mass with a history of applying raw frog meat into the umbilicus. Preoperative ultrasound examinations and computed tomography (CT) scanning misdiagnosed the mass as a scrotal teratoma. The scrotal mass was surgically removed, and the histopathology proved it to be scrotal sparganosis. This case displays the youngest patient ever reported with scrotal sparganosis, and the first description of CT characteristics of scrotal sparganosis. A detailed medical history is necessary for patients with scrotal masses suspected of sparganosis. In addition, ultrasound and CT examinations are helpful to rule out other causes of a scrotal mass.
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Affiliation(s)
- Yi-Ming Zhao
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
| | - Hao-Chuan Zhang
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
| | - Zhong-Rong Li
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
| | - Hai-Yan Zhang
- Department of Pathology, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
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Chu S, Lu X, Wang Y, Gao G, Xv F, Zee CS, Yao Z. Magnetic resonance imaging features of pathologically proven cerebral sparganosis. J Int Med Res 2013; 41:867-77. [PMID: 23680666 DOI: 10.1177/0300060513480925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The purpose of this study was to identify characteristic magnetic resonance imaging (MRI) features of cerebral sparganosis, a rare parasitic disease caused by the plerocercoid larva of Spirometra mansoni. Methods This retrospective study reviewed medical records, computed tomography (CT) and MRI scans and pathological specimens from patients with pathologically proven cerebral sparganosis. The location, signal intensity and contrast enhancement characteristics of the lesions were assessed. Results Records of 12 patients (seven male and five female; age range 8–35 years) were reviewed. A total of 13 lesions were identified: of the 10 patients with supratentorial lesions, nine had a single lesion and one had bilateral hemispheric lesions. Two patients had a single lesion in the ependyma of the 4th ventricle. All lesions were iso-hypointense on T1-weighted images, slightly hypointense on T2-weighted images and surrounded by extensive oedema. Ten of the 13 lesions demonstrated a ‘string-knots sign’, characterized by a tangled string in a knot-like shape on contrast-enhanced MRI. Conclusion A string-knots sign enhancement pattern in cortical–subcortical regions should suggest the diagnosis of cerebral sparganosis.
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Affiliation(s)
- Shuguang Chu
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Xingsui Lu
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yin Wang
- Department of Neuropathology, Huashan Hospital, Shanghai, China
| | - Gejun Gao
- Department of Radiology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Feijia Xv
- Department of Radiology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Chi-Shing Zee
- Department of Neuroradiology, University of Southern California, Los Angeles, CA, USA
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital, Shanghai, China
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Abstract
BACKGROUND Although there is much consensus, certain controversies still exist regarding the pathology of Fournier's gangrene. The purpose of this study was to determine the prevalence of the disease in the catchment area of the three teaching hospitals, to identify the systemic predisposing factors and local aetiological factors, and to assess the recommended role of aggressive surgical debridement as a part of treatment. MATERIALS AND METHODS This prospective study was conducted in the surgical departments of three tertiary care hospitals of the Khyber Medical University, Peshawar, Pakistan, from 1 January 2002 to 30 June 2007. Detailed history and examination of all patients were carried out to reach the diagnosis of Fournier's gangrene. After initial resuscitation, patients were treated aggressively, including surgical debridement. RESULTS Sixty patients were studied in the study period. The male to female ratio was 5:1. The age range was 20-75 years with mean 47+17.4 (SD) years. The socioeconomic status of patients was poor (the average income was less than $50 per week) in 36 (60%) and 24 (40%) were middle class (the average income being $50-100 per week). Thirty-nine patients (65%) presented in the hot humid months of the year. Extent of the disease was scrotum in 18 patients (30%), perineum in 30 (50%) and abdominal wall in 12 (20%). Systemic predisposing factors identified in our study were diabetes mellitus in 20 (33.33%) patients, chronic alcohol abuse in two (3.33%) and long-standing steroid therapy in four (6.67%) while in 34 patients (56.67%) no cause was identified. The local aetiological origin of Fournier's gangrene was urogenital in 14 (23.33%) patients, anorectal in 10 (16.67%) and cutaneous in 8 (13.33%) and no local pathologies could be identified in 28 (46.67%) patients. The mean time interval between first symptom and initial treatment was 2.5 days with a range of 1-7 days. Number of debridement sessions per patient was 2-6 (mean, 3.15). Mean hospital stay was 31+7 (SD) with a range of 10-50 days. Morbidity was 80%. Four patients (6.67%) died. Three of these patients presented to hospital 5-6 days too late. CONCLUSION Fournier's gangrene is not an uncommon disease in South Asia. Systemic predisposition such as diabetes mellitus, long-standing steroid therapy, chronic alcoholism and even the hot humid season can contribute to this dreadful disease. Local causes in the form of urogenital, anorectal and cutaneous disorders may trigger this disease in some patients. Early recognition of disease and aggressive surgical debridement are the main treatments.
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Abstract
INTRODUCTION This study evaluates the risk factors and prognostic variables that affect survival of patients with gangrene of Fournier. MATERIAL AND METHODS The study retrospectively analyzed 90 consecutive patients with gangrene of Fournier treated in our institution between 1975 and 2008. We evaluated the average age, associated systemic diseases, and the source, time of evolution and extent of necrotizing fasciitis. The outcomes were assessed according to whether the patient survived or died. All patients had aggressive surgical debridement, and received parenteral antibiotic therapy. RESULTS The mortality rate was 34.4%. The mean age was 63.0 years (range 33-95), a statistically significant difference was found between the age of the survivors (median age, 59.84 years) and those who died (median age, 70.20 years) (p = 0.001). Medical comorbidities were identified in 51 patients; the death rate was higher in patients who had any medical disease, especially those who suffered from cancer. Although diabetes mellitus was the most common associated pathology, it was not related to a statistically significant worst prognosis. The source of the infection was identified in 62 patients, who showed a higher mortality (p = 0.015), the mortality rate when a urological source is identified was 50%. Moreover, patients suffering from a more extensive necrotizing infection showed a worst prognosis. CONCLUSIONS The gangrene of Fournier has a high mortality rate. Large series are required to study prognostic variables of this disease. The patient age, the presence of systemic risk factors, especially cancer, a urological source of infection and the extent of the disease have impact on the prognosis of Fournier's gangrene.
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Sarkis P, Farran F, Khoury R, Kamel G, Nemr E, Biajini J, Merheje S. Gangrène de Fournier : revue de la littérature récente. Prog Urol 2009; 19:75-84. [DOI: 10.1016/j.purol.2008.09.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 09/03/2008] [Accepted: 09/12/2008] [Indexed: 11/29/2022]
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The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes. Int Urol Nephrol 2008; 40:997-1004. [PMID: 18563618 DOI: 10.1007/s11255-008-9401-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 05/16/2008] [Indexed: 12/19/2022]
Abstract
Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Several factors have been reported to contribute to the clinical outcomes. The primary aims of this study were to examine the clinical features of patients with FG and evaluate the predictivity of the Fournier's Gangrene Severity Index (FGSI) score on the outcomes. We carried out a collective retrospective chart review of patients diagnosed and treated for FG in three reference centers between January 1995 and July 2007. Seventy-two patients with FG with were included to the study. Data were collected on medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement and antibiotic therapy. Perianal and perirectal abscess, scrotal abscess and urethral stenosis were the leading etiological factors. Diabetes mellitus was the predominant risk factor. Etiological factors and risk factors did not significantly contribute to survival or mortality, and duration of the symptoms was significantly longer in the non-survivor's group (P < 0.05). The FGSI scores were higher in the non-survivor's group. Regression analysis showed a FGSIS score of 10.5 as the cut-off to the outcome. Based on these results, we conclude that a patient's metabolic status and the extent of disease at presentation are the most important factors determining the prognosis of FG. The FGSI score may be considered as an objective and simple tool to predict the outcome in the patient with FG and should be used in further studies of FG patient series for comparison purposes.
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Song T, Wang WS, Zhou BR, Mai WW, Li ZZ, Guo HC, Zhou F. CT and MR characteristics of cerebral sparganosis. AJNR Am J Neuroradiol 2007; 28:1700-5. [PMID: 17885230 PMCID: PMC8134205 DOI: 10.3174/ajnr.a0659] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Sparganosis is a rare parasitic infection in humans by a larval cestode of the genus Spirometra. Preoperative diagnosis of cerebral sparganosis in the past has been very difficult. Our objective was to evaluate the CT and MR features of cerebral sparganosis in order to make a definite diagnosis. MATERIALS AND METHODS We retrospectively reviewed 25 patients (13 male and 12 female; age range, 9-83 years) who proved to have cerebral sparganosis. Fifteen patients underwent MR imaging: 2 patients had CT scanning, and the remaining 8 had both CT and MR scanning. We focused on evaluating the imaging features on CT and MR. RESULTS All patients showed edema and degeneration of cerebral white matter. All but 1 had a unilateral lesion. Twenty-two patients had ipsilateral ventricular dilation. The new finding was a tunnel sign, approximately 4 cm in length and 0.8 cm in width, column or fusiform shaped on postcontrast coronal and sagittal MR images (n = 10). Thirteen patients showed bead-like enhancement, but solitary ring enhancement was common on the CT images (n = 2). The wall of the ring and tunnel appeared isointense or slightly hyperintense on T2-weighted images. Punctate calcifications were seen in 6 patients on CT images but only in 3 patients on the MR images. Hemorrhage was seen in 4 patients on the MR images. An intact whitish, stringlike, living worm was found (n = 5). CONCLUSION The most characteristic finding was a tunnel sign on postcontrast MR images. The most common finding was bead-shaped enhancement. MR is superior to CT in demonstrating the extent and number of lesions, except punctate calcifications. Combined with clinical data and enzyme-linked immunosorbent assay, the preoperative diagnosis of cerebral sparganosis could be established on MR imaging.
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Affiliation(s)
- T Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical College, Guangdong, China.
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Basoglu M, Ozbey I, Atamanalp SS, Yildirgan MI, Aydinli B, Polat O, Ozturk G, Peker K, Onbas O, Oren D. Management of Fournier's gangrene: review of 45 cases. Surg Today 2007; 37:558-63. [PMID: 17593474 DOI: 10.1007/s00595-006-3391-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 08/31/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE Fournier's gangrene is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in women. METHODS The clinical and operative records of 45 patients with Fournier's gangrene during a 14-year period were analyzed. RESULTS The etiology of the infection was identified in 39 patients. The most common causes were colorectal diseases and urogenital diseases. Four patients died with an overall mortality of 8.8%. The mortality rate was higher in patients with diabetes mellitus, but it was not statistically different. The age, duration of the symptoms, and the presence of rectal abscess were not found to be significant factors regarding mortality rate. CONCLUSIONS Surgery with extensive debridement of all necrotic tissue is the main stay of treatment.
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Affiliation(s)
- Mahmut Basoglu
- Department of General Surgery, School of Medicine, Ataturk University, 25070, Erzurum, Turkey
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Ferreira PC, Reis JC, Amarante JM, Silva ÁC, Pinho CJ, Oliveira IC, da Silva PN. Fournier's gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg 2007; 119:175-184. [PMID: 17255671 DOI: 10.1097/01.prs.0000244925.80290.57] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fournier's gangrene is a rare and potentially fatal infectious disease characterized by necrotic fasciitis of the perineum and abdominal wall, along with the scrotum and penis in men and the vulva in women. Fournier's gangrene is a true surgical emergency. Skin loss can be very incapacitating and difficult to repair. METHODS The authors reviewed retrospectively the clinical records of a series of 43 patients with Fournier's gangrene between the years 1985 and 2003 who, after initial treatment by the Departments of Urology and Surgery, were referred to the Department of Plastic Surgery for reconstruction. The following parameters were evaluated: age, gender, interval between onset of symptoms and diagnosis, clinical symptoms, lesion site, results of bacteriologic cultures, cause and predisposing factors, treatment and reconstructive procedures, length of hospital stay, and outcome. RESULTS The mean patient age was 56.6 years. Fifteen patients (34.9 percent) had diabetes mellitus. The cause of Fournier's gangrene was found in 32 patients (74.4 percent). The most common presentation was scrotal swelling, and scrotal involvement was found in 40 cases (93.0 percent). All of the patients underwent surgical debridement, and several reconstruction techniques were used. The mean length of hospital stay was 73.6 days. Two patients died. CONCLUSIONS Management of this infectious entity should be aggressive. Several techniques that are used to reconstruct the lost tissue have shown good results. The superomedial thigh skin flap has proven to be a reliable method of resurfacing large scrotal defects. Reconstructive surgery makes the return to a normal social life possible in many cases.
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Affiliation(s)
- Pedro Costa Ferreira
- Porto, Portugal From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital de São João, Porto Medical School
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Koo JH, Cho WH, Kim HT, Lee SM, Chung BS, Joo CY. A case of sparganosis mimicking a varicose vein. THE KOREAN JOURNAL OF PARASITOLOGY 2006; 44:91-4. [PMID: 16514289 PMCID: PMC2532653 DOI: 10.3347/kjp.2006.44.1.91] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent advances in radiological and serological techniques have enabled easier preoperative diagnosis of sparganosis. However, due to scarcity of cases, sparganosis has been often regarded as a disease of other etiologic origin unless the parasite is confirmed in the lesion. We experienced a case of sparganosis mimicking a varicose vein in terms of clinical manifestations and radiological findings. Sparganosis should be included among the list of differential diagnosis with the varicose vein.
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Affiliation(s)
- Ja-Hyun Koo
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
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