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Fang L, Wang Y, Gao Q, Yan B, Zhou J. Recurrent eosinophilic pleuritis caused by sparganum infection: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e20226. [PMID: 32481388 DOI: 10.1097/md.0000000000020226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Sparganosis is an infectious disease caused by a larval tapeworm of the genus Spirometra, which commonly invades subcutaneous tissues. Pulmonary and pleural involvement due to sparganum has been rarely reported previously. PATIENT CONCERNS We herein described a case of recurrent eosinophilic pleuritis in a 24-year-old woman. She was admitted with persistent cough and shortness of breath for more than 1 month. Initial chest computed tomography scan suggested right pleural effusion and diffuse pleural thickening. Slightly elevated eosinophil counts were found in both the peripheral blood and pleural fluid. She underwent right pleurectomy but histological examination failed to obtain an etiological diagnosis. Moreover, eosinophilic pleural effusion re-appeared in the contralateral thoracic cavity one month later. After re-admission, we reviewed her medical history meticulously and found she had a history of ingesting raw snake gallbladders before hospitalization. The final diagnosis was confirmed by the markedly positive reaction against sparganum antigen in both serum and pleural fluid sample. DIAGNOSIS Eosinophilic pleuritis caused by sparganum infection. INTERVENTIONS After the diagnosis, the patient was treated with praziquantel at 75 mg/kg/d for 3 days. OUTCOMES Pleural effusion absorbed completely and eosinophil count in peripheral blood returned to normal range. No evidence of recurrent pleural effusion had been observed in over one year of follow-up. LESSONS Clinicians need to be aware the possibility of sparganum infection in cases of eosinophilic pleuritis. The specific enzyme-linked immunosorbent assay remains a useful method in acquiring a rapid diagnosis, especially when histological examination is unable to detect the larvae in the thoracic cavity.
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Affiliation(s)
| | | | - Qiqi Gao
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Yan
- Department of Respiratory Medicine
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Zhu Y, Ye L, Ding X, Wu J, Chen Y. Cerebral sparganosis presenting with atypical postcontrast magnetic resonance imaging findings: a case report and literature review. BMC Infect Dis 2019; 19:748. [PMID: 31455261 PMCID: PMC6712767 DOI: 10.1186/s12879-019-4396-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022] Open
Abstract
Background Sparganosis, a rare and severe parasitic infection caused by the larvae of Spirometra species or simply sparganum, generally involves subcutaneous tissue or muscle. But occasionally, sparganum can also invade the human brain, resulting in cerebral sparganosis. Case presentation A 33-year-old woman presented with a 10-day history of headache. Postcontrast magnetic resonance imaging (MRI) revealed an irregular lesion with enhancement and the tunnel-shaped focus extending to the contralateral hemiphere. Cerebrospinal fluid (CSF) analysis disclosed pleocytosis (166 cells/μL) and an elevated protein concentration (0.742 g/L). Enzyme-linked immunosorbent assay (ELISA) revealed positive sparganum-specific antibody in both blood and CSF. Finally, the diagnosis of cerebral sparganosis was comfirmed. She received praziquantel treatment and got a favorable outcome during six-month follow-up. Conclusions Irregular enhancement and the tunnel sign that extends to the contralateral hemisphere on postconstrast MRI are unusual presentations of cerebral sparganosis. ELISA for sparganum-specific antibody can help confirm the diagnosis. Although surgery is the preferred treatment for cerebral sparganosis, praziquantel might also achieve satisfying outcomes.
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Affiliation(s)
- Yueli Zhu
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingqi Ye
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiansan Ding
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jimin Wu
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Seltmann A, Webster F, Martins Ferreira SC, Czirják GÁ, Wachter B. Age-specific gastrointestinal parasite shedding in free-ranging cheetahs (Acinonyx jubatus) on Namibian farmland. Parasitol Res 2019; 118:851-859. [PMID: 30706167 DOI: 10.1007/s00436-018-6190-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
The cheetah (Acinonyx jubatus Brookes 1828) is classified as "vulnerable" by the International Union for Conservation of Nature (IUCN). Threats to cheetah populations are a decrease of suitable habitats, an increase of conflicts with livestock farmers and potentially pathogens. While there is some information on the viral and bacterial pathogens circulating in cheetah populations, information on gastrointestinal parasites is scarce. Here, we investigate the gastrointestinal parasites in 39 free-ranging cheetahs in east-central Namibia using a coproscopical parasitological method. Most cheetahs (82%) shed eggs from Ancylostoma which comprised the majority of the total eggs in feces. Eggs and oocysts from Toxascaris (21% of cheetahs), Coccidia (13%), Physaloptera (8%), Taeniidae (5%), Dipylidium (3%), and Diphyllobothriidae (3%) were present at a lower prevalence. Parasite richness and Ancylostoma egg load were higher in juveniles and adults compared to cubs, but were not associated with sex. To our knowledge, this is the first study that assessed gastrointestinal parasites in free-ranging cheetahs and is a key starting point for future studies on the effect of parasites in this threatened species.
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Affiliation(s)
- Anne Seltmann
- Department of Wildlife Diseases / Department of Evolutionary Ecology, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany.
| | - Fay Webster
- Department of Evolutionary Ecology, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | | | - Gábor Árpád Czirják
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | - Bettina Wachter
- Department of Evolutionary Ecology, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
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Beck ES, Ramachandran PS, Khan LM, Sample HA, Zorn KC, O'Connell EM, Nash T, Reich DS, Venkatesan A, DeRisi JL, Nath A, Wilson MR. Clinicopathology conference: 41-year-old woman with chronic relapsing meningitis. Ann Neurol 2019; 85:161-169. [PMID: 30565288 PMCID: PMC6370480 DOI: 10.1002/ana.25400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Erin S Beck
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Prashanth S Ramachandran
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA.,Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Lillian M Khan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Hannah A Sample
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Elise M O'Connell
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Theodore Nash
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Daniel S Reich
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA.,Chan Zuckerberg Biohub, San Francisco, CA
| | - Avindra Nath
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Michael R Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA.,Department of Neurology, University of California, San Francisco, San Francisco, CA
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Hong SH, Kim T, Lee JM, Kim MJ, Kim SH. A 63-Year-Old Korean Woman With Abnormal Magnetic Resonance Imaging Results. Clin Infect Dis 2017; 65:1421-1422. [PMID: 29017259 DOI: 10.1093/cid/cix410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seok Ho Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Taeeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul.,Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jung Min Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Min-Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Lo Presti A, Aguirre DT, De Andrés P, Daoud L, Fortes J, Muñiz J. Cerebral sparganosis: case report and review of the European cases. Acta Neurochir (Wien) 2015; 157:1339-43; discussion 1343. [PMID: 26085111 DOI: 10.1007/s00701-015-2466-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
Sparganosis is a severe parasitic infection caused by the larvae of Spirometra mansoni, also called "sparganum." In human hosts, the Spirometra mansoni larva commonly targets the subcutaneous tissue or muscle. Sometimes it can also migrate into the brain, resulting in cerebral sparganosis, mainly characterized by focal neurological symptoms such as seizures and radiological "wandering lesions" on magnetic resonance images (MRIs). Clinical cases of cerebral sparganosis have been reported worldwide, mainly in Asian countries, but also in North America, South America and Australia. Only two cases have been previously reported in Europe. A 29-year-old male from Bolivia, who lived in Spain, presented to our service for seizures and a multicystic brain lesion, initially suspected to be a dysembryoplastic neuroepithelial tumor (DNET). He underwent gross total resection of the mixed solid/cystic lesion. Pathology revealed gliosis, multiple interconnected cystic cavities with fibrous walls, inflammatory cell infiltration and no necrotizing granulomatous reaction. Inside the cavities, a parasitic form was identified as the larva of the cestode Spirometra mansoni. At 1-year follow-up, the patient had no deficits and was seizure free. Clinicians should be alerted to the possible existence of this rare entity in Europe, especially in patients from endemic areas with a possible infection history as well as "wandering lesions" on the MRI.
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Development of a rapid diagnostic kit that uses an immunochromatographic device to detect antibodies in human sparganosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1360-3. [PMID: 24990912 DOI: 10.1128/cvi.00149-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A diagnostic kit using an immunochromatographic device was developed to replace the time-consuming immunodiagnostic methods for human sparganosis. The kit was found to be faster and easier to use than an enzyme-linked immunosorbent assay (ELISA) and showed higher sensitivity and specificity. It will be useful for the laboratory diagnosis of hospitalized cases of sparganosis.
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Lee YI, Seo M, Park HW. Recurred sparganosis 1 year after surgical removal of a sparganum in a Korean woman. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:75-8. [PMID: 24623886 PMCID: PMC3948998 DOI: 10.3347/kjp.2014.52.1.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/11/2013] [Accepted: 12/16/2013] [Indexed: 11/26/2022]
Abstract
Sparganosis, an infection due to the plerocercoid of Spirometra erinacei, are found worldwide but the majority of cases occur in East Asia including Korea. This report is on a recurred case of sparganosis in the subcutaneous tissue of the right lower leg 1 year after a surgical removal of a worm from a similar region. At admission, ultrasonography (USG) of the lesion strongly suggested sparganosis, and a worm was successfully removed which turned out to be a sparganum with scolex. Since sparganum has a variable life span, and may develop into a life-threatening severe case, a patient once diagnosed as sparganosis should be properly followed-up for a certain period of time. Although imaging modalities were useful for the diagnosis of sparganosis as seen in this case, serological test such as ELISA should also be accompanied so as to support the preoperative diagnosis.
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Affiliation(s)
- Young-Il Lee
- Department of Anatomy, College of Medicine, Dankook University, Cheonan 330-714, Korea
| | - Min Seo
- Department of Parasitology, College of Medicine, Dankook University, Cheonan 330-714, Korea
| | - Hyun-Woo Park
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan 330-714, Korea
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Abstract
Sparganosis is a zoonotic cestodiasis of human beings and animals caused by plerocercoid or second-stage larvae (sparganum) of pseudophyllidean tapeworms in host tissues. Cats are among definitive hosts in which the larva develops to adult stage in the intestines. Reports on larval infection involving various tissues and organs in cats are scarce. Rare single case reports of visceral sparganosis in cats are previously documented. The present report documents an unusual subcutaneous sparganosis in 2 Domestic Shorthair cats from southern Georgia. Veterinary clinicians should consider sparganosis as differential diagnosis for subcutaneous cyst-like masses in cats. As infected animals and animal tissues are sources of human infection, sparganosis warrants public awareness and due precaution to avoid human infection.
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Affiliation(s)
- Moges Woldemeskel
- 1Moges Woldemeskel, Tifton Veterinary Diagnostic and Investigational Laboratory, 43 Brighton Road, Tifton, GA 31793.
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10
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Ho TH, Lin MC, Yu WW, Lai PH, Sheu SJ, Bee YS. Ocular sparganosis mimicking an orbital idiopathic inflammatory syndrome. Orbit 2013; 32:395-398. [PMID: 24215169 DOI: 10.3109/01676830.2013.833253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sparganosis is an infection by the parasitic tapeworm larvae of Spirometra species. Ocular sparganosis is a rare disease that is easily misdiagnosed. We reported a rare case of ocular sparganosis mimicking orbital idiopathic inflammatory syndrome at initial presentation. A 34-year-old female presented with rapid progressive swelling of her left eyelid and mild proptosis for the duration of one month. The other ocular examinations were normal and the thyroid function was normal. Magnetic resonance imaging revealed a fusiform enlargement and mild heterogenous enhancement of the superior oblique muscle of the left orbit. First she received prednisolone therapy and the proptosis partially improved. Six months later, a white, flat and wrinkled string like worm wriggled out from the caruncular conjunctiva of the left eye. The pathology results confirmed that the worm was a Spirometra species larva. After removal of the larva and treatment with praziquantel, the proptosis was resolved without recurrence. Ocular sparganosis is a rare disease and only a few case reports have been reported. The drug therapy has not been effective and the surgical removal is the principal therapy. Despite its rarity, ocular sparganosis should be considered as a possible cause of orbital inflammation in patients.
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Affiliation(s)
- Tsai-Hsuan Ho
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung , Taiwan , ROC
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Hong D, Xie H, Zhu M, Wan H, Xu R, Wu Y. Cerebral sparganosis in mainland Chinese patients. J Clin Neurosci 2013; 20:1514-9. [DOI: 10.1016/j.jocn.2012.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/16/2012] [Accepted: 12/01/2012] [Indexed: 11/30/2022]
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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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Lescano AG, Zunt J. Other cestodes: sparganosis, coenurosis and Taenia crassiceps cysticercosis. HANDBOOK OF CLINICAL NEUROLOGY 2013; 114:335-45. [PMID: 23829923 DOI: 10.1016/b978-0-444-53490-3.00027-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Many cestodes are capable of invading the central nervous system (CNS), and several are highly prevalent in the developing world. Neurocysticercosis due to Taenia solium and echinococcosis due to Echinoccocus granulosus are two of the most common parasitic infections affecting humans, but other less well-known parasites can also infect the nervous system. Coenurosis, caused by Taenia spp. such as T. multiceps, T. serialis, or T. brauni; sparganosis, caused by Spirometra spp., and neurocysticercosis caused by T. crassiceps are three less frequent zoonotic conditions that should be considered in the differential diagnosis of patients presenting with CNS infection - especially if they have lived in or traveled through areas where these infections are endemic. Diagnosis of these infections is typically made through a combination of serological testing, histopathology, and neuroimaging.
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Affiliation(s)
- Andres G Lescano
- Department of Parasitology, and Public Health Training Program, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Simpson C, Jabbar A, Mansfield CS, Tyrrell D, Croser E, Abraham LA, Gasser RB. Molecular diagnosis of sparganosis associated with pneumothorax in a dog. Mol Cell Probes 2012; 26:60-2. [DOI: 10.1016/j.mcp.2011.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 08/16/2011] [Accepted: 08/18/2011] [Indexed: 11/24/2022]
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Deng L, Xiong P, Qian S. Diagnosis and stereotactic aspiration treatment of cerebral sparganosis: summary of 11 cases. J Neurosurg 2011; 114:1421-5. [PMID: 20486898 DOI: 10.3171/2010.4.jns1079] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Cerebral sparganosis is a rare but underestimated parasitic disease caused by infestation by sparganum. It is difficult to make a confirmed preoperational diagnosis of this disease given the absence of characteristic clinical manifestations. A detailed protocol for the diagnosis and treatment of cerebral sparganosis is still lacking in the literature. In this article the authors set out comprehensive procedures for the diagnosis and treatment of cerebral sparganosis, describing the use of a stereotactic aspiration technique complemented by microsurgery based on experience gained from multiple cases.
Methods
The disease history, clinical manifestations, imaging features, and therapeutic procedures for 11 patients with cerebral sparganosis were retrospectively analyzed. Stereotactic aspiration procedures were performed in all 11 patients and were complemented by microsurgeries in 3 patients. The learning and experience gained from these treatments were summarized, and a comprehensive protocol for the diagnosis and treatment of cerebral sparganosis was reviewed.
Results
Larvae of Spirometra mansoni were taken from all 11 patients: completely removed in 10 cases and partially removed in 1 case (discovered later). After surgery, clinical symptoms in all 11 patients were significantly improved. All epileptic symptoms were successfully cured, although in 1 case occasional seizures still occurred because of the incomplete removal of the larva. Muscle strength in the 4 patients who had hemiparesis prior to surgery recovered to normal. Symptoms in the 1 patient who had presented with partial body sensory disturbance resolved after surgery. There were no complications or deaths.
Conclusions
The authors concluded that an effective preoperative diagnosis of cerebral sparganosis can be made by detailed inquiry into the possible infection history and disease symptoms as well as careful scrutiny of characteristic radiological features and immunological testing results. In stereotactic operations performed to remove the larva, priority should be given to image-guided stereotactic aspiration given that it causes the smallest wounds. In cases in which stereotactic aspiration fails, stereotactic microsurgery should be performed to remove the larva. The surgeon must carefully avoid breaking the larva and leaving behind any larva residue during surgery.
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Affiliation(s)
- Lei Deng
- 1Department of Neurosurgery, No. 94 Hospital of People's Liberation Army, Nanchang, Jiangxi Province, People's Republic of China
| | - Pengju Xiong
- 1Department of Neurosurgery, No. 94 Hospital of People's Liberation Army, Nanchang, Jiangxi Province, People's Republic of China
| | - Suokai Qian
- 1Department of Neurosurgery, No. 94 Hospital of People's Liberation Army, Nanchang, Jiangxi Province, People's Republic of China
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Lv S, Zhang Y, Steinmann P, Zhou XN, Utzinger J. Helminth infections of the central nervous system occurring in Southeast Asia and the Far East. ADVANCES IN PARASITOLOGY 2010; 72:351-408. [PMID: 20624537 DOI: 10.1016/s0065-308x(10)72012-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although helminth infections of the central nervous system (CNS) are rare, their public health implications must not be neglected. Indeed, several helminth species can cause cerebrospinal infections, especially if humans serve as intermediate or non-permissive host. The diagnosis of cerebrospinal helminthiases is difficult, and the detection of parasites in cerebrospinal fluid is rarely successful. Cerebrospinal helminth infections therefore often remain undetected, and hence prognosis is poor. Increases in tourism and population movements are risk factors for cerebrospinal helminthiases and infections pose particular challenges to clinicians in non-endemic areas. In this review, we focus primarily on food-borne helminthiases that are endemic and often emerging in Southeast Asia and the Far East, namely angiostrongyliasis, gnathostomiasis, sparganosis, paragonimiasis and cysticercosis. Additionally, we discuss neuroschistosomiasis, a disease that is transmitted through human-water contact. For each disease, we describe the pathogen, its transmission route and possible mechanisms for entering the CNS. We also summarise common signs and symptoms, challenges and opportunities for diagnosis, treatment, clinical management, geographical distribution and epidemiology. The adoption of a comprehensive set of diagnostic criteria for different cerebrospinal helminthiases is proposed, including epidemiological history, typical signs and symptoms, neuroimaging and laboratory findings. Finally, risk factors, and research needs for enhanced patient management and population-based control measures are discussed.
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Affiliation(s)
- Shan Lv
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
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Abstract
Both helminthiases and epilepsy occur globally, and are particularly prevalent in developing regions of the world. Studies have suggested an association between epilepsy and helminth infection, but a causal relationship is not established in many helminths, except perhaps with neurocysticercosis. We review the available literature on the global burden of helminths, and the epidemiological evidence linking helminths to epilepsy. We discuss possible routes that helminths affect the central nervous system (CNS) of humans and the immunological response to helminth infection in the CNS, looking at possible mechanisms of epileptogenesis. Finally, we discuss the current gaps in knowledge about the interaction between helminths and epilepsy.
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Affiliation(s)
- R G Wagner
- MRC/Wits Rural Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Wiwanitkit V. A review of human sparganosis in Thailand. Int J Infect Dis 2005; 9:312-6. [PMID: 16023879 DOI: 10.1016/j.ijid.2004.08.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 08/10/2004] [Accepted: 08/10/2004] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sparganosis is a zoonosis that occurs occasionally in humans. The infection is reported in many countries but is most common in eastern Asia. In Thailand, a southeast Asian country, the infection is sporadic. DESIGN In this study the clinical presentations of human sparganosis cases in Thailand were investigated by means of a literature review. RESULTS Reports of 34 cases of sparganosis were found. The infections were ocular (17 cases), subcutaneous (ten cases), central nervous system (five cases), auricular (one case), pulmonary (one case), intraosseous (one case) and intraperitoneal (one case). Of these 34 cases, 14 had risk behaviour reported, 12 had a history of drinking impure water, five had a history of eating frog or snake meat and two had a history of using frog or snake meat as a poultice. Some cases had more than one risk factor. CONCLUSION Most cases of sparganosis in Thailand presented with superficial ocular mass lesions. The major risk behaviour in Thailand is drinking water contaminated with the infective organism. Some cases of serious deep visceral sparganosis have also been reported.
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Affiliation(s)
- Viroj Wiwanitkit
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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Abstract
International travel and increasingly exotic diets have resulted in an increase in cases of cutaneous larva migrans in industrialized countries. A broader spectrum of clinical presentation and complications of cutaneous larva migrans is recognized by clinicians. A new syndrome, eosinophilic enteritis, has been described in Australia and may be more widespread as new diagnostic tests are used more widely. Other causes of cutaneous migration, such as gnathostomiasis and sparganosis, should be considered, and a recent outbreak of gnathostomiasis in Mexico suggests that clinicians must be alert to these unusual infections arising in patients outside their traditional distribution.
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Affiliation(s)
- Stephen H. Gillespie
- Department of Medical Microbiology, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
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21
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Zhu XQ, Beveridge I, Berger L, Barton D, Gasser RB. Single-strand conformation polymorphism-based analysis reveals genetic variation within Spirometra erinacei (Cestoda: Pseudophyllidea) from Australia. Mol Cell Probes 2002; 16:159-65. [PMID: 12030766 DOI: 10.1006/mcpr.2001.0406] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined genetic variability within Spirometra erinacei (Cestoda: Pseudophyllidea) from different host species and geographical origins in Australia using a polymerase chain reaction (PCR)-based mutation detection approach, followed by DNA sequencing. Part of the cytochrome c oxidase subunit 1 gene (p cox 1) was amplified by PCR, scanned for sequence variation by single-strand conformation polymorphism (SSCP), and representative samples from different host species were selected for DNA sequencing. While no variation in SSCP profiles was detected among S. erinacei samples from dog, fox, cat, tiger snake and python, they differed in profile from 5 specimens from the green tree frog (Litoria caerulea). This was supported by sequence data which demonstrated that p cox 1 sequences of samples from the latter host species differed at 8 of 393 (2%) nucleotide positions from those from the non-amphibian host. Using a nucleotide difference in the p cox 1 sequence, a PCR-linked restriction fragment length polymorphism (RFLP) could be employed to unequivocally delineate between samples from non-amphibian and amphibian hosts. These findings demonstrate the existence of at least two genotypes within S. erinacei, which may have important implications for studying the epidemiology, ecology and systematics of this cestode.
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Affiliation(s)
- X Q Zhu
- Department of Veterinary Science, The University of Melbourne, 250 Princes Highway, Werribee, Victoria, Australia
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22
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Abstract
Tapeworms are among the oldest afflictions of humans. They continue, even today, to be an important cause of morbidity and mortality, worldwide. Taenia saginata and Taenia solium infections are still common in many developing countries. Diphyllobothrium latum infections, are decreasing, but this tapeworm, transmitted to humans through the eating of raw salmon, can cause severe anemia. Hymenolepis and Dipylidium infections may occur to children. Hydatid disease is a common cause of morbidity, especially among immigrant groups from endemic areas of the Mediterranean; the liver is the most common site of a hydatid cyst. Although surgery has been the mainstay of therapy, drug therapy and percutaneous aspiration have been used more frequently in recent years. praziquantel and albendazole are the two most useful drugs against various tapeworm infections.
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Affiliation(s)
- Herbert B. Tanowitz
- Departments of Pathology and Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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23
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Affiliation(s)
- I J Dunn
- Department of Radiology, University of British Columbia, Vancouver, Canada
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24
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Liu DW, Kato H, Sugane K. The nucleotide sequence and predicted secondary structure of small subunit (18S) ribosomal RNA from Spirometra erinaceieuropaei. Gene 1997; 184:221-7. [PMID: 9031632 DOI: 10.1016/s0378-1119(96)00599-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The nucleotide (nt) sequence of a small subunit (18S) ribosomal RNA gene from the plerocercoid of Spirometra erinaceieuropaei (SEP) was determined. The gene with 2182 bp in length is larger than that of most eukaryotes. Extra nt sequences occur in regions known to be variable (V4 and V7). The predicted secondary structure of the nt positions 679-933 (V4) revealed different helices from that of other eukaryotes. The region between nt positions 1540 and 1749 (V7) was different from that of other eukaryotes, but the secondary structure prediction by computer analysis demonstrated that this part of 18S rRNA sequence from S. erinaceieuropaei may form a single extended helix. Nt that were aligned with those of nine other parasites were used to estimate phylogenetic relationships. The data presented here clearly indicate that S. erinaceieuropaei is closely related to Echinococcus granulosus.
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Affiliation(s)
- D W Liu
- Department of Parasitology, Shinshu University School of Medicine, Nagano Prefecture, Japan
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25
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Garin YJ, Frottier J, Lavergne-Slove A, Houdart R, Poirot JL. Cutaneous sparganosis in France: the second case described from Europe. Case report. APMIS 1997; 105:14-6. [PMID: 9063495 DOI: 10.1111/j.1699-0463.1997.tb00533.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The first case of sparganosis is reported from France. The patient, a 21-year-old man, presented with a subcutaneous lump on the chest, and the diagnosis was made on histological examination after needle biopsy. He achieved a complete recovery.
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Affiliation(s)
- Y J Garin
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, Paris, France
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26
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Kim DG, Paek SH, Chang KH, Wang KC, Jung HW, Kim HJ, Chi JG, Choi KS, Han DH. Cerebral sparganosis: clinical manifestations, treatment, and outcome. J Neurosurg 1996; 85:1066-71. [PMID: 8929496 DOI: 10.3171/jns.1996.85.6.1066] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cerebral sparganosis is a rare parasitic disease caused by infestation by the plerocercoid larva of Spirometra mansoni. The authors retrospectively analyzed 17 cases of cerebral sparganosis treated at Seoul National University Hospital between 1986 and 1994. The patients' ages at diagnosis ranged from 6 to 57 years (median 32 years) and the male/female ratio was 13:4. Diagnosis was based on radiological findings, serological test results, operative findings, and histopathological examinations. Characteristic magnetic resonance (MR) findings consisted of widespread white matter degeneration and cortical atrophy, mixed-signal lesion (low in the central and high in the peripheral regions on T2-weighted images) with irregular dense enhancement of central foci and changes in the location and shape of the enhancing lesion in follow-up studies. Ten patients underwent surgical removal of the parasitic lesion, six received medical treatment alone (five with praziquantel and one with antiepileptic drugs), and one underwent insertion of a ventriculoperitoneal shunt and a course of praziquantel. Follow-up periods ranged from 13 to 111 months (mean 49 months). Seven patients who underwent complete removal of the lesion, live worm, or degenerative worm with surrounding granuloma showed a favorable course. Patients who received medical treatment alone or incomplete removal exhibited progression in their neurological deficits and their seizures could not be controlled. Medication with praziquantel seemed to have no killing effect on live worms. The authors conclude that MR imaging is the most valuable modality for the early detection of cerebral sparganosis and that complete surgical removal of granuloma together with worms, whether they are alive or degenerative, is the treatment of choice.
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Affiliation(s)
- D G Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Korea
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27
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Liu DW, Kato H, Nakamura T, Sugane K. Molecular cloning and expression of the gene encoding a cysteine proteinase of Spirometra erinacei. Mol Biochem Parasitol 1996; 76:11-21. [PMID: 8919991 DOI: 10.1016/0166-6851(95)02522-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A cDNA library constructed from plerocercoid of Spirometra erinacei (SEP) was immunoscreened using rabbit anti-plerocercoid proteinase polyclonal antibody. A 1.0-kb cDNA clone encoding a cysteine proteinase composed of 336 amino acids was isolated. The amino acid sequence predicted from the cDNA showed significant homology with human and mouse cathepsin L. N-terminal amino acid sequence of the native cysteine proteinase extracted from SEP was the same as that of mature proteinase predicted from the cloned gene. The gene encoding the proteinase was characterized by Southern and Northern blot analysis using the cDNA as a probe. The proteinase with a molecular mass of 34 kDa was demonstrated in in vitro translation products using anti-proteinase polyclonal antibody. A fusion protein derived from the cDNA synthesized by Escherichia coli (TB1) using the expression vector, pMAL-c2 was identified as an immunodominant antigen by epitope-selection method and had no cross-reactivity with other parasite-infected sera. A genomic DNA library derived from SEP was screened by the colony hybridization technique using the cDNA probe. A gene with 4.5 kb encoding the proteinase was obtained, which comprised three exons and two introns.
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Affiliation(s)
- D W Liu
- Department of Parasitology, Shinshu University School of Medicine, Matsumoto City, Japan
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28
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Abstract
Sparganosis is an infection caused by migrating larvae of the cestode genus Spirometra. There have been approximately 62 cases of sparganosis reported in the United States. Although a subcutaneous mass is the most common manifestation, sparganosis is not well-described in the dermatology literature. We present a case of cutaneous sparganosis in a 52-year-old Filipino American woman. Histologically, the sections showed a granulomatous panniculitis and dermatitis containing a section of a sparganum. A transverse section of an intact sparganum reveals an eosinophilic cuticle, loose stroma, calcareous bodies, and smooth muscle fibers.
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Affiliation(s)
- M P Griffin
- Department of Laboratory Medicine, Naval Medical Center, Portsmouth, VA 23708, USA
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29
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Lowichik A, Ruff AJ. Parasitic infections of the central nervous system in children. Part III: Space-occupying lesions. J Child Neurol 1995; 10:177-90. [PMID: 7642886 DOI: 10.1177/088307389501000303] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the last part of this three-part review of parasitic infections of the central nervous system in children, we consider parasites which due to their size, distribution, or the nature of the host response, tend to cause focal lesions in the brain and spinal cord and therefore present as space-occupying lesions which occasionally mimic malignant tumors. As in Parts I and II, infections are grouped according to their predominant geographic area. Such infections include cysticercosis, one of the more common and important infections of the central nervous system.
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Affiliation(s)
- A Lowichik
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, USA
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30
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Wong CW, Ho YS. Intraventricular haemorrhage and hydrocephalus caused by intraventricular parasitic granuloma suggesting cerebral sparganosis. Acta Neurochir (Wien) 1994; 129:205-8. [PMID: 7847165 DOI: 10.1007/bf01406506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 67-year-old female farmer presented with acute loss of consciousness. Computed tomograms showed a calcified mass in the cavum septi pellucidi with intraventricular haemorrhage and obstructive hydrocephalus. The patient became fully conscious after urgent external ventriculostomy and subsequently underwent craniotomy for the excision of the mass. Pathological examination of the mass demonstrated a granuloma surrounding a degenerating larva compatible with Spirometra mansonoides whose mimicking an intraventricular tumour has not been reported before.
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Affiliation(s)
- C W Wong
- Division of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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31
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Abstract
OBJECTIVE To report the first case of cerebral sparganosis diagnosed in Australia. CLINICAL FEATURES A 23-year-old East Timorese refugee, whose diet before migration included raw snakes and frogs, presented with a generalised tonic-clonic seizure and a nine-month history of episodic left hemianaesthesia. Computerised axial tomography of the brain showed a right frontal lesion, which was excised, and histological examination demonstrated changes typical of sparganosis. INTERVENTION AND OUTCOME Excision of the lesion resulted in cure. Postoperative eosinophilia and a subcutaneous nodule presumed to be due to disseminated sparganosis resolved following a course of praziquantel. CONCLUSION Clinicians should consider the possibility of unusual parasitic infections in refugees who present with intracranial space-occupying lesions, especially those from developing countries. A dietary history may aid the diagnosis.
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Affiliation(s)
- W J Munckhof
- Department of Microbiology and Infectious Diseases, Monash Medical Centre, Clayton, Vic
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32
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Kong Y, Cho SY, Kang WS. Sparganum infections in normal adult population and epileptic patients in Korea: a seroepidemiologic observation. THE KOREAN JOURNAL OF PARASITOLOGY 1994; 32:85-92. [PMID: 8025037 DOI: 10.3347/kjp.1994.32.2.85] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A seroepidemiologic observation of anti-Spirometra erinacei plerocercoid (sparganum) antibody (IgG) in serum was made in normal adult and epileptic patients in Korea from February, 1987 to September, 1990. Sera were tested by enzyme-linked immunosorbent assay (ELISA) for anti-sparganum antibody together with anti-Taenia solium metacestode, and anti-Paragonimus westermani antibodies. Sera reacted positively to sparganum antigen only were considered. Positive rate for anti-sparganum antibody in 850 normal adults was 1.9% (standardized rate by provincial population was 1.7%). In 2,667 randomly selected patients of epilepsy at 28 local centers of the Changmi Club, positive rate was 2.5% (standardized rate: 2.3%). In both normal adult and patient groups, the higher antibody rates were observed in Kangwon and Chonnam Provinces. Positive rates were 10 times higher in male than in female in normal adults and 4.5 times in male epileptic patients. The rates were elevated especially with age over 30-year. Odd ratio of the antibody was 1.32 which indicated an ambiguous etiologic factor for epilepsy.
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Affiliation(s)
- Y Kong
- Department of Parasitology, College of Medicine, Chung-Ang University, Seoul, Korea
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Huh S, Wang KC, Hong ST, Chai JY, Lee SH, Choi KS, Chi JG. Histopathological changes of the cat brain in experimental sparganosis. Pathol Res Pract 1993; 189:1181-6. [PMID: 8183738 DOI: 10.1016/s0344-0338(11)80841-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Histopathological changes of the brain were observed in 22 mongrel cats each of which was subjected to intracranial inoculation of 3 or 5 plerocercoids of Spirometra erinacei. The brains were examined at 2 weeks, 1, 3, and 6 months post-inoculation (PI). Grossly, the brain lesion consisted of a mass of worm capsule and/or hemorrhagic tract. Microscopically hypertrophied astrocytes, lymphocytes, plasma cells, RBCs, polymorphonuclear leukocytes, and hemosiderin laden macrophages were found around the worms or tracts in all groups. The number of reactive astrocytes increased mainly in the white matter. In the lesions 3 months PI, the sectioned worms were encircled with fibrous tissue along with numerous RBCs, inflammatory cells, and necrotic debris. Collagenous fibers were also demonstrated. Outside the inflammation, a wide edematous zone developed and numerous neuroglial fibers were also found. The location of the worms or the tracts was random in the brain lobes, but the worm seemed to migrate mainly along the white matter.
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Affiliation(s)
- S Huh
- Department of Parasitology, Seoul National University College of Medicine, Korea
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34
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Song CY, Choi DH, Kim TS, Lee SH. Isolation and partial characterization of cysteine proteinase from sparganum. KISAENGCH'UNGHAK CHAPCHI. THE KOREAN JOURNAL OF PARASITOLOGY 1992; 30:191-9. [PMID: 1420032 DOI: 10.3347/kjp.1992.30.3.191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A proteolytic enzyme was purified from the tissue extract of spargana (plerocercoids of Spirometra erinacei) by DEAE-Trisacryl M ion exchange chromatography and thiopropyl-sepharose affinity chromatography resulted in a 21-fold purification. The proteinase activity was assayed with a synthetic fluorescent substrate, carbobenzoxy-phenylalanyl-7-amino-4-trifluoromethyl-coumarin. SDS-polyacrylamide gel electrophoresis of the purified materials revealed a single 28,000 dalton band. Inhibitor profiles of the band indicated that it belonged to cysteine endopeptidases. It exhibited identical pH curves with optimum at pH 5.5, and 50% activity from pH 4.7 to 8. It could completely degrade collagen chains to three identical products. It also showed some activity on hemoglobin. Furthermore, the band on immunoblots was reactive to the sera of sparganosis patients. These results suggest that the proteolytic enzyme belongs to cysteine proteinase which plays a role in the tissue penetration. Also it may be used as the antigen for diagnosis of active sparganosis.
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Affiliation(s)
- C Y Song
- Department of Biology, Chung-Ang University, Seoul, Korea
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