Sparganosis of the spinal cord. Case report

Sparganosis presenting as cauda equina syndrome with molecular identification of the parasite in tissue sections

A 52-year-old woman presented with lower back pain, progressive symmetrical paraparesis with sensory impairment, and sphincter disturbance. Magnetic resonance imaging (MRI) of the whole spine revealed multiple intradural extramedullary serpiginous-mass lesions in the subarachnoid space continuously from the prepontine to the anterior part of the medulla oblongata levels, C7, T2-T8, and T12 vertebral levels distally until the end of the theca sac and filling-in the right S1 neural foramen. Sparganosis was diagnosed by demonstration of the sparganum in histopathological sections of surgically resected tissues and also by the presence of serum IgG antibodies by ELISA. DNA was extracted from unstained tissue sections, and a partial fragment of mitochondrial cytochrome c oxidase subunit 1 (cox1) gene was amplified using a primer set specific for Spirometra spp. cox1. After sequencing of the PCR-amplicon and alignment of the nucleotide sequence data, the causative agent was identified as the larva of Spirometra erinaceieuropaei.

Sparganosis in the lumbar spine : report of two cases and review of the literature

Sparganosis is a rare parasitic infection affecting various organs, including the central nervous system, especially the lumbar epidural space. This report describes the identification of disease and different strategies of treatments with preoperative information. A 42-year-old man presented with a 2-year history of urinary incontinence and impotence. He had a history of ingesting raw frogs 40 years ago. Magnetic resonance (MR) imaging showed an intramedullary nodular mass at conus medullaris and severe inflammation in the cauda equina. A 51-year-old woman was admitted with acute pain in the left inguinal area. We observed a lesion which seemed to be a tumor of the lumbar epidural space on MR imaging. She also had a history of ingesting inadequately cooked snakes 10 years ago. In the first patient, mass removal was attempted through laminectomy and parasite infection was identified during intra-operative frozen biopsy. Total removal could not be performed because of severe arachnoiditis and adhesion. We therefore decided to terminate the operation and final histology confirmed dead sparganum infection. We also concluded further surgical trial for total removal of the dead worm and inflammatory grannulation totally. However, after seeing another physician at different hospital, he was operated again which resulted in worsening of pain and neurological deficit. In the second patient, we totally removed dorsal epidural mass. Final histology and enzyme-linked immunosorbent assay (ELISA) confirmed living sparganum infection and her pain disappeared. Although the treatment of choice is surgical resection of living sparganum with inflammation, the attempt to remove dead worm and adhesive granulation tissue may cause unwanted complications to the patients. Therefore, the result of preoperative ELISA, as well as the information from image and history, must be considered as important factors to decide whether a surgery is necessary or not.

Helminth infections of the central nervous system occurring in Southeast Asia and the Far East

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.

Sparganosis presenting as radiculalgia at the conus medullaris

A 26-year-old female presented with severe lumbodorsal pain and hypesthesia in the right lower extremity. MRI of the spine revealed multiple lesions from L1 to S5; the largest was located at the conus medullaris. Diagnostic exploration revealed caseous, ivory-colored granulation tissue adhered to the conus medullaris and cauda eguina. Results of enzyme-linked immunosorbent assay and histopathological staining were consistent with sparganum infection. Our case report is unique because presentation was with lumbar radiculopathy instead of functional disorders of urination and defecation, atypical presentation for a conus medullaris lesion. Parasitic infection of the spinal cord with sparganosis should be considered when presentation is with signs and symptoms of spinal cord dysfunction of insidious onset.

Recurrent meningitis caused by cervico-medullary abscess, a rare presentation

BACKGROUND

Recurrent bacterial meningitis is usually a complication of cranial anatomical defect or the result of impaired humoral immunity, notably, defects of the complement system and agammaglobulinemia. It could present a diverse range of symptoms.

DISCUSSION

Meningitis as a presentation of intramedullary abscess is not common. Here we present a 7-year-old boy with recurrent meningitis as the first manifestation of an underlying upper cervical cord abscess.

A child with spinal intramedullary abscess

CASE REPORT

We report a case of an intramedullary spinal cord abscess (ISCA) in a 14-month-old child. This case demonstrates clinical and radiological features and emphasizes the importance of early diagnosis and treatment. Early surgical intervention and adjuvant antibiotic therapy have been shown to improve the clinical outcome. Successful outcome depends on early diagnosis and aggressive management.

DISCUSSION

Spinal intramedullary abscess is a rare neurosurgical entity. They can hardly be distinguished from neoplasms. Hart described the first case in 1830. Since then, approximately 70 cases have been reported. An acute spinal intramedullary abscess may present as a cord syndrome with back pain and fever, contrasting with chronic spinal intramedullary abscess, which tends to have a less specific symptomatology.

The nucleotide sequence and predicted secondary structure of small subunit (18S) ribosomal RNA from Spirometra erinaceieuropaei

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.

Intramedullary spinal cord abscess: case report

Intramedullary spinal cord abscesses are rare lesions with a poor prognosis unless diagnosed and treated promptly. We report a case of a Nigerian man with tuberculous meningitis that was complicated by an intraspinal cord abscess and was treated surgically. The literature regarding this uncommon clinical entity is reviewed.

Parasitic infections of the central nervous system in children. Part III: Space-occupying lesions

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.

Acute intramedullary spinal cord abscess: case report

We report the first case of an acute pyogenic intramedullary cervical spinal cord abscess, brain abscesses and meningitis due to an unusual anerobe, Bacteroides disiens. The importance of spinal magnetic resonance imaging for establishing the diagnosis is emphasized.

Isolation and partial characterization of cysteine proteinase from sparganum

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.