A case of sparganosis mimicking a varicose vein

Hand palm sparganosis: morphologically and genetically confirmed Spirometra erinaceieuropaei in a fourteen-year-old girl, Egypt

Two spargana of 5 and 7 cm long were removed from the right-hand palm of 14-year-old girl at the General Hospital, Qalyubia, Egypt. Sparganum is the 2nd larval stage (pleurocercoid) of Diphyllobothrid cestode species develops in the vertebrate second intermediate host through ingestion of the crustacean first intermediate host.Dogs and cats are the final hosts get infected through predation of the second vertebrate host.Human attracts infection through drinking water contaminated with the infected crustacean host or consumption of the flesh of of vertebrate hosts such as frogs and reptilian species. The surgically removed specimens were parsitologically identified as a non-proliferative metacestodes of a spirometran species that then on molecular analysis proved to be Spirometra erinaceieuropaei. The present report has allocated Egypt on the world sparganosis map.Molecular characterization of 28 S rRNA of S. erinaceieuropae and correlation to other Spirometra spp. from the Nile countries, particularly Ethiopia and Lake Victoria countries where the Nile waters originate, and from China were dealt with. Drinking of contaminated fresh water is the only proposed mode of infection in Egypt.

Proteomic and Immunological Identification of Diagnostic Antigens from Spirometra erinaceieuropaei Plerocercoid

Human sparganosis is a food-borne parasitic disease caused by the plerocercoids of Spirometra species. Clinical diagnosis of sparganosis is crucial for effective treatment, thus it is important to identify sensitive and specific antigens of plerocercoids. The aim of the current study was to identify and characterize the immunogenic proteins of Spirometra erinaceieuropaei plerocercoids that were recognized by patient sera. Crude soluble extract of the plerocercoids were separated using 2-dimensional gel electrophoresis coupled with immunoblot and mass spectrometry analysis. Based on immunoblotting patterns and mass spectrometry results, 8 antigenic proteins were identified from the plerocercoid. Among the proteins, cysteine protease protein might be developed as an antigen for diagnosis of sparganosis.

Diagnostic efficacy of a recombinant cysteine protease of Spirometra erinacei larvae for serodiagnosis of sparganosis

The mature domain of a cysteine protease of Spirometra erinacei plerocercoid larva (i.e., sparganum) was expressed in Escherichia coli, and its value as an antigen for the serodiagnosis of sparganosis was investigated. The recombinant protein (rSepCp-1) has the molecular weight of 23.4 kDa, and strongly reacted with the sparganum positive human or mice sera but not with negative sera by immunoblotting. ELISA with rSepCp-1 protein or sparganum crude antigen (SeC) was evaluated for the serodiagnosis of sparganosis using patient's sera. The sensitivity and specificity of ELISA using rSepCp-1 protein were 95.0% (19/20) and 99.1% (111/112), respectively. In contrast, the sensitivity and specificity of ELISA with SeC were 100% (20/20) and 96.4% (108/112), respectively. Moreover, in experimentally infected mice, the sensitivity and specificity of both ELISA assays were 100% for the detection of anti-sparganum IgG. It is suggested that the rSepCp-1 protein-based ELISA could provide a highly sensitive and specific assay for the diagnosis of sparganosis.

A case of inguinal sparganosis mimicking myeloid sarcoma

We report here a case of inguinal sparganosis, initially regarded as myeloid sarcoma, diagnosed in a patient undergone allogeneic hematopoietic transplantation (HSCT). A 56-year-old male patient having myelodysplastic syndrome was treated with allogeneic HSCT after myeloablative conditioning regimen. At day 5 post-HSCT, the patient complained of a painless palpable mass on the left scrotum and inguinal area. Pelvic magnetic resonance imaging and computed tomography revealed suspected myeloid sarcoma. Gun-biopsy was performed, and the result revealed eosinophilic infiltrations without malignancy. Subsequent serologic IgG antibody test was positive for sparganum. Excisional biopsy as a therapeutic diagnosis was done, and the diagnosis of sparganosis was confirmed eventually. This is the first report of sparganosis after allogeneic HSCT mimicking myeloid sarcoma, giving a lesson that the physicians have to consider the possibility of sparganosis in this clinical situation and perform adequate diagnostic and therapeutic approaches.

A case of sparganosis in the leg

The life-span of the sparganum in humans is not exactly known, but it may survive longer than 5 years in some patients. We experienced a case infected with a sparganum that is presumed to have lived for 20 years in a patient's leg. The patient was a 60-year-old woman, and she was admitted to a hospital due to ankle pain that was aggravated on dorsiflexion. She had noticed a mass on her knee some 20 years ago, but she received no medical management for it. The mass moved into the ankle joint 3 months before the current admission, and then the aforementioned symptoms appeared. A living sparganum was recovered by surgery, and the calcified tract near the knee was proved to be the pathway along which the larva had passed.

Breast and scrotal sparganosis: sonographic findings and pathologic correlation

OBJECTIVE

Sparganosis is caused by the tapeworm larva of the geneus Spirometra. Because sparganosis usually manifests as a migrating subcutaneous mass, sonography can play an important role in its diagnosis.

METHODS

In this series, we investigated 4 cases of subcutaneous sparganosis and focused on the sonographic findings. Three of the cases involved the breast, and the other involved the scrotum, as confirmed by surgery.

RESULTS

The characteristics of subcutaneous sparganosis included a poorly defined hyperechoic lesion with internal serpiginous tubular structures, anechoic serpiginous tubular structures with a surrounding hyperechoic lesion, and an elongated hyperechoic mass with a hypoechoic nodular lesion in the central portion.

CONCLUSIONS

We suggest that a mass combined with a hypoechoic tubular structure should raise the suspicion of subcutaneous sparganosis.

A surgically confirmed case of breast sparganosis showing characteristic mammography and ultrasonography findings

A case of breast sparganosis was confirmed by surgical excision of a worm (fragmented into 5 pieces) in a 59-year-old Korean woman suffering from a palpable mass in the left breast. Mammography and ultrasonography characteristically revealed the presence of several well-defined, isodense and hypoechoic tubular masses, in the upper quadrant of the left breast, each mass consisting of a continuous cord- or worm-like structure. During surgery, a long segment of an actively moving sparganum of Spirometra sp. and 4 small fragments of the same worm, giving a total length of 20.3 cm, were extracted from the upper outer quadrant of the left breast and the axillary region. The infection source remains unclear, because the patient denied ingesting any snake or frog meat or drinking untreated water.