Proliferating larval cestode in a man in Paraguay. A case report and review

Intestinal Parasites of Neotropical Wild Jaguars, Pumas, Ocelots, and Jaguarundis in Colombia: Old Friends Brought Back from Oblivion and New Insights

Neotropical wild felids (NWF) are obligate carnivore species present in Central and South America, and some are considered endangered due to constantly decreasing populations. NWF can become infected by a wide range of protozoan and metazoan parasites, some of them affecting their health conditions and others having anthropozoonotic relevance. Parasitological studies on NWF are still very scarce, and most data originated from dead or captive animals. On this account, the current study aimed to characterize gastrointestinal parasites of free-ranging jaguars (Panthera onca), pumas (Puma concolor), ocelots (Leopardus pardalis), and jaguarundis (Herpailurus yagouaroundi), i.e., four out of six NWF species endemic to Colombia. Fecal samples from jaguars (n = 10) and ocelots (n = 4) were collected between 2012 and 2017 as part of the Jaguar Corridor Initiative from six geographic locations in Colombia. In addition, cestode specimens were obtained during puma and jaguarundi necropsies. Scat samples were processed by standardized sodium acetate-acetic acid-formalin (SAF), sedimentation, and flotation techniques and by carbol fuchsin-stained fecal smears. Morphological evaluation of feces showed the presence of one cestode (Spirometra sp.), a nematode (Toxocara cati), an acanthocephalan (Oncicola sp.), and one cyst-forming coccidian (Cystoisospora-like oocysts). Feces oocysts were submitted to a Toxoplasma gondii-specific PCR for species identification, but no product was amplified. The cestodes isolated from a puma and jaguarundi were molecularly characterized by sequencing cytochrome c oxidase subunit I, identifying them as Taenia omissa and as a T. omissa sister lineage, respectively. These results collectively demonstrate the potential role of NWF as natural reservoir hosts for neglected zoonotic parasites (e.g., Spirometra sp., T. cati) and highlight their possible role in parasite transmission to human communities. Due to public health concerns, the occurrence of these parasites should be monitored in the future for appropriate zoonotic management practices in conservation strategies and wild felid health management programs.

Human proliferative sparganosis update

Proliferative sparganosis is one of the most bizarre and mysterious parasitic diseases ever described. The causative parasite is Sparganum proliferum, which is a pseudophyllidean cestode distinct from Spirometra tapeworms. Here we overview this rare but fascinating disease with the all original case reports on human patients published in the last 115 years. Proliferative sparganosis is clearly divided into two disease types, cutaneous and internal proliferative sparganosis. Cutaneous type starts with a skin eruption caused by the dermal invasion of a sparganum. Skin lesion progresses to larger areas of the body if left untreated. Various internal organs and body wall can be eventually affected. The clinical symptoms of patients in this group are very similar to each other. Molecular data suggest that cutaneous proliferative sparganosis is caused by S. proliferum of which genetic variation is limited, regardless of the time or localities of the emergence of patients. Internal proliferative sparganosis, on the other hand, is much more heterogeneous. Some cases show aggressive infection in internal organs, while others show only restricted lesions. Some of the cases that had been cited as proliferative sparganosis in the past literature were removed from the list, because they were judged as cyclophyllidean tapeworm infections. DNA sequencing is mandatory for the definite diagnosis of proliferative sparganosis. The Venezuelan strain of S. proliferum is maintained in experimental mice in Japan, which is fully prepared for the experimental study with advanced technologies in modern molecular biology.

Parasitism by larval tapeworms genus Spirometra in South American amphibians and reptiles: new records from Brazil and Uruguay, and a review of current knowledge in the region

Spargana are plerocercoid larvae of cestode tapeworms of the genus Spirometra, Family Diphyllobothriidae, parasitic to frogs, reptiles, birds and mammals. This parasitic disease in humans can be transmitted through the use and consumption of amphibians and reptiles. The available knowledge about Spirometra in South America is scarce, and there are only a few reports on the occurrence of sparganum in amphibians and reptiles, many of them published in old papers not easily available to researchers. In this work we present a review on this topic, provide new records in two species of amphibians and 7 species of reptiles from Brazil and Uruguay respectively. We also summarize current knowledge of Spirometra in the continent, along with an updated of host taxonomy. We could gather from the literature a total of 15 studies about amphibian and reptile hosts, published between 1850 and 2016, corresponding to 43 case reports, mostly from Brazil (29) and Uruguay (8), Argentina (3), Peru (2), and Venezuela (1); the majority of them related to reptiles (five lizards and 26 snake species), and 14 corresponded to amphibians (9 anurans). Plerocercoid larvae were located in different organs of the hosts, such as subcutaneous tissue, coelomic cavity, peritoneum, and musculature. The importance of amphibians and reptiles in the transmission of the disease to humans in South America is discussed. Relevant issues to be studied in the near future are the taxonomic characterization of Spirometra in the region and the biological risk of reptile meat for aboriginal and other rural communities.

Eosinophilia in Infectious Diseases

In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes.

Human sparganosis, a neglected food borne zoonosis

Human sparganosis is a food borne zoonosis caused by the plerocercoid larvae (spargana) of various diphyllobothroid tapeworms of the genus Spirometra. Human infections are acquired by ingesting the raw or undercooked meat of snakes or frogs, drinking untreated water, or using raw flesh in traditional poultices. More than 1600 cases of sparganosis have been documented worldwide, mostly in east and southeast Asia. Sporadic cases have been reported in South America, Europe, and Africa, and several cases have been described in travellers returning from endemic regions. Epidemiological data suggest that the increased effect of sparganosis on human health is because of greater consumption of raw meat of freshwater frogs and snakes. This Review provides information about the Spirometra parasites and their lifecycles, summarises clinical features, diagnosis, and treatment of human sparganosis, and describes geographical distribution and infection characteristics of Spirometra parasites in host animals.

Environmental determinants of the spatial distribution of Mesocestoides spp. and sensitivity of flotation method for the diagnosis of mesocestoidosis

Mesocestoides spp. are zoonotic cestodes of wild and domesticated carnivores. Although the adult stages are relatively harmless intestinal parasites, the metacestode stages (tetrathyridia) can be responsible for life-threatening peritonitis and pleuritis in several species including dogs, cats, non-human primates and probably man. The aim of the present study was to reveal the spatial distribution pattern of Mesocestoides spp. in the most important final hosts, red foxes (Vulpes vulpes), to analyse the relationship of these patterns with landscape and climate by geographical information systems and to evaluate faecal flotation method for the detection of infection in the final host. Fox carcasses, representing 0.5% of the total fox population were randomly selected out of all the foxes of Hungary. The intestinal tract was examined by sedimentation and counting technique. The sensitivity of the flotation method was evaluated by the testing of the faecal samples of 180 foxes infected with Mesocestoides spp. The prevalence of infection was high in foxes (45.8%; 95% CI=41.0-50.6%), and the parasite was detected in all areas of Hungary. The high prevalence of the parasite in foxes suggests that the infection might also be common in outdoor dogs and cats. Mesocestoides infection could not be detected in any of the foxes by flotation method indicating that the sensitivity of the method is less than 0.6%. Therefore, almost all canine and feline infections remain undetected in the veterinary practice. Based on the statistical analysis, the altitude was the only determinant of the spatial distribution of Mesocestoides spp. indicating that infections in carnivores including dogs and cats can be expected mainly in midland regions (150-750 m above sea level). It might be attributed to the altitude-dependent species richness and abundance of the intermediate and final hosts of the parasite.

Diagnosis of gastrointestinal parasites in reptiles: comparison of two coprological methods

Background

Exotic reptiles have become increasingly common domestic pets worldwide and are well known to be carriers of different parasites including some with zoonotic potential. The need of accurate diagnosis of gastrointestinal endoparasite infections in domestic reptiles is therefore essential, not only for the well-being of captive reptiles but also for the owners. Here, two different approaches for the detection of parasite stages in reptile faeces were compared: a combination of native and iodine stained direct smears together with a flotation technique (CNF) versus the standard SAF-method.

Results

A total of 59 different reptile faeces (20 lizards, 22 snakes, 17 tortoises) were coprologically analyzed by the two methods for the presence of endoparasites. Analyzed reptile faecal samples contained a broad spectrum of parasites (total occurence 93.2%, n = 55) including different species of nematodes (55.9%, n = 33), trematodes (15.3%, n = 9), pentastomids (3.4%, n = 2) and protozoans (47.5%, n = 28). Associations between the performances of both methods to detect selected single parasite stages or groups of such were evaluated by Fisher's exact test and marginal homogeneity was tested by the McNemar test. In 88.1% of all examined samples (n = 52, 95% confidence interval [CI] = 77.1 - 95.1%) the two diagnostic methods rendered differing results, and the McNemar test for paired observations showed highly significant differences of the detection frequency (P < 0.0001).

Conclusion

The combination of direct smears/flotation proved superior in the detection of flagellates trophozoites, coccidian oocysts and nematode eggs, especially those of oxyurids. SAF-technique was superior in detecting larval stages and trematode eggs, but this advantage failed to be statistically significant (P = 0.13). Therefore, CNF is the recommended method for routine faecal examination of captive reptiles while the SAF-technique is advisable as additional measure particularly for wild caught animals and individuals which are to be introduced into captive collections.

Subcutaneous sparganosis, a zoonotic cestodiasis, in two cats

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.

Normal and aberrant Mesocestoides tetrathyridia from Crocidura spp. (Soricimorpha) in Corsica and Spain

Tetrathyridia of Mesocestoides sp. were collected from the body cavities of the shrews (Insectivora), Crocidura russula, in Valencia, Spain and Crocidura suaveolens on the Mediterranean island of Corsica, France. Specimens were processed by routine microscopic and histological techniques, including examination with brightfield, phase-contrast, and differential-interference-contrast optics. Most tetrathyridia were clustered together inside host-derived fibrotic capsules, but some occurred free in the body cavity. All specimens examined from both locations had solid hindbodies, i.e., lacking a primary lacuna, thus conforming to the plerocercoid metacestode type; all possessed a single normal tetra-acetabulate scolex. All metacestodes from C. russula in Valencia were normal tetrathyridia. Those from C. suaveolens in Corsica were either normal tetrathyridia or had aberrant deep convolutions of an unusually elongated hindbody. No tetrathyridium from either location or host showed tegumental or excretory duct anomalies such as those reported by several authors from aberrant tetrathyridia and spargana in some other locations. No definitive evidence of asexual proliferation was visible in any of the tetrathyridia, but those with abnormally convoluted hindbodies from a single C. suaveolens in Corsica suggest the potential for asexuality by fission of the hindbody. These results add to our understanding of morphological and developmental variation among metacestodes in this widespread and variable genus.

Interactions between anomalous excretory and tegumental epithelia in aberrant Mesocestoides tetrathyridia from Apodemus sylvaticus in Spain

Tetrathyridia of Mesocestoides sp. (Platyhelminthes: Cestoda) were collected from the body cavities of Apodemus sylvaticus (Rodentia: Muridae) in Murcia, Spain, and processed by routine microscopical and histological techniques, including examination with brightfield, phase-contrast, and differential-interference-contrast optics. All specimens examined had solid hindbodies (i.e., lacked a primary lacuna), thus conforming to the plerocercoid metacestode type. The vast majority of tetrathyridia were highly aberrant, often lacking a scolex, varying greatly in body size, and exhibiting buds or duplexed body forms indicative of asexual proliferation. All of the aberrant forms, including those with normal scoleces and apparent absence of proliferation, possessed anomalous multi-lobed invaginations of the hindbody tegument, which were attached at many points to abnormally dilated excretory ducts. The tegumental and excretory epithelia were joined basally, but did not share a common lumen. These abnormal connections between these aberrant tegumental modifications and the abnormally dilated excretory ducts have not been described previously for any metacestode. This report contributes to understanding previously published reports of abnormalities in other plerocercoid metacestodes, including Mesocestoides spp. and diphyllobothriidean spargana.

Phylogenetic identification of Sparganum proliferum as a pseudophyllidean cestode by the sequence analyses on mitochondrial COI and nuclear sdhB genes

Sparganum proliferum is a larval cestode for which the adult stage is unknown. It is characterized by the continuous branching and budding when parasitized to humans, and causes fatal human sparganosis. However, the biological features of S. proliferum, including its taxonomic status, still remain obscure. Our previous investigation suggested that S. proliferum might be phylogenetically distinct from Spirometra erinaceieuropaei, by the analysis on mitochondrial NADH dehydrogenase subunit 3 (ND3) gene. However, mitochondrial DNA sequence in Platyhelminth is known to have heteroplasmy within a species. Therefore, in the present study, we have investigated the complete nucleotide sequences of mitochondrial cytochrome c oxidase subunit I (COI) gene and the partial nucleotide sequences of nuclear coded succinate dehydrogenase iron-sulfur protein subunit gene (sdhB). The results clearly demonstrated that S. proliferum is a distinct species from S. erinaceieuropaei, and that S. proliferum belongs to the order Pseudophyllidea.

Current views on geographic distribution and modes of infection of neurohelminthic diseases

Neurohelminthiases are more prevalent in geographic areas where environmental factors and poor sanitary conditions favor the parasitism between man and animals. In recent years, population shifts and rapid transport have facilitated the spread of certain helminthic diseases from endemic to non-endemic areas. Although many helminthic parasites are known to cause various human diseases afflicting many millions of people in the world, neurohelminthiases are often not diagnosed because they have been unrecognized by clinicians or confirmatory diagnostic tests are not easily available. Paragonimiasis and schistosomiasis (fluke diseases) are endemic in Asia, Africa and Central America; lesions in the central nervous system (CNS) due to ectopic parasitism of the preadult and adult flukes produce various clinical features that often mimic other diseases. In most cestodiasis (tapeworm disease), the adult worm that lodges in the alimentary tract does not involve the CNS; however, the larvae often enter the nervous system by migration or by metastasis via the systemic circulation, where they cause cystic lesions. Cysticercosis is the most common CNS helminthic infection especially in endemic areas where the parasitism between man and pigs is maintained. In other cestodiases, infections to man are often caused by ingestion of food or water contaminated with feces of the definitive hosts (mammals or man). Nematodes (roundworms) generally enter the CNS by ectopic migration of the infective larvae (larva migrans); the routes of infection to man vary with species of the nematodes, and the animal hosts they infest. Angiostrongylus cantonensis is a neurotropic nematode that requires the CNS of mammalian hosts for its growth; the third-stage larvae frequently invade skeletal muscles and the nervous system. Strongyloides, a gastrointestinal nematode, is known to cause CNS involvement in immunosuppressed patients. Recently, some nematodes heretofore unknown to cause human parasitism have been recognized as the causative agents of CNS infections.

Parasitic infections of the central nervous system in children. Part II: Disseminated infections

In the second segment of this three-part review of parasitic infections of the central nervous system in children, we consider parasitic infections which typically involve various tissues and organs in addition to the brain and spinal cord. Parasites capable of dissemination in immunocompetent hosts are discussed first, and, as in Part I, organisms are grouped according to their predominant geographic location. This is followed by a discussion of the unique aspects of toxoplasmosis, strongyloidiasis and infection with microsporidia in immunocompromised patients, with an emphasis on the central nervous system.

Sparganum proliferum: an overview of its structure and ultrastructure

A detailed study of the structure and ultrastructure of Sparganum proliferum was made possible for the first time thanks to the successful in vitro and in vivo maintenance of this rare parasite. Although S. proliferum exhibits many of the classical tegumental and parenchymal structures previously described for other larval cestodes, these are either arranged in a distinct fashion or, in some cases, may be completely different. Among the latter and of special interest are the single or multiple parenchymal cavities, surrounded by tegument, which in some instances appear to act as a primitive digestive tract.

Cerebral sparganosis caused by Spirometra mansonoides. Case report

Cerebral sparganosis is an uncommon parasitic zoonosis caused by the migrating larva of the genus Spirometra mansonoides. The clinical and computerized tomography presentation, as well as the operative and histopathological findings, of the first known case in Mexico are detailed. The dead larva elicited intense acute inflammation resulting in focal encephalitis. Surgical removal of the larva yielded excellent results.

Purification of antigenic protein of sparganum by immunoaffinity chromatography using a monoclonal antibody

The quality improvement of antigen (crude saline extract) of Spirometra mansoni pleroceroid (sparganum) was investigated by protein purification. The crude extract was fractionated by gel filtration through Sephacryl S-300 Superfine. Its third fraction was purified by affinity chromatography using a monoclonal antibody as ligand. When observed by SDS-PAGE, the purified protein was composed of 2 bands of 36 kDa and 29 kDa which were found already as the most sensitive components in the crude extract by immunoblots with patients sera. The quality of the purified antigen was evaluated in comparison with the crude extract by enzyme-linked immunosorbent assay (ELISA) for the specific (IgG) antibody in sera of human sparganosis, other parasitic and neurologic diseases, and normal control. When the purified antigen was used, the sensitivity was not altered but remained high (96.4%) while the specificity was increased from 86.8% to 96.9%.

Sparganosis of the spinal cord. Case report

Sparganosis of the spinal cord is a rare disease: only two cases have previously been described. A third case of spinal sparganosis is reported in which a sparganum was removed from the central canal of the patient's spinal cord. The clinical presentation and pathology are described. A brief review of the life cycle of the Spirometra is given and the possible mode of infestation is discussed.

Sparganosis of the brain. Report of two cases

Cerebral sparganosis is a rare disease; to date only eight cases have been described. Two new cases of cerebral sparganosis occurring in Chinese patients living in a metropolitan area are reported. Their clinical presentation and investigative results are presented and the operative and histological findings detailed. A brief review of the condition is given and the possible source of infection discussed.

Replicating helminth parasites of man

Most helminth parasites of man are unable to replicate within the human host. Thus, the worm burden of an infected person (on which the pathology largely depends - see Box 1) is a function of the number of infective forms to which the person is exposed. But for some species of helminths, the ability to replicate in man has a marked effect on the course and duration of infection, and for the pathogenesis of disease. In this review, David Grove discusses the mechanisms by which such replication may occur, and considers how this ability affects our approach to therapy and control.

Intracranial sparganosis: an uncommon infection. Case report

The first case of intracranial sparganosis to be reported from the United States is presented. The patient, a 27-year-old woman, complained of focal seizures involving the right lower extremity. A left parietal parasagittal craniotomy was performed, and a granuloma containing a sparganum was excised from the parietal lobe. The clinical and pathological features of sparganosis are reviewed. Only five cases of intracranial sparganosis have previously been described.