A sparganum from a Queensland woman

Sparganosis: an under-recognised zoonosis in Australia?

Sparganosis is a rare zoonotic parasitosis that is sporadically reported worldwide. In Australia, the causative tapeworms are considered endemic in wildlife animals, however, there have been only five reported human infections. We present three additional cases of sparganosis, involving two Australian born gentlemen who have never travelled overseas and a woman who emigrated from Ethiopia. The first man presented with two unusual subcutaneous lumps that migrated along the anterior abdominal wall connected by a tunnel. The second man presented with two separate lumps, one on the thigh and the other on the left upper abdomen over a 4-week interval. The woman presented with 6 weeks of intermittent fevers, night sweats, abdominal pain and passing intestinal worms. This series of patients suggests that sparganosis is under-recognised in Australia and serves as a reminder for clinicians to the varied presentations that can be characteristic of this lesser known zoonosis.

Parasitic worms of the central nervous system: an Australian perspective

The diagnosis and management of parasitic diseases of the central nervous system (CNS) is difficult, even for infectious diseases physicians and neurologists. Furthermore, few overviews of the spectrum of causative helminths and clinical syndromes have been published. In the present study, we review the seven most common parasitic diseases of the CNS: (i) cysticercosis, (ii) neuroschistosomiasis, (iii) paragonimiasis, (iv) angiostrongyliasis, (v) hydatid disease, (vi) sparganosis and (vii) gnathostomiasis. Major syndromes of parasitic disease of the CNS and their differential causes are discussed, including: (i) cystic lesions, (ii) enhancing granulomas (with and without creeping subcutaneous eruptions), (iii) eosinophilic meningoencephalitis and (iv) spinal cord disease. Specific risk factors that predispose to these infections are also discussed and particular attention is drawn to the situation in Australia.

Cerebral sparganosis in an East Timorese refugee

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.