Multiple sparganosis spinal infections mainly in the thoracic region: A case report

BACKGROUND

Spinal infection with sparganosis is rarely seen, and multiple spinal infections with sparganosis in the thoracic spine have not been reported.

CASE SUMMARY

In this case report, a 56-year old male patient suffered from back pain for 3 mo. Computed tomography examination of the thoracic spine showed bone destruction of the T4-5 vertebral body, as well as the right pedicle and lamina of T5. Magnetic resonance imaging showed high signals on T2W1 images and fat-suppressed images in the right vertebral body of T4-5 and the right pedicle and lamina of T5, a high signal in the vertebral canal, and similar high signals in the paravertebral and subcutaneous regions of the whole spine. Puncture biopsy showed sparganosis. Following definite diagnosis, the patient was treated with debridement of T4-5 infected lesions under a microscope, bone grafting and internal fixation. Postoperatively, the patient's back pain symptoms were significantly relieved; the incision healed after one-stage treatment, and albendazole antiparasitic treatment was administered.

CONCLUSION

Puncture biopsy is the most reliable method to diagnose infection by sparganum. Removal of infected lesions under the microscope and albendazole for antiparasitic treatment are safe and effective.

Sparganosis of a thoracic vertebra misdiagnosed as bone metastasis from lung cancer

Sparganosis is a rare parasitic infection caused by plerocercoid tapeworm larvae. We described a case of a 27-year-old man presenting with numbness in both legs and masses in the right lung and spine, initially thought to have spinal metastasis from lung cancer. However, after pathological and parasitological examinations, the patient was found to have spinal sparganosis, likely due to a history of consuming raw frogs. The patient was successfully treated with praziquantel, resulting in the recovery of muscle strength in his legs. This case highlights the importance of considering spinal sparganosis as a differential diagnosis in patients with spinal masses, especially those with a history of consuming raw or undercooked frogs. Accurate diagnosis and early treatment are crucial for managing this infection.

Cerebral sparganosis in a child with corpus callosum invasion: a case report

BACKGROUND

Invasion of the corpus callosum by sparganosis is rare in children. After invading the corpus callosum, sparganosis has various migration modes, which can break through the ependyma and enter the ventricles, thus causing secondary migratory brain injury.

CASE PRESENTATION

A girl aged 4 years and 7 months presented with left lower limb paralysis for more than 50 days. Blood examination showed that the proportion and absolute number of eosinophils in the peripheral blood were increased. Furthermore, enzyme-linked immunosorbent assay of serum and cerebrospinal fluid samples revealed positivity for IgG and IgM antibodies for sparganosis. Initial magnetic resonance imaging (MRI) revealed ring-like enhancements in the right frontoparietal cortex, subcortical white matter, and splenium of the corpus callosum. Within 2 months, a fourth follow-up MRI showed that the lesion had spread to the left parietal cortex, subcortical white matter, and deep white matter in the right occipital lobe and right ventricular choroid plexus, with left parietal leptomeningeal enhancement.

CONCLUSION

Migratory movement is one of the characteristics of cerebral sparganosis. When sparganosis invades the corpus callosum, clinicians should be aware that it may then break through the ependyma and enter the lateral ventricles, leading to secondary migratory brain injury. Short-term follow-up MRI is necessary to evaluate the migration mode of sparganosis and dynamically guide treatment strategies.

Spirometra infection in a captive Samar cobra (Naja samarensis) in the United States: An imported case?

We report a case of Spirometra infection in a Samar cobra (Naja samarensis) imported from the Philippines, belonging to a zoological collection in the southern United States. Under a poor post-surgical prognosis, the snake was euthanized, and at necropsy plerocercoids of a Diphyllobotriidea were found in its subcutaneous tissues and musculature. Molecular and phylogenetic analyses of the complete cytochrome oxidase c subunit I (cox1) gene of the mitochondrial DNA confirmed that the isolate belonged to the genus Spirometra and was closely related to Spirometra mansoni isolates from Asian countries (bootstrap support = 99.4%). Considering the origin and clinical history and handling of the animal, the snake probably arrived infected in America. We suggest the inclusion of diagnostic imaging in the investigation of sparganosis in research and disease surveillance protocols applied in the pre- and post-quarantine period to asymptomatic animals imported from endemic areas.

Cerebral sparganosis masquerading brain neoplasm: A rare incidental case

Sparganosis is a parasitic infection caused by plerocercoid larvae of the genera Spirometra. Cerebral sparganosis is one of its most serious complications wherein clinical and imaging findings may pose diagnostic challenge. Here we present a case of cerebral sparganosis which mimicked as brain tumour on clinicoradiological examination. The case is reported in view of its rarity in India and the need for awareness of the entity.

First Record of Spirometra erinaceieuropaei spargana Infection in Amphibians of South Asia: A Causative Agent of Surficial Abnormalities

BACKGROUND

Sparganosis is a zoonotic disease caused by Plerocercoid larvae (spargana) of the genus Spirometra. We aimed to provide molecular evidence for the infection of amphibians with Spirometra sp. in the inside and outside of Horton Plains National Park (HPNP), Sri Lanka.

METHODS

The prevalence of sparganum infection in wild frogs (Truga eques and Minverya agricola) was investigated in the inside and outside of HPNP from June 2019 to April 2021.A total of 1,434 Amphibians samples were surveyed to examine the spargana infection from the study site. To identify the species identity of the collected spargana, a portion of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene and nuclear 18S rRNA gene were amplified, sequenced, and analyzed.

RESULTS

A total of 539 infected amphibians (T. eques and M. agricola) samples were examined to survey from the study area. Spargana were detected in all dissected specimens belonging to the species Spirometra erinaceieuropaei that were genetically confirmed using the evolutionary conserved nuclear 18S rRNA gene and then compared to the GenBank deposit, indicating that S. erinaceieuropaei is the primary causal agent of sparganosis both inside and outside the HPNP.

CONCLUSION

Our finding is the first genetically confirmed record of S. erinaceieuropaei in amphibians in South Asia. However, further studies are needed to investigate the prevalence of sparagna infection in amphibians all over the island.

A case of breast sparganosis: with an emphasis on ultrasonographic findings

Sparganosis is a rare disease caused by the infestation of the plerocercoid tapeworm larva of the genus Spirometra. Human sparganosis is most commonly encountered in subcutaneous fat areas of the abdomen, limbs, and genitourinary tract. Breast sparganosis occur very rarely, accounting for less than 2% of total human sparganosis cases. Because of the disease's rarity, clinical suspicion is essential to reach the diagnosis of breast sparganosis. We present a case of mammary sparganosis in a 58 year-old woman on the ultrasonographic findings. The patient had a painless breast lump with a history of drinking impure water. On ultrasonography (US), we noted four masses, the largest lesion was suspected as sparganosis, and others tended to be benign lesions. The patient was treated following excisions by a US guided Vacuum-assisted breast biopsy system (VABB). The final diagnosis of all lesions was sparganosis.

Evolutionary transitions in broad tapeworms (Cestoda: Diphyllobothriidea) revealed by mitogenome and nuclear ribosomal operon phylogenetics

Broad tapeworms (Diphyllobothriidea) are parasites whose adults are capable of infecting a wide range of freshwater, marine and terrestrial tetrapods including humans. Previous works examining the evolution of habitat and host use in this group have been hampered by the lack of a well-resolved phylogeny. In order to produce a robust phylogenetic framework for diphyllobothriideans, we sequenced the complete mitochondrial genome of 13 representatives, carefully chosen to cover the major clades, and two outgroup species representing the Spathebothriidea and Haplobothriidea. In addition, complementary data from the nuclear ribosomal operon was sequenced for 10 representative taxa. Mitogenomes and ssrDNA and lsrDNA were used towards elucidating the phylogenetic framework for the Diphyllobothriidea. The Cephalochlamydidae is confirmed as the earliest diverging diphyllobothriidean lineage, and Solenophoridae and Diphyllobothriidae are sister groups. We infer a probable freshwater origin of the diphyllobothriideans. The ancestral condition for life cycle complexity could not be unambiguously resolved. However, we infer exclusive use of a three-host life cycle following the origin of the Solenophoridae + Diphyllobothriidae. Regarding definitive host use, although we infer reptiles as the most likely ancestral condition, this result should be revisited with a more densely sampled phylogeny in future studies. Freshwater habitat is used by the early diverging lineages within the Solenophoridae + Diphyllobothriidae clade. For the latter, habitat use shifts between freshwater and marine environments, and definitive host use includes marine and terrestrial mammals and birds. We use mitochondrial genomes to distinguish Schistocephalus species occurring in different species of sticklebacks and demonstrate conspecificity of Ligula cf. intestinalis specimens collected from two Fennoscandian ringed seal subspecies.

[Subcutaneous sparganosis: a case report]

This case report presents the diagnosis and treatment of a case with subcutaneous sparganosis.

Multispecies reservoir of Spirometra erinaceieuropaei (Cestoda: Diphyllobothridae) in carnivore communities in north-eastern Poland

Background

Spirometra erinaceieuropaei is a diphylobothriid tapeworm with a complex life-cycle including definitive, intermediate and paratenic (transport) hosts. Multiple routes of parasite transmission often make it impossible to determine what type of host a specific infected animal is considered to be. Spargana larvae cause sparganosis, a severe food- and water-borne disease mainly found in Asia. In Poland, Spirometra sp. was reported in large carnivores in Białowieża Primeval Forest for the first time in the 1940s and was recently confirmed as S. erinaceieuropaei in several mammals and snakes using molecular methods.

Methods

In total, 583 carcasses of 9 carnivore species were necropsied between 2013 and 2019 in north-eastern (NE) Poland. The larvae of S. erinaceieuropaei (spargana) were isolated from subcutaneous tissue, counted, and preserved for genetic analyses. We calculated the prevalence and intensity of infection. To assess spatial variation in S. erinaceieuropaei infection probability in NE Poland, we applied a generalized additive model (GAM) with binomial error distribution. To confirm the species affiliation of isolated larvae, we amplified a partial fragment of the 18S rRNA gene (240 bp in length).

Results

Spirometra larvae were found in the subcutaneous tissue of 172 animals of 7 species and confirmed genetically as S. erinaceieuropaei. The overall prevalence in all studied hosts was 29.5% with a mean infection intensity of 14.1 ± 33.8 larvae per individual. Native European badgers and invasive raccoon dogs were characterized by the highest prevalence. An analysis of parasite spread showed a spatially diversified probability of infection with the highest values occurring in the biodiversity hot spot, Białowieża Primeval Forest.

Conclusions

Our study revealed that various mammal species (both native and non-native) can serve as S. erinaceieuropaei reservoirs. The frequency and level of infection may differ between selected hosts and likely depend on host diversity and habitat structure in a given area. Further studies are needed to assess the distribution of the parasite throughout Europe and the environmental and biological factors influencing infection severity in wild mammals.

(cestoda; Diphyllobothriidae) in captive meerkats (Suricata suricatta)

We report three cases of sparganosis due to plerocercoids of the tapeworm Spirometra sp. in captive meerkats (Suricata suricatta) from a zoo exhibit in the southeastern United States. Two meerkats were euthanized, one due to an uncontrollable seizure and the other due to trauma, and at necropsy cysts containing cestode larvae were observed. A third meerkat had a subcutaneous nodule surgically removed, which contained similar larvae. The third animal died years later, and had numerous cestode larvae in the pleural and peritoneal cavities. The larvae were morphologically identified as plerocercoids of diphyllobothriidean cestodes. On necropsy, multiple nodules, ranging in size from 2.5 to 3.0 cm, were observed in the subcutaneous tissue and muscles. Multifocally, separating skeletal muscle fibers were longitudinal and transversal sections of cestode larva. Histologically, parasitic cysts contained large numbers of neutrophils and macrophages, admixed with proteinaceous material. Molecular and phylogenetic analyses confirmed that specimens from one of the meerkats belonged to the genus Spirometra and was closely related to Spirometra plerocercoids isolated from a snake from the United States and wild felids from South America. Meerkats likely became infected by ingesting infected second intermediate hosts, such as amphibians and reptiles that may have entered the exhibit. Management practices that minimize access of meerkats and other susceptible hosts to intermediate hosts should be implemented.

Spinal Sparganosis Coexisting with Acquired Arteriovenous Fistula of the Filum Terminale

BACKGROUND

Spinal sparganosis associated with filum terminale arteriovenous fistula (FTAVF) has not been reported in the literature. In previous studies, these 2 rare diseases were usually reported separately. We report the first case of spinal sparganosis with concomitant FTAVF.

CASE DESCRIPTION

Spinal sparganosis associated with FTAVF manifested in a middle-aged man with progressive back pain and paraparesis. Magnetic resonance imaging of the lumbosacral spine revealed large intradural mass-like lesions involving the conus medullaris and entire cauda equina. Additionally, there was degenerative spinal stenosis at the level of L2-3 to L5-S1. Magnetic resonance imaging of the thoracic spine disclosed abnormal hypersignal intensity extending from the level of the conus medullaris to T7 with tortuous intradural flow voids along the ventral more than dorsal surfaces of the spinal cord. Magnetic resonance angiography and spinal angiography confirmed FTAVF at the level of L3-4. The patient underwent surgical removal of the granulation tissues with lysis adhesions and obliteration of the FTAVF simultaneously in the same surgical session. Histologic findings were consistent with sparganosis.

CONCLUSIONS

The formation of FTAVF in the present case may have resulted from severe spinal canal stenosis caused by lumbar spondylosis and spinal sparganosis, inducing chronic inflammation and severe adhesion of spinal nerve roots. This evidence indicates that FTAVF may have been acquired.

Axillary sparganosis, changes in ultrasound images over six months: A case report

Sparganosis is an infestation caused by a tapeworm belonging to the genus Spirometra. The typical radiologic findings of sparganosis describe elongated, folded, band or tubular, hypoechoic structures with surrounding increased echogenicity in ultrasonography. These imaging features have been highly consistent with pathology results. Here, we report an interesting case of axillary sparganosis that manifested changes on ultrasound images over a period of 6 months.

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.

Subcutaneous Sparganosis on Abdomen Mimicking Multiple Lipomas

Human sparganosis is a food-borne zoonosis mainly caused by the plerocercoid belonging to the genus Spirometra. The most common clinical sign of sparganosis is a subcutaneous mass in the trunk including abdominal or chest wall. The mass may be mistaken for a malignant tumor, thereby causing difficulty in terms of diagnosis and treatment. A 66-year-old woman visited our clinic for the removal of a lipoma-like mass. It was movable, hard, and painless. We identified 2 white mass, measuring 0.2×4 cm and 0.2×1 cm. Pathologic findings indicated the white mass was a sparganum. She recalled having eaten a raw frog approximately 60 years before. A 35-year-old who lived North Korea was also presented to our clinic with an asymptomatic nodule on her abdomen. Intraoperatively, we found sparganum approximately 24 cm size. Subcutaneous masses are associated with clinical signs of inflammation or they may mimic a soft tissue neoplasm. While the incidence rate of sparganosis has decreased with economic development and advancements in sanitation, surgeons still encounter patients with sparganosis in the clinical setting. Therefore, a careful history is required in order to diagnose sparganosis.

Human Sparganosis in Korea

BACKGROUND

Sparganosis is a larval cestodiasis caused by the plerocercoid of Spirometra spp. Since the first description of human sparganosis in 1924, several hundred cases have been reported in Korea. However, systematic approaches for literature surveys of Korean sparganosis have seldom appeared.

METHODS

We searched publicly available databases such as PubMed, Research Information Sharing Service, and Korea Medical Citation Index with relevant Medical Subject Headings.

RESULTS

At least 438 Korean sparganosis cases have been described from 1924 to 2015. Preoperative diagnosis has been significantly increased since the 1980s due to popularization of serological and imaging diagnostics. Cases were largely detected from fifth decades in general, but cerebral sparganosis was detected in relatively young age groups (third and fourth decades). Sparganosis was prevalent in men (75.9%). Consumption of frog/snake and drinking unfiltered water were found in 63.4% and 16.9% of patients, respectively. Most frequently affected sites were subcutaneous tissues (49.9%), followed by the central nervous system (36.2%). Involvements of visceral organs (7.6%), ocular regions (3.6%), and muscles (2.7%) were noticed. In women, breast sparganosis constituted a large proportion (34.2%). Sparganosis associated with immunocompromised patients has recently been reported.

CONCLUSION

Sparganosis has been continuously reported in Korea during the past 90 years, although its incidence has decreased during the last 20 years. The disease is mostly characterized by subcutaneous nodule, but infection of the worm in vital organs often results in serious illness. Continuous awareness is warranted to monitor sparganosis occurrence and associated clinical consequences.

Identification of sparganosis based on next-generation sequencing

The incidence of sparganosis, a parasitic disease caused by plerocercoid larvae of the genus Spirometra, has gradually risen worldwide (especially in remote areas) in recent years. Pulmonary and pleural sparganosis, as well as other sites of infestation, including the subcutaneous tissues, the abdominal viscera, brain and eyes, has been reported. In clinical practice, due to the atypical signs and symptoms as well as limited laboratory approaches for the specific detection of sparganum, sparganosis is often misdiagnosed. In the present study, an 11-year-old girl visited the Department of Infectious Diseases in Shanghai Children's Medical Center for recurrent shoulder and chest pain and shortness of breath. Imaging tests demonstrated bilateral pleural and pericardial effusion, enlarged lymph nodes in front of the tracheal carina, and infection of the left lower lobe. Sparganum were not observed in the dissected soft tissue at the root of the right thigh with naked-eye and light microscopy examination. Histologic examination revealed granulomatous inflammation and tunnel-like necrosis with eosinophilic, neutrophilic and lymphocytic infiltration. Although the patient's serum was positive for sparganum antibodies, the diagnosis of sparganosis was not confirmed for more than three months. Ultimately, genomic DNA of Spirometra erinaceieuropaei was detected in the mass at the root of the right thigh using next-generation sequencing (NGS), confirming the diagnosis of sparganosis. The patient was treated with praziquantel (150 mg/kg/day) without recurrence after an eight-month follow-up. We present, for the first time, a study of human sparganosis diagnosed using NGS, which provided a clinically actionable diagnosis of a specific infectious disease from an uncommon pathogen.

Breast sparganosis: a case report

A 57-year-old Korean female patient presented with a migrated palpable left breast mass. Physical examination revealed a 3-cm soft, non-tender mass in the upper inner quadrant of her left breast. Mammography showed 8.2-cm extended nodular and tortuous tubular masses in the upper portion of her left breast. Ultrasonography revealed a 5.8-cm extended nodular, tortuous tubular and hypoechoic to anechoic lesion in the subcutaneous mammary parenchymal layer. A lumpectomy was conducted and revealed a 30-cm live tapeworm. Histopathologic examination of the excised breast tissue revealed chronic granulomatous inflammation and eosinophilic infiltration by a parasitic organism, which was confirmed as a sparganum. After surgery, the patient was treated with a single dose of praziquantel and albendazole. Asian countries such as Korea, China and Japan are known to have high endemicity of sparganosis, mostly because of their dietary customs. When examining patients from these countries, sparganosis should be considered because of the unique dietary customs despite the high level of hygiene.

The Tunnel Sign Revisited: A Novel Observation of Cerebral Melioidosis Mimicking Sparganosis

The tunnel sign has been described as a specific feature of cerebral sparganosis. We present a case of a 55-year-old gentleman found to have cerebral melioidosis and with initial imaging mimicking the appearance of sparganosis. This suggests that the tunnel sign in brain abscesses may be specific for infection by Burkholderia Pseudomallei, Spirometra Mansoni or Listeria Monocytogenes.

Orbital sparganosis in an 8-year boy: a case report

Background

Sparganosis is one of the neglected but important food-borne parasitic zoonoses, with higher prevalence in Asian countries. The infection is commonly located in the subcutaneous tissue, brain, breast, and lung, but fewer reported infections involve the eye. Because the majority of patients with sparganosis are adults, it is likely to be missed in children.

Case presentation

An 8-year-old boy presented to our clinic complaining of a painless ocular mass in his right eye for 1 month. The boy had a history of eating frogs and frog poultice applications to his eyelids. The patient was checked for an elliptical mass near the medial wall of the right eye. Serodiagnosis testing was positive in an enzyme-linked immunosorbent assay. During surgical operation on the patient, calcified parasite eggs and foreign body granulomatous reaction were found using histological examination. Due to early detection and surgery, the patient fully recovered with no damage to his eyesight.

Conclusions

Although rare, ocular sparganosis should be suspected in a mass of the eye when there is a history of eating frogs and frog poultice applications on eyelids. Early surgical resection is important for a good prognosis.

Electronic supplementary material

The online version of this article (10.1186/s12886-018-0675-8) contains supplementary material, which is available to authorized users.

A neglected risk for sparganosis: eating live tadpoles in central China

A 29-year-old farmer from central China was sent into the Emergency Department of the Affiliated Hospital of Zhengzhou University. He had a 15-day history of persistent high fever, abdominal distention and pain. The patient was clinically diagnosed as appendicitis and peritonitis, and treated with antibiotics in a local hospital, did not improve. On exploratory laparotomy, the appendicular perforation and peritonitis were seen; appendicectomy were performed, and antibiotics were given. However, high fever and abdominal pain still persisted; intestinal adhesion and obstruction, ascites appeared. He was given the “critically ill notice”. He had eosinophilia (12.95%) and the history of eating live frog tadpoles for treating his cutaneous pruritus 3 days before onset of the disease. Serum anti-sparganum antibodies assayed by ELISA were positive. This patient has hospitalized for one and half months and spend more than US$ 12 000. This patient was primarily diagnosed as visceral sparganosis, and cured with praziquantel.

Sparganosis is one neglected but important parasitic zoonosis of poverty. Human infections were mainly acquired by eating raw or uncooked meat of frogs and snakes infected with plerocercoids, using frog or snake flesh as poultices, or drinking raw water contaminated with infected copepods. However, sparganosis caused by ingestion of live tadpoles are emerging in central China. Our surveys showed that 11.93% of tadpoles in Henan province are infected with plerocercoids. Eating live tadpoles is a high risk for sparganum infection. The comprehensive public health education should be carried out for people in endemic areas and the bad habit of eating live tadpoles must be discouraged.

Establishment of the complete life cycle of Spirometra (Cestoda: Diphyllobothriidae) in the laboratory using a newly isolated triploid clone

Methods to maintain the life cycle of pathogenic organisms become powerful tools for studying molecular and cellular bases of infectious diseases. Spirometra erinaceieuropaei is a parasitic tapeworm that causes sparganosis in humans. Because S. erinaceieuropaei has a complex life cycle with different stages and host species requirements, there have been no reports to establish the complete life cycle in the laboratory. In this study, using Cyclops as the first intermediate host, mouse as the experimental second intermediate host, and dog as the final host, we succeeded in maintaining S. erinaceieuropaei in the laboratory. By repeating the established life cycle five times, we obtained a clonal population of S. erinaceieuropaei from a single adult worm. A karyotype study showed that the chromosome of this clone is triploid (3n=27), indicating that a genetically uniform strain is established by apomictic reproduction. The strain was named Kawasaki triploid (Kt). A partial sequence of mitochondrial cytochrome c oxidase subunit 1 gene of the strain Kt showed more than 98% similarity with those of S. erinaceieuropaei isolates from Australia, China, and South Korea, and the resultant phylogeny indicated that the strain Kt is a member of a distinctive clade from East Asia and Oceania. Our system will be particularly useful for studies of S. erinaceieuropaei infection and human sparganosis.

Presumptive case of sparganosis manifesting as a hepatic mass: A case report and literature review

A 60-year-old man was admitted due to rectosigmoid colon cancer, and a hepatic mass was incidentally found during the staging work-up. The mass appeared cystic with a thick wall and contained multiple bizarre cord-like structures on ultrasound, computed tomography and magnetic resonance imaging. The differential diagnoses included organizing abscess/hematoma, foreign body granuloma and parasite infestation. Serologic study revealed anti-sparganum antibodies. Over 4-year follow-up, the patient did not complain of symptoms, and no changes in the characteristics of the liver mass were observed. Hepatic sparganosis is rare; only two cases have been clinically reported, and no detailed radiologic description was available until now. This case report presents a detailed radiologic description of a hepatic mass that could most likely represent hepatic sparganosis.

Sparganosis in wild boar (Sus scrofa) - Implications for veterinarians, hunters, and consumers

From February to March 2016 we found plerocercoids of Spirometra sp. in four wild boar hunted in Białowieża Primeval Forest, north-eastern Poland. Plerocercoids were located subcutaneously and in muscle tissue. A sequence of a nuclear 18S rRNA gene was used for genetic specification of the samples. The analyzed gene fragment showed 100% identity with the Spirometra erinacei sequence. Thus, the emerge of human sparganosis due to consumption of undercooked or smoked wild boar meat is likely in the areas where wild boar is an approved food source, especially in the absence of routine guidelines for vets. It has become a priority to inform the public about possibilities and consequences of this zoonosis.

Endoscopic resection of sparganosis presenting as colon submucosal tumor: A case report

Human sparganosis is a rare parasitic disease caused by infection with the tapeworm Sparganum, the migrating plerocercoid (second stage) larva of Spirometra species. Sparganosis usually involves subcutaneous tissues and/or muscles of various parts of the body, but involvement of other sites such as the brain, eye, peritoneopleural cavity, urinary track, scrotum, and abdominal viscera has also been documented. Infections caused by sparganum have a worldwide distribution but are most common in Southeast Asia such as China, Japan, and South Korea. Rectal sparganosis is an uncommon disease but should be considered in the differential diagnosis of unusual and suspicious rectal submucosal tumors. We report a case of rectal sparganosis presenting as rectal submucosal tumor. We performed endoscopic submucosal dissection of the rectal submucosal tumor. The sparganosis was confirmed based on the presence of calcospherules in the submucosal layer on histological examination. Moreover, the result of the immunoglobulin G antibody test for sparganosis was positive but became negative after endoscopic submucosal dissection. Though rare, rectal sparganosis should be considered in the differential diagnosis of rectal submucosal tumor-like lesions. This case suggests that physicians should make effort to exclude sparganosis through careful diagnostic approaches, including detailed history taking and serological tests for parasites. In this report, we aimed to highlight the clinical presentation of Sparganum infection as a rectal submucosal tumor.

Axillary sparganosis which was misunderstood lymph node metastasis during neoadjuvant chemotheraphy in a breast cancer patient

Sparganosis of the breast is an uncommon disease, but should be considered in the differential diagnosis of unusual and suspicious breast masses. A history of ingesting contaminated water and direct ingestion of snakes and frogs may help in differential diagnosis of the mass. Complete surgical removal is the treatment of choice and provides a definite diagnosis. We report a case of multiple axillary lymph node sparganosis. It was first considered as an axillary metastasis of breast cancer because a newly axillary mass appeared in follow-up radiologic study after neoadjuvant chemotherapy. We performed curative breast cancer surgery and sparganosis was confirmed by extracting the worm during axillary dissection.

Eosinophilic pleuritis due to sparganum: a case report

Sparganosis is a rare parasitic disease caused by migrating plerocercoid tapeworm larva of the genus Spirometra. Infection in humans is mainly caused by the ingestion of raw or inadequately cooked flesh of infected frogs, snakes, and chickens. Here, we report a rare case of a 45-year-old man who was admitted to our hospital with left lower chest pain. The chest radiograph and computed tomography (CT) scan revealed localized pleural effusion in the left lower lobe; further, peripheral blood eosinophilia and eosinophilic pleural effusion were present. Percutaneous catheter drainage was performed, which revealed long worm-shaped material that was identified as a sparganum by DNA sequencing. The patient showed clinical improvement after drainage of the sparganum. This study demonstrates the importance of considering parasitic diseases in the differential diagnosis of eosinophilic pleural effusion.

A case report of testicular sparganosis misdiagnosed as testicular tumor

Sparganosis is a parasitic infestation of human by plerocercoid larvae. Sparganum is usually reported to be found in the subcutaneous tissues as well as other organs, including scrotum. However, testicular sparganosis is extremely rare, because of strong capsule of tunica albuginea. An urban-living 54-yr-old Korean man presented with left scrotal pain for 6 yr. Both testes look normal physically. Ultrasonography revealed poorly defined, heterogeneous mass with increased echogenicity in the left testis. This case was misdiagnosed as testicular tumor and underwent orchiectomy, but was diagnosed as testicular sparganosis by histopathology. Sparganosis should be included for differential diagnosis of testis tumor in countries where sparganosis is prevalent.

Occurrence of human sparganosis in Kerala

Human sparganosis is a rare zoonotic disease caused by the larval stages of Spirometra sp. A seven cm worm recovered from a painful swelling in the right inguinal region of a 9 year old boy from Kunnamkulam in Thrissur District, Kerala was identified as sparganum based on morphology. This is the first case report of the disease from Kerala state. Possible mode of infection and control measures are suggested. Increased public awareness about risks associated with drinking contaminated water is important to prevent further incidence in the locality.

Sparganosis in Russell's viper snake: a case report

The occurrence of the plerocercoid larva, Sparganum of Sparganum spp. in two Russell's viper snakes maintained in Chennai snake park trust, Chennai is reported for the first time from Southern India. The cestode larvae were found in the sub cutis and were flat, solid, wrinkled, ribbon like creamy white in colour with peudosegmentation with anterior end possessing bothria. The cuticles, subcuticular cells and parenchymatous tissue stained by acetic alum carmine further confirmed the cestode larvae.

Migration of sparganosis from the brain to the cervical spinal cord

Central nervous system (CNS) sparganosis is a rare parasitic infestation caused by ingestion of the raw or inadequately cooked snakes or frogs. Sparganum is well known for its ability of migrating though the tissue, therefore, it can cause various neurological symptoms if it involves neurological systems. A 51-year-old male patient visited our department of neurosurgery complaining of the motor weakness and radiating pain on both upper extremities over 4 months. He had a history of ingesting raw snakes untill his late twenties. The magnetic resonance (MR) images of cervical spine revealed an intramedullary ill-defined enhancing lesion with the aggregated cysts in the upper cervical spinal cord. Under presumptive diagnosis of sparganosis, we took brain MR image. The brain MR images revealed the signal change in right fronto-temporal lobe suggesting the trajectory of parasitic migration via ventricular systems. He underwent a midline myelotomy and granuloma removal followed by the posterior laminoplasty. Pathologic findings showed inflammatory changes and necrosis with keratinized tissue suggesting the CNS sparganosis. We report an uncommon case of CNS sparganosis migrated from the brain to the spinal cord with literature review.

A Case of Sparganosis mansoni in the Thigh: Serological Validation of Cure Following Surgery

Cases of Sparganum mansoni, caused by the plerocercoid larva of the tapeworm S. mansoni, occur throughout the world, particularly in Asian, Middle Eastern, and European countries. However, cases of infection with this parasite are rarely seen in Japan. Here, we present a case of a 61-year-old woman with a solitary subcutaneous nodule in left inner aspect of the thigh, from which a long, slender, whitish worm was surgically removed. The parasite was histopathologically identified as S. mansoni. Serological testing confirmed cure of the infection after surgical removal of the parasite. The authors advocate immunoserological examination in case of S. mansoni.

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.

A case of sparganosis that presented as a recurrent pericardial effusion

Sparganosis is caused by a larval tapeworm of the genus Spirometra, which commonly invades subcutaneous tissue, but less frequently invades muscle, intestines, spinal cord, and the peritoneopleural cavity. The authors managed a female patient who presented with a recurrent pericardiopleural effusion and peripheral eosinophilia. The anti-sparganum-specific IgG serum level was significantly higher than normal control levels. In this patient, sparganosis was caused by the ingestion of raw frogs in an effort to control her thyroid disease. The recurrent pericardiopleural effusion and peripheral eosinophilia were controlled by 3 consecutive doses of praziquantel (75 mg/kg/day). The patient is doing well 4 years after presentation. Sparganosis should be considered a rare, but possible cause of recurrent pericardial effusion and peripheral eosinophilia. Immunoserologic testing using enzyme linked immunosorbent assays can be helpful in diagnosing human sparganosis, especially in cases without a subcutaneous lump or mass. Praziquantel is an alternative treatment for sparganosis in surgically-unresectable cases.