[Metagenomic sequencing for diagnosis of sparganosis mansoni: a case report]

The patient was found to develop a migrating mass in the lower abdomen without any known cause in 2000, and the cause had not been identified following multiple diagnoses since then. The mass was found to migrate to the left anterior axillary regions on August 11, 2020. Then, three segments of incomplete white worms were resected through minimally invasive surgery, and metagenomic sequencing revealed sparganosis mansoni. After surgical resection of complete worms was performed on October 21, 2021, the case was cured and discharged from the hospital. Follow-up revealed satisfactory outcomes and no new mass was found throughout the body.

A Human Case of Lumbosacral Canal Sparganosis in China

In this study, we intended to describe a human case of lumbosacral canal sparganosis in People’s Republic of China (China). A 56-year-old man was admitted to Xiangya Hospital Central South University in Changsha, Hunan province, China after having an experience of perianal pain for a week. An enhancing mass, a tumor clinically suggested, was showed at the S1–S2 level of the lumbosacral spine by the examination of magnetic resonance imaging (MRI) with gadolinium contrast. The patient was received the laminectomy from S1 to S2, and an ivory-white living worm was detected in inferior margin of L5. In ELISA-test with cerebrospinal fluid (CSF) and serum samples, anti-sparganum antibodies were detected. He had a ingesting history of undercooked frog meat in his youth. By the present study, a human case of spinal sparganosis invaded in lumbosacral canal at the S1–S2 level was diagnosed in China. Although the surgical removal of larvae is known to be the best way of treatment for sparganosis, we administered the high-dosage of praziquantel, albendazole and dexamethasone to prevent the occurrence of another remain worms in this study.

Breast Sparganosis Presenting with a Painless Breast Lump: Report of Two Cases

Sparganosis is a parasitic infestation caused by sparganum, a plerocercoid tapeworm larva of the genus Spirometra. Since the first case of human sparganosis reported in 1908, sparganosis has been a global disease, and is common in China, Japan, and Southeast Asian countries. Consumption of raw snakes, frogs, fish, or drinking contaminated beverages are sources of human infections. Human sparganosis usually manifests in subcutaneous fat in areas such as the abdomen, genitourinary tract, and limbs. Breast sparganosis cases are rare, representing less than 2% of total cases of human infections. Complete surgical extraction of the sparganum is the treatment of choice. Because of the rarity of the disease, clinical suspicion is vital to reach the diagnosis of breast sparganosis. Here we report 2 rare cases of breast sparganosis presenting with a painless breast lump, both treated with surgical excision and sparganum extraction.

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.

Contralateral migration of cerebral sparganosis through the splenium

Even though it has been known for some time that the cerebral sparganosis could migrate to the contralateral hemisphere, there have been no reports which described the route of migration. This paper reports a case of cerebral sparganosis which migrated from the right temporo-occipital lobe to the contralateral temporo-occipital lobe though the splenium over a period of 3 years. A 24-year-old man visited our hospital complaining of headache for about a month. Three years ago, non-contrast MRI had been performed in a local hospital, and the major finding was cortical atrophy and ventricular dilatation in the right temporo-occipital lobe area, which were compatible with cerebral sparganosis. After admission to our hospital, we performed MRI which showed a 2 cm-sized well-enhanced mass in the left temporo-occipital area. The findings of the right side were similar to the MRI checked 3 years ago. The presence of multiple calcifications and small enhanced lesions on the right side also indicated that the old lesion had been a cerebral sparganosis. The most important finding was that the FLAIR image showed that the entire splenium had high signal intensity which linked the high signal areas of both hemispheres. The patient underwent surgery with the guidance of neuronavigation. The mass was well-capsulated, and removed totally in an en bloc fashion. After opening the capsule, we found a long worm which showed the shape of a whole lava but no movement. The histopathological diagnosis was sparganosis.

Case of subcutaneous sparganosis: Use of imaging in definitive preoperative diagnosis

Herein, we report a rare case of subcutaneous sparganosis in a 60-year-old Japanese woman. She had a 2 cm x 2 cm elastic-hard, subcutaneous nodule, which was the larva of a tapeworm, and a surrounding granuloma in her internal thigh. It was thought that she became infected by drinking water contaminated with the worm. She was definitively diagnosed by enzyme-linked immunosorbent assay (ELISA). After excision of the lesion, the titer of ELISA showed clear decline; therefore, we could conclude that she had been completely freed from sparganosis. The magnetic resonance imaging (MRI) and ultrasound sonography of her subcutaneous nodule demonstrated the characteristic signs: a band-like structure in the MRI and a coiled linear hypoechoic body in a clear, oval mass in the ultrasound sonography.

A case of oular sparganosis in Korea

Purpose

To present a case of ocular sparoganosis presenting as itching sensation.

Methods

A 60-year-old woman presented for removal of an itchy subconjunctival mass in her left eye. Her ocular findings were normal, except for a subconjunctival mass (1.5×1.5 mm).

Results

A parasite excised from the subconjunctival mass was identified as a sparganum, by microscopic examination after hematoxylin-eosin staining. The mummified parasite was identified as the plerocercoid phase of the sparganum, by microscopy.

Conclusions

Although rare, parasitic disease should be suspected in a palpable subconjunctival mass unresponsive to the medical treatment.

Neuroimaging and pathological findings in a child with cerebral sparganosis

The authors report the case of a 6-year-old boy with cerebral sparganosis due to infection with a plerocercoid tapeworm larva of Spirometra mansoni. Magnetic resonance imaging revealed an area of irregular long T2 signal in the right frontal lobe. When compared with images obtained 2 years earlier, the lesion appeared to have migrated into the parietal lobe. During surgery for the removal of a granuloma, the parasite was discovered and excised. Following surgery, the patient's neurological deficits markedly improved. The authors review the pathological and imaging features of cerebral sparganosis.

Sparganum mansoni parasitic infection in the lung showing a nodule

Reported herein is a 57-year-old man infected by Sparganum mansoni, a kind of tapeworm, showing a solitary nodule of the middle lobe of the right lung. Because a transbronchial biopsy could not diagnose the nodule, a right middle lobectomy was performed on suspicion of malignant tumor. The lesion was diagnosed as sparganosis by histological and immuno-serological examinations. Histological examination revealed granulomatous inflammation with neutrophil and eosinophil infiltration around the worm and interstitial pneumonia surrounding the nodule. Moreover, vasculitis with foreign body giant cell was seen around the lesion. To the authors' knowledge this is the second case of sparganosis limited in the lung, and the current report presents the first detailed histological description of a pulmonary sparganosis case.

Ocular sparganosis

A 50-year-old male attended outpatients department with complaints of irritation, foreign body sensation and mild redness in his right eye. On examination a conjunctival nodule was found with localised inflammation. All investigations were normal. Surgical excision of the nodule was contemplated. During local dressing a live tapeworm about 20 cm in length and 3 mm in breadth emerged. Pathological examination confirmed it to be a tapeworm spirometra. The case was diagnosed to be ocular sparganosis.

Surgical removal of a live worm by stereotactic targeting in cerebral sparganosis. Case report

A 64-year-old man presented with generalized tonic clonic convulsion followed by weakness of the right lower extremity. He had a medical history of hypertension, hyperlipidemia, and right cerebellar infarction. Computed tomography (CT) showed a small high density nodule with an enhanced perifocal low density area in the left occipital lobe. T1-weighted magnetic resonance (MR) imaging showed a ring-shaped and partial string-like nodule with enhancement by gadolinium. T2-weighted MR imaging showed the white matter of the left occipital lobe as high intensity. CT and MR imaging seemed to indicate metastatic brain tumors, although cortical atrophy and ventricular dilation were recognized. Left parietal craniotomy was performed under stereotactic targeting to obtain a definitive diagnosis. During manipulation at the center of the targeted lesion, a white, tape-like body was found and recognized to be a live worm. Serological testing revealed strong immunopositivity against Spirometra mansoni. The infection route in the present case was probably through eating raw chicken meat. Cerebral sparganosis is extremely rare but should be considered in the differential diagnosis of metastatic brain tumors, especially in endemic areas.

A case of sparganosis mimicking a varicose vein

Recent advances in radiological and serological techniques have enabled easier preoperative diagnosis of sparganosis. However, due to scarcity of cases, sparganosis has been often regarded as a disease of other etiologic origin unless the parasite is confirmed in the lesion. We experienced a case of sparganosis mimicking a varicose vein in terms of clinical manifestations and radiological findings. Sparganosis should be included among the list of differential diagnosis with the varicose vein.

Sparganosis in male breast

Humans can acquire infection by sparganum or plerocercoid larva of the tapeworm from drinking water containing infected Cyclops species and by ingesting infected snakes, birds, or other mammals. Once infected, the plerocercoid larva migrate slowly in the tissues and present as a subcutaneous lesion, making the correct diagnosis difficult. A 38-year-old man visited our clinic due to a breast mass. Due to suspicion of gynecomastia or breast cancer, he underwent tumor excision. Unexpectedly, a long white worm was found in the breast tissue and the pathologic finding showed sparganosis. After the surgery, mebendazole was prescribed for 1 week. No recurrence of the sparganosis was found during 1-year follow-up.

Eyelid sparganosis

PURPOSE

To report a case of sparganosis in the muscle layer of the eyelid.

DESIGN

Observational case report.

METHODS

A 67-year-old man with migratory painful swelling on the eyelid that was unresponsive to medications was evaluated and treated surgically.

RESULTS

Computed tomography showed a 1.5 x 1.5-cm sized, thick-walled lesion and ultrasound biomicroscopy showed hypoechoic tubular and cystic lesions. During surgery, a white, thread-like plerocercoid, 7 cm in length was detected in the orbicularis muscle of the lower eyelid. Histopathologic examination demonstrated the characteristic feature of the sparganum larva and foreign body granulomatous reaction. Serodiagnosis by enzyme-linked immunosorbent assay was positive. Three months postoperatively, the lesion resolved completely.

CONCLUSION

Although rare, sparganosis should be suspected in a moving eyelid mass unresponsive to the medical treatment.

Fournier's gangrene associated with sparganosis in the scrotum

Fournier's gangrene is a necrotizing fasciitis of the scrotum or perineum that may extend by way of the fascial planes to the penis and the anterior abdominal wall up to the clavicles, buttocks, or lower extremities. It is a life-threatening progressive disease that requires aggressive antibiotic therapy and early radical debridement. Sparganosis is a parasitic infection that occurs principally in cats and dogs, but human infestations have been reported, albeit rarely. Recently, we experienced a case of Fournier's gangrene associated with sparganosis in the scrotum, which was treated with antibiotics and extensive debridement including removal of a white, flat, shiny sparganum worm.

Cerebral sparganosis

A 22 years male patient presented with recurrent seizures, CT and MRI diagnosis of tuberculoma was made and the patient was treated. When seizures persisted, a craniotomy was done and the excised mass revealed an abscess with a segment of broad solid non-cavitory body, wall with no scolex and loose stroma and smooth muscle fibers. A diagnosis of sparganosis cerebral abscess was made. The case is reported in view of the rarity of cerebral sparganosis in India and the need for awareness of the entity in India.

Testicular sparganosis in a child from Uruguay

A patient 9 years old had a painless tumor in the left testicle. The left testicle measured about 5 cm long and about 3 cm wide and was stony hard in part. From an echographic image, the patient was diagnosed to have a hematoma in the left testicle. The left testicle was surgically removed. From histological observations, burrows were surrounded by numerous eosinophils in the testicle, epididymis and tunica vaginalis. Cross sections of spargana were in the burrows. Severe granulomatous orchitis and epididymitis were around the burrows. This case was the second one of human sparganosis in Uruguay.

Human sparganosis in Italy. Case report and review of the European cases

Infections with Spargana, the larvae of Spirometra spp., are rarely found in humans in Europe. So far only six cases have been discussed in the literature, four from Italy and two from France. We here report a new case in a 50-year-old workman, a freshwater sports fisherman from Bologna in Northern Italy. The infection manifested as a subcutaneous nodule in the thigh, 2x3 cm in size, slightly painful when compressed, somewhat mobile under the skin, present for 9 months, with recurrent periods of local itchiness associated with redness and slight oedema. The lump was removed surgically. Histological sections of the biopsied material revealed the presence of a sparganum. Drinking water contaminated by copepods, containing procercoid larvae of this parasite, seems to be the medium of infection.

Sparganosis: a rare case of the oral cavity

Sparganosis is a rare parasitic disease. We here reported an extremely rare case of intraoral sparganosis in a 21-year-old Thai female. Clinically, the lesion presented as an asymptomatic nodule 1 cm x 1 cm in the left upper labial mucosa. An excisional biopsy was performed and the pathological examinations revealed a larva of a sparganum surrounded by a fibrous capsule heavily infiltrated with eosinophils. Excision of the lesion was curative. The possible route of infection of the patient might be due to drinking water, contaminated with Cyclops containing procercoid larvae.

Intraosseous proliferative sparganosis: a case report and review of the literature

Intraosseous proliferative sparganosis is an extremely rare parasitic disease in which the larvae of incomplete differentiated sparganum proliferate in the human bone. We present the first case of intraosseous proliferative sparganosis arising in the long bone. The patient was a 51-year-old man who complained of a slow growing painful mass on his right leg. The radiographic findings showed an infiltrative osteolytic lesion with speckled calcification at the proximal tibia the clinical diagnosis of which favored chondrosarcoma. Incisional biopsy revealed an innumerable number of small globular shapes, whitish parasites. Histologically, the parasites were composed of a few layers of smooth muscle and several calcerous bodies that were enclosed within a single row of tegumental cells. The latter exhibited a wavy appearance and coated with microvilli. These morphologic findings confirmed the nature of these maldifferentiated larvae. The patient was treated by partial resection of the lesion. This should remind clinicians that parasitic infection of the bone can produce a tumor-like lesion.

[Two cases of abdominal masses caused by foreign bodies which were preoperatively diagnosed as urachal abscess]

A 61-year-old man and a 59-year-old woman were referred to our hospital because of lower abdominal pain and discomfort, pollakisuria and a lower abdominal mass. In both patients, radiological studies and cystoscopy caused us to suspect a urachal abscess. We performed operations transperitoneally. In the male patient, fish bones were detected between the mass and ileum. A partial cystectomy was performed on the female patient, and the histological diagnosis was Sparganosis mansoni. In both cases, it was very difficult to make a correct diagnosis before the operations, but surgical treatment was successfully performed.

Subcutaneous sparganosis--a case report and a review of human sparganosis in Taiwan

Human sparganosis is a rare parasitic disease infected by plerocercoid larva (sparganum) of Spirometra species. It was usually diagnosed accidentally and has long been underestimated. In this report, we describe a 53-year-old woman presenting as an enlarging subcutaneous nodule in the right thigh for 3 months, which was excised in the belief that it was a lipoma. Characteristic sparganum accompanied by granulomatous inflammation, eosinophilic infiltrate and sinus tract in the subcutaneous tissue were discovered under microscopic examination of the excised tissue. Contaminated drinking water was presumed to be the infectious source. Complete excision is a curative treatment. We also review previously documented 19 human sparganosis in Taiwan to provide the clinical context for this report.

Sparganosis of brain and spinal cord: unusual tapeworm infestation (report of two cases)

Among the diseases due to cerebral parasitism, those caused by sparganum mansoni, the larval form of Spirometra mansoni, are very rare. We report two cases, one involving the frontoparietal area in a 38-year-old male and presenting as a mass lesion and another in a 10-year-old girl, presenting with paraparesis due to mid-thoracic compressive mass lesion. Pathological examination of the resected lesion revealed the characteristic plerocercoid larva, spargana, enclosed in acute inflammatory exudate, resembling an abscess. Postoperative recovery was good, suggesting that the best treatment for cerebral or spinal sparganosis mansoni is surgical excision. Serological tests for diagnosis were not carried out in these cases, since parasitic infection was not suspected. Although generally the role of immunodiagnosis is limited due to rarity of the condition, in endemic areas such tests may be useful in preoperative diagnosis.

Cerebral sparganosis with intracerebral hemorrhage: a case report

We describe the clinical case and radiologic findings in a woman with cerebral sparganosis in which intracerebral hemorrhage was the presenting feature with hemiparesis and dysarthria. CT demonstrated high-density lesions in the right frontoparietal area, suggesting a hematoma. With conservative management, hemiparesis improved and follow-up CT revealed what looked like a resolving hematoma. Two weeks later, she complained once again of aggravated left hemiparesis and facial weakness. Diagnosis of sparganosis was made on the basis of brain MRI and ELISA. Stereotactic surgery was performed, and a live larva of sparganum was successfully removed.

Cerebral sparganosis: clinical manifestations, treatment, and outcome

Cerebral sparganosis is a rare parasitic disease caused by infestation by the plerocercoid larva of Spirometra mansoni. The authors retrospectively analyzed 17 cases of cerebral sparganosis treated at Seoul National University Hospital between 1986 and 1994. The patients' ages at diagnosis ranged from 6 to 57 years (median 32 years) and the male/female ratio was 13:4. Diagnosis was based on radiological findings, serological test results, operative findings, and histopathological examinations. Characteristic magnetic resonance (MR) findings consisted of widespread white matter degeneration and cortical atrophy, mixed-signal lesion (low in the central and high in the peripheral regions on T2-weighted images) with irregular dense enhancement of central foci and changes in the location and shape of the enhancing lesion in follow-up studies. Ten patients underwent surgical removal of the parasitic lesion, six received medical treatment alone (five with praziquantel and one with antiepileptic drugs), and one underwent insertion of a ventriculoperitoneal shunt and a course of praziquantel. Follow-up periods ranged from 13 to 111 months (mean 49 months). Seven patients who underwent complete removal of the lesion, live worm, or degenerative worm with surrounding granuloma showed a favorable course. Patients who received medical treatment alone or incomplete removal exhibited progression in their neurological deficits and their seizures could not be controlled. Medication with praziquantel seemed to have no killing effect on live worms. The authors conclude that MR imaging is the most valuable modality for the early detection of cerebral sparganosis and that complete surgical removal of granuloma together with worms, whether they are alive or degenerative, is the treatment of choice.

[A case of Sparganosis mansoni with a painless mass in the inguinal region and the scrotum]

Sparganosis mansoni rarely occurs in the inguinal and perineal regions in Japan. A case of Sparganosis mansoni with a painless mass in the left inguinal region is presented. A 67-year-old male visited our hospital with a complaint of a painless mass in the left inguinal region in May, 1995, and another mass appeared in the scrotum two days after the first visit. Ultrasonography revealed a solid subcutaneous mass 2 cm in diameter. These masses were surgically excised by an inguinal approach and a parasite, 10 cm in length, was found in the mass. The parasite was diagnosed histologically as Sparganosis mansoni, which is a larva of the genus Diphyllobothrium.

Cerebral sparganosis mansoni--case report

An 80-year-old male with paresis of the right upper extremity underwent surgery for a suspected metastatic brain tumor. A live Sparganum mansoni worm was removed from the parietal lobe through a left parietal craniotomy. Retrospective evaluation of magnetic resonance (MR) images revealed ipsilateral ventricular dilatation, despite the presence of a mass lesion resembling a metastatic brain tumor. This interesting MR imaging finding is an important point for differentiating between a brain tumor and cerebral sparganosis.

Intraventricular haemorrhage and hydrocephalus caused by intraventricular parasitic granuloma suggesting cerebral sparganosis

A 67-year-old female farmer presented with acute loss of consciousness. Computed tomograms showed a calcified mass in the cavum septi pellucidi with intraventricular haemorrhage and obstructive hydrocephalus. The patient became fully conscious after urgent external ventriculostomy and subsequently underwent craniotomy for the excision of the mass. Pathological examination of the mass demonstrated a granuloma surrounding a degenerating larva compatible with Spirometra mansonoides whose mimicking an intraventricular tumour has not been reported before.

Cerebral sparganosis diagnosed and treated with stereotactic techniques. Report of two cases

Infestation of the central nervous system with sparganum, the larva of Spirometra mansoni, is rare. Only 27 cases have been reported in the literature; however, the true incidence might be underestimated. Two cases are reported that were definitively diagnosed by stereotactic biopsy techniques. Without a positive histological diagnosis, the first case would have been diagnosed as having a metastatic brain tumor and a course of radiotherapy would probably have been initiated. Differentiation between granuloma of cerebral sparganosis and brain tumors such as meningiomas, gliomas, and metastatic tumors is often difficult before operation. Detailed magnetic resonance imaging might offer some help in such cases. Emphasis is placed on the increasing importance of stereotactic surgery in the diagnosis and treatment of an intracerebral mass lesion, including cerebral sparganosis.

Cerebral sparganosis: case report and review

Sparganosis is a rare infection caused by a tapeworm larva from the genus Spirometra. A 21-year-old Indian man presented with an 18-month history of episodic confusion followed by a grand mal seizure. Computed tomography and magnetic resonance imaging of the brain confirmed the presence of a lesion of the left occipital lobe. Subsequent stereotactic biopsy revealed a plerocercoid larva or sparganum. Surgical resection resulted in cure. This case prompted a review of the literature on central nervous system sparganosis. Altogether, 17 other cases of primary cerebral sparganosis have been reported previously. Seizures, headache, and focal neurologic signs are common at presentation. Neuroradiologic imaging is sensitive but not specific for the identification of lesions. Enzyme-linked immunosorbent assay of cerebrospinal fluid or serum may be diagnostically helpful. However, the diagnosis is generally made after surgical resection, which is usually curative.

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.

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.

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

Large tumors removed from the lower abdomen and pleural cavity of a 24-year-old male Amerindian in Paraguay consisted mainly of multitudes of minute, proliferating, acephalic cestode larvae embedded in fibrous tissue. The parasite resembled Sparganum proliferum Stiles 1908 but was markedly less differentiated. From a review of the literature and examination of available reference material, it is concluded that in addition to the present one there are eight well documented cases of proliferating acephalic larval cestode infection in man: five in Japan and one in Florida (USA) that were S. proliferum, one in Pennsylvania (USA) that was an undifferentiated cysticercus or cysticercoid, and one in Taiwan that probably was an undifferentiated tetrathyridium. In four other cases the parasites are reclassified as being of doubtful nature in three and a racemose cysticercus in one. Review of the known species of proliferating cestode larvae naturally occurring in animals failed to identify possible sources of the acephalic forms observed in man.