Case Report: Disseminated Cysticercosis due to Intentional Ingestion of Parasitic Worm Eggs for Weight Loss

A 20-year-old female resident of Beijing intended to consume the eggs of the parasitic worm, Taenia saginata, for weight loss; however, she apparently inadvertently ingested Taenia solium (pork tapeworm) eggs, which resulted in disseminated cysticercosis. Cysticerci developed in the brain, tongue, muscles, liver, peritoneum, and subcutaneous tissues. She was administered oral albendazole and praziquantel. After four 10-day courses of treatment, most of the cysts disappeared and she recovered. After 3 years, the patient remains in good health.

Subcutaneous ticks: a first report in a golden jackal, and their absence in non-canid carnivores

BACKGROUND

Ticks are hematophagous arthropods which normally attach to the surface of the host's skin. Their aberrant presence in the subcutaneous tissue of a few carnivores, predominantly foxes, has been reported. However, there have been no reports of this phenomenon in other carnivores such as mustelids or golden jackals. Our aim was to investigate the host spectrum for this aberrant localization of ticks.

METHODS

Between 2015 and 2020, a total of 198 carcasses of 12 species of carnivore were examined by parasitological necropsy. When a subcutaneous tick was found, the nodule was removed, carefully dissected, and stored in ethanol. The morphological identification of the subcutaneous tick was carried out to species level.

RESULTS

A single subcutaneous tick was found in one carcass, that of a golden jackal (Canis aureus). The tick was identified as a female Ixodes ricinus. All the other carcasses were negative for the presence of subcutaneous ticks.

CONCLUSION

To our knowledge, this is the first report of a subcutaneous tick in a golden jackal. This finding broadens the host spectrum of subcutaneous ticks, and reinforces the idea that, among carnivores, this phenomenon only occurs in canids.

Under the skin: Ixodes ticks in the subcutaneous tissue of red foxes (Vulpes vulpes) from Germany

BACKGROUND

Ixodes spp. are vectors of zoonotic pathogens. All three active life stages (larvae, nymphs, adults) need to feed on a host in order to develop. Usually ticks parasitize attached to the external surface of their hosts' skin. Interestingly, in some cases ticks can also be found in the subcutaneous tissue in a variety of hosts, such as red foxes (Vulpes vulpes), raccoon dogs (Nyctereutes procyonoides) and dogs.

METHODS

The visceral side of 126 red fox-furs from Germany was examined visually searching for ticks. The localization of ticks was recorded and assigned to ten specific body parts. Morphological identification of ticks was performed according to standardized taxonomic protocols. Ticks which could not be further identified were examined genetically via conventional PCR targeting the 16S rRNA and cox1 gene. Hematoxylin and eosin (H&E) staining was used for histopathological examination.

RESULTS

In 111 out of 126 (88.1%) examined coats, at least one tick was found in the subcutaneous tissue. A total of 1203 ticks were removed from the subcutaneous tissue. Well-preserved ticks could be identified based on morphological criteria, but most ticks were in a progressed state of decomposition. Here, morphological species identification was not successful. Also, PCR methods did not lead to a successful species identification. The following species and development stages were found by morphological identification: Ixodes ricinus (female, n = 289; male, n = 8; nymph, n = 1), I. hexagonus (female, n = 2), I. canisuga (female, n = 1). Male I. ricinus were found individually or copulating in pairs with females. Subcutaneous ticks were localized at three predominant affected body parts: ears, axillar and inguinal region. Histological examination of subcutaneous ticks revealed a granulomatous panniculitis.

CONCLUSIONS

To the authors' knowledge, this is the first finding of highly prevalent subcutaneous ticks in red foxes from Germany. Subcutaneous location of ticks seems to be very common in red foxes and the rule rather than the exception. Deep embedment of longirostra and long feeding times of females seem to put the subcutaneous location in favor. Most foxes were infested in the inguinal area, where the skin is thin and less hairy.

Dirofilaria hongkongensis infection presenting as recurrent shoulder mass

In 2012, a novel canine Dirofilaria species, D. hongkongensis was identified in Hong Kong that caused human diseases and subsequently reported in an Austrian traveller returning from the Indian subcontinent. Here we present a case of human infection by D. hongkongensis manifested as recurrent shoulder mass. Diagnosis was achieved by cox1 gene sequencing of the excised specimen. The case illustrated that parasitic infection represents an important differential diagnosis for musculoskeletal lesions.

A cardiac and subcutaneous canine dirofilariosis outbreak in a kennel in central France

Canine dirofilarioses are nematode infections caused by two species of the genus Dirofilaria: D. immitis and D. repens. We describe here an outbreak of D. immitis and D. repens infection in military working dogs (MWDs) housed in a kennel in the Indre department (centre of France). Out of a total of 17 dogs, 6 (35.2%) tested positive for D. immitis, D. repens or both parasites. Infested dogs were treated and prophylactic measures were implemented for the entire kennel staff. To our knowledge, this is the first documented description of an outbreak of canine cardiopulmonary dirofilariasis in the center of France, unlike in the south of this country, where D. immitis and D. repens dirofilariasis are enzootic. In France, as mosquito vectors expand their territory and new non-native vectors are introduced, it is likely that the distribution area of these two diseases of domestic and wild carnivores will be wider and underestimated.

A case of autochthonous human Dirofilaria infection, Germany, March 2014

In March 2014, an infection with the nematode Dirofilaria repens was diagnosed in a German citizen in the federal state of Saxony-Anhalt. The patient had developed an itching subcutaneous nodule containing a female worm, which was identified as D. repens by 12S ribosomal ribonucleic acid (rRNA) gene sequencing. Autochthonous human D. repens infections have not been described in Germany so far, but this finding is consistent with the recent detection of D. repens in mosquitoes from east Germany.

Human dirofilariosis in Poland: the first cases of autochthonous infections with Dirofilaria repens

Dirofilaria (Nochtiella) repens Railliet et Henry, 1911 (Nematoda: Onchocercidae) is a subcutaneous parasite of dogs and other carnivorous animals, with human acting as incidental hosts. D. repens occurs endemically in warm climates on various continents, in Europe mainly in Mediterranean countries. The aim of this study was to summarize information on human dirofilariosis in Poland, taking into consideration parasitological and epidemiological data. Between April 2009-December 2011, in the parasitological laboratories of Medical University in Warsaw and the National Institute of Public Health/National Institute of Hygiene, fragments of affected human tissues and parasite specimens were examined microscopically. Molecular methods were used to confirm the results from eight microscopic investigations. A literature review to summarize all data on dirofilarial infections in humans in Poland was conducted. In these investigations, autochthonous dirofilariosis was found in humans for the first time in Poland. During the last 3 years, 12 new cases of human D. repens dirofilariosis were recognized. Since 2007, a total of 18 D. repens infection have been found in humans in Poland. Parasitic changes were located in various parts of the body, in the form of subcutaneous nodules containing single nematodes surrounded by granulation tissue (15 cases). In 3 cases, a subconjuctival localization was found. Seventeen of the 18 described cases were noted in central Poland where dirofilariosis occured in dogs. In this area, autochtonous infection was identified in 3 women who had never left Poland in their lives; the others were probably infected outside the country while staying in endemic regions. Data on human and canine infection collected from central Poland during the last 5 years indicates that Dirofilaria repens has been introduced into our country, and that the infection is successfully spreading, with the border of the endemic area currently on 52°N, 21°E. To control the epidemiological situation it is necessary to identify D. repens hosts within local mosquito populations, and to monitor dogs. Because of the increasing number of cases of human infections, whether introduced or local, physicians should take dirofilariosis into consideration in differential diagnosis of skin and eye diseases.

Primary hydatid cyst with an unusual location--a case report

Human cystic echinococcosis, a zoonotic infection caused by Echinococcus granulosus, is still a largely extended public health problem in endemic regions (China, Middle East, Mediterranean region, South America, Russian Federation, etc.). Primary echinococcosis may develop in almost any organ (liver, lung, kidney, spleen, mediastinum, heart, brain, bones, pancreas, breast, ovaries, etc.). The liver and the lungs are the most frequently involved organs. Primary hydatid disease of the soft tissue is extremely rare, even in endemic areas. The paper will be focused on analyzing this rare disease. A 46-years old woman who came to our Department of Surgery with a 7/8 cm painless, round, palpable mass in the subcutaneous tissue of the proximal anteromedial side of the right thigh. Based on clinical and laboratory findings and imaging techniques we suspected a hydatid cyst. Conservative surgery associated with antihelminthic substances intraoperative and Albendazole postoperative was performed. After an uneventful recovery the patient was discharged 7 days after operation. No local or systemic recurrences were detected during 1 year follow up.

Intramuscular and subcutaneous sparganosis: Sonographic findings

A case of subcutaneous and intramuscular sparganosis was confirmed on surgical excision of a worm in a 60-year-old woman suffering from painful masses in the right thigh. Sonography and MRI revealed an ill-defined intramuscular lesion and multiple cystic lesions in the subcutaneous tissue. At the time of the excision, a sparganum larva was found in the adductor longus muscle. If an intramuscular mass with a serpiginous cystic tract is seen on imaging studies in an endemic area, musculoskeletal sparganosis should be included in the differential diagnosis of a soft tissue tumor.

Sonographic detection of subcutaneous fly larvae in human myiasis

Sonographers increasingly face imported diseases such as subcutaneous myiasis. In myiasis, some fly species such as the American Dermatobia hominis and the African Cordylobia anthropophaga use humans as intermediate hosts for the maturation of their larvae. High-resolution gray-scale and color Doppler sonography enabled us to identify D hominis larvae in 2 travelers to Central America by visualizing their typical shape, segmentations, and the continuous fluid transport inside the larval body cavity and spiracles. The small C anthropophaga larva in an individual returning from Namibia was initially not detected. Only when using color Doppler sonography was the larva discerned by its intralarval fluid transport. Sonography enables clinicians to locate viable subcutaneous larvae in suspected cases of myiasis.

[Dirofilariasis--Dirofilaria repens--first time described in Polish patients]

In this paper the first cases of human dirofilariasis in Poland are presented. The clinical manifestations were typical subcutaneous nodules with the adult worm (D. repens) in the center. Past medical history of the 5 patients revealed their trips to endemic countries, so the imported infection was considered. However 2 of these cases were difficult to interpret. It is unclear whether the infections should be considered endemic or imported, because of patients' short visits abroad which happened long time (10 years) ago.

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.

[Subcutaneous hydatid cyst. Case report of an exceptional location]

Primary subcutaneous cyst hydatid disease is an exceptional entity. We report a new case involving a 70-year-old woman hospitalized for a subcutaneous mass in the hypogastric area with no local inflammatory signs. Radiological examination was consistent with a partially calcified subcutaneous cyst in the hypogastric area. Complete surgical resection of the mass was performed with uneventful postoperative recovery. Histopathological examination of the surgical specimen demonstrated multivesicular hydatid cyst.

Microfilariae in fine needle aspirates: a report of 22 cases

The objective of the study is to document the value of fine needle aspiration cytology (FNAC) in the diagnosis of filariasis at all possible sites in both exfoliative cytologic material and fine needle aspirates. Both unguided and guided FNACs of all foci were studied over a period of two years between 1999 to 2000. Total 22 cases of filariasis were detected which included subcutaneous swellings(7), breast(3), thyroid(3), lymphnodes(3), effusions(3), cervical scrape(1), eyeball(1), sputum(1) and bronchial washing(1). In none of these cases was filariasis considered a diagnostic possibility. Cytologic smears showed eosinophils in 9 cases, oval ova and embryonated eggs in 2 cases. Microfilariae were associated with other diseases in 13 cases, including 6 cases of malignancy. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 6 of the 22 cases. In endemic areas,filariasis should be considered one of the differential diagnosis of a swelling. Thus demonstration and identification of the parasite in cytologic smears played a significant role in the prompt recognition of the disease and institution of specific treatment, thus obviating the more severe manifestations of lymphatic frilariasis.

Subcutaneous Taenia crassiceps infection in a patient with non-Hodgkin's lymphoma

Infections with larvae of Taenia crassiceps are rare in humans and have mostly affected patients with acquired immunodeficiency syndrome. We report the first case of a patient with malignancy (non-Hodgkin's lymphoma) and infection of the subcutis and muscles of the hand and forearm. Surgery and antiparasitic chemotherapy led to a complete cure.

Disseminated cysticercosis involving orbit, brain and subcutaneous tissue

Human cysticercosis is caused by dissemination of embryos of Taenia solium from the intestine via the hepatoportal system to the tissues and organs of the body. We report, probably the first case, where orbital cysticercosis was associated with multiple Cysticercus cellulosae cysts in the brain and subcutaneous tissue. Thorough screening for all the sites of involvement by the cyst is extremely useful for knowing the extent of dissemination, infection control, and for epidemiological purposes.

Subcutaneous dirofilariasis caused by Dirofilaria repens

Human dirofilariasis caused by Dirofilaria repens D. repens is a common zoonosis in the Mediterranean countries and parts of South Asia. During the last decade, it has been reported from countries previously considered non-endemic. This is likely due to the increased awareness regarding Dirofilaria infection. In some such cases however, dirofilariasis correlated with the travel of the patient to the endemic areas. We present the case of a Saudi male who had D. repens infection in the subcutaneous tissues of the forearm. The patient had traveled to Iraq, Syria, United Arab Emirates and Kuwait in the last 2 years. However, the known Dirofilaria endemic countries were not visited. Any prior occurrence of the human dirofilariasis in the Kingdom of Saudi Arabia is not documented. Lack of epidemiological studies or incidence reports in the Arabian region precludes any factual evaluation of Dirofilaria prevalence, which requires increased awareness amongst health workers regarding its potential occurrence in the native population.

[The first case of diagnosis of dirofilariasis from the microfilariae detected in the human subcutaneous tumor punctate]

The paper describes the first case of diagnosis of dirofilariasis from the microfilariae detected in the subcutaneous tumor punctate from a person who has the clinical manifestations of D. repens invasion and resides in the Saratov Region that is endemic in dirofilariasis. The fact of detection of microfilariae in the man undergone invasion is assessed not only as the first case in the lifetime diagnosis of the first case of diagnosis of subcutaneous dirofilariasis, but also as the first case of verification of that a female can achieve sexual maturity in the organism of an accidental host and its impregnation if there are even single specimens of both sexes, which is characteristic in human invasiveness. On this basis, the authors consider it wrong to refer this helminthiasis to as a group of diseases defined as "Larva migrans cutaneous" since this is inconsistent with the biology of a causative agent that accomplishes migration at the adult stage in the host's organism and does not orient a physician to establish a correct clinical and parasitological diagnosis.

A case of subcutaneous dirofilariasis of the eyelid in the South Indian state of Kerala

This report describes a case of dirofilariasis of the upper eyelid of a young female patient from Kerala. This is probably the first reported case from India in which a live dirofilarial worm was recovered from the subcutaneous tissues of the eyelid.

Perineal nodule due to enterobiasis: an aspiration cytologic diagnosis

Subcutaneous swelling due to Enterobious vermicularis infection is rare. Their presence in perineal subcutaneous tissue is unusual and a clinical curiosity. A case of subcutaneous nodule in the perineum due to E. vermicularis infection diagnosed on fine-needle aspiration is described. Tissue reaction was granulomatous with neutrophils and eosinophils. Lack of familiarity with the morphology of parasites or its eggs, degeneration, and inadequate sampling may make the diagnosis difficult. This case report provides the morphologic clues to cytopathologists toward rendering a diagnosis and alerts them to the possibility of parasitic infection in unusual locations.