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.

Genetic Identification of Spirometra erinaceieuropaei Spargana in Liaoning and Hubei Provinces, PR China

Spargana were collected from human and frogs in Liaoning and Hubei Provinces, China. PCR amplification and direct sequencing of A cox1 fragment was PCR-amplified from genomic DNA extracted from 7 specimens (5 from humans and 2 from frogs). The cox1 fragment (390 bp) showed 97–100% similarity to the reference sequence of S. erinaceieuropaei and 88–89% to the reference sequence of S. decipiens. There were 1–12 bases different between these worms, but no obvious genetic variation (0–3.3%) to the references. There was little difference of cox1 gene between sparganum samples of humans and frogs (1–3%). This study is the first report on S. erinaceieuropaei spargana from humans in Liaoning and Hubei Provinces.

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.

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.

Differential Diagnosis of Human Sparganosis Using Multiplex PCR

Human sparganosis was diagnosed by morphological and genetic analyses in Korea. The complete mitochondrial genomes of Spirometra erinaceieuropaei and S. decipiens isolated in Korea have been recorded. Present study was performed to provide information to diagnose the etiologic agent of sparganosis by multiplex PCR using mitochondrial genome sequences of S. erinaceieuropaei and S. decipiens. In an effort to examine the differential diagnosis of spirometrid tapeworms, multiplex PCR assays were performed on plerocercoid larvae of S. erinaceieuropaei and S. decipiens. The PCR products obtained using species-specific primers were positively detected in all PCR assays on mixture of S. erinaceieuropaei and S. decipiens DNA. S. erinaceieuropaei-specific bands (239 bp and 401 bp) were obtained from all PCR assays using a mixture of S. erinaceieuropaei-specific primers (Se/Sd-1800F and Se-2018R; Se/Sd-7955F and Se-8356R) and S. erinaceieuropaei template DNA. S. decipiens-specific bands (540 bp and 644 bp) were also detected in all PCR assays containing mixtures of S. decipiens-specific primers (Se/Sd-1800F and Sd-2317R; Se/Sd-7955F and Sd-8567R) and S. decipiens template DNA. Sequence analyses on these species-specific bands revealed 100% sequence identity with homologous regions of the mtDNA sequences of S. erinaceieuropaei and S. decipiens. The multiplex PCR assay was useful for differential diagnosis of human sparganosis by detecting different sizes in species-specific bands.

Identificación de larvas productoras de miasis obtenidas del cepario de la Universidad Colegio Mayor de Cundinamarca con importancia en salud pública / Identification of Myasis-producing Larvae from the Universidad Colegio Mayor de Cundinamarca

Resumen Las miasis son infestaciones parasitarias en humanos y animales causadas por estadios larvarios de moscas; son de distribución mundial y son una enfermedad frecuente en nuestro medio. En la literatura solo existen algunos casos reportados; por lo cual, su verdadera incidencia es difícil de establecer debido al sub-registro y ausencia de tipificación de larvas. Objetivo. Identificar, clasificar y caracterizar morfológicamente las larvas causantes de miasis como base para futuras aplicaciones e intervenciones en salud pública. Materiales y métodos. Se analizaron 262 larvas obtenidas del cepario de la Universidad Colegio Mayor de Cundinamarca que se encontraban almacenadas sin ningún tipo de identificación, organización e historia. Resultados. Se realizó la identificación con estereoscopio y claves dicotómicas de las familias Cuterebridae, Oestridae y Calliphoridae. Las especies encontradas son asociadas a diferentes tipos de miasis humana y animal, entre ellas; Dermatobia hominis, Dermatobia cyaniventris, Oestrus ovis, Cochliomyia hominivorax y Lucilia sp. Discusión. Las formas más comunes de este parasitismo son cavitarias y forunculares; causadas por Dermatobia hominis y Cochliomyia hominivorax, sin embargo, éstas no son de reporte obligatorio ante los servicios médicos humanos. Por lo tanto, es indispensable la información y capacitación de profesionales de la salud para la correcta conservación, identificación y reporte de las larvas extirpadas en pacientes con miasis, hasta el punto de ser considerada una práctica de rutina en el diagnóstico clínico.

Abstract Myiasis is the parasitic infestation of the body in humans and animals caused by larval stages of flies; such diseases are worldwide distributed and they are frequent in our environment. In the literature, there are only a few reports; therefore, its real incidence is difficult to be established due to sub-recorded cases and absence of larval typing. Objective. To identify, classify and morphologically characterize myasis-producing larvae of importance in public health. Material and methods. 262 larvae were analysed, obtained from the Universidad Colegio Mayor de Cundinamarca that were stored without any identification, organization and history. Results. Larvae were identified using a stereomicroscope and morphology was based on dichotomous keys of the Cuterebridae, Oestridae and Calliphoridae families. The species found are associated with different types of myiasis, including; Dermatobia hominis, D. cyaniventris, Oestrus ovis, Cochliomyia hominivorax, C. macellaria and Lucilia spp. Discussion. As a conclusion, we found that cavitary and foruncular were the most common forms of this parasitism in the collection from the Universidad Colegio Mayor de Cundinamarca. and that Dermatobia hominis and Cochliomyia hominivorax were the main involved species; however, these are not mandatory reporting species for medical services. Therefore, generating information about preservation, identification and recording of myasis-producing larvae, as well as training of professionals in public health might be considered as a routine practice for an accurate clinical diagnosis.

Sparganosis of the Unilateral Breast: A Case Report

Sparganosis is a parasitic infection caused by the sparganum, the plercercoid of the genus Spirometra. The preoperative diagnosis of breast sparganosis is difficult in most cases because it is a rare parasitic infection less than 2% of all cases. We report a 62-year-old woman case of breast sparganosis that were confirmed by surgical removal of worms from the right breast. The radiologic images of the patient also revealed characteristic features of breast sparganosis. The patient described the migrating palpable breast mass, which strongly suggested the possibility of breast sparganosis. The treatment of choice and confirmative diagnosis for sparganosis are complete surgical extraction of the sparganum irrespective of infected site. Inspection of the mass site with detailed medical history and radiological examinations are important for preoperative diagnosis of sparganosis patients.

Mass Death of Predatory Carp, Chanodichthys erythropterus, Induced by Plerocercoid Larvae of Ligula intestinalis (Cestoda: Diphyllobothriidae)

We describe here the mass death of predatory carp, Chanodichthys erythropterus, in Korea induced by plerocercoid larvae of Ligula intestinalis as a result of host manipulation. The carcasses of fish with ligulid larvae were first found in the river-edge areas of Chilgok-bo in Nakdong-gang (River), Korea at early February 2016. This ecological phenomena also occurred in the adjacent areas of 3 dams of Nakdong-gang, i.e., Gangjeong-bo, Dalseong-bo, and Hapcheon-Changnyeong-bo. Total 1,173 fish carcasses were collected from the 4 regions. To examine the cause of death, we captured 10 wondering carp in the river-edge areas of Hapcheon-Changnyeong-bo with a landing net. They were 24.0-28.5 cm in length and 147-257 g in weight, and had 2-11 plerocercoid larvae in the abdominal cavity. Their digestive organs were slender and empty, and reproductive organs were not observed at all. The plerocercoid larvae occupied almost all spaces of the abdominal cavity under the air bladders. The proportion of larvae per fish was 14.6-32.1% of body weight. The larvae were ivory-white, 21.5-63.0 cm long, and 6.0-13.8 g in weight. We suggest that the preference for the river-edge in infected fish during winter is a modified behavioral response by host manipulation of the tapeworm larvae. The life cycle of this tapeworm seems to be successfully continued as the infected fish can be easily eaten by avian definitive hosts.

Genetic Identification of Spirometra decipiens Plerocercoids in Terrestrial Snakes from Korea and China

Human sparganosis is a zoonotic disease caused by infection with larval forms (procercoid/plerocercoid) of Spirometra spp. The purpose of this study was to identify Spirometra spp. of infected snakes using a multiplex PCR assay and phylogenetic analysis of mitochondrial DNA sequence data from the spargana of terrestrial snakes obtained from Korea and China. A total of 283 snakes were obtained that included 4 species of Colubridae comprising Rhabdophis tigrinus tigrinus (n=150), Dinodon rufozonatum rufozonatum (n=64), Elaphe davidi (n=2), and Elaphe schrenkii (n=7), and 1 species of Viperidae, Agkistrodon saxatilis (n=60). The snakes were collected from the provinces of Chungbuk, Chungnam, and Gyeongbuk in Korea (n=161), and from China (n=122). The overall infection rate with spargana was 83% (235/283). The highest was recorded for D. rufozonatum rufozonatum (100%), followed by A. saxatilis (85%) and R. tigrinus tigrinus (80%), with a negative result for E. davidi (0%) and E. schrenkii (0%). The sequence identities between the spargana from snakes (n=50) and Spirometra erinaceieuropaei (KJ599680) or S. decipiens (KJ599679) control specimens were 90.8% and 99.2%, respectively. Pairwise genetic distances between spargana (n=50) and S. decipiens ranged from 0.0080 to 0.0107, while those between spargana and S. erinaceieuropaei ranged from 0.1070 to 0.1096. In this study, all of the 904 spargana analyzed were identified as S. decipiens either by a multiplex PCR assay (n=854) or mitochondrial cox1 sequence analysis (n=50).

Molecular Detection of Spirometra decipiens in the United States

The genus Spirometra belongs to the family Diphyllobothriidae and order Pseudophyllidea, and includes intestinal parasites of cats and dogs. In this study, a plerocercoid labeled as Spirometra mansonoides from the USA was examined for species identification and phylogenetic analysis using 2 complete mitochondrial genes, cytochrome c oxidase I (cox1) and NADH dehydrogenase subunit 3 (nad3). The cox1 sequences (1,566 bp) of the plerocercoid specimen (USA) showed 99.2% similarity to the reference sequences of the plerocercoid of Korean Spirometra decipiens (GenBank no. KJ599679), and 99.1% similarity in regard to nad3 (346 bp). Phylogenetic tree topologies generated using 4 analytical methods were identical and showed high confidence levels with bootstrap values of 1.00, 100%, 100%, and 100% for Bayesian inference (BI), maximum-likelihood (ML), neighbor-joining (NJ), and maximum parsimony (MP) methods, respectively. Representatives of Diphyllobothrium and Spirometra species formed a monophyletic group, and the sister-genera status between these species was well supported. Trapezoic proglottids in the posterior 1/5 region of an adult worm obtained from an experimentally infected cat were morphologically examined. The outer uterine loop of the uterus coiling characteristically consisted of 2 complete turns. The results clearly indicated that the examined Spirometra specimen from the USA matched to S. decipiens very well, and indicated possible presence of the life cycle of this species in this region.

Aspiración estereotáctica de una larva de Spirometra spp. / Stereotactic aspiration of Spirometra mansonides larvae

Brain sparganosis is a non-common parasite infection by Diphyllobothrium or Spirometra mansonoides larvae. This last one is responsible for most of the infestations in humans. We report a 19 years male patient bearer of a brain sparganosis. The patient presented with headache and left hemiparesis. CT diagnosis of right thalamic lesions was made and aspiration biopsy was performed using stereotactic system, obtaining a whole and death larvae. Histopathology confirms a CNS parasitism and it was treated initially with albendazol. ELISA test confirmed Spirometra spp. infestation. The patient developed asymptomatic with total remission of the lesions. It constitutes the second report in Cuba of brain sparganosis.

Se presenta el caso clínico de un varón con 19 años de edad y el diagnóstico de una esparganosis cerebral. Consultó por cefalea y una hemiparesia izquierda. En una tomografía computarizada cerebral con contraste se observaron lesiones talámicas derechas. Se realizó una biopsia cerebral guiada por estereotaxia con aspiración completa de un verme. En el estudio histopatológico se planteó un probable parasitismo de SNC y fue tratado inicialmente con albendazol. Se confirmó la infección por Spirometra spp. por test de ELISA. Evolucionó con regresión de síntomas y remisión imagenológica de las lesiones. Este caso constituye el segundo reporte en Cuba de una infestación cerebral por este parásito y aspiración estereotáctica de la larva de Spirometra spp.

Infestación ocular por plerocercoide de Spirometra mansonoides: primer reporte en el Perú / Ocular infestation by plerocercoid of Spirometra mansonoides: first case report in Perú

La plerocercoidiosis es una zoonosis parasitaria producida por la larva plerocercoide de Spirometra. Esta larva migra por el tejido de la pared intestinal, mediante la ruta subcutánea y puede llegar a diferentes áreas del cuerpo humano como la cabeza, el cerebro y la órbita ocular. Se reporta el caso de un varón de 45 años procedente de la Amazonía peruana, quien presentó ardor asociado con edema y hemorragia conjuntival en el borde ocular externo del ojo derecho, durante once meses. Se observó un helminto localizado en la cavidad orbitaria derecha, el cual se extrajo y por estudios morfológicos e histopatológicos se identificó como Spirometra mansonoides de localización ocular el que se reporta por primera vez en el Perú.

Plerocercoidosis is a parasitic zoonosis caused by plerocercoid larvae of the genus Spirometra. The larvae migrate through the intestinal wall tissue, by subcutaneous route and can reach different areas of the body like the head, the brain and the eye socket. A case is reported of a 45 year-old man from the Peruvian Amazon with burning sensation associated with conjunctival edema and hemorrhage in the outer eye border of the right eye for eleven months. A localized worm in the right orbital cavity was observed, which was extracted. Morphological and histopathological studies identified it as Spirometra mansonoides localized in the eye, which is the first case reported in Perú.

Usefulness of Ultrasonography in the Diagnosis of Sparganosis: A Case Report / 대한피부과학회지

Sparganosis is a kind of parasitic skin disease caused by sparganum, the plerocercoid larvae of the taper worm of the genus Spirometra. Sparganosis usually manifests as migrating or fixed subcutaneous nodules; therefore, it should be differentiated from lipoma, cysts, and cutaneous malignancies. Although the final diagnosis of sparganosis in humans depends on the identification of the worm in an infected tissue, suspicion for the presence of the parasite and careful history taking are important before making the diagnosis. However, it might be difficult for a clinician to suspect the existence of sparganosis because the incidence of this disease is extremely low. Therefore, an effective method for differentiating sparganosis from other skin disorders is needed. We suggest that ultrasonography could be an answer to this problem, on the basis of our experience of a case of cutaneous sparganosis in a 65-year-old woman showing very characteristic ultrasonographic findings.

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.

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

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 by Ingestion of Undercooked Snakes That Mimicked Peritoneal Carcinomatosis / 대한내과학회지

Sparganosis is a zoonosis caused by sparganum. Humans can be exposed to sparganum by ingesting undercooked snakes or drinking infected copepods harboring sparganum. Sparganosis commonly manifests as migrating subcutaneous masses and may involve multiple organ systems such as the musculoskeletal system, central nervous system, the eyes, and the genitourinary system. We report here a case of laparoscopically confirmed sparganosis caused by ingestion of undercooked snakes. The sparganosis involved the liver and peritoneum and was initially difficult to differentiate from peritoneal carcinomatosis.