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Xiang H, Wang J, Tan D, Xiong Y, Huang P, Shen Y, Xu Y, Gong Z, Hu F, Xu C, Wu J, Liu W, Liu J, Wan H, Hong D, Xie H. The serum IgG antibody level as a biomarker for clinical outcome in patients with cerebral sparganosis after treatment. Front Immunol 2023; 14:1158635. [PMID: 37051247 PMCID: PMC10083495 DOI: 10.3389/fimmu.2023.1158635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionCerebral sparganosis is a rare parasitic infection of the brain tissue. The remission of MRI change and clinical symptom has been used to evaluate the therapeutic effect. However, there is no study to correlate the serum IgG antibody level of sparganum to the prognosis of disease after treatment. Methods87 patients with cerebral sparganosis were collected from three medical centers. Clinical symptoms and MRI changes were evaluated at 12 months after initial treatment, and serum IgG antibody level of sparganum was evaluated at 2, 6, and 12 months after treatment. The positive cut-off value was based on 2.1 times the optical density (OD) of negative control. The index value was defined as the sample OD divided by the cut-off value.ResultsAmong the 87 patients after treatment, 71 patients had good clinical outcomes, and 16 had poor clinical outcomes. The area under the curve (AUC) showed that the index value measured at 12 months after treatment had the best prediction effect, with a value of 2.014. In the good-outcome group, the index values were less than 2.014 in all 71 patients, and only 8 patients had mildly enhanced residual lesions on MRI. In the poor-outcome group, the index values were more than 2.014 in all 16 patients, and all patients still showed significantly enhanced lesions on MRI. Compared with poor-outcome patients, only 2 patients with good outcomes had disease recurrence after treatment.DiscussionThis study provided evidence that the serum IgG antibody level of sparganum was a promising biomarker to evaluate the prognosis of patients with cerebral sparganosis after treatment.
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Affiliation(s)
- Haijie Xiang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jie Wang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dandan Tan
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ying Xiong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pengcheng Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Xu
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Zhihong Gong
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Fei Hu
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Chunhua Xu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jie Wu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Wei Liu
- Department of Outpatient, The Nanchang City First Hospital, Nanchang, China
| | - Junpu Liu
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Hui Wan
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Daojun Hong, ; Huiqun Xie,
| | - Huiqun Xie
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
- *Correspondence: Daojun Hong, ; Huiqun Xie,
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Idro R, Ogwang R, Barragan A, Raimondo JV, Masocha W. Neuroimmunology of Common Parasitic Infections in Africa. Front Immunol 2022; 13:791488. [PMID: 35222377 PMCID: PMC8866860 DOI: 10.3389/fimmu.2022.791488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Parasitic infections of the central nervous system are an important cause of morbidity and mortality in Africa. The neurological, cognitive, and psychiatric sequelae of these infections result from a complex interplay between the parasites and the host inflammatory response. Here we review some of the diseases caused by selected parasitic organisms known to infect the nervous system including Plasmodium falciparum, Toxoplasma gondii, Trypanosoma brucei spp., and Taenia solium species. For each parasite, we describe the geographical distribution, prevalence, life cycle, and typical clinical symptoms of infection and pathogenesis. We pay particular attention to how the parasites infect the brain and the interaction between each organism and the host immune system. We describe how an understanding of these processes may guide optimal diagnostic and therapeutic strategies to treat these disorders. Finally, we highlight current gaps in our understanding of disease pathophysiology and call for increased interrogation of these often-neglected disorders of the nervous system.
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Affiliation(s)
- Richard Idro
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Rodney Ogwang
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Antonio Barragan
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Joseph Valentino Raimondo
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willias Masocha
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
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3
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Hu J, Liao K, Feng X, Jiang D, Liu H, Zheng Q, Qiu H, Hua F, Xu G, Xu C. Surgical treatment of a patient with live intracranial sparganosis for 17 years. BMC Infect Dis 2022; 22:353. [PMID: 35397512 PMCID: PMC8994396 DOI: 10.1186/s12879-022-07293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of sparganosis, especially intracranial live sparganosis is very low in China. Due to the lack of typical clinical manifestations, it is difficult to make a clear preoperative diagnosis of the disease, which often leads to delays the disease and serious consequences. Case presentation A 23-year-old man presented with a 17-year history of intermittent seizures and right extremity numbness and weakness. Magnetic resonance imaging (MRI) showed patchy, nodular and line-like enhancement. Enzyme-linked immunosorbent assay (ELISA) detected positive antibodies to Spirometra mansoni in peripheral blood and cerebrospinal fluid (CSF). In addition, during the operation, an ivory-colored live sparganosis was removed under the precise positioning of neuronavigation, and the patient was diagnosed with cerebral sparganosis. The patient began praziquantel and sodium valproate treatment after the operation, and was followed up for 3 months. There was no recurrence of epilepsy, and the weakness and numbness of the right limb improved. Conclusion Nonspecific clinical manifestations often make the diagnosis of cerebral sparganosis difficult, and a comprehensive diagnosis should be made based on epidemiological history, clinical manifestations, ELISA results and imaging findings. Surgery is the preferred method for the treatment of cerebral sparganosis, and more satisfactory results can be achieved under the precise positioning of neuronavigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07293-7.
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Chen Y, Chen X, Kang H. Case Report: Moving Tumor-Like Foci Behind Refractory Epilepsy-Cerebral Sparganosis Successfully Treated by Surgery After Failure of Praziquantel Treatment. Front Neurol 2022; 13:838849. [PMID: 35222259 PMCID: PMC8866191 DOI: 10.3389/fneur.2022.838849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
Abstract
Cerebral sparganosis is clinically non-specific and easily misdiagnosed, exposing patients to the risk of severe brain damage and neurological dysfunction caused by actively migrating larvae. Diagnostic biomarkers from typical cases can help to establish an early diagnosis and proper treatment. We present a 25-year-old woman who suffered from 9 years of refractory epilepsy and was misdiagnosed with glioma and subjected to surgery. The postoperative pathology confirmed granuloma, and the tumor-like foci reappeared 3 months later. Along with the “tunnel sign” on MRI, cerebral sparganosis was suspected and confirmed by positive serum and cerebrospinal fluid antibodies against Spirometra mansoni. The patient visited us after a failure of four cycles of praziquantel treatment, recurrent seizures and hemiplegia with basal ganglia foci. Craniotomy was not carried out until the larva moved to the superficial lobe on follow-up MRIs, and pathology revealed sparganosis granuloma. The patient became seizure-free and recovered myodynamia but had long-lasting cognitive dysfunction due to severe brain damage. This case indicated the importance of tunnel signs and moving tumor-like foci on MRI as diagnostic clues of cerebral sparganosis. An early diagnosis is vitally important to avoid severe neural dysfunction by the long-living and moving larvae. Surgical removal of the larva is a critical remedy for cases failed by praziquantel treatment.
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Affiliation(s)
- Yusi Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huicong Kang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Huicong Kang
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5
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Liu C, Chen Z, Shaban UT, Wang M, Zhou G, Wang N, Liu Y. Misdiagnosis of cerebral sparganosis co- existing with HIV/AIDS: a case report. Int J Infect Dis 2022; 117:264-266. [PMID: 35151855 DOI: 10.1016/j.ijid.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022] Open
Abstract
Sparganosis, especially cerebral sparganosis is a rare co-morbidity of HIV/AIDS. Due to nonspecific symptoms of sparganosis, diagnosis and treatment are challenging with a very high rate of misdiagnosis. This paper summarizes the clinical data of the case cerebral sparganosis in an HIV/AIDS patient. It provides a reference for the treatment of HIV/AIDS coexisting with parasitic encephalopathy (cerebral sparganosis). Cerebral sparganosis has been reported worldwide, especially in Asian countries. To our knowledge, this is the first case report of cerebral sparganosis associated with HIV/AIDS.
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Affiliation(s)
- Chun Liu
- Changsha, Hunan, People's Republic of China.the first hospital of changsha
| | - Zhong Chen
- Changsha, Hunan, People's Republic of China.the first hospital of changsha.
| | - Ummulbanin T Shaban
- Changsha, Hunan, People's Republic of China.central south university, xiangya school of public health
| | - Min Wang
- Changsha, Hunan, People's Republic of China.the first hospital of changsha
| | - Guoqiang Zhou
- Changsha, Hunan, People's Republic of China.the first hospital of changsha
| | - Ning Wang
- Changsha, Hunan, People's Republic of China.the first hospital of changsha
| | - Yan Liu
- Changsha, Hunan, People's Republic of China.the first hospital of changsha
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Feng L, Jiao X, Zeng C, Zhao CW, Li R, Zhang L, Yang Z, Liao W, Liu D, Xiao B, Yang Z. Migration characteristics as a prognostic factor in cerebral sparganosis. Int J Infect Dis 2022; 117:28-36. [PMID: 35017108 DOI: 10.1016/j.ijid.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To differentiate diagnostic and prognostic factors from the clinical material of patients with cerebral sparganosis in central South China. METHODS Consecutive patients with cerebral sparganosis from our hospital between 2010 and 2018 were retrospectively enrolled. The clinical manifestations, radiographic features, treatment, and outcomes of these patients were analyzed. RESULTS Thirty patients with cerebral sparganosis were included, and foci migration on magnetic resonance imaging was detected in 22 patients, from whom we observed 4 migration modes: interlobar migration (50.0%, 11/22); transmidline migration (27.3%, 6/22); transventricular migration (13.6%, 3/22); and cerebellum-brainstem migration (9.1%, 2/22). The percentage of good outcomes was higher in patients with live worm capture than in those without live worm capture (75.0%, 12/16 vs 33.3%, 2/6). Exposure to preoperative antiparasitic medication was associated with worm migration toward the cortical surface, which led to a higher probability of live worm capture. CONCLUSIONS We propose 4 modes of sparganosis migration that are correlated with worm capture and neurologic prognosis. We found that exposure to antiparasitic medication was associated with worm migration toward the cortical surface, leading to a higher probability of live worm capture. These observations suggest a novel significance for preoperative medication of cerebral sparganosis.
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Affiliation(s)
- Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xiao Jiao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Chang Zeng
- Health Management Center, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Charlie W Zhao
- Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, USA, 06520
| | - Rong Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Leiyao Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
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7
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Lu Y, Sun JH, Lu LL, Chen JX, Song P, Ai L, Cai YC, Li LH, Chen SH. Proteomic and Immunological Identification of Diagnostic Antigens from Spirometra erinaceieuropaei Plerocercoid. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:615-623. [PMID: 34974668 PMCID: PMC8721309 DOI: 10.3347/kjp.2021.59.6.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/27/2021] [Indexed: 11/23/2022]
Abstract
Human sparganosis is a food-borne parasitic disease caused by the plerocercoids of Spirometra species. Clinical diagnosis of sparganosis is crucial for effective treatment, thus it is important to identify sensitive and specific antigens of plerocercoids. The aim of the current study was to identify and characterize the immunogenic proteins of Spirometra erinaceieuropaei plerocercoids that were recognized by patient sera. Crude soluble extract of the plerocercoids were separated using 2-dimensional gel electrophoresis coupled with immunoblot and mass spectrometry analysis. Based on immunoblotting patterns and mass spectrometry results, 8 antigenic proteins were identified from the plerocercoid. Among the proteins, cysteine protease protein might be developed as an antigen for diagnosis of sparganosis.
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Affiliation(s)
- Yan Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); WHO Collaborating Center for Tropical Diseases; NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention); National Center for International Research on Tropical Diseases; Shanghai,
P. R. China
| | - Jia-Hui Sun
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); WHO Collaborating Center for Tropical Diseases; NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention); National Center for International Research on Tropical Diseases; Shanghai,
P. R. China
| | - Li-Li Lu
- The Third Hospital of Shijiazhuang City, Shijiazhuang,
P. R. China
| | - Jia-Xu Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); WHO Collaborating Center for Tropical Diseases; NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention); National Center for International Research on Tropical Diseases; Shanghai,
P. R. China
| | - Peng Song
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); WHO Collaborating Center for Tropical Diseases; NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention); National Center for International Research on Tropical Diseases; Shanghai,
P. R. China
| | - Lin Ai
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); WHO Collaborating Center for Tropical Diseases; NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention); National Center for International Research on Tropical Diseases; Shanghai,
P. R. China
| | - Yu-Chun Cai
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); WHO Collaborating Center for Tropical Diseases; NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention); National Center for International Research on Tropical Diseases; Shanghai,
P. R. China
| | - Lan-Hua Li
- School of Public Health, Weifang Medical University, Weifang,
P. R. China
| | - Shao-Hong Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); WHO Collaborating Center for Tropical Diseases; NHC Key Laboratory of Parasite and Vector Biology (National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention); National Center for International Research on Tropical Diseases; Shanghai,
P. R. China
- Corresponding author ()
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Lesionectomy for cerebral sparganosis and concomitant epilepsy: A case series of 15 patients. Epilepsy Res 2021; 176:106747. [PMID: 34455177 DOI: 10.1016/j.eplepsyres.2021.106747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/12/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report the clinical characteristics and surgical outcomes of patients with cerebral sparganosis and concomitant epilepsy. METHODS We retrospectively collected the clinical data of all patients with cerebral sparganosis and concomitant epilepsy who underwent lesionectomy as treatment at Xiangya Hospital, Central South University between January 2015 and August 2019. Seizure outcomes were evaluated according to the International League Against Epilepsy (ILAE) classification. ILAE classes 1 and 2 were defined as favorable seizure outcomes, whereas ILAE classes 3-6 were defined as unfavorable seizure outcomes. RESULTS Fifteen patients with cerebral sparganosis and concomitant epilepsy who underwent lesionectomy as treatment met the inclusion criteria. Live worms were surgical removed in 80 % of patients. With a mean follow-up of 2.4 ± 1.1 years, 66.7 % of patients demonstrated favorable seizure outcomes, with improvement of symptoms other than seizures. Longer seizure duration associated with unfavorable seizure outcomes. CONCLUSIONS Lesionectomy is an effective treatment for patients with cerebral sparganosis and concomitant epilepsy. Early surgical treatment may offer more benefits to such patients.
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9
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Hwang YH, Son W, Kim YW, Kang DH, Chang HH, Goo YK, Hong Y, Chung DI. A Retrieved Sparganum of Spirometra erinaceieuropaei from a Korean Man during Mechanical Thrombectomy. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:309-313. [PMID: 32615744 PMCID: PMC7338899 DOI: 10.3347/kjp.2020.58.3.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/05/2020] [Indexed: 11/23/2022]
Abstract
Human sparganosis is a zoonotic disease caused by infection and migration of the plerocercoid of Spirometra spp. Although sparganosis were reported from most parts of the body, the sparganum parasitizing inside cerebral artery is remarkably uncommon. We report a case of cerebral intravascular sparganosis in an elderly patient with acute ischemic stroke who was diagnosed by retrieving sparganum during mechanical thrombectomy. Finally, the parasites were identified as Spirometra erinaceieuropaei using multiplex PCR and cox1 gene sequencing.
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Affiliation(s)
- Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Wonsoo Son
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea.,Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Yong-Won Kim
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea.,Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea.,Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Youn-Kyoung Goo
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Yeonchul Hong
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Dong-Il Chung
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
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10
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Zhu Y, Ye L, Ding X, Wu J, Chen Y. Cerebral sparganosis presenting with atypical postcontrast magnetic resonance imaging findings: a case report and literature review. BMC Infect Dis 2019; 19:748. [PMID: 31455261 PMCID: PMC6712767 DOI: 10.1186/s12879-019-4396-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022] Open
Abstract
Background Sparganosis, a rare and severe parasitic infection caused by the larvae of Spirometra species or simply sparganum, generally involves subcutaneous tissue or muscle. But occasionally, sparganum can also invade the human brain, resulting in cerebral sparganosis. Case presentation A 33-year-old woman presented with a 10-day history of headache. Postcontrast magnetic resonance imaging (MRI) revealed an irregular lesion with enhancement and the tunnel-shaped focus extending to the contralateral hemiphere. Cerebrospinal fluid (CSF) analysis disclosed pleocytosis (166 cells/μL) and an elevated protein concentration (0.742 g/L). Enzyme-linked immunosorbent assay (ELISA) revealed positive sparganum-specific antibody in both blood and CSF. Finally, the diagnosis of cerebral sparganosis was comfirmed. She received praziquantel treatment and got a favorable outcome during six-month follow-up. Conclusions Irregular enhancement and the tunnel sign that extends to the contralateral hemisphere on postconstrast MRI are unusual presentations of cerebral sparganosis. ELISA for sparganum-specific antibody can help confirm the diagnosis. Although surgery is the preferred treatment for cerebral sparganosis, praziquantel might also achieve satisfying outcomes.
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Affiliation(s)
- Yueli Zhu
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingqi Ye
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiansan Ding
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jimin Wu
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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11
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Angwafor SA, Bell GS, Njamnshi AK, Singh G, Sander JW. Parasites and epilepsy: Understanding the determinants of epileptogenesis. Epilepsy Behav 2019; 92:235-244. [PMID: 30711777 DOI: 10.1016/j.yebeh.2018.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
There is a large body of evidence suggesting that parasites could be a major preventable risk factor for epilepsy in low- and middle-income countries. We review potentially important substrates for epileptogenesis in parasitic diseases. Taenia solium is the most widely known parasite associated with epilepsy, and the risk seems determined mainly by the extent of cortical involvement and the evolution of the primary cortical lesion to gliosis or to a calcified granuloma. For most parasites, however, epileptogenesis is more complex, and other favorable host genetic factors and parasite-specific characteristics may be critical. In situations where cortical involvement by the parasite is either absent or minimal, parasite-induced epileptogenesis through an autoimmune process seems plausible. Further research to identify important markers of epileptogenesis in parasitic diseases will have huge implications for the development of trials to halt or delay onset of epilepsy.
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Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé 1, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Gagandeep Singh
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), the Netherlands.
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Follow-up study of high-dose praziquantel therapy for cerebral sparganosis. PLoS Negl Trop Dis 2019; 13:e0007018. [PMID: 30640909 PMCID: PMC6331082 DOI: 10.1371/journal.pntd.0007018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/22/2018] [Indexed: 11/20/2022] Open
Abstract
Background Cerebral sparganosis is the most serious complication of human sparganosis. Currently, there is no standard for the treatment of inoperable patients. Conventional-dose praziquantel therapy is the most reported treatment. However, the therapeutic outcomes are not very effective. High-dose praziquantel therapy is a useful therapeutic choice for many parasitic diseases that is well tolerated by patients, but it has not been sufficiently evaluated for cerebral sparganosis. This study aims to observe the prognoses following high-dose praziquantel therapy in inoperable patients and the roles of MRI and peripheral eosinophil absolute counts during follow-up. Methodology Baseline and follow-up epidemiological, clinical, radiological and therapeutic data related to 10 inoperable patients with cerebral sparganosis that were treated with repeated courses of high-dose praziquantel therapy, with each course consisting of 25 mg/kg thrice daily for 10 days were assessed, followed by analyses of the prognoses, MRI findings and peripheral eosinophil absolute counts. Principal findings Baseline clinical data: the clinical symptoms recorded included seizures, hemiparesis, headache, vomiting and altered mental status. Peripheral blood eosinophilia was found in 3 patients. The baseline radiological findings were as follows. Motile lesions were observed in 10 patients, including aggregated ring-like enhancements, tunnel signs, serpiginous and irregular enhancements. Nine of the 10 patients had varying degrees of white matter degeneration, cortical atrophy and ipsilateral ventricle dilation. The follow-up clinical data were as follows. Clinical symptom relief was found in 8 patients, symptoms were eliminated in 1 patient, and symptoms showed no change from baseline in 1 patient. Peripheral blood eosinophilia was found in 2 patients. The follow-up radiological findings were as follows. Motile lesions that were transformed into stable, chronic lesions were found in 8 patients, and motile lesions that were eliminated completely were found in 2 patients. Conclusions High-dose praziquantel therapy for cerebral sparganosis is effective. The radiological outcomes of motile lesions are an important indicator during the treatment process, especially during follow-ups after clinical symptoms have improved. Peripheral eosinophil absolute counts cannot be used as an effective prognostic indicator. Sparganosis is a rare parasitic disease with a high prevalence in East Asia. Because of limited radiological technology and clinical experience, the prevalence of cerebral sparganosis is likely underestimated in developing countries. Cerebral sparganosis is the most serious complication of human sparganosis. Currently, it is generally believed that the most effective treatment for cerebral sparganosis is surgical treatment. However, the choice of treatment is a challenge for inoperable patients, including those with multifocal lesions or lesions in deep structures or important functional areas and those refusing invasive treatment due to personal willingness. Currently, there is no standard for the treatment of inoperable patients. In addition, anthelmintic treatment for sparganosis has rarely been reported in the literature. High-dose praziquantel therapy is a useful therapeutic choice for many cerebral parasitic diseases, including neurocysticercosis, and is well tolerated for patients, but it has not been sufficiently evaluated for the treatment of cerebral sparganosis. This study aims to describe the clinical, radiological and therapeutic data following high-dose praziquantel therapy for ten inoperable patients. All patients reached clinical cure after one to five courses. These results suggest that high-dose praziquantel therapy for cerebral sparganosis could achieve favorable outcomes and that MRI plays an important role in follow-up, especially when clinical symptoms have improved.
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Efficacy comparison between long-term high-dose praziquantel and surgical therapy for cerebral sparganosis: A multicenter retrospective cohort study. PLoS Negl Trop Dis 2018; 12:e0006918. [PMID: 30346956 PMCID: PMC6211769 DOI: 10.1371/journal.pntd.0006918] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/01/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background Sparganosis is a parasitic infection caused by the plerocercoid larvae of Spirometra mansoni in East and Southeast Asia. The plerocercoid larvae sometimes invade the encephalon, resulting in severe cerebral sparganosis. Surgical removal of the larvae is considered a standard therapy for cerebral sparganosis. In contrast, the efficacy and safety of long-term, high-dose praziquantel treatment for cerebral sparganosis have not been explored. Methodology/Principal findings In this multicenter retrospective study, we assessed the records of 96 patients with cerebral sparganosis who consulted at three medical centers from 2013 to 2017. Forty-two patients underwent surgical lesion removal, and the other 54 patients received long-term, high-dose praziquantel (50 mg/kg/day for 10 days, repeated at monthly intervals). The primary outcome was the complete disappearance of active lesions on cerebral magnetic resonance imaging. The secondary outcomes included the modified Rankin scale score at 90 days, incidence of seizure, eosinophil count, and serological Spirometra. mansoni antibody titer. The efficacy of praziquantel treatment was similar to that of surgical lesion removal for cerebral sparganosis with respect to both the primary outcome and secondary outcomes. Although binary logistic regression models also supported the primary outcome after adjustment for age, sex, lesion location, and loss to follow-up, some unavoidable confounders might have biased the statistical power. No significant clinical complications or laboratory side effects occurred in the praziquantel group with the exception of a relatively benign allergic reaction. Conclusions/Significance In this small-sample, nonrandomized, retrospective exploratory study, some patients with cerebral sparganosis were responsive to long-term, high-dose praziquantel with an efficacy similar to that of surgical lesion removal. These findings increase the treatment flexibility for this serious infection. Sparganosis is most prevalent in developing countries in East and Southeast Asia, probably because public health strategies have not prioritized its prevention. The plerocercoid larvae of Spirometra mansoni sometimes invade the brain parenchyma, resulting in cerebral sparganosis. In general, surgical removal of the larvae is considered a standard therapy for cerebral sparganosis. One alternative treatment for sparganosis is short-term, low-dose praziquantel, which has had limited success. However, the efficacy and safety of long-term, high-dose praziquantel treatment for cerebral sparganosis have not been explored. In this study, we evaluated the effectiveness of long-term, high-dose praziquantel for treatment of cerebral sparganosis in China. We conducted a retrospective exploratory study using routinely recorded data from 96 patients at three medical centers. Forty-two patients underwent surgical lesion removal, and the other 54 patients received long-term, high-dose praziquantel. Treatment of cerebral sparganosis by long-term, high-dose praziquantel showed an efficacy similar to that of surgical lesion removal with respect to the primary outcome (complete disappearance of the active lesions on cerebral magnetic resonance imaging). However, this was a small-sample, nonrandomized retrospective study, and the results should be further confirmed by a large-sample prospective study or other studies.
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Peh WM, Hean GG, Clement YHR. The Tunnel Sign Revisited: A Novel Observation of Cerebral Melioidosis Mimicking Sparganosis. J Radiol Case Rep 2018; 12:1-11. [PMID: 30651915 PMCID: PMC6312124 DOI: 10.3941/jrcr.v12i8.3441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
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.
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Affiliation(s)
- Wee Ming Peh
- Department of Diagnostic Imaging, National University Hospital, Singapore
- Department of Nuclear Medicine & Molecular Imaging, Singapore General Hospital, Singapore
| | - Goh Giap Hean
- Department of Pathology, National University of Singapore, Singapore
| | - Yong Hsiang Rong Clement
- Department of Diagnostic Imaging, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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15
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The Brief Case: Central Nervous System Sparganosis in a 53-Year-Old Thai Man. J Clin Microbiol 2018; 55:352-355. [PMID: 28122993 DOI: 10.1128/jcm.01328-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cui J, Wang Y, Zhang X, Lin XM, Zhang HW, Wang ZQ, Chen JX. A neglected risk for sparganosis: eating live tadpoles in central China. Infect Dis Poverty 2017; 6:58. [PMID: 28468685 PMCID: PMC5415782 DOI: 10.1186/s40249-017-0265-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/17/2017] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Jing Cui
- Department of Parasitology, Medical College, Zhengzhou University, Zhengzhou, China
| | - Ye Wang
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Xi Zhang
- Department of Parasitology, Medical College, Zhengzhou University, Zhengzhou, China
| | - Xi-Meng Lin
- Institute of Parasitic Diseases, Center for Disease Prevention and Control of Henan Province, Zhengzhou, China
| | - Hong-Wei Zhang
- Institute of Parasitic Diseases, Center for Disease Prevention and Control of Henan Province, Zhengzhou, China
| | - Zhong-Quan Wang
- Department of Parasitology, Medical College, Zhengzhou University, Zhengzhou, China.
| | - Jia-Xu Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China.
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Abstract
Human sparganosis is a parasite infection caused by the larva of a tapeworm of the genus Spirometra. Ocular, central nervous system, auricular, pulmonary, intraosseous, intraperitoneal, and subcutaneous manifestations of this infection in the neck or inguinal region have been described.The authors report the rare occurrence of cutaneous forehead sparganosis of a 19-year-old male who presented with a soft subcutaneous mass in the forehead, along with a related literature review.
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Liao H, Li D, Zhou B, Liu J, Li Y, Liu H, Wu Y, Zhu X, Tan C. Imaging characteristics of cerebral sparganosis with live worms. J Neuroradiol 2016; 43:378-383. [DOI: 10.1016/j.neurad.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 10/20/2022]
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Cerebral Sparganosis in Children: Epidemiologic and Radiologic Characteristics and Treatment Outcomes: A Report of 9 Cases. World Neurosurg 2016; 89:153-8. [DOI: 10.1016/j.wneu.2016.01.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 11/19/2022]
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Abstract
In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes.
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Affiliation(s)
- Elise M O'Connell
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Building 4, Room B105, Bethesda, MD 20892, USA.
| | - Thomas B Nutman
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Building 4, Room B105, Bethesda, MD 20892, USA
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Liu Q, Li MW, Wang ZD, Zhao GH, Zhu XQ. Human sparganosis, a neglected food borne zoonosis. THE LANCET. INFECTIOUS DISEASES 2015; 15:1226-1235. [PMID: 26364132 DOI: 10.1016/s1473-3099(15)00133-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/26/2015] [Accepted: 06/08/2015] [Indexed: 12/19/2022]
Abstract
Human sparganosis is a food borne zoonosis caused by the plerocercoid larvae (spargana) of various diphyllobothroid tapeworms of the genus Spirometra. Human infections are acquired by ingesting the raw or undercooked meat of snakes or frogs, drinking untreated water, or using raw flesh in traditional poultices. More than 1600 cases of sparganosis have been documented worldwide, mostly in east and southeast Asia. Sporadic cases have been reported in South America, Europe, and Africa, and several cases have been described in travellers returning from endemic regions. Epidemiological data suggest that the increased effect of sparganosis on human health is because of greater consumption of raw meat of freshwater frogs and snakes. This Review provides information about the Spirometra parasites and their lifecycles, summarises clinical features, diagnosis, and treatment of human sparganosis, and describes geographical distribution and infection characteristics of Spirometra parasites in host animals.
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Affiliation(s)
- Quan Liu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, China; Military Veterinary Institute, Academy of Military Medical Sciences, Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun, Jilin Province, China
| | - Ming-Wei Li
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, China; Department of Veterinary Medicine, Agricultural College, Guangdong Ocean University, Huguangyan, Zhanjiang, Guangdong Province, China
| | - Ze-Dong Wang
- Military Veterinary Institute, Academy of Military Medical Sciences, Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun, Jilin Province, China
| | - Guang-Hui Zhao
- College of Veterinary Medicine, Northwest A & F University, Yangling, Shaanxi Province, China
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, China.
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Lo Presti A, Aguirre DT, De Andrés P, Daoud L, Fortes J, Muñiz J. Cerebral sparganosis: case report and review of the European cases. Acta Neurochir (Wien) 2015; 157:1339-43; discussion 1343. [PMID: 26085111 DOI: 10.1007/s00701-015-2466-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
Sparganosis is a severe parasitic infection caused by the larvae of Spirometra mansoni, also called "sparganum." In human hosts, the Spirometra mansoni larva commonly targets the subcutaneous tissue or muscle. Sometimes it can also migrate into the brain, resulting in cerebral sparganosis, mainly characterized by focal neurological symptoms such as seizures and radiological "wandering lesions" on magnetic resonance images (MRIs). Clinical cases of cerebral sparganosis have been reported worldwide, mainly in Asian countries, but also in North America, South America and Australia. Only two cases have been previously reported in Europe. A 29-year-old male from Bolivia, who lived in Spain, presented to our service for seizures and a multicystic brain lesion, initially suspected to be a dysembryoplastic neuroepithelial tumor (DNET). He underwent gross total resection of the mixed solid/cystic lesion. Pathology revealed gliosis, multiple interconnected cystic cavities with fibrous walls, inflammatory cell infiltration and no necrotizing granulomatous reaction. Inside the cavities, a parasitic form was identified as the larva of the cestode Spirometra mansoni. At 1-year follow-up, the patient had no deficits and was seizure free. Clinicians should be alerted to the possible existence of this rare entity in Europe, especially in patients from endemic areas with a possible infection history as well as "wandering lesions" on the MRI.
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Zhao YM, Zhang HC, Li ZR, Zhang HY. Scrotal sparganosis mimicking scrotal teratoma in an infant: a case report and literature review. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:545-9. [PMID: 25352706 PMCID: PMC4210740 DOI: 10.3347/kjp.2014.52.5.545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 07/05/2014] [Accepted: 08/03/2014] [Indexed: 12/05/2022]
Abstract
Sparganosis is an infection with a parasitic tapeworm larva that occurs by eating infected foods or drinking contaminated water. The larvae can migrate to a tissue or muscle in the chest, abdominal wall, extremities, eyes, brain, urinary tract, pleura, pericardium, spinal canal, or scrotum. Herein, we report a 5-month old infant with scrotal sparganosis who was initially suspected to have a scrotal inflammatory mass with a history of applying raw frog meat into the umbilicus. Preoperative ultrasound examinations and computed tomography (CT) scanning misdiagnosed the mass as a scrotal teratoma. The scrotal mass was surgically removed, and the histopathology proved it to be scrotal sparganosis. This case displays the youngest patient ever reported with scrotal sparganosis, and the first description of CT characteristics of scrotal sparganosis. A detailed medical history is necessary for patients with scrotal masses suspected of sparganosis. In addition, ultrasound and CT examinations are helpful to rule out other causes of a scrotal mass.
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Affiliation(s)
- Yi-Ming Zhao
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
| | - Hao-Chuan Zhang
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
| | - Zhong-Rong Li
- Department of Pediatric Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
| | - Hai-Yan Zhang
- Department of Pathology, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Zhejiang 325027, China
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Cheng KB, Gao BL, Liu JM, Xu JF. Pulmonary sparganosis mansoni: a case report from a non-endemic region. J Thorac Dis 2014; 6:E120-4. [PMID: 24977019 DOI: 10.3978/j.issn.2072-1439.2014.06.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/10/2014] [Indexed: 11/14/2022]
Abstract
Sparganosis mansoni is a parasitic disease caused by the larva of Spirometra mansoni. It occurs worldwide, but only a few patients show pulmonary involvement. Here, we present a case of pulmonary sparganosis mansoni in a non-endemic region. A 32-year-old Chinese woman presented with intermittent bloody phlegm, peripheral blood eosinophilia, and migratory patch shadows in both lungs. She had been misdiagnosed with eosinophilic pneumonia. She had a history of eating raw frogs, and the sparganum mansoni antibody was positive in both her blood and bronchoalveolar lavage fluid. Several sparganum mansoni were found in a frog sample that the patient provided. Consequently, she was diagnosed with pulmonary sparganosis mansoni. After two oral courses of praziquantel were administered, her symptoms and radiological lesions improved significantly. To our knowledge, this is the first case of pulmonary sparganosis mansoni occuring in Shanghai. Oral praziquantel is effective for the treatment of sparganosis mansoni, although its course of therapy may need to be repeated.
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Affiliation(s)
- Ke-Bin Cheng
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Bei-Lan Gao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jin-Ming Liu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jin-Fu Xu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Kim JI, Kim TW, Hong SM, Moon TY, Lee IS, Choi KU, Yu HS. Intramuscular sparganosis in the gastrocnemius muscle: a case report. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:69-73. [PMID: 24623885 PMCID: PMC3948997 DOI: 10.3347/kjp.2014.52.1.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/29/2013] [Accepted: 11/04/2013] [Indexed: 11/23/2022]
Abstract
Sparganosis is a parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra. Although the destination of the larva is often a tissue or muscle in the chest, abdominal wall, extremities, eyes, brain, urinary tract, spinal canal, and scrotum, intramuscular sparganosis is uncommon and therefore is difficult to distinguish from a soft tissue tumor. We report a case of intramuscular sparganosis involving the gastrocnemius muscle in an elderly patient who was diagnosed using ultrasonography and MRI and treated by surgical excision. At approximately 1 cm near the schwannoma at the right distal sciatic nerve, several spargana worms were detected and removed.
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Affiliation(s)
- Jeung Il Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea
| | - Tae Wan Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea
| | - Sung Min Hong
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea
| | - Tae Yong Moon
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea
| | - In Sook Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea
| | - Kyung Un Choi
- Department of Pathology, School of Medicine, Pusan National University, Yangsan 626-870, Korea
| | - Hak Sun Yu
- Department of Parasitology, School of Medicine, Pusan National University, Yangsan 626-870, Korea. ; Immunoregulatory Therapeutics Group in Brain Busan 21 Project, Pusan National University, Yangsan 626-870, Korea
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