Case report: Molecular diagnosis of subcutaneous Spirometra erinaceieuropaei sparganosis in a Japanese immigrant

Cestodiasis in 2 Puerto Rican crested anoles

Two adult male Puerto Rican crested anoles (Anolis cristatellus cristatellus) housed in a research facility were presented with debilitation and were euthanized. On autopsy, anole 1 had a large cystic white structure in the left pelvic limb, which protruded through the ruptured epidermis, and a large, poorly demarcated swelling in the right caudal abdomen. Anole 2 had masses in the mid-dorsum, caudal dorsum, left pelvic limb, and tail. These masses contained variably sized cestode larvae, which ruptured into the coelomic cavity. Evaluation of the larvae revealed a thickened and wrinkled anterior end, with a cleft-like invagination, consistent with either a plerocercoid sparganum or a tetrathyridium. Histologically, several cestode larvae were contained in the body wall of both anoles. These were up to 650 μm in diameter, with a thin tegument and a spongy parenchyma. The spongy parenchyma contained numerous, up to 30 μm diameter, sharply demarcated, basophilic-to-black structures (calcareous corpuscles). There was pneumonia and hepatitis in anole 2, suggestive of potential secondary infection subsequent to immunosuppression. Molecular amplification of the cytochrome C oxidase subunit 1 revealed 100% homology for the COX1 gene of the diphyllobothriid tapeworm Spirometra erinaceieuropaei, also known as Spirometra mansoni.

Molecular identification of sparganum of Spirometra mansoni isolated from the abdominal cavity of a domestic cat in Vietnam

Cats normally play a role of the definitive host in which the plerocercoid (sparganum), the second larval form of Spirometra spp., develops into an adult in the intestines. However, some cases of cats with visceral or subcutaneous sparganosis were sporadically reported worldwide. We herein documented the discovery of a sparganum in abdominal cavity of a domestic cat during a surgery of dystocia. The larva was molecularly identified as Spirometra mansoni, belonging to Type I, that was recently misidentified to be S. erinaceieuropaei in several Asian countries. This is the first report for sparganum of S. mansoni in the cat. The future study is necessary to provide further insights into the species of Spirometra causing sparganosis and spirometrosis in humans and other animals.

Epidemiology, Diagnosis, and Prevention of Sparganosis in Asia

Sparganosis is a zoonotic parasitic disease caused by the larvae (spargana) of the genus Spirometra, which is widely distributed globally and threatens human health. More than 60 species of Spirometra have already been identified, and over 2000 cases have been reported. This review summarizes the prevalence of humans, frogs, snakes, and other animals with spargana. Furthermore, the infection mode, distribution, and site are summarized and analyzed. We also describe the epidemiology, molecular diagnosis, and other aspects which are of considerable significance to preventing sparganum.

First Clinical Cases of Spirometrosis in Two Cats in Korea

This study reports the first two clinical cases of spirometrosis caused by Spirometra sp. in cats in Korea. In these two cases, the cats vomited, and long proglottids of tapeworm were recovered. The sick cats presented with anorexia and lethargy. However, they unexpectedly showed no diarrhea, which is the main symptom of spirometrosis. Based on a fecal floatation test as well as morphological and molecular analyses, the parasite was diagnosed as Spirometra sp. The 2 cases were treated with praziquantel. This study suggests regular monitoring of health and deworming in companion animals, even when animals are well cared for, with regular preventive medication. Additionally, spirometrosis should be considered in the differential diagnosis in cases of gastrointestinal symptoms in Spirometra endemic areas.

Spirometra species from Asia: Genetic diversity and taxonomic challenges

Despite considerable controversy concerning the taxonomy of species within the genus Spirometra, human sparganosis and spirometrosis mainly in Asia and Europe has long been confidently ascribed to Spirometra erinaceieuropaei. Recently, the mitochondrial genomes of purported "S. erinaceieuropaei", "Spirometra decipiens" and "Spirometra ranarum" from Asia have been determined. However, it has been pointed out that the morphological criteria used for identifying these species are unsuitable and thus these identifications are questionable. In the present study, therefore, Spirometra samples from Asia were re-examined based on mitochondrial cytochrome c oxidase subunit 1 gene sequences and the identification of these species was discussed. Haplotype network and phylogenetic analyses revealed that: i) two distinct Spirometra species, Type I and Type II, are present in Asia and neither of which is close to likely European "S. erinaceieuropaei"; ii) Type I is genetically diverse and widely distributed, however Type II is known so far from Japan and Korea; iii) "S. decipiens" and "S. ranarum" reported from Asia are conspecific with Type I; iv) Type I is probably conspecific with Spirometra mansoni, and Type II may represent an undescribed species.

Low prevalence of spargana infection in farmed frogs in the Yangtze River Delta of China

Frogs are the main source of infection for human sparganosis. In this study, the prevalence and pathogenicity of plerocercoid larvae (sparganum) in frogs collected from the Yangtze River Delta in East China were investigated. A total of 386 frogs belonging to five species were purchased from farmers' markets across all three provincial level areas in the Yangtze River Delta region. The overall prevalence was 4.9% (19/386), and 39 spargana were detected visually, with the intensity ranging from 1 to 11. The spargana infection rate was 7.7% (11/143) in Jiangsu Province and 4.4% (8/181) in Shanghai City, while no spargana infection was detected in Zhejiang Province. In five tested frog species, only Rana nigromaculata and R. limnocharis were found to harbor spargana infection, with a prevalence of 7.7% (13/168) and 6.3% (6/95), respectively. There was no significant difference among the months of the experimental period, July to September. The spargana mostly parasitized the muscle tissues of frogs, especially in the hind legs. All the spargana were identified by molecular analysis based on cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase subunit 1 (nad1) genes, and all plerocercoids were Spirometra erinaceieuropaei. Nine mice were infected orally with 1 to 3 scoleces, and 77.8% (14/18) of plerocercoids were found in mice at the 30th day post infection. No obvious clinical symptoms were observed in the mice; however, histopathological analysis showed an inflammatory cellular response in all tissues except intestinal tissue. Hematologic analysis showed an increased number of white blood cells (WBCs) at the 18th day post infection. These results indicated that R. nigromaculata and R. limnocharis are a potential source of zoonotic sparganosis in the Yangtze River Delta of China, and farmed frogs may substantially reduce zoonotic risk as compared to eating wild frogs. Our findings will provide data for frog food safety and prevention and control of sparganosis in the region.

Case Report: Human Subcutaneous Sparganosis in a Thai Migrant

Human sparganosis is a cestode infection which is neglected as a differential diagnosis outside endemic countries. Diagnosis and therapy may be challenging depending on the clinical presentation and anatomic localization. The disease manifests predominantly as subcutaneous nodule(s) or intracranial mass lesion(s). Infection is primarily acquired by ingesting raw or undercooked amphibian or reptile flesh or by drinking water containing copepods. We report an unusual case of subcutaneous Spirometra erinaceieuropaei sparganosis presenting with two nonmigratory nodules in close proximity to each other on the right thigh of a Thai woman living in Switzerland.

Molecular cloning and characterization of plerocercoid-immunosuppressive factor from Spirometra erinaceieuropaei

A platyhelminth, Spirometra erinaceieuropaei, belonging to the class Cestoda, causes human sparganosis, and infection with its larva results in subtle inflammation in the body of its host. We previously reported the purification of a glycoprotein, plerocercoid-immunosuppressive factor (P-ISF) from the excretory/secretory products of S. erinaceieuropaei plerocercoids that may be involved in immuno-modification. We determined the sequence of P-ISF from the N-terminal and the internal 10 amino acids of P-ISF using degenerate PCR and 5'- and 3'-RACE methods. The putative gene encoding P-ISF was 1443 bp long and the gene contained 10 exons and 9 introns in a genomic DNA of size 5205 bp. P-ISF consists of 480 amino acids including the N-terminal signal peptide sequence, and has two unknown domains,-cestoda cysteine-rich domains (CCDs) and a fibronectin type III domain between the two CCDs. All cysteine residues were conserved in the two CCDs, which shared 62% amino acid identities. Homologous analysis revealed that the CCDs were homologous with an unknown protein of Diphyllobothrium latum. To produce specific antibodies, we expressed recombinant P-ISF (rP-ISF) using wheat germ protein synthetic system. P-ISF was localized in the sub-cutaneous tissues and the parenchymal tissues of plerocercoids. Transcription of P-ISF was detected only in plerocercoid stage, but not in adult stage. Western blotting also showed a band in plerocercoide stage but not in adult. The rP-ISF did not suppress nitrite production in RAW 264.7 cells stimulated with LPS, and this might be due to lack of carbohydrate chains in the recombinant protein.

Molecular Identification of Spirometra erinaceieuropaei Tapeworm in Cases of Human Sparganosis, Hong Kong

Human sparganosis is a foodborne zoonosis endemic in Asia. We report a series of 9 histologically confirmed human sparganosis cases in Hong Kong, China. All parasites were retrospectively identified as Spirometra erinaceieuropaei. Skin and soft tissue swelling was the most common symptom, followed by central nervous system lesions.

Spirometra erinaceieuropaei in a wildcat (Felis silvestris) in Iran

The zoonotic helminth, Spirometra, has several species with almost global distribution. Herein, we describe the first detailed molecular detection of Spirometra erinaceieuropaei in a road-killed wildcat (Felis silvestris) in Iran and its identification at the species level using CO1 gene. Genomic DNA was extracted using CTAB extraction method. The DNA then was applied for PCR amplification of cytochrome c oxidase subunit I (CO1) gene. Afterwards, PCR product was sequenced and obtained data were analyzed and multiple aligned using BLAST program, ClustalX and Bioedit software. Microscopy findings and diagnostic clues revealed that the parasite is a Spirometra sp. cestode. Consequently, molecular analysis on the basis of cytochrome c oxidase subunit 1 (CO1) gene demonstrated that the species is Spirometra erinaceieuropaei. Regarding optimum climate conditions and previous reports of animal infection in this region, the likelihood of human involvement should be potentially considered.

Rapid identification of nine species of diphyllobothriidean tapeworms by pyrosequencing

The identification of diphyllobothriidean tapeworms (Cestoda: Diphyllobothriidea) that infect humans and intermediate/paratenic hosts is extremely difficult due to their morphological similarities, particularly in the case of Diphyllobothrium and Spirometra species. A pyrosequencing method for the molecular identification of pathogenic agents has recently been developed, but as of yet there have been no reports of pyrosequencing approaches that are able to discriminate among diphyllobothriidean species. This study, therefore, set out to establish a pyrosequencing method for differentiating among nine diphyllobothriidean species, Diphyllobothrium dendriticum, Diphyllobothrium ditremum, Diphyllobothrium latum, Diphyllobothrium nihonkaiense, Diphyllobothrium stemmacephalum, Diplogonoporus balaenopterae, Adenocephalus pacificus, Spirometra decipiens and Sparganum proliferum, based on the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene as a molecular marker. A region of 41 nucleotides in the cox1 gene served as a target, and variations in this region were used for identification using PCR plus pyrosequencing. This region contains nucleotide variations at 12 positions, which is enough for the identification of the selected nine species of diphyllobothriidean tapeworms. This method was found to be a reliable tool not only for species identification of diphyllobothriids, but also for epidemiological studies of cestodiasis caused by diphyllobothriidean tapeworms at public health units in endemic areas.

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

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

The genome of the sparganosis tapeworm Spirometra erinaceieuropaei isolated from the biopsy of a migrating brain lesion

BACKGROUND

Sparganosis is an infection with a larval Diphyllobothriidea tapeworm. From a rare cerebral case presented at a clinic in the UK, DNA was recovered from a biopsy sample and used to determine the causative species as Spirometra erinaceieuropaei through sequencing of the cox1 gene. From the same DNA, we have produced a draft genome, the first of its kind for this species, and used it to perform a comparative genomics analysis and to investigate known and potential tapeworm drug targets in this tapeworm.

RESULTS

The 1.26 Gb draft genome of S. erinaceieuropaei is currently the largest reported for any flatworm. Through investigation of β-tubulin genes, we predict that S. erinaceieuropaei larvae are insensitive to the tapeworm drug albendazole. We find that many putative tapeworm drug targets are also present in S. erinaceieuropaei, allowing possible cross application of new drugs. In comparison to other sequenced tapeworm species we observe expansion of protease classes, and of Kuntiz-type protease inhibitors. Expanded gene families in this tapeworm also include those that are involved in processes that add post-translational diversity to the protein landscape, intracellular transport, transcriptional regulation and detoxification.

CONCLUSIONS

The S. erinaceieuropaei genome begins to give us insight into an order of tapeworms previously uncharacterized at the genome-wide level. From a single clinical case we have begun to sketch a picture of the characteristics of these organisms. Finally, our work represents a significant technological achievement as we present a draft genome sequence of a rare tapeworm, and from a small amount of starting material.

An Unusual Cause of a Breast Mass in a Patient from China

Sparganosis is a parasitic infection caused by Spirometra spp. and often presents as a subcutaneous swelling, most commonly noticed in the abdominal wall or extremities. Amphibians such as frogs ingest infected copepods (crustaceans that have ingested coracidia, i.e., Spirometra spp. embryos) and serve as a secondary intermediate host. Complete surgical excision is recommended for definitive diagnosis and treatment. Granulomatous inflammation is the most common histologic finding. Although dissemination can occur, most cases are localized. Serum enzyme-linked immunosorbent assay (ELISA) has been suggested as a potential surveillance tool. Medical therapy with antiparasitic agents, such as praziquantel, is not typically recommended but may be effective at high doses. Preventing recurrence thus depends on adequate surgical removal of the parasite. We report a case of a breast mass caused by sparganosis infection in a Chinese female whose likely exposure was due to frog consumption. The diagnosis was confirmed on surgical excision and no systemic antiparasitic therapy was required.

The genome of the sparganosis tapeworm Spirometra erinaceieuropaei isolated from the biopsy of a migrating brain lesion

BACKGROUND

Sparganosis is an infection with a larval Diphyllobothriidea tapeworm. From a rare cerebral case presented at a clinic in the UK, DNA was recovered from a biopsy sample and used to determine the causative species as Spirometra erinaceieuropaei through sequencing of the cox1 gene. From the same DNA, we have produced a draft genome, the first of its kind for this species, and used it to perform a comparative genomics analysis and to investigate known and potential tapeworm drug targets in this tapeworm.

RESULTS

The 1.26 Gb draft genome of S. erinaceieuropaei is currently the largest reported for any flatworm. Through investigation of β-tubulin genes, we predict that S. erinaceieuropaei larvae are insensitive to the tapeworm drug albendazole. We find that many putative tapeworm drug targets are also present in S. erinaceieuropaei, allowing possible cross application of new drugs. In comparison to other sequenced tapeworm species we observe expansion of protease classes, and of Kuntiz-type protease inhibitors. Expanded gene families in this tapeworm also include those that are involved in processes that add post-translational diversity to the protein landscape, intracellular transport, transcriptional regulation and detoxification.

CONCLUSIONS

The S. erinaceieuropaei genome begins to give us insight into an order of tapeworms previously uncharacterized at the genome-wide level. From a single clinical case we have begun to sketch a picture of the characteristics of these organisms. Finally, our work represents a significant technological achievement as we present a draft genome sequence of a rare tapeworm, and from a small amount of starting material.