A case of mammary sparganosis due to infection with Spirometra mansoni.

The authors report the case of a 56-year-old woman with mammary sparganosis due to infection with a plerocercoid tapeworm larva of Spirometra mansoni. Magnetic resonance imaging revealed an area of heterogeneous density in outer upper quadrant of the right breast, with a high likelihood of malignancy. During surgery for the removal of a granuloma, the parasite was discovered and excised. The authors review the pathological and imaging features of mammary sparganosis.

Case report: the first case of human infection by adult of SPIROMETRA ERINACEIEUROPAEI in VIETNAM.

BACKGROUND: Tapeworms of the genus Spirometra include species whose larval stages can infect humans, causing a disease called sparganosis. Cases of human infection with adult worms are very rare and have been reported in Korea and China. Here we report the first case of human infection with an adult of Spirometra erinaceieuropaei in Vietnam. CASE PRESENTATION: A 23-year-old male was admitted to 103 Military Hospital, Hanoi, Vietnam with fever, weight loss and epigastric discomfort. Preliminary diagnosis based on discovery of parasite eggs in his faeces incorrectly determined a fluke as the agent of the infection and praziquantel was prescribed. Two days later he passed out proglottids in his stool. The tapeworm was identified as Spirometra erinaceieuropaei using morphological and molecular tools. CONCLUSION: This is the first case of human infection with adult worm of Spirometra erinaceieuropaei in Vietnam.

Analysis of structures, functions, and epitopes of cysteine protease from Spirometra erinaceieuropaei Spargana.

Spirometra erinaceieuropaei cysteine protease (SeCP) in sparganum ES proteins recognized by early infection sera was identified by MALDI-TOF/TOF-MS. The aim of this study was to predict the structures and functions of SeCP protein by using the full length cDNA sequence of SeCP gene with online sites and software programs. The SeCP gene sequence was of 1 053 bp length with a 1011 bp biggest ORF encoding 336-amino acid protein with a complete cathepsin propeptide inhibitor domain and a peptidase C1A conserved domain. The predicted molecular weight and isoelectric point of SeCP were 37.87 kDa and 6.47, respectively. The SeCP has a signal peptide site and no transmembrane domain, located outside the membrane. The secondary structure of SeCP contained 8 α -helixes, 7 ß -strands, and 20 coils. The SeCP had 15 potential antigenic epitopes and 19 HLA-I restricted epitopes. Based on the phylogenetic analysis of SeCP, S. erinaceieuropaei has the closest evolutionary status with S. mansonoides. SeCP was a kind of proteolytic enzyme with a variety of biological functions and its antigenic epitopes could provide important insights on the diagnostic antigens and target molecular of antisparganum drugs.

Sparganosis mimicking an intramedullary tumor of the cervical cord.

Sparganosis is a rare parasitic infection caused by the migrating plerocercoid larva of the tapeworm Spirometra mansoni that rarely affects the central nervous system. When sparganosis involves the spinal cord, it often affects the thoracic area. Here we report a patient with sparganosis mimicking an intramedullary tumor of the cervical cord. A 51-year-old male presented with slowly progressive paresthesias in all extremities and left-sided motor weakness. MRI of the spinal cord revealed an enhancing lesion from C1 to C4 that was suggestive of an intramedullary tumor. The results of enzyme-linked immunosorbent assays of the cerebrospinal fluid were consistent with infection with Spirometra mansoni, and the larvae were surgically removed. Sparganosis may mimic an intramedullary tumor of the spinal cord and should be considered in the differential diagnosis of a cervical cord mass with an uncertain course.

Severe infection of wild-caught snakes with Spirometra erinaceieuropaei from food markets in Guangzhou, China involves a risk for zoonotic sparganosis.

Wild-caught snakes are a popular and traditional food in China. However, little known to the public, snakes are also intermediate hosts of Spirometra erinaceieuropaei, a food- and water-borne pathogen of sparganosis. Therefore, we investigated the prevalence of S. erinaceieuropaei in 10 popular species of wild-caught snakes in Guangzhou City (Guangdong Province) between July 2009 and July 2010. One hundred and twenty-four specimens of 10 species (including Enhydris plumbea, Zoacys dhumnades, Elaphe radiate, Elaphe taeniura, Elaphe carinata, Ptyas mucosus, Ptyas korros, Naja naja atra, Bungarus fasciatus, and Bungarus multicinctus) were randomly selected from a total of 1,160 wild-caught snakes. They were obtained from food markets in 5 representative districts (Huadou, Panyu, Tianhe, Haizhu, and Conghua). The specimens were killed, necropsied, and examined for parasitic helminths. Of the snakes examined, 29.8% were infected by spargana and the worm burden per infected snake ranged from 1 to 221. Most species were infected except for En. plumbea, B. fasciatus, and B. multicinctus. Prevalence even reached 100% in Zoacys dhumnades. More than half (53.5%) of the spargana were located in muscular tissue, 36.4% in subcutaneous tissue, and 10.1% in the coelomic cavity. The study revealed the potential risk for the zoonotic sparganosis by eating wild-caught snakes and will be helpful in arousing public health concern about the consumption of snake meat.

Two-dimensional immunoblot analysis of antigenic proteins of Spirometra plerocercoid recognized by human patient sera.

Sparganosis is caused by invasion of Spirometra plerocercoid into various tissues/organs. Subcutaneous sparganosis can be diagnosed and treated by worm removal, while visceral/cerebral sparganosis is not easy to diagnose. The diagnosis depends largely on the detection of specific antibodies circulating in the patients' sera. Previous studies demonstrated that 31 and 36kDa proteins of the sparganum invoked specific and sensitive antibody responses, but also showed cross reactions with cysticercosis sera. We enriched protein fractions containing 31-36kDa through gel filtration and examined immune recognition pattern against the patient sera by 2-dimensional electrophoresis (2-DE) followed by immunoblotting. Serum samples from sparganosis patients recognized 8-10 protein spots of 31 and 36kDa with different isoelectric point (pI) values with variable combinations, in which four spots of 31kDa with pIs 3.4, 3.9, 4.0 and 4.1, and one 36kDa spot (pI 3.5) appeared to be specifically reactive. One 31kDa protein spot with pI 3.3 and two spots of 36kDa with pIs 3.3 and 3.5 reacted crossly with neurocysticercosis sera. Neither sera from patients with other parasitic infections nor those from healthy controls showed positive reaction. Two-DE/immunoblot analysis might be highly available in differential serodiagnosis of human sparganosis.

[Human plerocercoidosis and sparganosis: I. A historical review on aetiology].

Plerocercoid should not be confused with Sparganum. The scolex of plerocercoid has a bothrium or bothrial slit but there is no true scolex in sparganum. Plerocercoid is a developmental stage of an animal tapeworm, genus Spirometra. Sparganum is another generic name of a pseudophyllidean cestode. Plerocercoid causes benign plerocercoidosis and sparganum causes "malignant sparganosis". Plerocercoidosis is a parasitic zoonosis which can be food-borne, water-borne, contact-borne or mother-borne. During the past 20 years, there has been significant progress in studies of human plerocercoidosis and sparganosis, especially the former. Spirometra erinacei-europiea plerocercoidosis and sparganosis prolifera distributed mainly in East Asia. Spirometra mansonoides plerocercoidosis has been reported from the USA. Up to the present, approximately 1400 cases of plerocercoidosis were reported from China, Japan, Korea, USA and Thailand, and at least 16 well-documented cases of human proliferating sparganosis were reported worldwide (in Japan, China, Thailand, USA, Paraguay, Venezuela, and the Philippines). The life cycle of Sparganum is unknown. For plerocercoid, human being acts as a dead-end hosts, copepod and frogs serve as intermediate hosts, and snakes and carnivorous animals are its paratenic hosts. This review summarizes the research progress on aetiology and pathogenesis of human plerocercoidosis and sparganosis. The second part (in press) will be concentrated on their pathology, clinical manifestations, diagnosis, treatment, epidemiology, control and prevention.

A review of human sparganosis in Thailand.

BACKGROUND: Sparganosis is a zoonosis that occurs occasionally in humans. The infection is reported in many countries but is most common in eastern Asia. In Thailand, a southeast Asian country, the infection is sporadic. DESIGN: In this study the clinical presentations of human sparganosis cases in Thailand were investigated by means of a literature review. RESULTS: Reports of 34 cases of sparganosis were found. The infections were ocular (17 cases), subcutaneous (ten cases), central nervous system (five cases), auricular (one case), pulmonary (one case), intraosseous (one case) and intraperitoneal (one case). Of these 34 cases, 14 had risk behaviour reported, 12 had a history of drinking impure water, five had a history of eating frog or snake meat and two had a history of using frog or snake meat as a poultice. Some cases had more than one risk factor. CONCLUSION: Most cases of sparganosis in Thailand presented with superficial ocular mass lesions. The major risk behaviour in Thailand is drinking water contaminated with the infective organism. Some cases of serious deep visceral sparganosis have also been reported.

Excretory/secretory products from plerocercoids of Spirometra erinaceieuropaei suppress the TNF-alpha gene expression by reducing phosphorylation of ERK1/2 and p38 MAPK in macrophages.

We previously reported that excretory/secretory products from plerocercoids of Spirometra erinaceieuropaei suppress gene expression and production of tumour necrosis factor-alpha in murine macrophages stimulated with lipopolysaccharide. The present study investigated the suppressive mechanisms of tumour necrosis factor-alpha mRNA by excretory/secretory products in lipopolysaccharide-stimulated murine macrophages. Electrophoretic mobility shift assay and supershift assay revealed that neither nuclear translocation of nuclear factor-kappa B nor conformation of the p50/p65 nuclear factor-kappa B subunits was affected by the treatment of excretory/secretory products in lipopolysaccharide-stimulated macrophages. Inhibition of extracellular signal-regulated protein kinase 1/2 with PD98059 or p38 mitogen-activated protein kinase with SB203580 partially reduced tumour necrosis factor-alpha mRNA expression, and a combination of the two inhibitors additionally suppressed the level of tumour necrosis factor-alpha mRNA, revealing that both pathways are crucial for full induction of the gene. Northern blot analysis showed that excretory/secretory products additionally suppressed tumour necrosis factor-alpha mRNA expression in cells treated with PD98059 or SB208530 and, in turn, we found that excretory/secretory products reduced phosphorylation of extracellular signal-regulated protein kinase 1/2 and p38 mitogen-activated protein kinase in lipopolysaccharide-stimulated macrophages by Western blot analysis. This is the first report demonstrating that excretory/secretory products from parasites suppress tumour necrosis factor-alpha mRNA expression by reducing phosphorylation of extracellular signal-regulated protein kinase 1/2 and p38 mitogen-activated protein kinase without any effect on nuclear factor-kappa B activity in macrophages stimulated with lipopolysaccharide. We hypothesise that excretory/secretory products may enable this parasite to survive within the host.

Survey of Spirometra erinaceieuropaei in frogs in Taiwan and its experimental infection in cats.

Eighteen of 56 (32.1%) wild Rana limnocharis from central and south Taiwan were found to contain plerocercoids of Spirometra erinaceieuropaei. This is the first report of S. erinaceieuropaei infections in frogs in Taiwan, with the plerocercoids being recovered from the thigh and back muscles or under the skin. Other species of frogs examined, including nine wild R. latouchii, one wild Buergeria robustus and 110 cultured R. rugulosa were free of infection. The plerocercoids were orally inoculated into four cats; three of which were each given a single plerocercoid and one a dose of three plerocercoids. Daily faecal examination showed that two cats started shedding eggs of S. erinaceieuropaei on day 8 postinfection (PI) and the other two on day 10 PI. The highest eggs per gram and eggs per day for a single worm was found to be 428,000 and 14,416,000 respectively. Only the cat inoculated with three plerocercoids shed proglottids in its faeces during the 2 month observation period.

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

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