Sparganosis

Ala, Vishal, Akash, and Anthony

Sparganosis

Geographical Distribution

• Cosmopolitan disease.
• However, most cases are reported in southeast Asia (e.g. China, Korea etc.).
• Spargana is endemic in North America.
• Human infections are rare but fatal.

Morphology

Continued

• Has bothrids (two longitudinal grooves) at the anterior end, instead of suckers.
• Larva has an unsegmented strobila 20 to 30 cm in length, bundles of longitudinal muscle fibers scattered throughout the mesenchyme, and a thick tegument.

Case Example #2

Background Information

Life Cycle

Continued...

• Second intermediate host (fish, reptile, etc.) ingest the procercoid when the infected copepod is ingested.
• Procercoid develops into plerocercoid within the second intermediate host.
• Cycle is completed when a definitive host (dog or human) ingests the infected intermediate host.
• Incubation period ranges from 20 days to 14 months.
• However, larva can live for decades in the body.

• Ingested sparganum penetrates intestinal epithelial, then goes to the peritoneal cavity.
• Plerocercoid can then migrate anywhere in the body.
• Symptoms can vary based on location of plerocercoids.
• Subcutaneous tissue, urinary tract, lungs, pleural cavity or CNS.

• 13 year old male in China.
• Constant headaches for 6 years.
• Seizures.
• MRI
• Showed lesions (tunnel signal).
• Movement of lesions - parasite alive.

• Infection caused by plerocercoid (larval cesotode).
• Spirometra mansoni, S. ranarum, S. mansonoides, S. ericanie and Spargana proliferum.
• Adult stage is still unknown.

Life Cycle

Symptoms Continued

Morphology

• Proliferative and nonproliferative forms.
• Living worm may elicit little tissue reaction.
• Worms encyst less often in human host.
• Death of sparganum causes granuloma to surround worm body
• Nonproliferative form more common than proliferative.
• Proliferative forms cause granulomas, but they are more widespread
• Necrosis, eosinophilia, and inflammation common when granuloma forms.

• Wrinkled, whitish, ribbon-shaped organism.
• 3 millimeters in width and up to 30 centimeters long.
• Cesotode lacks a bladder.

Symptoms of S. proliferum

Case Example # 1

• Unembryonated eggs are passed in the feces.
• Eggs become embryonated in the water.
• Coracidia hatch and are ingested by a copepod.
• Coracidia develop into procercoid within the copepod (first intermediate host).

• Weakness, headache, seizures and numbness/tingling sensations occur when S. proliferum invades the brain.
• Vertigo or deafness occurs if S. proliferum invades the inner ear.
• Lesions can also occur if more than one cesotode are in the same site.
• Can cause blindness if S. proliferum settles within the eye.
• Cerebral sparganosis causes seizures, fatigue, confusion, fever, and coma.

Hosts

• Humans are accidental hosts.
• Copepods (crustaceans) are the first intermediate hosts.
• Second intermediate hosts can be reptiles or amphibians.
• Definitive hosts are dogs, cats, and other mammals.

• 61 year old Korean man goes to a clinic with two 3 cm movable, hard masses in right axillary (armpit) and inguinal (groin) areas.
• The masses are painless and no other symptoms at the time.

Prevention

Transmission

• Sparganosis rates should decrease with greater developments in society health and sanitation.
• Avoid eating infected hosts such as frogs, and snakes.
• Properly cook meats/organs.
• Water should be boiled.
• Health Education is key.

Life Cycle

Spargana removed from chest cavity.

Treatment

• By ingestion of contaminated water with procercoids.
• procercoids penetrate intestine and then are able to migrate to subcutaneous tissues and muscles.

• By ingestion of poorly cooked or raw chicken, fish, frogs, and snakes.

• Placing raw poultices of the second intermediate hosts on open wounds.
• used for medicinal reasons (reduce inflammation).

Spargana in groin tissue.

References

What they found...

• Surgery is best.

• Praziquantel (drug).
• Dose of 120-150 mg/kg body weight over two days (oral).
• Limited success.
• Mechanism not known.

Punch (skin) biopsy from groin area mass shows sparganosis. Then, computerized tomography reveals sparganosis.

Diagnosis

Conclusion

• Smith, S. (2007). Sparganosis. Retrieved February 15, 2015 from https://web.stanford.edu/class/humbio103/ParaSites2006/Sparganosis/SPARGANOSIS WEBSITE.htm
• Reeder, M. (n.d.). Sparganosis. Retrieved February 15, 2015, from http://www.isradiology.org/tropical_deseases/tmcr/chapter7/clinical13.htm
• Sparganosis. (2013, November 23). Retrieved February 20, 2015, from http://www.cdc.gov/dpdx/sparganosis/index.html
• Sparganosis. (2015, January 27). Retrieved February 20, 2015, from http://en.wikipedia.org/wiki/Sparganosis

References Continued

• Hou, X. (2012, November 25). Differentiation and diagnosis of migrating cerebral sparganosis: 2 case reports from China. Retrieved March 7, 2015, from http://www.scirp.org/journal/PaperInformation.aspx?paperID=25511#.VQeWh454q3s
• Yoon, H, et al. (2013, April 26). Multiple Sparganosis in an Immunosuppressed Patient. Retrieved March 7, 2015, from http://synapse.koreamed.org/DOIx.php?id=10.5999/aps.2013.40.4.479&vmode=PUBREADER
• Procop, G. (2014, July 21). Retrieved March 15, 2015, from https://books.google.ca/books?id=jYcZBAAAQBAJ&pg=PT1212&lpg=PT1212&dq=how does spargana damage humans&source=bl&ots=c5IAv9qS8F&sig=F8wz-9fhj2rwqZjr43WPwYHVXIo&hl=en&sa=X&ei=lVUIVdCiEMu0oQSa84CgCg&ved=0CC4Q6AEwAg#v=onepage&q=how does spargana damage humans&f=false

• Excisional biopsy- recovery of spargana from infected tissue is diagnostic.
• Computer tomography and magnetic resonance imaging - displaying sparganosis as coiled body on band-like structures.
• Serology techniques.
• Note: Infecting a suitable host with sparganum and harvesting the adult worm is best way to identify the species.

• Cesotode larva, not the adult causes damage.
• Complex life cycle, with first intermediate host usually copepod.
• Symptoms dependant on location of S. proliferum migration.
• Disease severity depends on number of cesotodes in body.
• Removal of cesotodes in combination of medication is best treatment.
• Altering human behaviour (culture contribution) can decrease transmission.

Patient recalled eating the flesh of a snake as a child, approximately 45 years ago.