Sparganosis Contaminated Water Containing Copepods (Fig
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S Sparganosis contaminated water containing copepods (Fig. 2) infected with ▶ procercoid larvae of Bin Ye Spirometra. Department of Parasitology, Chongqing Medical The incubation period of sparganosis resulting University, Chongqing, China from the application of raw flesh poultices is 2 days to 10 days; however, it is described that sparganum larva can remain in the body for Sparganosis is an infection of ▶ sparganum,a months or years before symptoms present (Liu ▶ plerocercoid larva of the genus ▶ Spirometra 1990). The spargana can cause migratory inflam- tapeworm. mation nodules or abscesses in the human body. The first sparganosis case was described by The larva in the abscess is surrounded by an ▶ Patick Manson in China in 1882. The disease intense mixed ▶ inflammatory reaction, often is most prevalent in Asia, especially in China, containing large numbers of eosinophils. The Vietnam, Thailand, Korea, and Japan, although nodule is delimited by granulation tissue. By cases have been described sporadically around lesion locations, sparganosis is divided into sub- the world. Most cases in Asian countries are cutaneous, ocular, buccal cavity, cerebral, and caused by Spirometra mansoni, while most visceral types. Clinical symptoms also vary cases in North America by ▶ Spirometra according to the locations of spargana. Most mansonoides. commonly, the spargana invade and migrate Usually, dogs and cats are the definitive hosts through subcutaneous tissue or muscle, espe- of Pseudophyllidea tapeworm ▶ Spirometra spp. cially in the abdominal wall, chest, limbs, breast, ▶ Sparganum is a parasite of carnivores, found groin, labia, or scrotum. The early stages of dis- usually in amphibians (second intermediate ease are often asymptomatic. The larvae may hosts) or reptiles (paratenic hosts). As an acci- cause small and migratory subcutaneous nodules dental host, human becomes infected by consum- (1 to 2 cm in diameter) with erythema, pruritus, ing raw tadpoles or raw flesh of amphibians and swelling and are often accompanied by pain- (Fig. 1), reptiles, birds, or mammals such as ful edema. Discrete subcutaneous nodules may pigs and dogs for medicinal purposes or for indig- appear and disappear over a period of time. The enous food cultures or by placing raw flesh poul- ocular and maxillofacial sparganosis is found tices of amphibians or snakes infected with occasionally. The symptoms of the ocular spargana on open wounds, lesions, and eyes for sparganosis include eye pain, edematous swell- medicinal reasons, even by drinking ing, lacrimation, orbital cellulitis, exophthalmos, and corneal ulcer. If untreated, a mass ocular # Springer-Verlag Berlin Heidelberg 2015 H. Mehlhorn (ed.), Encyclopedia of Parasitology, DOI 10.1007/978-3-642-27769-6_2923-2 2 Sparganosis Sparganosis, Fig. 1 A sparganum dissociated from the frog’s thigh flesh headaches are common symptoms of cerebral sparganosis. Preoperative diagnosis is rare, although the infection may also be diagnosed by identification of eosinophilia or identification of sparganum in a tissue specimen. Diagnosis depends on patholog- ical examination of sparganum sections after tis- sue biopsy and excision of nodule lesion. The lesions in the brain can be observed by tomogra- phy and magnetic resonance imaging. Antisparganum ELISA test of cerebrospinal fluid or serum may be used when biopsy and excision procedures are not feasible. Seropreva- lence of IgG antibodies for spargana in sera of patients can be measured by ELISA; it should be included in differential diagnosis for patients with eosinophilia-associated lesions of the cen- tral nervous system, liver, and lungs (Lee et al. 2010). ELISA using excretory-secretory antigens of S. mansoni spargana may be applied to early serodiagnosis of sparganosis since its specificity in detecting serum samples of patients with cysticercosis, echinococcosis, paragonimiasis, clonorchiasis, and schistosomia- Sparganosis, Fig. 2 The copepod infected with sis and healthy persons was significantly greater Spirometra procercoids may serve as the first intermediate host of Spirometra than that of crude antigen ELISA (Cui et al. 2011). Two-dimensional electrophoresis followed by immunoblot analysis might be lesion may lead to blindness. Although the cere- highly available in differential serodiagnosis of bral or visceral case is rare, the brain abscesses human sparganosis because the 31 kDa and might be serious. Seizures, hemiparesis, and 36 kDa proteins of the sparganum could invoke specific and sensitive antibody responses, and the Sparganosis 3 on open wounds, lesions, and eyes. Avoiding ingestion of raw fleshes of frog or snake is the best prevention. Avoid drinking water from field ponds or ditches in all rural endemic areas because the unsanitary water may contain infected copepods. Sparganum The common name for the second larva is plero- cercoid, e.g., of the tapeworm Diphyllobothrium latum or ▶ Spirometra spp., ▶ Eucestoda. The plerocercoid larva is wrinkled, unsegmented, whitish, and ribbon shaped, 3 mm in width and up to 30 cm long. The larva is solid bodied with Sparganosis, Fig. 3 The anterior end of sparganum with two longitudinal grooves two longitudinal grooves (Fig. 3) at the anterior end. The larval section presents bundles of longi- tudinal muscle fibers scattered throughout the sera from sparganosis patients recognized 8–10 mesenchyme and a thick tegument. protein spots of 31 and 36 kDa with different isoelectric point (pI) values with variable combi- nations, in which four spots of 31 kDa with pIs 3.4, 3.9, 4.0, and 4.1 and one 36 kDa spot (pI 3.5) Spirometra appeared to be specifically reactive (Rahman et al. 2011). A genus of tapeworm in Diphyllobothriidae, Surgical removal is the best choice for therapy Pseudophyllidea, and ▶ Eucestoda. of sparganosis. The antihelminthic ▶ praziquantel or ▶ albendazole is often used for viscera sparganosis. However, it was demon- Spirometra spp. strated that albendazole had no obvious efficacy for treating sparganosis in mice (Cui et al. 2012) There are several species of Spirometra, includ- and that albendazole at a dosage of 400 mg ing S. mansoni, S. mansonoides, S. erinacei, bi-daily for 30 days was ineffective to human S. ranarum, S. decipiens, S. houghtoni, and cerebral sparganosis (Gonzenbach et al. 2013). S. proliferum. S. mansoni is predominately The treatment with praziquantel has produced found in Asia, and S. mansonoides is predomi- only limited success when the chemical was nately in the United States. S. houghtoni and administered at a total dose of 120–150 mg/kg S. erinacei are found in China and Japan, respec- body weight, over a 2-day period. A successful tively. S. proliferum have been reported in Japan, therapy for cerebral sparganosis may be achieved the United States, Venezuela, and Paraguay. by a high-dosage regimen of praziquantel (3 Â 25 mg/kg body weight daily) for 7 days combined with cimetidine (3 Â 400 mg daily) and a high carbohydrate diet to increase plasma Spirometra mansoni level of praziquantel (Gonzenbach et al. 2013). Prevention should focus on public health edu- A predominant species of the genus Spirometra cation of abandoning the medical practices of tapeworm of dogs and cats in Asia, ▶ Cestodes. applying raw animal flesh as medicinal poultices 4 Sparganosis Spirometra mansonoides infections of mice and human sparganosis by ELISA using ES antigens of Spirometra mansoni spargana. Parasitol Res 108(6):1551–1556 A predominant species of the genus Spirometra Cui J, Wang MM, Zhao YW, Gan GH, Hu BW, Jiang P, tapeworm of dogs and cats in North and South Qi X, Liu LN, Wang ZQ (2012) Efficacy of America, ▶ Cestodes. albendazole for treatment of mice infected with Sparganum mansoni. Chin J Parasitol Parasit Dis 30(1):71–72 (In Chinese) Gonzenbach RR, Kong Y, Beck B, Buck A, Weller M, Poultice Semmler A (2013) High-dose praziquantel therapy for cerebral sparganosis. J Neurol 260(5):1423–1425 A poultice is a piece of cloth or paper with a soft Lee MK, Hong SJ, Kim HR (2010) Seroprevalence of tissue invading parasitic infections diagnosed by substance such as a mixture of herbs on it. It is put ELISA in Korea. J Korean Med Sci 25(9):1272–1276 over a painful or swollen part of the human body Liu GZ (1990) A brief introduction of sparganosis in order to reduce the pain or swelling. mansoni in China. Chin J Parasitol Dis Control 3(2):152–154 (In Chinese) Rahman M, Lee EG, Bae YA (2011) Two-dimensional immunoblot analysis of antigenic proteins of References Spirometra plerocercoid recognized by human patient sera. Parasitol Int 60(2):139–143 Cui J, Li N, Wang ZQ, Jiang P, Lin XM (2011) Serodiagnosis of experimental sparganum.