Clinical Features of Pulmonary Sparganosis

doi:10.1097/MAJ.0000000000000578

The American Journal of the Medical Sciences

Volume 350, Issue 6, December 2015, Pages 436-441

https://doi.org/10.1097/MAJ.0000000000000578 Get rights and content

Abstract:

Background:

Sparganosis is an infectious disease caused by the sparganum of Spirometra species, which seldom invades the respiratory system. The aim was to describe the clinical features and outcomes of pulmonary sparganosis.

Methods:

A total of 40 patients with pulmonary sparganosis were reviewed, including 12 cases known from this experience and 28 cases reported in the literature.

Results:

Among these 40 patients at an average age of 45.4 ± 11.1 years (men 29), 34 (85%) had a history of ingesting raw or undercooked meat (mainly frogs or snakes). The top 3 symptoms were coughing (60.0%), fever (57.5%) and chest pain (42.5%). Peripheral blood eosinophilia was found in 30 cases (75%). Lesions were located in lung parenchyma, airway, pleura and pulmonary vessels of the patients. Thirty-one patients (77.5%) had pleural effusion. The diagnosis was established by antisparganum antibody test in 30 cases (75%) and by pathology in 9 cases (22.5%); I case was not mentioned. Among the 35 cases with follow-up information, 2 treated with complete surgical removal and 31 with oral administration of praziquantel had no recurrence; the remaining 2 died without effective treatments.

Conclusions:

As an extremely rare and life-threatening parasitic zoonosis, pulmonary sparganosis should be diagnosed by combining the epidemiology, patient history, eosinophilia and the positive antisparganum antibody test result together if no worm was detected. Oral praziquantel is considered to be an effective treatment.

Section snippets

Subjects

Among 40 cases of pulmonary sparganosis, 12 were diagnosed and treated at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1999 to December 2014, and 28 were obtained from the literature. The literature retrieval was conducted using the key word “sparganosis” in both the English and Chinese languages in PubMed, the China Academic Journals Full-text Database (CAJ), Google and Chinese Wangfang Database. Among more than 1,500 reported cases of sparganosis, only 23

Clinical Presentation

The 40 cases aged between 45.4 ± 11.1 years (range: 24–67 years), including 29 men and 11 women, were from China (26 cases), Japan (8 cases), South Korea (5 cases) and Thailand (1 case). Behavioral risk factors were associated with pulmonary sparganosis: 34 cases (85%) had the history of eating raw or undercooked meat (mainly frogs or snakes), including 21 (52.5%) who had ingested them frequently. Six cases had direct contact with contaminated stream (Table 1). For these patients with pulmonary

DISCUSSION

Sparganosis is a neglected disease, but it is an important food borne parasitic zoonosis, which has been reported in 39 countries in the world.²⁸ Spirometra spp. are found worldwide, but human infections are rare.³ With recent globalization and changing dietary habits, the reported cases of sparganosis have gradually increased.3., 15., 18. So far, pulmonary sparganosis is mainly reported in eastern and southeastern Asia. There are 3 hosts throughout the life cycle of Spirometra: the first

CONCLUSIONS

In summary, the clinical diagnosis of pulmonary sparganosis should be based on the clinical manifestation, chest imaging, eosinophilia, positive antibody test, as well as the epidemiology and patient history. Although pathological examination is considered as the gold diagnostic standard, the antisparganum ELISA test is now a useful alternative tool for early diagnosis, especially in suspected cases where biopsy and excision procedures are not feasible. As complete surgical removal may not be

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Cited by (9)

Low prevalence of spargana infection in farmed frogs in the Yangtze River Delta of China
2020, Infection, Genetics and Evolution
Citation Excerpt :
Lee et al. (2002) also found that the human sparganosis infection rate was 3.3% (24/719) in Korea, and that all patients habitually consumed frogs and raw water. Li et al. (2015) summarized 40 cases of pulmonary sparganosis from China (n = 26), Japan (n = 8), South Korea (n = 5) and Thailand (n = 1) and found that 34 cases (85.0%) had a history of eating raw or undercooked meat (mainly frogs or snakes), and 21 (52.5%) ate them frequently. Therefore, infected frogs act as a major source of zoonotic sparganosis.
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.
Pulmonary Sparganosis Identified by Metagenomic Next-Generation Sequencing: A Case Report
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Sparganosis: An under-recognised zoonosis in Australia?
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First report of sparganosis manifested by pleuritis and decreased peripheral blood eosinophils in Jiangsu province, China
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: The authors have no financial or other conflicts of interest to disclose. N.L., Y.X. and Y.F. contributed equally to this work.

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Clinical InvestigationClinical Features of Pulmonary Sparganosis

Abstract:

Background:

Methods:

Results:

Conclusions:

Section snippets

Subjects

Clinical Presentation

DISCUSSION

CONCLUSIONS

Braz J Infect Dis

Korean Circ J

J Diagn Concepts Pract

Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi

Retrospective epidemiological analysis of sparganosis in mainland China from 1959 to 2012

Epidemiol Infect

Human parasitology

The genome of the sparganosis tapeworm spirometra erinaceieuropaei isolated from the biopsy of a migratingbrain lesion

Genome Biol

Thirty-seven human cases of sparganosis from Ethiopia and south Sudan caused by spiro-metra spp

Am J Trop Med Hyg

Eosinophilic pleuritis due to sparganum: a case report

Korean J Parasitol

Pulmonary sparganosis mansoni: a case report from a non-endemic region

J Thorac Dis