SPIROMETRA, H. NANA- DR.

ASUNCION November 19, 2014

SPIROMETRA
CASE:
A 61 year old man complained of on and off, dry,
non-productive cough for 2 months with
occasional dyspnea, intermittent low-grade fever,
anorexia, and weight loss. He was a smoker with
40 pack years. There is no history of CA or PTB in
the family. A chest x-ray revealed an abnormal
pulmonary shadow.
A CT scan of the lungs was further requested.
- Right upper lobe: 1-3 cm nodule
- Lower lobe of right lung: smaller nodule,
hyperechoic
- TB lesion on upper lung
Intraoperative findings showed minute nodules
with exudates on the surface of the parietal
pleura.
- wiry material larva embedded in the
parietal pleura of the lung
VATS biopsy (Video assisted thoracoscopy) in the
pleura and right upper and lower lobes was
performed
- Eosinophilic body (cut section of larval
parasite) embedded in pleura
Mononuclear cells
- Intense inflammatory reaction response
to parasite
Laboratory data revealed a 9000/cu. mm. WBC
count (normal) with slightly increased eosinophil
count (80%) and increased C-reactive protein
(ongoing inflammatory reaction).
Serum ELISA was taken several days after the
procedure and was tested positive for antiSparganum Antibody.
Disease: SPARGANOSIS
- similar to Diphyllobothria
- disease is associated with plerocercoid larva
(Spargana) in man
- Spirometra species
- Intermediate host: man
- Definitive host: dogs and cats, wild
carnivorous animals
Intermediate hosts:
1st: Cyclops (crustacean)
2nd: small rodents, snakes, frogs, fish, humans*

*Humans: 2nd intermediate host or paratenic (not

obligatory to life cycle) host
A. Branching Spargana
- Spirometra proliferum
- reported cases in Japan and US
- unknown morphology of adult worm and life
cycle
- larva: irregular, lateral, supernumerary
processes that bud off as new spargana in tissues
Diagnosis: larva in chylous, nodular lesions on
affected tissues (skin, subcutaneous tissues,
lungs)
B. Non-branching Spargana
- Spirometra mansoides
- Epidemiology:
- East and Southeast Asia, Japan, Indochina
- less encountered in Africa, Europe, North and
South America, and Africa
- humans acquire Sparganosis by:
- ingestion of infected Cyclops containing
procercoid in drinking water
- consuming fish, frogs, snakes, or rodents
harboring the plerocercoid
- penetration of cutaneous tissues
Adult Sperometra
- resembles Dyphillobothrium latum but smaller
in size
- ribbon-like flat body
Plerocerdoid (also known as Sparganum)
- often white
- varying size cm or mm in length
- ability to have very strong muscular activity
- ability to elongate or shorten
Egg
- similar to D. latum
- operculated
- longer, narrower
- more flattened on one side

SPIROMETRA, H. NANA- DR. ASUNCION November 19, 2014

Symptomatology
- local indurations, periodic giant urticaria,
edema, and erythema
- chills and fever
- high eosinophilia only larval form elicits
immune response
*outcome is always dependent on location of
parasite

Definitve Hosts: dogs and cats

LIFE CYCLE
unembryonated eggs discharged into moist
environment
eggs embryonate
hatch and release coracidium
coracidium is ingested by crustacean (similar
to D. latum)
crustacean harbors coracidium
coracidium transforms to procercoid
procercoid settles in body cavity of crustacean
crustacean is ingested by frog, fish, reptile,
or amphibian
procercoid transforms to plerocercoid
man accidentally ingests plerocercoid by
eating raw fish,
raw frog, raw snakes, raw rodents (O.o)
dead end infection
Pathogenicity
- found in any part of the body of man
* muscular contractility of sparganum causes
further inflammation and tissue damage
- eyes, subcutaneous and muscular tissue of
thorax, abdomen, thighs, inguinal region, thoracic
viscera
* most common thorax and abdomen
-migrate through tissues: inflammation and
edema of surrounding tissues
*chronicity but absence of fibrous tissue
deposition
continuously moves within affected tissues
unless calcified by chemotherapy
- degenerated larva: intense local inflammation
and necrosis

Cutaneous sparganosis
- pointed nodules = embedded Sparganum larva
encircles
Therapy: remove larva
- pruritic/painful nodule seen in subcutaneous
tissue, noed in extremities, trunk, genitalia,
breast

Ocular sparganosis
- infected eye
- encountered in Southeast Asia
- orbital edema, ptosis in affected eye
- pain, intense lacrimation of eye
- Treatment: remove Sparganum causing
inflammation and edema

Cerebral Sparganosis
CT Scan
-hyperechoic dense, wiry objects within brain
parenchyma

SPIROMETRA, H. NANA- DR. ASUNCION November 19, 2014

pathogenic for cerebral sparganosis
-not associated with ischemia or any organism
causing lesions
Histologic section:
intense
inflammatory
reaction around
affected area

DIAGNOSIS, TREATMENT, AND PREVENTION

Diagnosis:
- finding larvae in lesions
- not just based on clinical data
- best to look for larva
Treatment:
- surgical removal of larval plerocercoid
Prevention:
- In endemic areas: drinking water should be
boiled
or
filtered,
thorough
cooking
of
intermediate hosts (fish/frogs)
- use of protective equipment when handling
contaminated water
HYMENOLEPIS NANA
CASE:
A 6 year old boy experienced weight loss of about
5 kg and reported a periodic fever predominantly
at night time for 2 to 3 months. He also
complained of abdominal pain. No family history
of cancer.
Clinical examination showed multiple mobile,
non-tender submandibular lympg nodes with
maximum size of 1 x 1 cm. A solid, tender
epigastric mass extending to the umbilical region
was palpated. The abdomen was soft with no
organomegaly.
*epigastric to umbilicus = small intestine
Lab tests requested include: CBC, U/A, and
fecalysis. All were normal.
An abdominal UTZ showed presence of a mass 6
x 3 cm in size, located between the aorta and
superior mesenteric artery.

CT scan of the abdomen showed multiple,

integrated mesenteric lymph nodes with areas of
distended loops of small bowels with areas of
thickened wall.
Head CT scan was normal.
*ongoing
inflammation

distended
and
thickened
associated with chronic persistent infection
deposition of fibrous tissue
*enteritis distention of small bowels
Bone marrow aspiration and biopsy revealed
increased number of PMNs and eosinophils.
A repeat stool exam showed positive for nonoperculated eggs.
A repeat CBC was done and revealed mild
eosinophilia (10%).
probably parasitic infection
HYMENOLEPIS NANA
Disease: Dwarf tapeworm infection
Common name: dwarf tapeworm
Definitive host: humans, mice, rats
NO INTERMEDIATE HOST
Infective stage: embryonated egg
Epidemiology
- more than 20 million worldwide is infected
*increased number of cases reported in US
- younger age group is more affected
- transmission is dependent on immediate
contact
- hand to mouth
- contaminated food and water
- chief source of infection: humans

Adult: very short worm

- 200 proglottids; very short life span: several
days
Scolex of H. nana
-small globular scolex
- with rostellum (very
small)
- single ring of hooks
- 4 muscular suckers
- short, retractile

SPIROMETRA, H. NANA- DR. ASUNCION November 19, 2014

Proglottids
- broad than long
- 1 genital pore on lateral ends, usually lateral left
side
- 3 round testes
- bilobed ovary
*gravid proglottid: similar to other
Cyclophyllideans
- sacular uterus
- less eggs: <200 eggs within gravid uterus
- very short segment

Ova
- oval to globular
- 2 membranes enclosing embryo
- with 6 hooks (3 pairs)
hexacanth embryo
- thinner filaments (polar filaments/ thickenings)
- seen within embryo
- non-operculated
- embryonated (mature) when laid

LIFE CYCLE
proglottid ruptures in intestine
disseminate through apolysis
detach from main scolex, neck, immature
proglottids
attach to intestinal lumen
lays embryonated eggs
immediatedly infective once released into
environment
ingested by host (insect/rodent)
ingested by humans from contaminated food,
water,
hands
reaches small intestine and releases larva
another infection occurs in human host
*autoinfection is prominent
Infective stage: embryonated egg
Diagnostic stage: embryonated egg and
proglottids
Pathogenicity
- no intestinal mucosal damage
- light infections: asymptomatic or vague
abdominal disturbances
- fairly heavy infections: lack of appetite,
abdominal pain, diarrhea, anorexia, vomiting,
dizziness
due to elaborated byproducts of worm
- heavy infections: enteritis
DIAGNOSIS, TREATMENT, AND PREVENTION
Diagnosis:
Finding eggs, sometimes proglottids, in feces
Treatment:

SPIROMETRA, H. NANA- DR. ASUNCION November 19, 2014

DOC: Praziquantel 25 mg/kg SD
Alternative:
- Niclosamide 2 g (4 tabs) OD for 5 7 days
(adult)
o Children: 1 g OD for 5 days
- Paromomycin 45 mg/kg daily for 4 doses
with an hour interval per dose for 5 days

Prevention:
- Difficult
- Better hygiene practices
- eliminate sources: control rodents
- environmental sanitation prevent spread