Sparganosis is a rare parasitic disease caused by the larval stages of tapeworms of the genus Spirometra. Though considered a neglected disease, it often makes its way into headlines when sporadic cases are reported, as these worms find their way into human bodies, leading to a variety of health complications. Recently, a notable report from Australia has cast a spotlight on sparganosis due to new case findings that suggest this zoonosis might be under-recognised within the country (DOI: 10.1136/bcr-2018-228396).
The Study and Its Findings
Published in BMJ Case Reports on May 5, 2019, the article titled “Sparganosis: an under-recognised zoonosis in Australia?” brings forward three additional cases of this parasitic affliction (Tran et al., 2019). These new instances add to the small number of previously reported cases of sparganosis in humans in Australia, which was registered at five until the time of the publication. The case report intends to raise awareness among clinicians and public health authorities about the varied clinical presentations of sparganosis and the potential underestimation of its occurrence.
The cases involved two Australian-born men who had never traveled outside the country and a woman who had emigrated from Ethiopia. They presented with symptoms ranging from subcutaneous lumps that migrated beneath the skin to intermittent fevers, night sweats, abdominal pain, and observations of intestinal worms. This range of presentations underscores the challenges in diagnosing sparganosis, which can mimic several other conditions. These cases have contributed to a growing body of evidence that suggests the zoonosis is under-recognized in the Australian medical community.
A World of Neglected Parasites
Globally, sparganosis is considered a neglected disease and is sporadically reported in various part of the world. Despite being rare, its occurrence is more common in East and Southeast Asia. The infection usually occurs when humans inadvertently become intermediate hosts by consuming raw or undercooked food, such as reptile or amphibian meat, which contain the viable parasite larvae (Liu et al., 2015). Additionally, drinking water contaminated with copepods or using raw frog meat as a poultice, a traditional remedy in some cultures, can result in infestation (Li et al., 2015).
The View from Down Under
In Australia, sparganosis is even less recognized with very few documented occurrences in humans. Historically, human infections have been seen with incidents dating as far back as the early 20th century (Cleland, 1918). The country has a rich array of wildlife, some of which serves as natural reservoirs of the tapeworm. The larval form of these tapeworms, or spargana, can indeed be found in native Australian fauna, hinting at the zoonotic potential within the country (Hughes & Biggs, 2002).
However, the low number of reported human infections compared to the likely prevalence of the parasite in wildlife could point to a gap in clinical awareness and reporting. Researchers urge a higher index of suspicion for sparganosis, particularly in patients presenting with unusual, migratory subcutaneous lumps or a history suggestive of exposure to wildlife or consumption of unconventional foods (Tran et al., 2019).
Treatment and Prognosis
Once properly diagnosed, the mainstay of treatment for sparganosis is surgical removal of the parasitic larvae. These larvae can form nodules in various tissues, including the muscles and the brain, leading to potentially severe clinical outcomes if not addressed (Anders et al., 1984). Early detection and intervention thus become crucial in managing sparganosis effectively. Recovery is generally good if the larva is completely removed and no significant damage has been made to the surrounding tissue.
The Future of Sparganosis Detection and Management in Australia
This report emphasizes the need for wider recognition of sparganosis among healthcare providers in Australia. Public health campaigns and clinician education could be beneficial in reducing the risk and aiding earlier diagnosis. Additionally, broader research into the disease’s prevalence in Australian wildlife could contribute to a better understanding of the zoonotic risks presented to the public.
Implications and Recommendations
The authors argue that a consolidated effort is indispensable for the mitigation and efficient management of sparganosis in Australia. These efforts must include improved clinical suspicion, reporting protocols, public awareness campaigns, and expanded research into the presence and transmission dynamics of Spirometra species in Australian wildlife. Early diagnosis and complete surgical removal remain the cornerstones of effective treatment for the disease, underscoring the importance of medical education in recognizing its presentation.
Keywords
1. Sparganosis in Australia
2. Zoonotic Diseases Australia
3. Rare Parasitic Infections
4. Sparganosis Treatment
5. Spirometra Tapeworm Australia
References
1. Tran, Q. R., Tran, M. C., Mehanna, D. (2019). Sparganosis: an under-recognised zoonosis in Australia? BMJ Case Rep, 12(5), e228396. DOI: 10.1136/bcr-2018-228396
2. Lescano, A. G., Zunt, J. (2013). Other cestodes: sparganosis, coenurosis and Taenia crassiceps cysticercosis. Handb Clin Neurol, 114, 335–45. DOI: 10.1016/B978-0-444-53490-3.00027-3
3. Hughes, A. J., Biggs, B. A. (2002). Parasitic worms of the central nervous system: an Australian perspective. Intern Med J, 32, 541–53. DOI: 10.1046/j.1445-5994.2002.00265.x
4. Liu, Q., Li, M. W., Wang, Z. D., et al. (2015). Human sparganosis, a neglected food borne zoonosis. Lancet Infect Dis, 15, 1226–35. DOI: 10.1016/S1473-3099(15)00133-4
5. Li, N., Xiang, Y., Feng, Y., et al. (2015). Clinical Features of Pulmonary Sparganosis. Am J Med Sci, 350, 436–41. DOI: 10.1097/MAJ.0000000000000578