Case report: the first case of human infection by adult of SPIROMETRA ERINACEIEUROPAEI in VIETNAM
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Tapeworms of the genus Spirometra include species whose larval stages can infect humans, causing a disease called sparganosis. Cases of human infection with adult worms are very rare and have been reported in Korea and China. Here we report the first case of human infection with an adult of Spirometra erinaceieuropaei in Vietnam.
A 23-year-old male was admitted to 103 Military Hospital, Hanoi, Vietnam with fever, weight loss and epigastric discomfort. Preliminary diagnosis based on discovery of parasite eggs in his faeces incorrectly determined a fluke as the agent of the infection and praziquantel was prescribed. Two days later he passed out proglottids in his stool. The tapeworm was identified as Spirometra erinaceieuropaei using morphological and molecular tools.
This is the first case of human infection with adult worm of Spirometra erinaceieuropaei in Vietnam.
KeywordsCase report Spirometraerinacei europaei Adult worm Human Vietnam Molecular analysis
Cytochrome c oxidase subunit I
Polymerase Chain Reaction
Spirometra is a tapeworm genus in the order Diphyllobothriidea  that includes several species: S. erinacei (=S. erinaceieuropaei), Sparganum mansoni, Spirometra mansonoides and an aberrant form of Spirometra proliferum .
Spirometra has a complicated life cycle with three hosts. The definitive hosts are dogs, cats, and some other mammals where adult worms live in the small intestine and produce unembryonated eggs that are discharged in faeces. Once in fresh water, the unembryonated eggs hatch to become coracidia. The first intermediate hosts are copepods (Cyclops) taking up the coracidia, which develop into procercoid larvae in Cyclops. When fish, reptiles, or amphibians consume the copepods, they become the second intermediate host of Spirometra. Procercoid larvae penetrate the intestinal tract of the second intermediate host, become plerocercoid larvae (sparganum larvae), then migrate to the subcutaneous tissues and muscles. The cycle begins again as a definitive host takes up a second intermediate host. Many amphibians, reptiles and even mammals can become paratenic hosts when they are infected with spargana .
Humans can be accidental definitive, second intermediate or paratenic hosts as well. Larval stages of some species such as S. erinaceieuropaei, S. mansoni, S. mansonoides, S. proliferum can infect humans and cause a disease called sparganosis  which is endemic in Asian countries including China , Hong Kong , South Korea , Japan , and Thailand . Cases of human infection with adult worms are very rare and have been reported in Korea and China [10, 11].
We report a case of human infection with adult of S. erinaceieuropaei identified by its morphology and genetic analysis in Vietnam. To our knowledge, this is the first case of adult S. erinaceieuropaei recovered from human in Vietnam.
The most common state of infection with this tapeworm is larvae. Only a few cases of human infection with adult worms have been reported so far [10, 11]. The patients usually suffered minor health problems and were successfully treated with praziquantel .
Vietnam and the south-eastern Asia region witness a large number of zoonotic diseases (taeniasis, trichinellosis) relating to the habit of eating raw meat . Vietnamese people also traditionally practice using frog flesh as dressings for open wounds or eyes for medical purposes . Water hygiene is another problem since clean water is not accessible in some areas. These factors lead to Vietnam being a conducive environment for diverse parasitological diseases in general and infections with Spirometra in particular. Although Vietnam is considered an endemic area of sparganosis , human clinical cases have been rarely reported, e.g. a subcutaneous sparganosis case published by Vortel el al. .
This is the first case where an adult worm of Spirometra erinaceieuropaei was retrieved from human in Vietnam. The name of the tapeworm is Spirometra erinaceieuropaei, as confirmed by morphological and molecular tools. Further research to determine the exact epidemiological situation in Vietnam is necessary to facilitate appropriate preventive measures. Health education should be augmented to promote hygienic behaviors such as eating thoroughly cooked meat and drinking boiled water to prevent meat borne and waterborne diseases.
The authors are grateful to Mr. Robert Mayrhofer and Ms. Linh Khanh Le for revising the English text.
Availability of data and materials
The sequence generated and analysed during the current study is available in the Genbank under the code MF682495.
ATL designed the study and created the final draft of the manuscript. LQDT collected data relating to the Case Report. HBTN, HNTN and AND conducted the study, as well as morphological and molecular analyses. All authors read and approved of the final manuscript.
Ethics approval and consent to participate
Consent for publication
Written informed consent was obtained from the patient for the publicationof this case report and any accompanying images. A copy of the writtenconsent is available for review by the Editor of this journal.
The authors declare that they have no competing interests.
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