Table 2.
Case no.; references | Patient, immune status and case history | Pathological findings | Etiological diagnosis: morphology and DNA analysis (PCRa, sequencing) |
---|---|---|---|
Case 1 Shea et al. (1973); Freeman et al. (1973) |
17-year-old immunocompetent Canadian woman, with decreased visual acuity of her right eye since two months. Four months earlier she suffered from a severe generalized erythematosus skin condition. A family dog infected most probabely with T. crassiceps (based on proglottid morphology) lived in intimate association with the patient. |
A large motile cyst with a scolex and several smaller cystic leisons were observed at the posterior pole of her right eye. With a putative diagnosis of a T. crassiceps cysticercosis, cysts were removed by surgical intervention. |
Morphology. Based on clinical material and from the established isolate in mice, T. crassiceps cysticerci were identified by rostellar hook morphology and numbers as well as by the budding proliferation of the cysticerci. DNA analysis. Nd. |
Case 2 Klinker et al. (1992) |
33-year-old German male, AIDS patient with a Pneumocystis carinii pneumonia and cerebral toxoplasmosis presented a growing paravertebral haematoma. The patient reported a fall around 4 weeks before the first symptoms appeared. | Subcutaneous, paravertebral infiltrate resembling a haematoma which spread over several weeks to cover almost the entire back. A spontaneous rupture of the infiltrate released “whitish spherical masses, 2–3 mm in diameter”. |
Morphology.T. crassiceps diagnosis was confirmed by the number of hooks and the typical budding of the cysticerci. DNA analysis. Nd. |
Case 3 Chermette et al. (1995) |
33-year-old Frenchman, AIDS patient (stage IV). Suffered around 2 months earlier of a haematoma of the left arm after a fall. | Subcutaneous and muscular tissues invasion of the left arm with extension to the pectoral region. A surgical intervention revealed multiple larval forms. |
Morphology. Ovoid (4 mm × 2 mm), transparent vesicles of different developmental stages, some containing one scolex with 4 suckers and 2 rows of rostellar hooks, some with external buds at the opposite site of the scolex. DNA analysis. Nd. |
Case 4 Chuck et al. (1997) |
38-year-old USA woman, (immune status not mentioned) with blurred vision in the right eye that had persisted for 4 weeks. The patient played with a 6-month-old German shepherd shortly before the dog passed a tapeworm. | Dilated fundus examination revealed a large, elevated, clear, fluid filled subretinal mass with several oval cystic structures of varying sizes. |
Morphology. One of the cysts contained a mature scolex with characteristic hooks. Budding on the distal part of the cysticerci was indicative for T. crassiceps. DNA analysis. Nd. |
Case 5 Francois et al. (1998) |
38-year-old Frenchman with severe AIDS. He denied using intravenous drugs. Two months before admission he noticed a rapid progressive swelling in the right arm and forearm. The patient was in close contact with dogs and frequently walked in the forests of Normandy and Jura. | MRI showed a mass, suggesting a soft tissue neoplasm with numerous, heterogenous, invasive cystlike lesions. Surgery revealed lesions “containing a yellowish viscous fluid, hundreds of granules, and cysticerci like small vesicles”. |
Morphology. invaginated scolex with two rows of small and large rostellar hooks, endogenous budding of the cysticerci. DNA analysis. Nd. |
Case 6 Maillard et al. (1998) |
34-year-old Frenchman, AIDS patient (C3) clinical disease, developed a traumatic haematoma on the left arm after a fall in the countryside. One month later, the swelling spread to the left pectoral region. | US and MRI showed a dissociation of muscular fibres. An incision on the left arm produced “a fluid that contained many transparent, spherical masses, 1–3 mm in diameter”. |
Morphology. Microscopic examination revealed parasites compatible with larvae of T. crassiceps with single or multiple external buds at the opposite side of the scolex. DNA analysis. Nd. |
Case 7 Heldwein et al. (2006) |
82-year-old German woman, with a history of colon cancer with hemicolectomy and a B cell non-Hodgkin's lymphoma treated with fludarabine phosphate and cyclophosphamide two months before admission. She had also undergone radiotherapy of retrocardiac and iliac lymph nodes. Progressive pain and swelling in the left forearm and back of the left hand had started six weeks earlier after a fall on the hand with soft tissue injury. | US and MRI of the limb showed massive oedema of subcutaneous tissue and in between muscles and tendons and multiple cystic lesions were demonstrated. At fasciotomy jelly-like tissue containing multiple spherical masses with diameters of up to 2 mm, “similar to fish spawn”, was removed from the subcutis, muscles, and tendons. |
Morphology. Cysticerci with an ellipsoid cystic body, a long and retractable neck, and a single scolex with four suckers and two rows of hooklets. Additionally, buds at the posterior end of the larvae were observed. DNA analysis. Nd. |
Case 8 Goesseringer et al. (2011); Flammer Anikpeh et al. (2014) |
47-year-old Swiss woman, severely immunodeficient (HIV-1 RNA viral load of >4 million copies/mL). Suffered from an injury to her right wrist during her work as a zoo-employee 5 months earlier. Exposed to dogs and foxes. | Swollen and painful right forearm for 2 weeks with clinical presentation and MRI suggestive for a necrotising fasciitis. “Surgical exploration revealed small transparent cystic bodies resembling white caviar”. |
Morphology. Small (4–5 mm) transparent cystic bodies with a retractable neck and a single scolex with four suckers and two rows of hooklets as well as budding were indicative for T. crassiceps. DNA analysis.12S [P6]:“Sequence analysis of a fragment of the small subunit rRNA gene1 permitted species identification” (but this was not substantiated). |
Case 9 Schmid et al. (2014) |
57-year-old Swiss woman, immunocompetent (serological testing for HIV negative) and other immunological parameters were inconspicuous, presented with swelling and an 8-cm haematoma localized on the right temple. She had no history of a traumatic incident. | Sonography revealeds a hypoechogenic lesion within the temporal muscle. A small amount of whitish material was aspirated. |
Morphology. Smears revealed a putative tapeworm larva and accumulation of eosinophilic granulocytes (Papanicolaou stains). DNA analysis.12S [P6] sequence analysis tentatively identified the parasite as T. crassiceps. nad1 [P3]: Identity 421/421 bp or 100% with T. crassiceps nad1, (GenBank AF216699). |
Case 10 Ntoukas et al. (2013) |
51-year-old immunocompetent German (Regensburg, southern Germany) woman, was hospitalized with progressive headache, nausea, vomiting and cerebellar ataxia but no further neurologic deficits. She had been living with her dog (not regularly dewormed, with free access to garden and forest) in a rural area for many years. |
Craniotomy revealed subdural and intracerebellar jelly-like tumorous tissue (≈30 × 30 mm). The tumor consisted of multiple spherical masses with diameters of 2–4 mm, which was resected. |
Morphology. Gross morphology and histology revealed typical structures of cestode larvae. DNA analysis.12s [P5]: Identity 99% with T. crassiceps and cox1 [P1]: identity 450/450 bp or 100%, with T. crassiceps. |
Case 11 (Ronald Neafie, pers. comm.)b |
US Patient (Oregon) without immunosuppression | Site of infection: Eye (subretinal) | No details given |
Case 12 (Ronald Neafie, pers. comm.)b |
US Patient (Maine) without immunosuppression | Site of infection: Subcutis, shoulder | No details given |
Primer pairs [P] used are given in squared brackets and refer to Table 6.
Cited in Ntoukas et al. (2013).