脑曼氏裂头蚴病误诊1例

doi:10.12140/j.issn.1000-7423.2022.06.022

摘要/Abstract

摘要：

患者，男，16岁，在读学生，成都市新都区人。于2017年因癫痫发作，在外院就诊，误诊为“脑血管瘤”，先后行伽马刀术3次，术后症状均有所改善；于2021年11月因视物重影、言语失流利、步态不稳等症状，且影像学检查示不排除患“脑肿瘤”可能，再次行脑部开颅手术，术中见脑组织内有白色棉线样虫体1条，考虑可能是“寄生虫”，遂将患者转院至成都市公共卫生临床医疗中心作进一步的诊治。入院后询问患者病史并进行相关检查。患者曾有食未煮熟水产品史。血常规检查示，嗜酸粒细胞数和百分比均在正常范围；血清学检测结果为裂头蚴IgG抗体阳性。复阅上家医院拍摄的影像学报告和病理切片等，MRI报告示，脑干区、左侧小脑半球不均匀片状异常信号，增强后呈环状强化；CT报告示，脑干左侧份（桥脑及中脑）、左侧小脑半球斑点状及小结节强化；脑组织病理切片，见典型坏死性隧道及肉芽肿，并可见寄生虫样虫体结构3段，虫体有体壁横纹、体内纵行肌及石灰小体等为“曼氏裂头蚴”虫体特征性结构。确诊该患者为脑裂头蚴病。予吡喹酮治疗[25 mg/(kg·d)× 4 d（共4个疗程，每次间隔1个月）]，首个疗程后出院。6个月后随访，影像学复查示脑部病灶基本消失，临床症状明显好转。

关键词: 癫痫, 寄生虫, 曼氏裂头蚴, 脑裂头蚴病

Abstract:

A 16-year-old male patient, who is a student, lived in Xindu district of Chengdu. In 2017, the patient was misdiagnosed as having "cerebral hemangioma" due to epilepsy in another hospital, followed by gamma knife radiosurgery three times. The patien’s symptoms were relieved after each operation. However, the patient underwent brain surgery due to visual ghosting, unable to speak freely, gait instability and radiographic suggests brain tumour could not be excluded in July 2021. During the surgery, one white worm was found in the brain tissue. The patient was transferred to the Public health clinical centre of Chengdu due to a suspected parasitic infection. The patient had a history of consuming uncooked aquatic products, blood cell count showed eosinophil count and eosinophil percentage were normal, and serum Sparganum mansoni specific IgG antibodies were positive. MRI showed inhomogeneous flaky abnormal signal and ring strengthening after enhancements in the brainstem and left cerebellar hemisphere, and CT showed speckle and small nodule enhancement in left brainstem(pons and midbrain) and left cerebellar hemisphere. Brain histopathology showed necrotic tunnel and granulomatous inflammation. The transverse striation of the body wall, longitudinal muscle and calcareous corpuscles were found in the three parasite bodies. Therefore, the patient was diagnosed with cerebral sparganosis. Praziquantel [25 mg/(kg·d), lasted 5 days, 4 courses, each treatment interval of 1 month] was used for deworming treatment. The radiographic changes mostly disappeared and the symptoms improved after 6 months.

Key words: Epilepsy, Parasite, Sparganum mansoni, Cerebral sparganosis

中图分类号:

R383.31

荣智利, 石婷婷. 脑曼氏裂头蚴病误诊1例[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(6): 817-820.

RONG Zhi-li, SHI Ting-ting. A misdiagnosed case of brain sparganosis mansoni[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2022, 40(6): 817-820.

图/表 2

参考文献 15

[1]	Lin XM, Liu CJ, Zhang HW, et al. Epidemiological investigation on sparganosis mansoni and animal experiments[J]. Chin J Parasitol Parasit Dis, 2010, 28(2): 132-134. (in Chinese)
	(蔺西萌, 刘长军, 张红卫, 等. 曼氏裂头蚴病流行病学调查及动物实验[J]. 中国寄生虫学与寄生虫病杂志, 2010, 28(2): 132-134.)
[2]	Guo RZ. Pathologic colour atlas of infectious disease and parasitosis[M]. Guiyang: Guizhou Science and Technology Publish House, 2012: 220-227. (in Chinese)
	(郭瑞珍. 传染病学与寄生虫病病理学彩色图谱[M]. 贵阳: 贵州科技出版社, 2012: 220-227.)
[3]	Shi DM, Wang XL, Chen L, et al. Clinical characteristics and misdiagnosis analysis of sparganosis: a retrospective study of 52 cases[J]. J Diagn Concepts& Pract, 2020, 19(1):37-43. (in Chinese)
	(史冬梅, 王晓琳, 陈璐, 等. 曼氏裂头蚴病52例临床特点及误诊分析[J]. 诊断学理论与实践, 2020, 19(1): 37-43.)
[4]	Ye SK, Xu L, Huang Q, et al. The epidemiology, clinical feature, radiology and outcome of 8 cases with cerebral sparganosis mansoni[J]. Chin J Parasitol Parasit Dis, 2018, 36(2): 144-147. (in Chinese)
	(叶善可, 徐烈, 黄琴, 等. 8例脑曼氏裂头蚴病的流行病学特点、临床特征、影像学表现与预后分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(2): 144-147.)
[5]	Yan XQ, Li XL, Sun ZQ, et al. Clinical features of 83 cases of cerebral sparganosis[J]. Chin J Parasitol Parasit Dis, 2021, 39(2): 240-245. (in Chinese)
	(闫学强, 李晓龙, 孙祯卿, 等. 83例脑裂头蚴病患者临床资料分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(2):240-245.)
[6]	Xie HQ, Long Y, Xu Y, et al. Clinical features, radiological characteristics, and pathological changes in 42 patients with cerebral sparganosis[J]. Chin L Neurol, 2015, 48(2): 108-113. (in Chinese)
	(谢慧群, 龙勇, 徐芸, 等. 脑曼氏裂头蚴病患者42例的临床、影像与病理特点分析[J]. 中华神经科杂志, 2015, 48(2): 108-113.)
[7]	Mo ZS, Li XH, Lei ZY, et al. Clinical analysis of 25 sparganosis cases[J]. Chin J Parasitol Parasit Dis, 2013, 31(3): 218-220. (in Chinese)
	(莫志硕, 李新华, 雷姿颖, 等. 25例裂头蚴病患者临床特点分析[J]. 中国寄生虫学与寄生虫病杂志, 2013, 31(3): 218-220.)
[8]	Kim H, Kim SI, Cho SY. Serological diagnosis of human sparganosis by means of micro-ELISA[J]. Kisaengchunghak Chapchi, 1984, 22(2): 222-228.
[9]	Chung YB, Kong Y, Yang HJ, et al. IgG antibody responses in early experimental sparganosis and IgG subclass responses in human sparganosis[J]. Korean J Parasitol, 2000, 38(3): 145-150.
[10]	Shen MQ, Liu J, Yang LQ, et al. Diagnosis and treatment for four cases of sparganosis mansoni[J]. Chin J Parasitol Parasit Dis, 2015, 33(2): 125-126. (in Chinese)
	(沈美清, 刘建, 杨利群, 等. 人感染曼氏裂头蚴病4例诊治分析[J]. 中国寄生虫学与寄生虫病杂志, 2015, 33(2): 125-126.)
[11]	Ding YJ, Liu J, Xie AM. Imaging characteristics of cerebral sparganosis[J]. J Nanchang Univ Med Sci, 2011, 51(5): 35-37, 41. (in Chinese)
	丁耀军, 柳健, 谢安明. 脑裂头蚴病的影像学特征分析[J]. 南昌大学学报(医学版), 2011, 51(5):35- 37, 41.)
[12]	Mao QQ, Zheng XY, Jia XL, et al. Relationships between total/free prostate-specific antigen and prostate volume in Chinese men with biopsy-proven benign prostatic hyperplasia[J]. Int Urol Nephrol, 2009, 41(4): 761-766.
[13]	Presti AL, Aguirre DT, De Andrés P, et al. Cerebral sparganosis: case report and review of the European cases[J]. Acta Neurochir, 2015, 157(8): 1339-1343.
[14]	Kim DG, Paek SH, Chang KH, et al. Cerebral sparganosis: clinical, manifestations, treatment, and outcome[J]. J Neurosurg, 1996, 85(6): 1066-1071.
[15]	Jin X, Tan JL, Sun ZQ, et al. Experience in diagnosis and successful removal of live worms for cerebral echinococcosis[J]. J Clin Neurosurg, 2019, 16(6): 518-526. (in Chinese)
	(金鑫, 谭家亮, 孙祯卿, 等. 脑裂头蚴病的诊断及手术取出活虫的经验[J]. 临床神经外科杂志, 2019, 16(6): 518-526.)