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Experimental Human Infection with the Sparganum Larva of Spirometra Mansonoides (Mueller, 1935)¹

1. The authors experimentally infected themselves with the sparganum larva of Spirometra mansonoides on November 26, 1938, by introducing the heads of three larvae beneath the skin of the left arm over the biceps muscle, two into Mueller, one into Coulston. These heads measured at most 2 mm. in length.

2. On February 2, 1939 a sparganum 50 mm. in length, representing a growth of 48 mm., was removed from Coulston's arm after it had migrated from the site of injection to the region of the axilla, a distance of about 12 cm., where it was found under the deep fascia.

3. On February 3, 1939 a sparganum 60 mm. long, representing a growth of about 58 mm., was removed from the biceps muscle of Mueller under local anesthetic. Only a fragment of the tail end of the other worm, about 10 mm. long, could be found at this time.

4. On March 4, 1939, a second sparganum about 60 mm. long was removed from Mueller.

5. This last sparganum was fed to an ova-free, known unin-fected cat, and produced a normal adult worm 50 inches in length. Ova of this worm were cultured and the procercoids found infective for rhesus monkeys demonstrating that the worm had not suffered any loss of vigor by human passage.

6. Symptoms associated with infection were local induration at the site of the worm, periodic giant urticaria, edema, and erythema. These periodic symptoms appeared to coincide with movements of the worm which from time to time broke out of the surrounding reaction zone, presumably liberating into the circulation walled off toxins. These periodic local reactions were attended by chills and fever and feelings of profound depression and malaise.

7. Eosinophilia appeared, rising to 10 per cent in Mueller on the 32nd day, and to 9 per cent in Coulston on the 23rd to the 27th day.

8. A positive skin reaction was elicited to scratch tests or intradermal tests with antigens prepared from Spirometra mansonoides adult and sparganum, T. crassicollis adult and cysticercus, T. pisiformis adult and cysticercus, and T. serrata. Also with the substance of a plerocercoid found in Great Lakes ciscoes. Antigens for intradermal use were prepared by Dr. J. T. Culbertson of Columbia University. They were not lipid free.

9. While the subjects were still infected skin testing did not elicit any immediate reaction, only delayed reaction after about 10 or 12 hours.

10. After removal of the worms the subjects developed an immediate reaction to skin tests, while retaining the delayed reaction. The delayed reaction in the case of the scratch tests is recurrent several times at 10 to 12 hour intervals.

11. In over 60 control skin tests on volunteers only one "false positive" was obtained, and that in the case of a student who gave a history suggesting that he may at one time have been infected with a sparganum.

12. The two authors still show strongly positive reactions to skin tests at the present writing (January 8, 1941), almost 20 months after removal of the worms.

13. Complement fixation tests were unsatisfactory on the two experimentally infected humans, possibly because of the employment of too weak an antigen, or more probably because the serum was kept for too long a time before performing the tests.

14. Pathological changes were extensive and in the nature of chronic inflammatory reaction, with local necrotic areas surrounding the worm.

15. In both subjects the spargana exhibited migration, in one case penetrating and forming a gallery in the biceps muscle, in the other passing to the region of the axilla. Encapsulation though extensive was not sufficient to wall off the spargana.

16. With the establishment of Spirometra mansonoides as a potential human parasite physicians throughout the geographic range of the worm should be informed of its nature and educated to watch out for it. The use of antigens of tapeworm substance for diagnosis is recommended.

17. It further appears that this parasite may constitute another potential waterborn disease throughout its range in the eastern United States, and render swimming in certain natural bodies of water carrying the copepod intermediate host, or the use of shallow well or spring water, etc., dangerous.

18. Such antigens as we used are not specific, since they retain the lipid fraction. Spirometra antigens elicited positive reactions in hydatid disease patients. It is probable that a more specific antigen can be prepared by preliminary removal of the lipids before extraction.

Received February 2, 1941.
¹ This research and its publication were aided by several grants from the Hendricks Research Fund of the Syracuse University College of Medicine.