Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland.
J Plast Reconstr Aesthet Surg. 2011 Jul;64(7):e174-6. doi: 10.1016/j.bjps.2011.02.011. Epub 2011 Mar 6.
We report a rare case of human Taenia crassiceps infection in a 47-year-old female patient with untreated acquired immunodeficiency syndrome and chronic hepatitis C infection. Little experience exists regarding the appropriate treatment of this infection. Usually, a combination of anthelmintic drugs is applied. Whether surgical measures are indicated have not been clarified. In our patient, initial surgery showed an abscess and fluid collection with numerous transparent cysts localised in the subcutaneous tissue of the cubital fossa. Parasitological and pathological examinations identified these structures as larvae of the cestode T. crassiceps. After treatment with anthelmintic medications, the patient was discharged in good condition. However, the patient presented with the clinical symptoms of an acute fasciitis of the right upper extremity 7 days later. The deteriorating general condition entailing a pre-septical state demanded emergency debridement and fasciectomy of the right arm. After the surgery, the patient recovered fully.
Surgical treatment appears to be an important measure to reduce the tissue parasite load in patients with severe immunodeficiency. It also has to be questioned whether the bioavailability and the penetration of the drugs commonly administered is sufficiently high to treat such a fulminant infection alone.
我们报告了一例罕见的人类多头绦虫感染病例，患者为一名 47 岁女性，患有未经治疗的获得性免疫缺陷综合征和慢性丙型肝炎感染。对于这种感染的适当治疗方法，经验很少。通常，应用驱虫药物的联合治疗。是否需要手术措施尚未明确。在我们的患者中，最初的手术显示出一个脓肿和积液，伴有许多透明的囊肿位于肘窝的皮下组织中。寄生虫学和病理学检查将这些结构鉴定为带绦虫幼虫。在驱虫药物治疗后，患者状况良好出院。然而，7 天后，患者出现右侧上肢急性筋膜炎的临床症状。病情恶化导致预败血症状态，需要紧急清创和右臂筋膜切开术。手术后，患者完全康复。
手术治疗似乎是减少严重免疫缺陷患者组织寄生虫负荷的重要措施。也有必要质疑常用药物的生物利用度和穿透性是否足以单独治疗如此暴发性感染。
