Vol. 22, No.

4 April 2000 V

CE Refereed Peer Review

FOCAL POINT
★Although Spirometra infections
are less prevalent than are those
caused by other tapeworms, they
do occur in cats and, less
commonly, in dogs and should
be considered a potential cause
of chronic diarrhea in pets
allowed to consume prey.
KEY FACTS
■ Spirometra is endemic in some
areas of the southeastern United
States; dogs and cats with access
to wild prey are at risk for
infection.
Spirometra Infection
in Cats and Dogs
University of Georgia
Susan Little, DVM, PhD
Dana Ambrose, MS
ABSTRACT: Spirometra are tapeworm parasites of the small intestine in cats, wild felids, rac-
coons, and occasionally dogs. Spirometra infections occur regularly in the southeastern Unit-
ed States and can result in persistent diarrhea in some infected animals. When appropriate fe-
cal examination is performed, identification of the characteristic operculated eggs allows a
straightforward diagnosis. However, prolonged, high-dose anthelmintic therapy is needed to
fully resolve clinical disease. Lack of awareness of this parasite may delay accurate diagnosis
and appropriate therapy in infected pets. This article reviews the life history, diagnosis, treat-
ment, and zoonotic nature of and the clinical disease associated with Spirometra infections in
cats and dogs.

S
■ The operculated eggs of
pirometra species are pseudophyllidean tapeworms for which domestic and
Spirometra, which resemble and
wild carnivores serve as definitive hosts. Infection caused by tapeworms is
are sometimes mistaken for fluke
occasionally diagnosed in cats and, less commonly, dogs that have access to
eggs, are readily detected by
vertebrate prey in areas where the parasite is endemic. Several species of Spirome-
standard flotation methods.
tra have been reported in cats and dogs.1,2 Infected animals may be asymptomat-
ic or develop mild to moderate enteritis with associated diarrhea, weight loss,
■ Effective anthelmintic treatment
and vomiting.3 Reaching an accurate diagnosis may be difficult even when eggs
for Spirometra in dogs and
are detected on fecal examination; some veterinarians are unfamiliar with this
cats requires administering
parasite, and the organism is relatively rare in small animals in many areas of
praziquantel at a higher dose and
North America. In addition, Spirometra differs from the more familiar Dipylidi-
for a longer period than that
um caninum and Taeniid (Taenia species, Echinococcus species) tapeworms of
needed to remove Dipylidium
small animals in key aspects of life history, diagnostic features, and treatment
caninum, Taenia species, and
recommendations. Appreciating these differences and recognizing the potential
Echinococcus species.
significance of this parasite in cats and dogs are essential components of treating
and preventing Spirometra infections.
■ Humans may become infected
with plerocercoids of Spirometra
EPIDEMIOLOGY
after drinking contaminated
In the United States, Spirometra has been reported in cats from Louisiana,4
water or ingesting infected
New York,5 Texas,6 New Jersey,7 Hawaii,8 Pennsylvania,3 South Carolina,9 and
undercooked meat, but the eggs
Florida10 and in bobcats from North Carolina,11 Texas,6 Florida,11,12 Georgia,13
shed by cats and dogs are not
and West Virginia.13 Although widely distributed, Spirometra is commonly
infectious to humans.
found in domestic cats in Florida and the gulf coastal states1,10 where abundant
aquatic ecosystems to support the parasite’s life cycle are available. From 1990 to
1999, 33 cats and one dog were diagnosed with Spirometra by the Clinical Para-
Small Animal/Exotics
sitology Service at the University of Georgia’s College
of Veterinary Medicine; diagnosis was made by identifi-
cation of eggs in fecal samples or, in some cases, vomit-
ed segments of adult tapeworms. Most of these cases
were from Georgia, South Carolina, and Florida. We
have found that Spirometra infection in cats is not un-
usual in areas of the southeastern United States where
the parasite is endemic in nature.
LIFE CYCLE
Unlike other tapeworms in small animals, adult
Spirometra species in the small intestine of cats or dogs
do not shed egg-laden proglottids in the host’s feces.
Rather, individual eggs are shed in the feces following
discharge from the uterine pore of adult tapeworms.
The operculated egg then hatches in water, releasing a
free-swimming coracidium (ciliated oncosphere). The
coracidium is ingested by the first intermediate host, a
copepod of the genus Cyclops, and develops into a pro-
cercoid. When a second intermediate host (i.e., any
vertebrate other than a fish) consumes the infected
copepod, the procercoid develops into a plerocercoid in
the muscles or connective tissue of this host. When
consumed by a definitive host (cats, wild felids, rac-
coons, and occasionally dogs), the plerocercoid attaches
to the small intestine and develops into an adult tape-
worm, which can be up to 1.5 m long. Eggs are released
from the uterine pores of gravid proglottids and are evi-
dent in the host’s feces approximately 10 to 30 days af-
ter infection.2,14
If the second intermediate host is eaten by another
non-fish vertebrate rather than a definitive host, the
plerocercoids migrate through the tissue but remain as
plerocercoids in the new paratenic (transport) host;
thus the larval Spirometra can infect and survive in a se-
ries of paratenic hosts until finally consumed by a suit-
able carnivore definitive host. This adaptation not only
increases the likelihood that the parasite will eventually
find an appropriate definitive host but also results in
large numbers of plerocercoids in omnivorous animals
that regularly consume infected second intermediate
hosts.2,14
CLINICAL DISEASE
Sound experimental evidence demonstrating the
pathogenic nature of adult Spirometra in cats and dogs
is lacking. However, the closely related tapeworm Di-
phyllobothrium latum is known to cause diarrhea, nau-
sea, and weakness in infected humans.15 Although not
all infections with Spirometra result in overt clinical dis-
ease, enteritis and associated diarrhea in individual ani-
mals has been reported. 3 Several cases diagnosed
through the University of Georgia’s Clinical Parasitolo-
PROGLOTTIDS ■ OPERCULATED EGG ■ PLEROCERCOIDS ■ PSEUDOPHYLLIDEAN TAPEWORM
Compendium April 2000
gy Service had a history of diarrhea, weight loss, and/or
vomiting on presentation. Clinical disease usually re-
solves following appropriate anthelmintic therapy.
The mechanism for disease with Spirometra species
has not been elucidated. A small proportion of D. la-
tum–infected individuals develop anemia as a result of
parasite absorption of vitamin B12 and subsequent B12
deficiency in the host.16 Selective uptake of vitamin B12
by plerocercoid and adult Spirometra has also been dem-
onstrated,17 but the role of this phenomenon in the
pathogenesis of disease in cats and dogs is unclear.
The presence of plerocercoids can also induce disease
in the second intermediate host or subsequent para-
tenic hosts. These plerocercoids are commonly called
spargana, and the condition caused by their presence in
the intermediate host’s tissue is termed sparganosis. Al-
though cats and dogs are usually definitive hosts,
sparganosis is occasionally reported in these animals.2
When present in subcutaneous tissue, the plerocercoids
cause relatively mild inflammation that usually appears
as a nonpainful subcutaneous mass.18–21 However, or-
gan-specific disease may develop if the spargana mi-
grate to such aberrant locations as the brain,22–25 spinal
cord,26 urinary bladder,27 eye,28–30 or intestine31 (refer to
the Zoonotic Potential section).
The plerocercoids of some Spirometra species repli-
cate asexually in the intermediate or paratenic host,
resulting in a severe pathogenic condition known as
proliferative sparganosis.2 In these cases, the dividing
plerocercoids lodge in visceral organs (e.g., liver, spleen,
and stomach) and cause chronic inflammation and re-
sultant fibrosis.10 This condition is apparently rare in
dogs and cats in the United States,10 but several cases of
proliferative sparganosis have been reported in Aus-
tralian dogs.32
DIAGNOSIS
Spirometra infections are reportedly difficult to diag-
nose in veterinary practice; most identifications and con-
firmations are made by veterinary parasitologists.1 This
difficulty may be partly due to unfamiliarity with this
parasite, even in areas where Spirometra infections are
common. Most veterinarians should be able to reliably
identify these infections on routine fecal examination.
The yellowish-brown operculated eggs of Spirometra
(Figure 1) resemble those of the closely related pseudo-
phyllidean tapeworm D. latum. However, D. latum is
most common in the Great Lakes region of North Amer-
ica33 and is rarely seen in the southeastern United States.
For clinical purposes, when these characteristic eggs are
found, a presumptive diagnosis of Spirometra can be
made in areas where this parasite is endemic.
Spirometra eggs also resemble and are sometimes mis-
Compendium April 2000 Small Animal/Exotics

taken for fluke eggs.1,33 Careful by gross recognition of plero-

measurement of the eggs un- cercoids in subcutaneous tis-
der consideration aids in re- sue and fascia (Figure 3).
solving questions regarding Identifying these plerocer-
their identity. Spirometra eggs coids past the level of spar-
average 60 by 36 µm and are gana, however, requires feed-
shed unembryonated. Thus ing them to a definitive host
they are much smaller than and then recovering the ad-
those of the dog and cat lung ults,14 a procedure usually not
fluke, Paragonimus (75 to 118 pursued in clinical work or
µm by 42 to 67 µm).34 Platy- wildlife prevalence surveys.
nosomum, the liver fluke of cats,
produces smaller operculated TREATMENT
eggs (45 µm long) that con- No anthelmintics are la-
tain a fully developed miracid- beled for eliminating infection
ium when passed in feces.14,33 Figure 1—Spirometra eggs (60 by 36 µm) can be identified with adult Spirometra species
Zinc sulfate centrifugation, on fecal flotation by the presence of an operculum (arrow) in cats and dogs. Failure has
sucrose centrifugation, and on the narrower end. been reported with albenda-
sodium nitrate flotation solu- zole (25 mg/kg twice daily for
tions are routinely used by the 10 days) and niclosamide
University of Georgia’s Clini- (333 mg/kg, single dose).3 At-
cal Parasitology Laboratory to tempts to treat Spirometra
effectively recover Spirometra clinically have also shown that
eggs. Some authors support standard doses of praziquantel
the use of these standard flota- (5 mg/kg, single dose) are not
tion techniques 7,9,35 whereas effective.3 Increased doses of
others assert that zinc sulfate praziquantel (7.5 mg/kg for 2
(specific gravity, 1.18) and consecutive days) have been
sodium nitrate (specific gravi- reported to be effective36,37;
ty, 1.18) are insufficient to however, we have found that
float these eggs. 3 Spirometra even higher doses (25 mg/kg
eggs can also be easily recov- for 2 consecutive days) may
ered with fecal sedimentation be necessary to eliminate this
procedures and even demon- parasite from infected cats.
strated on direct smears when Figure 2—Mature segments of Spirometra adults demon- Toxicity problems have not
the fecal sample contains nu- strating characteristic medial location of uterine pores (ar- been reported with these praz-
merous eggs. row). (Courtesy of Glen Caldwell, College of Veterinary iquantel doses in small ani-
Short chains of senile pro- Medicine, University of Georgia, Athens, Georgia). mals.38,39 Treatment of prolif-
glottids of adult worms are erative sparganosis with high
sometimes shed in feces of or doses of praziquantel and
more commonly vomited by infected cats or dogs.1 We mebendazole has been pursued but is generally unreward-
have found that these segments are usually less than 5 cm ing, and the prognosis is guarded.32,40 Reinfection is likely
long, although longer parasitic fragments may occasion- in areas where Spirometra is endemic but can be prevent-
ally be expelled. The proglottids are wider than they are ed by limiting access to intermediate host prey species.
long and contain a distinct, centrally located uterine pore
(Figure 2), characteristic of pseudophyllidean tapeworms ZOONOTIC POTENTIAL
(Spirometra and Diphyllobothrium).15 A scolex (holdfast Spirometra species are zoonotic parasites. Humans
organ) is not present on expelled senile segments of can become infected with the plerocercoids of this tape-
worms. However, if an intact worm is found at necropsy worm by inadvertently drinking water contaminated
and the scolex examined, the long slitlike bothria and ab- with copepods infected with procercoids, ingesting ple-
sence of hooks or suckers also allow identification of the rocercoids in the flesh of infected second intermediate
parasite as a pseudophyllidean cestode.15 or paratenic hosts, or via direct migration from infected
Infection in the intermediate host is readily diagnosed flesh into a wound or across a mucous membrane.15 In-

LIVER FLUKE ■ STANDARD FLOTATION TECHNIQUES ■ SCOLEX

Small Animal/Exotics
Figure 3—Plerocercoids (spargana; arrows) of Spirometra re-
leased from cysts in the fascia of the muscles of a feral hog.
(Courtesy of Dr. Mary Gray, USDA, Athens, Georgia, and
Glen Caldwell, College of Veterinary Medicine, University
of Georgia, Athens, Georgia).
fections with large numbers of plerocercoids have been
reported in feral pigs in Florida and Texas.41 Spargana
survive and remain infective in decaying flesh and re-
frigerated storage (5˚C) for 2 weeks, but freezing
(–12˚C for not less than five days) or thorough cooking
render the plerocercoids noninfectious to humans.2,42
Human sparganosis is rare and usually presents as
subcutaneous nodules containing the plerocercoid tape-
worm 18–21; most infected individuals are from the
southeastern United States.41 Nodules have been report-
ed in such sites as the scrotum43 and breast,44,45 resulting
in more severe clinical disease. Surgical removal allows a
complete recovery. In some cases, the plerocercoid de-
velops in the brain or spinal cord and causes severe cen-
tral nervous system disease and even death.22–26 Prolifer-
ative sparganosis, sometimes involving the central
nervous system, has also been reported in humans.46–48
CONCLUSION
Spirometra may be diagnosed in cats and dogs that
have access to wild prey in areas of North America where
SUBCUTANEOUS NODULES ■ HUMAN SPARGANOSIS
Compendium April 2000
the parasite is endemic. In the southeastern United
States, many veterinary practices and referral diagnostic
laboratories routinely find Spirometra eggs during fecal
examination of cats and occasionally dogs. Nonetheless,
many veterinarians are unaware of this parasite.
One reason this parasite is relatively unfamiliar is that
it is generally ignored as a small animal parasite by most
veterinary texts; indeed, Spirometra did not appear in
Sloss and Kemp’s Veterinary Clinical Parasitology—the
text many practicing veterinarians rely upon as an aid to
identifying unusual parasite findings—until the most re-
cent (sixth) edition.33 This historic oversight may con-
tribute to misidentification of Spirometra eggs as those of
D. latum or other parasites that shed operculated eggs.
Many cases of Spirometra in cats and dogs are asymp-
tomatic, but some infected animals present with gas-
troenteritis caused by the presence of adult worms in the
small intestine. Although straightforward, successful
treatment and resolution of clinical disease require ele-
vated doses of praziquantel for 2 consecutive days.
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About the Authors
Dr. Little and Ms. Ambrose are affiliated with the Depart-
ment of Medical Microbiology and Parasitology, College
of Veterinary Medicine, University of Georgia, Athens,
Georgia.