Description, Causes and Risk Factors:
Infection with the cestode Diphyllobothrium latum; human infection is caused by ingestion of raw or inadequately cooked fish infected with the plerocercoid larva. Leukocytosis and eosinophilia may occur; if the worm is high enough in the alimentary canal, it may preempt the supply of vitamin B12 or alter its absorption, leading to hyperchromic macrocytic anemia resembling pernicious anemia, although the condition is rare, even in hyperendemic areas.
Alternative Name: Bothriocephaliasis, fish tapewarm infection.
Diphyllobothrium latum is the largest parasite of humans (up to 10 m in length). It and Sparganum mansoni are the only human tapeworms with aquatic life cycles. In freshwater, eggs of D. latum from human feces hatch into free-swimming larvae, which are ingested by microcrustaceans. The microcrustaceans are ingested by fish, in which the larvae become infective.
The fish tapeworm (Diphyllobothrium latum), is the largest parasite that infects humans. Humans become infected when they eat raw or undercooked freshwater fish that contain tapeworm cysts.
The infection is seen in many areas where humans eat uncooked or undercooked fish from rivers or lakes. Diphyllobothriasis is seen in Eastern Europe, North and South America, African countries in which freshwater fish are eaten, and in some Asian countries.
After a person has eaten infected fish, the larva begin to grow in the intestine. They are fully grown in 3 - 6 weeks. The adult worm, which is segmented, may reach a length of 30 feet. Eggs are formed in each segment of the worm and are passed in the stool. Occasionally, parts of the worm may also be passed in the stool.
Diphyllobothriasis occurs worldwide, especially where cool lakes are contaminated by sewage. Infections in the US and northern Europe occur in people who eat raw freshwater fish. Infection is less common with current sewage treatment.
Infection is usually asymptomatic, but mild GI symptoms may be noted. Fish tapeworms take up dietary vitamin B12, which occasionally results in vitamin B12 deficiency and megaloblastic anemia.
Other symptoms include
Nausea, vomiting, or diarrhea.
Loss of appetite and weight loss.
Abdominal discomfort or pain.
Diagnosis and Tests:
Diagnosis is by identification of characteristic operculated eggs or broad proglottids in stool.
Tests may include:
Stool examination for eggs and parasites.
Complete blood count, including differential.
Treatment is with a single oral dose of praziquantel Some 5 to 10 mg/kg. Alternatively, a single 2-g dose of niclosamide is given as 4 tablets (500 mg each) that are chewed one at a time and swallowed. For children, the dose is 50 mg/kg once.
Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.
Preventive measures: Avoiding raw freshwater fish and cooking fish enough (to more than 140 degrees F for 5 minutes) will prevent infection with the fish tapeworm. Freezing fish to -4 degrees F for 24 hours also kills fish tapeworm eggs.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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