Diphyllobothriasis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2], Kalsang Dolma, M.B.B.S.[3]
Synonyms and keywords: Fish tapeworm infection, Diphyllobothrium latum infection, Diphyllobothrium infection
Overview
Diphyllobothriasis is an infection caused commonly by diphyllobothrium latum. It usually causes abdominal pain, diarrhea, and numbness of extremeties. The diagnosis is made by identifying eggs of the parasite in the stools. This infection is medically treated with a single dose of praziquantel. The transmission of diphyllobothriasis can be prevented by avoiding undercooked or raw fish meat.
Historical Perspective
Eggs of Diphyllobothrium are found in France and Germany dates back to 4000 BC. In 1592 AD, first recognizable description of the disease was by T. Dunus and the lifecycle was fully elucidated at the end of 19th century.
Classification
There is no known classification for diphyllobothriasis but it may be classified on the basis of the organisms causing it.
Pathophysiology
Diphyllobothriasis is a disease caused by Diphyllobothrium latum. D. latum has an aquatic life cycle and it is usually transmitted to the humans by ingesting the affected aquatic intermediate host (freshwater or marine fish). D. latum decreases the intestinal absorption of vitamin B12 resulting in megaloblastic anemia in humans.
Causes
Diphyllobothrium is a genus of tapeworm which can cause Diphyllobothriasis in humans through consumption of raw or undercooked fish. The principal species causing diphyllobothriosis is Diphyllobothrium latum, known as the broad or fish tapeworm, or broad fish tapeworm. D. latum is a pseudophyllid cestode that infects fish and mammals. D. latum is native to Scandinavia, western Russia, and the Baltics, though it is now also present in North America, especially the Pacific Northwest. Other members of the genus Diphyllobothrium include Diphyllobothrium dendriticum (the salmon tapeworm), which has a much larger range (the whole northern hemisphere), D. pacificum, D. cordatum, D. ursi, D. lanceolatum, D. dalliae, and D. yonagoensis, all of which infect humans only infrequently. In Japan, the most common species in human infection is D. nihonkaiense, which was only identified as a separate species from D. latum in 1989.[1]
Differentiating (Disease name) from other Conditions
Diphyllobothriasis must be differentiated from threadworm infections like taeniasis, hymenolepiasis, and schistosomiasis.
Epidemiology and Demographics
Diphyllobothriasis occurs in areas where lakes and rivers coexist with human consumption of raw or undercooked freshwater fish. It is particularly common in Japan, Scandinavia, Siberia, with sporadic cases in North and South America.
Risk Factors
The common risk factors in the development of diphyllobothriasis are eating raw or poorly cooked fish meat.
Screening
There is insufficient evidence to recommend routine screening for diphyllobothriasis.
Natural History, Complications and Prognosis
If left untreated, patients with diphyllobothriasis may progress to develop cholecystitis/cholangitis and anemia. Common complications of diphyllobothriasis include megaloblastic anemia, cholecystitis/cholangitis, and intestinal obstruction. Prognosis is generally good.
Diagnosis
History and Symptoms
The symptoms of diphyllobothriasis may include abdominal pain, diarrhea, nausea, vomiting, and less commonly numbness of toes and fingers.
Physical Examination
Patients with diphyllobothriasis are usually asymptomatic but may be irritated. Physical examination of patients with diphyllobothriasis is usually remarkable for abdominal tenderness, pale conjunctiva/skin, and decreased vibration and position senses.[2][3][4]=}}</ref>
Laboratory Findings
Diphyllobothriasis can be diagnosed with the morphological identification of diphyllobothrium eggs and adults. Molecular diagnosis can also be made with the PCR.
Chest X Ray
There are no X-ray findings associated with Diphyllobothriasis.
CT
There are no CT findings associated with Diphyllobothriasis.
MRI
There are no MRI findings associated with Diphyllobothriasis.
Echocardiography or Ultrasound
There are no echocardiography or ultrasound findings associated with Diphyllobothriasis.
Other Imaging Findings
There are no other imaging findings associated with Diphyllobothriasis.
Other diagnostic findings
There are no other diagnostic findings associated with Diphyllobothriasis.
Treatment
Medical Therapy
Drugs used for diphyllobothriasis include either praziquantel or niclosamide.
Surgery
Surgical intervention is not recommended for the management of Diphyllobothriasis.
Primary Prevention
Effective measures for the primary prevention of diphyllobothriasis include avoiding/limiting consuming raw fish, proper cooking, and storing of fish meat.
Secondary Prevention
The secondary prevention strategies for diphyllobothriasis are similar to its primary preventive measures.
Reference
- ↑ Lou YS, Koga M, Higo H; et al. (1989). "A human infection of the cestode, Diphyllobothrium nihonkaiense". Fukuoka Igaku Zasshi. 80: 446–50. PMID 2807129.
- ↑ Baron, Samuel (1996). Medical microbiology. Galveston, Tex: University of Texas Medical Branch at Galveston. ISBN 0-9631172-1-1.
- ↑ Scholz T, Garcia HH, Kuchta R, Wicht B (2009). "Update on the human broad tapeworm (genus diphyllobothrium), including clinical relevance". Clin. Microbiol. Rev. 22 (1): 146–60, Table of Contents. doi:10.1128/CMR.00033-08. PMC 2620636. PMID 19136438.
- ↑ Feng XF (1989). "[Cervical anastomosis of the stomach transposed through the esophageal bed--report of 536 cases]". Zhonghua Zhong Liu Za Zhi (in Chinese). 11 (5): 374–6. PMID 2620636.