First known case of human bertiellosis in a child in Paraná, Brazil / Primeiro caso conhecido de bertielose humana em uma criança no Paraná, Brasil

ABSTRACT Objective: To describe the first known case of human Bertiellosis in Paraná (Brazil). Case description: A 6-year-old male residing in the Brazilian state of Paraná was suffering from intermittent nonspecific abdominal pain and abdominal distension, associated with expulsion of live tapeworms in his feces for 7 months. He had a history of interaction with monkeys on an island. His first feces analysis was inconclusive, with an initial hypothesis of an atypical Taenia. However, after additional research, the parasitologist identified pregnant proglottids of Bertiella sp. The patient was initially treated with an unknown dosage of albendazole and nitazoxanide, as it was believed he had been infected with Taenia sp. Since the symptoms persisted, praziquantel 10 mg/kg was prescribed without further proglottids elimination. Comments: Human Bertiellosis is a rare zoonosis, with less than one hundred cases reported. However, it is a cause of chronic abdominal pain and should be kept as a differential diagnosis, especially in cases reporting recurrent tapeworm expulsion in feces and refractory treatment with albendazole.

RESUMO Objetivo: Descrever o primeiro caso conhecido de bertielose humana no Paraná, Brasil. Descrição do caso: Criança de seis anos do sexo masculino, residente no Paraná, Brasil, apresentava dor abdominal inespecífica intermitente e distensão abdominal, associadas à expulsão de helmintos vivos em suas fezes havia sete meses. Tinha um histórico de interação com macacos em uma ilha. Sua primeira análise de fezes foi inconclusiva, com hipótese inicial de uma Taenia atípica. No entanto, após pesquisas adicionais, o parasitologista identificou proglótides gravídicas de Bertiella sp. O paciente foi inicialmente tratado com uma dosagem desconhecida de albendazol e nitazoxanida, pois se acreditava que havia sido infectado por Taenia sp. Diante da persistência dos sintomas, foi prescrito praziquantel 10 mg/kg, sem mais eliminação de proglótides. Comentários: A bertielose humana é uma zoonose rara, com menos de cem casos relatados. No entanto, é uma causa de dor abdominal crônica e deve ser mantida como diagnóstico diferencial, principalmente nos casos que relatam expulsão recorrente de helmintos nas fezes e que são refratários ao tratamento com albendazol.

Cisticercosis subcutánea / Subcutaneous cisticercosis

Resumen Se presenta el caso de una paciente de 57 años de edad, natural del distrito de San Martín de Porres en Lima, quien acude a emergencias en el Hospital II Lima Norte-Callao Luis Negreiros Vega de EsSalud por presentar una tumoración en el muslo derecho. La paciente refiere dolor al palpar el muslo y al ponerse en marcha, por lo que se realizan estudios y se procede a la exéresis quirúrgica de dicha tumoración. El análisis macroscópico indicó fragmento de tejido de 5x4x11cm con losange de piel de 4x1.5cm y superficie irregular compuesta de tejido adiposo; al corte a 0.8cm de la piel presenta formación nodular de color pardo amarillento de 1.5x1.8cm con formación quística de 0.6cm, bien delimitada por el tejido fibroso. Además, presenta otras tres formaciones quísticas de 0.3 a 0.8cm de diámetro. De igual forma, el diagnóstico histológico señaló formaciones quísticas en tejido celular subcutáneo de paredes fibrosas recubiertas en su parte interna por macrófagos y células epitelioides a cuerpo extraño, compatible con cisticercosis subcutánea.

Abstract This paper reports the case of a 57-year-old female patient from the San Martín de Porres district in Lima, who attended the emergency room at Hospital II Lima Norte-Callao Luis Negreiros Vega of EsSalud due to a tumor in her right thigh. The patient complained of thigh pain on palpation and when she started walking. Studies were carried out and the tumor was surgically removed. The macroscopic analysis found a piece of tissue of 5x4x11cm, lozenge of the skin of 4x1.5cm, and an irregular surface composed of adipose tissue. Upon sectioning, 0.8cm of the skin showed a yellowish brown nodular formation of 1.5x1.8cm, with a cystic formation of 0.6cm, well delimited by fibrous tissue. In addition, three other cystic formations were found, with 0.3 to 0.8cm of diameter. The histological diagnosis found cystic formations in the subcutaneous cellular tissue of fibrous walls, covered by macrophages in the inner part and foreign body epithelioid cells, which is compatible with subcutaneous cysticercosis.

Dipylidium caninum infection in an infant：a rare case report and literature review

Dipylidiasis is a zoonotic parasitic infection caused by Dipilydium caninum, a common intestinal tapeworm of dogs and cats. Humans may be accidental hosts when the cysticercoid larva is ingested, mainly infants and young children due to their playing habits and their proximity with dogs and cats. It is considered a rare infection in the world. In the past 20 years only 16 cases have been reported in Europe, China, Japan, India, Sudan, Latin America and the United States. We describe a case of dipylidiasis observed in a 9-month-old girl who likely acquired the infection through games with her pet dog. In a stool sample, we observed 6 proglottids of tapeworm. Each proglottid segment was about 8-9 mm long and 2-3 mm thick. A wet mount revealed proglottids with two genital pores, one on each side, and eggs were clustered in packets containing 8-12 and surrounded by a thin membrane. The patient was successfully treated with a single dose of praziquantel. The pet dog was seen by the veterinary and also showed parasitism by Dipylidium. To the best of our knowledge, this is the only human case reported in Spain according to the literature reviewed.

A Human Case of Hymenolepis diminuta in a Child from Eastern Sicily

We report a case of Hymenolepis diminuta infection in a 2-year-old child living in a suburban area of Catania, Italy. This case was initially referred to us as Dipylidium caninum infection, which was not cured after being treated twice with mebendazole. However, by analyzing the clinical presentation and stool samples we arrived to the diagnosis of H. diminuta infection. The case presented with atypical allergic manifestations which had never been reported as clinical features of symptomatic H. diminuta infection; remittent fever with abdominal pain, diffuse cutaneous itching, transient thoracic rash, and arthromyalgias. The patient was treated with a 7-day cycle of oral niclosamide, which proved to be safe and effective. This case report emphasizes that a correct parasitological diagnosis requires adequate district laboratories and trained personnel. In addition, we recommend the importance of reporting all H. diminuta infection cases, in order to improve knowledge on epidemiology, clinical presentation, and treatment protocols.