Three cases of Diphyllobothrium nihonkaiense infection in Korea.

Until 2012, a total of 48 cases of diphyllobothriasis had been reported in Korea, all of which were morphologically identified as Diphyllobothrium latum. However, some of these specimens were analyzed by nucleotide sequencing of the mitochondrial cox1 gene, which showed that all were D. nihonkaiense, not D. latum. After that, 3 further cases of diphyllobothriasis were confirmed as D. nihonkaiense. In the present study, 3 new cases of D. nihonkaiense were detected from 2011 through 2013. The hosts were infected through consumption of salmonid fishes, such as the trout or salmon, and 2 of them experienced severe diarrhea prior to proglottid passage. All of the tapeworms were confirmed to be D. nihonkaiense by genetic identification. This proved again that most diphyllobothriasis in Korea have been caused by D. nihonkaiense.

Extracorporeal worm extraction of Diphyllobothrium nihonkaiense with amidotrizoic acid in a child.

Infection cases of diphyllobothriid tapeworms are not much in the below teen-age group. We report a case of Diphyllobothrium nihonkaiense infection in a 13-year-old boy. He presented with severe fatigue, occasional abdominal pain at night time. He also had several episodes of tapeworm segment discharge in his stools. By his past history, he had frequently eaten raw fish including salmon and trout with his families. Numerous eggs of diphyllobothriid tapeworm were detected in the fecal examination. We introduced amidotrizoic acid as a cathartic agent through nasogastroduodenal tube and let nearly whole length (4.75 m) of D. nihonkaiense be excreted through his anus. After a single dose of praziquantel, the child's stool showed no further eggs, and his symptoms disappeared. The evacuated worm was identified as D. nihonkaiense by mitochondrial cox1 gene analysis. Here we report a successful extracorporeal worm extraction from an infection case of D. nihonkaiense by the injection of amidotrizoic acid.

Molecular detection of Diphyllobothrium nihonkaiense in humans, China.

The cause of diphyllobothriosis in 5 persons in Harbin and Shanghai, China, during 2008-2011, initially attributed to the tapeworm Diphyllobothrium latum, was confirmed as D. nihonkaiense by using molecular analysis of expelled proglottids. The use of morphologic characteristics alone to identify this organism was inadequate and led to misidentification of the species.

Human infection by a "fish tapeworm", Diphyllobothrium latum, in a non-endemic country.

We document a case of locally acquired "broad- or fish-tapeworm" infection caused by Diphyllobothrium latum in a 27-year-old Spanish man, confirmed by molecular analysis (COI gene). The patient had naturally expelled a worm of 110 cm in length, but the physical examination did not yield any remarkable findings, and the patient did not suffer from any particular symptoms. Laboratory test results were normal except for a remarkable increase in the red blood cell count, and an evident decrease in the mean corpuscular volume and mean corpuscular hemoglobin. Vitamin B12 and folic acid values were in the normal range without signs of anemia. It was suggested that these anomalies in erythrocyte formation might not be related to the parasite, and analysis of the patient's anamnestic data revealed that the infection could only have been caused by the ingestion of imported fish, although no light could be shed on the specific source of infection. From a public health viewpoint, this human case of fish-borne zoonosis is exemplary, suggesting that not only is control of fish and fish product quality essential, but also increased awareness of the general population with regard to changes in culinary habits.

Prevalence, intensity, and abundance of infection and pathogenesis caused by diphyllobothriosis in vulnerable, native fish and introduced trout in Lake Panguipulli, Chile.

Diphyllobothriosis in fish from freshwater ecosystems in southern Chile was first reported in 1949. Infection by plerocercoids of Diphyllobothrium latum and Diphyllobothrium dendriticum occurs in introduced trout (Oncorhynchus mykiss) and native fish. We determined the prevalence, mean intensity, and mean abundance of seasonal infection and tissue damage produced by Diphyllobothrium spp. in native fish (Percichthys trucha, Odontesthes mauleanum, and Basilichthys australis) and introduced trout (O. mykiss) from Lake Panguipulli, Chile. Prevalence, mean intensity, and mean abundance of D. latum infection were significantly greater in trout than they were in native fish. Prevalence and mean abundance were similar in O. mauleanum and P. trucha, but they were greater than those in B. australis. Prevalence and abundance were similar among seasons between sexes for the four hosts. For all host species, except P. trucha, there was a statistically significant positive correlation between host length and the abundance of plerocercoids. Infections in muscle tissue were present in 61% of trout compared with 23% in O. mauleanum and 12% in P. trucha, suggesting a greater risk for human infection when consuming trout. In general, prevalence of infection by D. dendriticum was lower than was D. latum prevalence. Encapsulation of plerocercoids was common and severe in 71% of the trout examined. Only slight encapsulation of plerocercoids was found in the native O. mauleanum, and no encapsulation was observed in P. trucha or B. australis. The greater concentration of plerocercoids in the walls of the digestive tract of trout suggests a more-rapid immune response in trout than in native fish. The low frequency of encapsulation of plerocercoids in native fish would mean greater tissue damage in the natives than that observed in the trout because they are free to migrate among the viscera, potentially endangering these native fish populations in regions where Diphyllobothrium spp. are endemic.

Four human cases of Diphyllobothrium latum infection.

Diphyllobothrium latum infections in 4 young Korean men detected from 2008 to 2012 are presented. Three were diagnosed based on spontaneously discharged strobila of the adult worm in their feces, and 1 case was diagnosed by finding the worm at colonoscopy examination in a local clinic. The morphologic characteristics of the gravid proglottid and eggs were consistent with D. latum. All patients were treated with praziquantel 15 mg/kg, and follow-up stool examinations were done at 2 months after the medication. The main clinical complaints were intermittent gastrointestinal troubles such as indigestion, abdominal distension, and spontaneous discharge of tapeworm's segments in their feces. The most probable source of infection was the flesh of salmon or trout according to a patient's past history. These are the 45th to 48th recorded cases diagnosed by the adult worm in the Republic of Korea since 1971.

[Morpho-functional changes of cloacal bursa of the herring gull in experimental infection with gull tapeworm].

Using the methods of light microscopy, the quantitative changes in the cells of the cloacal bursa of herring gull (Larus argentatus mongolicus) chicks were studied during experimental infection with gull-tapeworm Diphyllobothrium dendriticum. The area of the follicles within the bursa and the number of eosinophils in the infected chicks were found to increase. In the follicles the number of blast cells and large lymphocytes was elevated. The reduction of small lymphocytes and plasma cells numbers in the infected gulls may be due to a slower cell cycle or cell migration into the inflammatory focus. Overall, the changes in the bursa indicate the suppression of the B-link of the host immune system in tapeworm invasion.

[Changes in mast cell composition in the hamster duodenum in experimental diphyllobothriosis].

The morphometric investigation was performed to study the reaction of mast cells (MC) in mucosal lamina propria of hamster duodenum to experimental infection with tapeworm Diphyllobothrium dendriticum. The invasion was found to result in a significant increase of MC cells absolute content, changes in the proportions of their functional groups, increased anaphylactic MC degranulation, enhanced MC precursor migration and their accelerated differentiation.

[The reaction of the bursa and thymus eosinophils in the herring gull after the experimental infection with gull-tapeworm].

Using the methods of light microscopy, eosinophil topography, quantitative and qualitative changes (degranulation level of and a cationic protein content) were studied in the thymus and bursa of 36 herring gull nestlings Larus argentatus mongolicus (Suskin, 1925) 2 weeks after experimental infestation with gull-tapeworm Diphyllobothrium dendriticum (Nitsch, 1824). Eosinophils in the thymus were located in trabecules, mainly close to the blood vessels, thymic (Hassall's) corpuscles and also directly inside them, while in the bursa they were found within the internodular space. As compared with the control bird counts, relative eosinophil count in the birds with an average invasion intensity was increased 3.8 times in the thymus and 2.5 times in the bursa. In birds with high invasion intensity, these counts were increased 4 times in the thymus and 1.2 times in the bursa.

Selected pathological, immunohistochemical and ultrastructural changes associated with an infection by Diphyllobothrium dendriticum (Nitzsch, 1824) (Cestoda) plerocercoids in Coregonus lavaretus (L.) (Coregonidae).

The pathological changes induced by an infection of Diphyllobothrium dendriticum (Nitzsch, 1824) plerocercoids in powan, Coregonus lavaretus (L.), from Loch Lomond, Scotland, were assessed using immunohistochemical and ultrastructural techniques. In a sample of 26 powan, the occurrence of encysted plerocercoids of D. dendriticum on the outer surface of the stomach was 38.5% (n = 10) with the number of cysts ranging from 4 to 15 and measuring 4.2 +/- 1.0 mm x 3.4 +/- 0.9 mm (mean +/- SD). Histological examination of intestinal samples also revealed plerocercoids (2-21) encapsulated within a proliferation of mesenteric fibrous tissues of the gastric wall and, occasionally, by the gut lamina propria-submucosa and lamina muscularis. In section, cysts were tri-layered and were formed from a series of concentric whorls of fibroblast and collagen fibre-based connective elements. The extent of necrosis within each muscle layer and the serosa of the stomach differed, notably within the latter that was marked by a chronic inflammatory reaction and fibrosis. Within the cyst and around it, a large number of degranulating mast cell/eosinophilic granule cells were seen, in addition to melano-macrophage centres. Immunohistochemical staining of sections of infected stomach revealed a high density of elements, in close proximity to plerocercoids, staining positive for serotonin, bombesin, substance P and galanin. Uninfected material did not present the same levels of activity. Sections through both infected and uninfected tissue were also tested for elements containing vasoactive intestinal peptide, met-enkephalin, calcitonin gene-related peptide, neuropeptide Y and nitric oxide synthase, but these were absent.

A rare case of diphyllobothriasis from Pondicherry, South India.

Diphyllobothriasis is an intestinal parasitic infection caused by the ingestion of raw fresh-water fish containing the infectious larvae of Diphyllobothrium spp. This infection is uncommon in India. We report a case of diphyllobothriasis that occurred in Pondicherry, India, in a 5-year-old boy hailing from a fishing community. He attended the Pediatric OPD with spontaneous discharge of segments of the adult parasite. The segments (macroscopically and microscopically) were identified as those of Diphyllobothrium latum. The stool examination also revealed characteristic oval eggs.

Diphyllobothrium latum: a case of an incidental finding.

Colorectal cancer screening can be performed by fecal occult blood testing, sigmoidoscopy, double contrast barium enema or colonoscopy. Colonoscopy has the significant advantage that polyps can be removed during the same procedure. Occasionally, colonoscopy can also reveal unexpected findings, including parasitic infections, even in asymptomatic patients. Tapeworms or cestodes are hermaphroditic parasites, which can live for considerable periods of time in the human gastrointestinal tract. Fish tapeworm (Diphyllobothrium species) are endemic in various parts of the world, the commonest species being Diphyllobothrium latum. Humans are the main definitive host for D. Latum and the majority of individuals harbouring the parasite are asymptomatic, while 40% of infected individuals may have low vitamin B12 levels. We describe a case of D. latum infection found on routine colonoscopic screening for colorectal cancer in an asymptomatic patient, which was successfully treated with praziquantel. The infection likely arose following raw fish (sushi) consumption.

A surgically confirmed case of breast sparganosis showing characteristic mammography and ultrasonography findings.

A case of breast sparganosis was confirmed by surgical excision of a worm (fragmented into 5 pieces) in a 59-year-old Korean woman suffering from a palpable mass in the left breast. Mammography and ultrasonography characteristically revealed the presence of several well-defined, isodense and hypoechoic tubular masses, in the upper quadrant of the left breast, each mass consisting of a continuous cord- or worm-like structure. During surgery, a long segment of an actively moving sparganum of Spirometra sp. and 4 small fragments of the same worm, giving a total length of 20.3 cm, were extracted from the upper outer quadrant of the left breast and the axillary region. The infection source remains unclear, because the patient denied ingesting any snake or frog meat or drinking untreated water.

Annoying vacation souvenir: Fish tapeworm (Diphyllobothrium sp.) infestation in an Austrian fisherman.

Diphyllobothriosis is infestation with the fish tapeworm. Although the worldwide incidence has decreased in recent decades, increased travel and the new popularity of dishes involving raw fish (e.g. sushi) may provide a higher risk of infestation in formerly low-risk areas. We report an Austrian fisherman who passed a 75 cm tapeworm segment in his stool. Infestation presumably occurred 14 months earlier during a fishing tour in Alaska. At presentation, the patient was asymptomatic, reported no weight loss and showed neither anaemia nor eosinophilia. He was cured with a single dose of 10 mg/kg body weight praziquantel.

Reappearance of human diphyllobothriasis in a limited area of Lake Como, Italy.

BACKGROUND: Very few sporadic cases of autochthonous diphyllobothriasis have been reported in Italy during the past 20 years, probably due to the drastic decrease or disappearance of some fish species, mainly Perca fluviatilis L., known as the intermediate host of the infective larval stage of this tapeworm. However, increasing consumption of raw or undercooked fish during the last years as influenced by Oriental cuisine, played an important role in a number of new single cases of the infection or microepidemics. PATIENTS: We describe six cases which were diagnosed within a period of 4 months, which all originated from the area of Lake Como (Lombardy region). All subjects had previously eaten raw perch fillets. Four individuals complained of gastrointestinal signs and symptoms, whereas two were asymptomatic. DISCUSSION: Parasitological diagnosis was achieved in four cases by recovery of typical operculated eggs in stool specimens; in two others by morphological features of proglottids recovered from feces. Treatment with niclosamide, as a single oral dose, cured the infection in all subjects. This is the first report of this infection in Italy in the last 10 years.

Tapeworms (cestodiasis).

Nearly all of the cestodes, or tapeworms (class Cestoda in the phylum Platyhelminthes, the flatworms), are parasitic as adults in the intestinal tract of vertebrates. This article discusses the epidemiology, diagnosis, and treatment of taeniasis, diphyllobothriasis, hymenolepiasis, dipylidiasis, and other tapeworm infections.