收稿日期: 2021-09-29
修回日期: 2022-03-09
网络出版日期: 2022-07-06
One case of Diphyllobothrium latum infection caused by raw salmon
Received date: 2021-09-29
Revised date: 2022-03-09
Online published: 2022-07-06
湘南学院附属医院于2021年9月收治1例58岁男性患者,自诉发现右颈部肿块伴疼痛1周,有长期生食三文鱼、生腌虾等饮食习惯。查体：颈软,气管居中,双侧甲状腺未扪及肿物,右侧胸锁乳突肌可扪及肿物大小约5 cm × 5 cm × 3 cm,质地中等,形状规则,边界欠清,活动度差,不随吞咽上下活动,右颈部及锁骨上窝可扪及多发肿大淋巴结,大者约2 cm × 1 cm,质地中等,活动度可。血常规示嗜酸粒细胞计数2.1 × 109/L（0.02 × 109/L~0.52 × 109/L）,嗜酸粒细胞百分比10.4%（0.4%~8.0%）;粪常规未见明显异常。血清裂头蚴IgG抗体阳性。颈部彩超示右侧胸锁乳突肌内探及多发囊实性混合回声区,范围约60 mm × 25 mm × 53 mm,形态欠规则,边界欠清,内部回声欠均匀;肿物包膜完整,内似有蜷曲的条索状物,包膜周围血供丰富。颈部增强CT示：右侧胸锁乳突肌下端明显膨大,密度不均,其内可见多发低密度区,增强时实质部分可见环形强化。术中探查见右侧胸锁乳突肌肿物具有完整包膜,切开囊内有无色液体流出、3条白色寄生虫缓慢蠕动。虫体乳白色、长带状,长约15 cm,头节细小、呈匙形,背腹面各有1条窄而深凹的吸槽,体前端有凹陷且稍大,体不分节但具有横皱褶,尾部细。结合虫体形态学鉴定和患者流行病学史,诊断为阔节裂头蚴感染。术后予吡喹酮（总剂量120 mg/kg,分5日服,一日3次）驱虫治疗,3月后随访未见异常。
欧阳兵 , 李仁喜 . 食生三文鱼致感染阔节双叶槽绦虫1例[J]. 中国寄生虫学与寄生虫病杂志, 2022 , 40(3) : 295 -298 . DOI: 10.12140/j.issn.1000-7423.2022.03.023
A 58-year-old male patient was admitted to the Affiliated Hospital of Xiangnan University in September 2021. He complained of a right neck mass accompanied by pain for 1 week and had a long history of having raw salmon and raw pickled shrimp diet. Physical examination showed a soft neck, midline trachea, and no palpable thyroid mass on both sides. The palpable right sternocleidomastoid muscle had a size of approximately 5 cm × 5 cm × 3 cm, medium texture, regular shape, unclear boundary, poor mobility, no movement with swallowing, and multiple enlarged lymph nodes were palpable in the right neck and supraclavicular fossa, the largest was about 2 cm × 1 cm, with medium texture and good mobility. Blood cell count showed eosinophil count 2.1 × 109/L (0.02 × 109/L-0.52 × 109/L), eosinophil percentage 10.4% (0.4%-8%). Routine stool examination showed no obvious abnormality. Serum IgG antibody was positive. Colour ultrasound of the neck showed multiple cystic, solid mixed echo areas in the right sternocleidomastoid muscle, with a range of about 60 mm × 25 mm × 53 mm, irregular shape, unclear boundary and uneven internal echo. The capsule of the tumour is intact, there seems to be a coiled cord inside, and the blood supply around the capsule is rich. Contrast-enhanced CT of the neck showed that the lower end of the right sternocleidomastoid muscle was significantly enlarged with uneven density, with multiple low-density areas within it, and annular enhancement was observed in the parenchyma during enhancement. Intraoperative exploration revealed that the right sternocleidomastoid muscle mass had a complete capsule. After the incision, clear fluid flowed out of the capsule accompanied by 3 white parasites slowly peristalsis. The parasite body is milky white, long band, the head segment is small, spoon-shaped, the parasite body is relatively large, its dorsal and ventral surface each has a narrow and deep concave suction groove, the front end of the body is depressed and slightly larger, the body does not segment but has transverse folds, the tail is thin. Combined with the morphological identification and epidemiological history of the patients, the infection was considered as Diphyllobothrium latum infection. After the operation, praziquantel (total dose 120 mg/kg, divided into 5 days, three times a day) was treated with deworming, and no abnormality was found in follow-up 3 months later.
Key words： Diphyllobothrium latum; Salmon; Sternocleidomastoid; Praziquantel
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