Clinical characteristics of patients with intestinal Diphyllobothrium tapeworm infection

doi:10.12140/j.issn.1000-7423.2023.04.010

Abstract

Abstract:

Objective To summarize and analyze the characteristics of clinical manifestation and laboratory indicators of patients with intestinal infection of Diphyllobothrium tapeworm. Methods The medical record, including gender, age, epidemiological history (residence, history of overseas traveling and dietary habits), clinical manifestation, laboratory examinations when admitted (blood routing test, liver function, fecal examination for parasite eggs, and parasite species identification), treatment record and prognosis were collected from 18 diphyllobothriasis cases diagnosed at the Beijing Friendship Hospital, Capital Medical University from January 2009 to July 2022. Information on patients' clinical features and the changes in laboratory findings were summarized and analyzed. Results The 18 cases included 9 male and 9 female respectively, of them the age ranged from 8 to 47 years with an average of (28.88 ± 11.57) years. Epidemiological inquiry indicated that 12 cases were locals from Beijing, while 6 patients were from other provinces, among them 7 patients had overseas traveling history, and all patients had history of consuming raw/undercooked fish meat and beef. The clinical manifestation of the 18 cases were abdominal pain and distension in 6 cases, and dizziness in 2 cases, whereas anal pruritus and body weight loss were not seen, and 10 were asymptomatic. The inflammatory indicator of leukocyte count, C-reactive protein, erythrocyte sedimentation rate, anemia indicator of erythrocyte and hemoglobin, eosinophils count, and liver function showed no abnormal changes. Fecal examination found Diphyllobothrium tapeworm eggs in the samples from 8 cases, and proglottids from all cases. Deworming regime with Chinese medicine areca-pumpkin seed cured all patients. Conclusion Most of the cases infected with Diphyllobothrium tapeworm are asymptomatic or showed only mild gastrointestinal symptoms, with no significant abnormal changes in blood routine test and liver function examination. Early diagnosis could be made by fecal examination etiologically and epidemiological inquiry.

Key words: Diphyllobothrium, Infection, Clinical characteristics, Epidemiology, Food-borne parasitic diseases

CLC Number:

R532.31

LI Xiaoli, LI Shaogang, WU Zhaoyong. Clinical characteristics of patients with intestinal Diphyllobothrium tapeworm infection[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2023, 41(4): 459-463.

Figures/Tables 3

Table 1

Table 2

Fig. 1

References 19

[1]	Scholz T, Kuchta R, Brabec J. Broad tapeworms (Diphyllobothriidae), parasites of wildlife and humans: recent progress and future challenges[J]. Int J Parasitol Parasites Wildl, 2019, 9:359-369. doi: 10.1016/j.ijppaw.2019.02.001
[2]	Cai YC, Chen SH, Yamasaki H, et al. Four human cases of Diphyllobothrium nihonkaiense (Eucestoda : Diphyllobothriidae) in China with a brief review of Chinese cases[J]. Korean J Parasitol, 2017, 55(3): 319-325. doi: 10.3347/kjp.2017.55.3.319
[3]	Qian MB, Li SZ, Zhou XN. Epidemiological status and control of important food-borne parasitic diseases in China[J]. J Trop Dis Parasitol, 2021, 19(5): 241-244. (in Chinese)
	(钱门宝, 李石柱, 周晓农. 我国重要食源性寄生虫病的流行和控制[J]. 热带病与寄生虫学, 2021, 19(5): 241-244.)
[4]	Pozio E. How globalization and climate change could affect food-borne parasites[J]. Exp Parasitol, 2020, 208: 107807. doi: 10.1016/j.exppara.2019.107807
[5]	Cong W, Elsheikha HM. Biology, epidemiology, clinical features, diagnosis, and treatment of selected fish-borne parasitic zoonoses[J]. Yale J Biol Med, 2021, 94(2): 297-309. pmid: 34211350
[6]	Byun TJ, Han DS, Ahn SB, et al. Multiple colonic aphthoid ulcers caused by Diphyllobothrium latum infection[J]. Endoscopy, 2009, 41 Suppl 2: E181-182.
[7]	Li YR, Li LS, Jiang DW, et al. A case of Diphyllobothrium latum infection after eating raw salmon[J]. Chin J Parasitol Parasit Dis, 2013, 31(6): 494. (in Chinese)
	(李燕榕, 李莉莎, 江典伟, 等. 食生三文鱼感染阔节裂头绦虫1例报告[J]. 中国寄生虫学与寄生虫病杂志, 2013, 31(6): 494.)
[8]	Tsuboi M, Hayakawa K, Yamasaki H, et al. Clinical characteristics and epidemiology of intestinal tapeworm infections over the last decade in Tokyo, Japan: a retrospective review[J]. PLoS Negl Trop Dis, 2018, 12(2): e0006297. doi: 10.1371/journal.pntd.0006297
[9]	Katahira H, Matsuda AT, Maeda S, et al. Diphyllobothrium stemmacephalum (Cestoda : Diphyllobothriidae) found from a harbor porpoise in northern Japan, with comments on a geographical gap with human infection cases in southern Japan[J]. Parasitol Int, 2022, 87: 102487. doi: 10.1016/j.parint.2021.102487
[10]	Menconi V, Pastorino P, Momo I, et al. Occurrence and spatial distribution of Dibothriocephalus Latus (Cestoda : Diphyllobothriidea) in Lake Iseo (Northern Italy): an update[J]. Int J Environ Res Public Health, 2020, 17(14): 5070. doi: 10.3390/ijerph17145070
[11]	Kim JH, Lee JH. Images in clinical medicine. Diphyllobothrium latum during colonoscopy[J]. N Engl J Med, 2010, 362(11): e40. doi: 10.1056/NEJMicm0810335
[12]	Zhang YG, Qi ZJ, Tao RG. A case of ileum perforation complicated with abdominal abscess caused by Taenia saginata[J]. Chin J Parasitol Parasit Dis, 2020, 38(5): 629-630. (in Chinese)
	(张永国, 祁之俊, 陶荣刚. 牛带绦虫感染致回肠穿孔并发腹腔脓肿1例[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(5): 629-630.)
[13]	Mitre E, Klion AD. Eosinophils and helminth infection: protective or pathogenic?[J]. Semin Immunopathol, 2021, 43(3): 363-381. doi: 10.1007/s00281-021-00870-z
[14]	Jiang JQ, Eedun MT, Bao HE, et al. Association of eosinophils with immune responsesin parasitic infections[J]. Heilongjiang Animal Sci Veter Med, 2016, 495(2): 63-67. (in Chinese)
	(姜建强, 额尔敦木图, 包花尔, 等. 嗜酸性粒细胞与寄生虫感染免疫的相关性[J]. 黑龙江畜牧兽医, 2016, 495(2): 63-67.)
[15]	Sharma K, Wijarnpreecha K, Merrell N. Diphyllobothrium latum mimicking subacute appendicitis[J]. Gastroenterol Res, 2018, 11(3): 235-237. doi: 10.14740/gr989w
[16]	Zhang W, Che F, Tian S, et al. Molecular identification of Diphyllobothrium nihonkaiense from 3 human cases in Heilongjiang Province with a brief literature review in China[J]. Korean J Parasitol, 2015, 53(6): 683-688. doi: 10.3347/kjp.2015.53.6.683
[17]	Chen S, Ai L, Zhang Y, et al. Molecular detection of Diphyllobothrium nihonkaiense in humans, China[J]. Emerg Infect Dis, 2014, 20(2): 315-318. doi: 10.3201/eid2002.121889
[18]	Scholz T, Kuchta R. Fish-borne, zoonotic cestodes (Diphyllobothrium and relatives) in cold climates: a never-ending story of neglected and (re)-emergent parasites[J]. Food Waterborne Parasitol, 2016, 4: 23-38. doi: 10.1016/j.fawpar.2016.07.002
[19]	An YC, Sung CC, Wang CC, et al. Molecular identification of Diphyllobothrium latum from a pediatric case in Taiwan[J]. Korean J Parasitol, 2017, 55(4): 425-428. doi: 10.3347/kjp.2017.55.4.425

临床特点 Clinical characteristics	例数 No. cases (n = 18)
腹痛、腹胀 Abdominal pain and distension	6
头晕 Dizziness	2
无症状 Asymptomatic	10
排节片史 Passage of proglottids	18
病程 Duration of disorder
< 6个月 < 6 months	11
≥ 6个月 ≥ 6 months	7
就诊前服用驱虫药物 Use of albendazole before hospitalization	7
随访时间（> 1年） Follow-up period in years (> 1 year)	18
预后（痊愈） Outcome (recurrence)	18

检测指标 Variable	平均值（最小值，最大值） Mean（Minimum, Maximum）	参考值范围 Range of normal values
外周血常规 Routine blood tests
白细胞 White blood cell（WBC，× 10⁹/L）	5.79 (3.49, 8.39)	3.50~9.50
红细胞 Red blood cell（RBC，× 10¹²/L）	4.77 (4.07, 5.69)	4.30~5.80
血红蛋白 Hemoglobin（HGB，g/L）	142.31 (121.00, 168.00)	130~175
嗜酸粒细胞 Eosinophils（EOS，× 10⁹/L）	0.24 (0.08, 0.65)	0.02~0.52
炎性指标 Inflammatory indicators
C-反应蛋白 C-reactive protein (CRP，mg/L)	3.33 (0.63, 9.00)	0~8
血沉 Erythrocyte sedimentation rate（ESR，mm/h)	9.60 (5.00, 14.00)	0~20
肝功能检测 Liver function tests
丙氨酸转氨酶 Alanine aminotransferase (ALT，U/L)	14.75 (8.00, 32.00)	9~50
天冬氨酸转氨酶 Aspartate aminotransferase (AST，U/L)	17.33 (10.90, 20.90)	15~40
白蛋白 Albumin (ALB，g/L）	42.11 (37.30, 47.70)	40~55