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Diphyllobothriasis Clinical Presentation

  • Author: Derek Ryan Linklater, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: Feb 24, 2016
 

History

Most persons with diphyllobothriasis are asymptomatic. Patients do not usually observe passage of segments in the stool, as is noted in other tapeworm infections. A few reports have documented patients who presented after vomiting a ball of worms that were determined to be fish tapeworms.

Among persons with diphyllobothriasis who are symptomatic, the following are the most common symptoms[3] :

Other, less common, symptoms include the following:

  • Fatigue
  • Diarrhea
  • Dizziness
  • Weakness (rare)
  • Numbness of extremities
  • Sensation of hunger
  • Pruritus ani

One study looked at a selection of symptoms in a group of patients who were affected but nonanemic. Increased symptoms of fatigue, extremity numbness, and anorexia occurred in the affected group. Abdominal pain was not a significant symptom. Gastrointestinal (GI) obstruction is rare, but when it does occur, patients present with acute abdominal pain associated with vomiting, distention, or both.

Megaloblastic anemia is also rare. Studies note that about 40% of patients have decreased serum vitamin B-12 levels, but fewer than 2% of patients are anemic.[4] Patients with an underlying problem (eg, celiac disease or congenital malabsorption) are at higher risk of developing a symptomatic infection. Anemic patients can present with pallor, breathlessness, and neurologic symptoms such as weakness, numbness, and disturbances in coordination. The symptoms depend on the severity.

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Physical Examination

D latum has an unusual affinity for vitamin B-12, and the presentation of diphyllobothriasis may resemble that of megaloblastic anemia. No typical examination findings are noted, except for those seen in severe cases of anemia. Because significant anemia affects less than 2% of persons infected with D latum, most patients with diphyllobothriasis have no signs of illness .

The following physical findings associated with diphyllobothriasis are rare and are most likely related to underlying nutritional anemia:

  • Pallor
  • Glossitis
  • Dyspnea
  • Tachycardia
  • Weakness
  • Hypoesthesia
  • Paresthesias
  • Disturbances of movement and coordination, loss of vibratory sense and proprioception (related to degeneration of the posterior columns of the spinal cord)

If the patient presents with obstruction, the following physical findings may be noted:

  • Abdominal tenderness
  • Abdominal distention
  • Peritoneal signs
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Contributor Information and Disclosures
Author

Derek Ryan Linklater, MD Assistant Professor of Military and Emergency Medicine, F Edward Hebert School Of Medicine; Assistant Clinical Professor of Emergency Medicine, Texas A&M Health Science Center College of Medicine; Clinical Instructor of Pediatrics, Baylor College of Medicine

Derek Ryan Linklater, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, Society for Academic Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Coburn H Allen, MD Assistant Professor of Pediatrics, Dell Children's Hospital

Coburn H Allen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Alia Rai, MD Adolescent Medicine Fellow, Department of Pediatrics, West Virginia University

Alia Rai, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Society for Adolescent Medicine

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Arizono N, Shedko M, Yamada M, Uchikawa R, Tegoshi T, Takeda K, et al. Mitochondrial DNA divergence in populations of the tapeworm Diphyllobothrium nihonkaiense and its phylogenetic relationship with Diphyllobothrium klebanovskii. Parasitol Int. 2009 Mar. 58(1):22-8. [Medline].

  2. Church C, Neill A, Schotthoefer AM. Intestinal infections in humans in the Rocky Mountain region, United States. J Parasitol. 2010 Feb. 96(1):194-6. [Medline].

  3. Lee EB, Song JH, Park NS, et al. A case of Diphyllobothrium latum infection with a brief review of diphyllobothriasis in the Republic of Korea. Korean J Parasitol. 2007 Sep. 45(3):219-23. [Medline].

  4. Lal S, Steinhart AH. Diphyllobothrium latum: a case of an incidental finding. World J Gastroenterol. 2007 Mar 28. 13(12):1875-6. [Medline].

  5. Koontz F, Weinstock JV. The approach to stool examination for parasites. Gastroenterol Clin North Am. 1996 Sep. 25(3):435-49. [Medline].

  6. Wicht B, Yanagida T, Scholz T, Ito A, Jiménez JA, Brabec J. Multiplex PCR for differential identification of broad tapeworms (Cestoda: Diphyllobothrium) infecting humans. J Clin Microbiol. 2010 Sep. 48(9):3111-6. [Medline]. [Full Text].

  7. Hirata M, Yamaguchi Y, Ikei Y, et al. A case of Diphyllobothrium latum/nihonkaiense infection identified by capsule endoscopy in small intestine. Gastrointest Endosc. 2006 Jul. 64(1):129; discussion 130. [Medline].

  8. Soga K, Sakagami J, Handa O, Konishi H, Wakabayashi N, Yagi N, et al. Long fish tapeworm in the intestine: an in situ observation by capsule endoscopy. Intern Med. 2011. 50(4):325-7. [Medline].

  9. Craig P, Ito A. Intestinal cestodes. Curr Opin Infect Dis. 2007 Oct. 20(5):524-32. [Medline].

 
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Life cycle of diphyllobothrium.
Egg of Diphyllobothrium latum with arrow pointing to operculum.
Proglottids of Diphyllobothrium latum.
 
 
 
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