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Diphyllobothriasis Treatment & Management

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

Approach Considerations

Most patients with diphyllobothriasis, unless they have severe symptoms, can be safely treated as outpatients. Inpatient care is not generally required but may have to be considered in advanced, resistant, or complicated cases.

Diphyllobothriasis is treated by pharmacologic means; surgical treatment is not required unless otherwise indicated (eg, in a patient presenting with intestinal obstruction). Even in the face of decreased vitamin B-12 levels, less than 2% of patients with diphyllobothriasis develop anemia. Vitamin supplementation may be required in severe cases. As a rule, no activity limitations or restrictions are necessary.

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Pharmacologic Therapy

Treatment of diphyllobothriasis is pharmacologic. Because the parasite’s biochemical pathways are different from those of the human host, drug toxicity is directed toward the parasite, the egg, or the larvae. Mechanisms of action vary within a drug class. Antiparasitic actions may include the following:

  • Inhibition of microtubules, causing irreversible block of glucose uptake
  • Tubulin polymerization inhibition
  • Depolarizing neuromuscular blockade
  • Cholinesterase inhibition
  • Increased cell membrane permeability, resulting in intracellular calcium loss
  • Vacuolization of the schistosome tegument
  • Increased cell membrane permeability to chloride ions via chloride channels alteration

Praziquantel is considered the drug of choice for D latum infection, with niclosamide as an alternative.[9]

The neurologic and hematologic manifestations of vitamin B-12 deficiency respond well to supplementation. In the case of vitamin B-12 deficiency secondary to diphyllobothriasis, the signs and symptoms may resolve with antiparasitic therapy alone.

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Consultations

Resistant or advanced cases of diphyllobothriasis may require consultation with a gastroenterologist and an infectious disease specialist. Consultation with a hematologist may be considered, depending on the severity of anemia. In the case of suspected obstruction, consultation with a surgeon is indicated.

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Long-Term Monitoring

The patient’s stool should be reexamined on day 7 after therapy to test for cure. The presence of any Diphyllobothrium segments or ova in the stool on posttherapy day 7 constitutes a treatment failure. If the first course of treatment fails, a second identical course of therapy may be administered.

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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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