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Diphyllobothriasis Workup

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

Laboratory Studies

Laboratory studies that may be used in the diagnosis of diphyllobothriasis include the following:

  • Microscopic stool examination for ova and parasites [5]
  • Complete blood count (CBC) - Eosinophilia may be present
  • Hemoglobin level and hematocrit - These may be below or at the lower end of the reference range
  • Mean cell volume - This may be above or at the higher end of the reference range
  • Peripheral smear
  • Vitamin B-12 level
  • Folate level

Diagnosis of D latum infection is based on identification of the operculated eggs in the stool (see the images below). Usually, this is not difficult, because of the large quantity of eggs (≥1 million) produced each day.

Proglottids of Diphyllobothrium latum. Proglottids of Diphyllobothrium latum.
Egg of Diphyllobothrium latum with arrow pointing Egg of Diphyllobothrium latum with arrow pointing to operculum.

The anemia produced by diphyllobothriasis is typically associated with increased free hydrochloric acid in gastric juice, in contrast to the relative achlorhydria invariably observed in true pernicious anemia.

A multiplex polymerase chain reaction (PCR) has been described.[6]

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Other Studies

In general, no imaging studies are required to evaluate diphyllobothriasis, unless they are clinically indicated by other aspects of the patient’s presentation. For example, patients who present with obstruction require appropriate testing, starting with both flat and upright abdominal radiography.

On occasion, cases of diphyllobothriasis have been successfully identified by means of capsule endoscopy.[7, 8] This procedure is painless and may provide useful adjunctive information for the treatment of this disease.

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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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