Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

Class Summary

Antimicrobial agents are used to eradicate the infecting organism (most often, D latum). Praziquantel is the drug of choice; niclosamide is an alternative.

Praziquantel (Biltricide)

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Praziquantel is used in the treatment of several different infestations and is the drug of choice for diphyllobothriasis. It increases cell membrane permeability in susceptible worms, resulting in loss of intracellular calcium, massive contractions, and paralysis of musculature. Tablets should be swallowed with liquid during meals; keeping the tablets in the mouth may result in a bitter taste that can induce nausea or vomiting. It is effective as a single dose of 25 mg/kg. While a lower dose of 10 mg/kg has been reported to be effective against D. pacificum, 25 mg/kg is the typical dose administered for D. latum and D. nihonkaiense.

Niclosamide (Niclocide)

Alternative treatment for diphyllobothrium infections. This drug has limited availability is some countries. It acts by inhibition of mitochondrial oxidative phosphorylation and glucose uptake in the parasite. It is effective as a single oral dose of 2 g in adults and side effects rare.

Scholz T, Garcia HH, Kuchta R, Wicht B. Update on the human broad tapeworm (genus diphyllobothrium), including clinical relevance. Clin Microbiol Rev. 2009 Jan. 22 (1):146-60, Table of Contents. [QxMD MEDLINE Link].
Kuchta R, Serrano-Martínez ME, Scholz T. Pacific Broad Tapeworm Adenocephalus pacificus as a Causative Agent of Globally Reemerging Diphyllobothriosis. Emerg Infect Dis. 2015 Oct. 21 (10):1697-703. [QxMD MEDLINE Link].
Scholz T, Kuchta. Fish-borne, zoonotic cestodes (Diphyllobotrium and relatives) in cold clilmates: A never-ending story of neglected and (re)-emergent parasites. Food and Waterborne Parasitology. 2016. 4:23-38.
Kuchta R, Brabec J, Kubáčková P, Scholz T. Tapeworm Diphyllobothrium dendriticum (Cestoda)--neglected or emerging human parasite?. PLoS Negl Trop Dis. 2013. 7 (12):e2535. [QxMD MEDLINE Link].
Sharma K, Wijarnpreecha K, Merrell N. Diphyllobothrium latum Mimicking Subacute Appendicitis. Gastroenterology Res. 2018 Jun. 11 (3):235-237. [QxMD MEDLINE Link].
Nyberg W, Grasbeck R, Saarni M, von Bonsdorff. Serum vitamin B12 levels and incidence of tapeworm anemia in a population heavily infected with Diphyllobothrium latum. Am J Clin Nutr. 1961 Sep-Oct. 9 (5):606-12. [QxMD MEDLINE Link].
Jimenez JA, Rodriguez S, Gamboa R, Rodriguez L, Garcia HH, Cysticercosis Working Group in Peru. Diphyllobothrium pacificum infection is seldom associated with megaloblastic anemia. Am J Trop Med Hyg. 2012 Nov. 87 (5):897-901. [QxMD MEDLINE Link].
Kitamoto H, Inoue S, Okamoto K, Inokuma T. Scanning early catches the worm: abdominal ultrasound as a possible screening method for intestinal cestodes. Lancet. 2019 Oct 5. 394 (10205):1264. [QxMD MEDLINE Link].
Choi HJ, Lee J, Yang HJ. Four human cases of Diphyllobothrium latum infection. Korean J Parasitol. 2012 Jun. 50 (2):143-6. [QxMD MEDLINE Link].
Park SC, Keum B, Jeen YT, Chun HJ. Diphyllobothrium latum accidentally detected by colonoscopy. Dig Liver Dis. 2011 Aug. 43 (8):664. [QxMD MEDLINE Link].
Stanciu C, Trifan A, Singeap AM, Sfarti C, Cojocariu C, Luca M. Diphyllobothrium latum identified by capsule endoscopy--an unusual cause of iron-deficiency anemia. J Gastrointestin Liver Dis. 2009 Jun. 18 (2):142. [QxMD MEDLINE Link].
Nomura Y, Fujiya M, Ito T, Ando K, Sugiyama R, Nata T, et al. Capsule endoscopy is a feasible procedure for identifying a Diphyllobothrium nihonkaiense infection and determining the indications for vermifuge treatment. BMJ Case Rep. 2010 Aug 31. 2010:3023. [QxMD MEDLINE Link].
Maithel S, Duong AK, Zhang J, Nguyen DL. An unusual cause of vitamin B12 and iron deficiency. Cleve Clin J Med. 2015 Jul. 82 (7):406-8. [QxMD MEDLINE Link].
Arizono N, Yamada M, Nakamura-Uchiyama F, Ohnishi K. Diphyllobothriasis associated with eating raw pacific salmon. Emerg Infect Dis. 2009 Jun. 15 (6):866-70. [QxMD MEDLINE Link].
Waeschenbach A, Brabec J, Scholz T, Littlewood DTJ, Kuchta R. The catholic taste of broad tapeworms - multiple routes to human infection. Int J Parasitol. 2017 Nov. 47 (13):831-843. [QxMD MEDLINE Link].
Bruschi F, Gómez-Morales MA. Parasites. Aldsworth T, Stein RA. Foodborne Diseases. Third Edition. Academic Press; 2017. 305-324. [Full Text].
Kuhn JA, Knudsen R, Kristoffersen R, Amundsen PA. A simplified method to estimate Diphyllobothrium spp. infection in salmonids. J Fish Dis. 2017 Jul. 40 (7):863-871. [QxMD MEDLINE Link].
Gustinelli A, Menconi V, Prearo M, Caffara M, Righetti M, Scanzio T, et al. Prevalence of Diphyllobothrium latum (Cestoda: Diphyllobothriidae) plerocercoids in fish species from four Italian lakes and risk for the consumers. Int J Food Microbiol. 2016 Oct 17. 235:109-12. [QxMD MEDLINE Link].
Vindigni SM, Hahn H, Zhang Q. Intermittent obstructive symptoms in a patient with diphyllobothriasis. Gastrointest Endosc. 2017 Dec. 86 (6):1185-1186. [QxMD MEDLINE Link].
Villazanakretzer DL, Napolitano PG, Cummings KF, Magann EF. Fish Parasites: A Growing Concern During Pregnancy. Obstet Gynecol Surv. 2016 Apr. 71 (4):253-9. [QxMD MEDLINE Link].
Ikuno H, Akao S, Yamasaki H. Epidemiology of Diphyllobothrium nihonkaiense Diphyllobothriasis, Japan, 2001-2016. Emerg Infect Dis. 2018 Aug. 24 (8):[QxMD MEDLINE Link].
Kasteler SD. Diphyllobothriasis in a U.S. Military Aviator. Aerosp Med Hum Perform. 2018 May 1. 89 (5):473-477. [QxMD MEDLINE Link].
Cabello FC. Salmon aquaculture and transmission of the fish tapeworm. Emerg Infect Dis. 2007 Jan. 13 (1):169-71. [QxMD MEDLINE Link].
Sampaio JL, de Andrade VP, Lucas Mda C, Fung L, Gagliardi SM, Santos SR, et al. Diphyllobothriasis, Brazil. Emerg Infect Dis. 2005 Oct. 11 (10):1598-600. [QxMD MEDLINE Link].
An YC, Sung CC, Wang CC, Lin HC, Chen KY, Ku FM, et al. Molecular Identification of Diphyllobothrium latum from a Pediatric Case in Taiwan. Korean J Parasitol. 2017 Aug. 55 (4):425-428. [QxMD MEDLINE Link].
Ramana K, Rao S, Vinaykumar M, Krishnappa M, Reddy R, Sarfaraz M, et al. Diphyllobothriasis in a nine-year-old child in India: a case report. J Med Case Rep. 2011 Jul 29. 5:332. [QxMD MEDLINE Link].
Hernández-Orts JS, Scholz T, Loizaga R, García NA, Crespo EA, Kuchta R. Marine fish imported from Argentina as source of human diphyllobothriosis in Europe? Ecological evidence from dolphins. Zoonoses Public Health. 2021 May 15. [QxMD MEDLINE Link].
Kuchta R, Radačovská A, Bazsalovicsová E, Viozzi G, Semenas L, Arbetman M, et al. Host Switching of Zoonotic Broad Fish Tapeworm (Dibothriocephalus latus) to Salmonids, Patagonia. Emerg Infect Dis. 2019 Nov. 25 (11):2156-2158. [QxMD MEDLINE Link].
Diphyllobothrium latum (and other species) FAQs. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/parasites/diphyllobothrium/faqs.html. January 10, 2012; Accessed: April 22, 2019.
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. [QxMD MEDLINE Link].
Lal S, Steinhart AH. Diphyllobothrium latum: a case of an incidental finding. World J Gastroenterol. 2007 Mar 28. 13(12):1875-6. [QxMD MEDLINE Link].
Nawa Y, Hatz C, Blum J. Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis. 2005 Nov 1. 41 (9):1297-303. [QxMD MEDLINE Link].
Koontz F, Weinstock JV. The approach to stool examination for parasites. Gastroenterol Clin North Am. 1996 Sep. 25(3):435-49. [QxMD MEDLINE Link].
Hall A, Latham MC, Crompton DW, Stephenson LS. Taenia saginata (Cestoda) in western Kenya: the reliability of faecal examinations in diagnosis. Parasitology. 1981 Aug. 83 (Pt 1):91-101. [QxMD MEDLINE Link].
Pawlowski Z. Taenia solium Cysticercosis. From Basic to Clinical Sciences. CABI Publishing; 2002.
Mega JD, Galdos-Cardenas G, Gilman RH. Tapeworm Infections. Magill AJ, Hill DR, Solomon T, Ryan ET. Hunter's Tropical Medicine and Emerging Infectious Disease. Ninth Edition. London: W.B. Saunders; 2013. 895-902.
Fang FC, Billman ZP, Wallis CK, Abbott AN, Olson JC, Dhanireddy S, et al. Human Diphyllobothrium nihonkaiense infection in Washington State. J Clin Microbiol. 2015 Apr. 53 (4):1355-7. [QxMD MEDLINE Link].
Yera H, Estran C, Delaunay P, Gari-Toussaint M, Dupouy-Camet J, Marty P. Putative Diphyllobothrium nihonkaiense acquired from a Pacific salmon (Oncorhynchus keta) eaten in France; genomic identification and case report. Parasitol Int. 2006 Mar. 55 (1):45-9. [QxMD MEDLINE Link].
Park SH, Eom KS, Park MS, Kwon OK, Kim HS, Yoon JH. A case of Diphyllobothrium nihonkaiense infection as confirmed by mitochondrial COX1 gene sequence analysis. Korean J Parasitol. 2013 Aug. 51 (4):471-3. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Craig P, Ito A. Intestinal cestodes. Curr Opin Infect Dis. 2007 Oct. 20(5):524-32. [QxMD MEDLINE Link].
Chai JY. Praziquantel treatment in trematode and cestode infections: an update. Infect Chemother. 2013 Mar. 45 (1):32-43. [QxMD MEDLINE Link].
Page SW. Maddison JE, Page SW, Church DB. Small Animal Clinical Pharmacology. Second Edition. Edinburgh: W.B. Saunders; 2008. 198-260.
Oi H, Nakamura H, Nakabayashi T, Waki K. Method for ejecting cestodes: duodenal tube injection of gastrografin. AJR Am J Roentgenol. 1984 Jul. 143 (1):111-3. [QxMD MEDLINE Link].
Robert-Gangneux F, Autier B, Gangneux JP. Dibothriocephalus nihonkaiensis: an emerging concern in western countries?. Expert Rev Anti Infect Ther. 2019 Sep. 17 (9):677-679. [QxMD MEDLINE Link].
Reilly DF. The Things They Carry: Diphyllobothriasis at Sea, a Case Report. Mil Med. 2020 Mar 2. 185 (3-4):e510-e512. [QxMD MEDLINE Link].
Björkenheim B. Optic neuropathy caused by vitamin-B12 deficiency in carriers of the fish tapeworm, Diphyllobothrium latum. Lancet. 1966 Mar 26. 1 (7439):688-90. [QxMD MEDLINE Link].
Craig N. Fish tapeworm and sushi. Can Fam Physician. 2012 Jun. 58 (6):654-8. [QxMD MEDLINE Link].

Media Gallery

Life cycle of diphyllobothrium.
Egg of Diphyllobothrium latum with arrow pointing to operculum.
Proglottids of Diphyllobothrium latum.
Diphyllobothrium life cycle. This illustration depicts the life cycle of different species of Diphyllobothrium parasitic cestodes, the causal agents of the disease diphyllobothriasis. Courtesy of the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/dpdx/diphyllobothriasis/).

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Author

Shireen R Chacko, MBBS Resident Physician, Department of Internal Medicine, Albert Einstein Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Antonette B Climaco, MD Attending Physician, Division of Infectious Diseases, Department of Medicine, Einstein Healthcare Network

Antonette B Climaco, MD is a member of the following medical societies: American Academy of HIV Medicine, HIV Medicine Association, Infectious Diseases Society of America, Philippine Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, 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.

Additional Contributors

David R Haburchak, MD, FACP Key Faculty, Wellstar Kennestone Internal Medicine Residency Program, Wellstar Health System

David R Haburchak, MD, FACP is a member of the following medical societies: American College of Physicians, American Osler Society, American Society for Microbiology, Christian Medical and Dental Associations, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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.

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.

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