Diphyllobothrium Infection is caused by human intestinal infection with the cestode Diphyllobothrium latum or other Diphyllobothrium species. It is endemic in areas where humans frequently consume raw or pickled fish. Diphyllobothriasis is caused by ingestion of raw or undercooked infected fish and subsequent intestinal infection. In general, diphyllobothriasis carries an excellent prognosis. D latum is not invasive, and mortality due to diphyllobothriasis is rare. Occasionally, infestation can lead to severe megaloblastic anemia or intestinal obstruction. Although it is well described, megaloblastic anemia is in fact very unusual. Gastrointestinal (GI) obstruction is also rare but may occur, especially when numerous worms are present and form a substantial bulk in the GI tract. 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:
•Indigestion or dyspepsia
•Passage of proglottids
•Numbness of extremities
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:
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. Sensation of hunger Megaloblastic anemia occurs in are conditions. Studies note that about 40% of patients have decreased serum vitamin B-12 levels, but fewer than 2% of patients are anemic. Praziquantel is considered the drug of choice for D latum infection, with niclosamide as an alternative.
Antimicrobial agents are used to eradicate the infecting organism (most often,Diphyllobothrium latum). Praziquantel is the drug of choice; niclosamide is an alternative.
Diphyllobothriasis is a worldwide disease that affects people near fresh water and appropriate intermediate hosts. Areas where consumption of raw or precooked fish is popular tend to have endemicity.Diphyllobothriasis has no reported age predilection or sexual predilection. In addition, it has no known racial predilection, except as would be expected on the basis of geographic and cultural factors. . Outbreaks associated with the increased popularity and availability of fresh salmon (as opposed to canned or frozen salmon) have been described.