diphyllobothriasis

Diphyllobothriasis
Classification and external resources
ICD-10	B70.0
ICD-9	123.4
DiseasesDB	29539
MedlinePlus	001375
eMedicine	med/571
MeSH	D004169

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/12 17:25:23」(JST)

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Diphyllobothriasis is the infection caused by the tapeworm Diphyllobothrium.

Geographic distribution

Diphyllobothriasis occurs in areas where lakes and rivers coexist with human consumption of raw or undercooked freshwater fish. Such areas are found in Europe, newly independent states of the former Soviet Union, North America, Asia, Uganda, Peru (because of Ceviche), and Chile. It is particularly common in Japan, because of Sushi or Sashimi.

Around the middle of the 20th century in Japan, before advancements in refrigeration, many sushi/sashimi connoisseurs suffered great morbidity and mortality from Diphyllobothrium after eating unrefrigerated sashimi. Through research in parasitology, scientists came to realize that the primary cause was the relatively favorable parasite-breeding conditions that raw fish offered.

The disease is rare in the United States. It was, however, once more common and was referred to as "Jewish housewife's disease" because Jewish housewives preparing the traditional "gefilte fish" frequently tasted the fish before it was cooked.

Clinical features

Differential symptoms of parasite infection by raw fish: Clonorchis sinensis (a trematode/fluke), Anisakis (a nematode/roundworm) and Diphyllobothrium a (cestode/tapeworm),^[1] all have gastrointestinal, but otherwise distinct, symptoms. ^[2] ^[3] ^[4] ^[5]

Diphyllobothriasis can last for decades if untreated. Most infections are asymptomatic. Manifestations may include abdominal discomfort, diarrhea, vomiting and weight loss. Vitamin B12 deficiency with subsequent megaloblastic anemia may occur, but has not for several decades in D. latum infections, possibly because of improved nutrition. In one test, nearly half of the ingested vitamin was absorbed by D. latum in otherwise healthy patients, while 80-100% was absorbed by the worm in patients with anemia. It is not known why anemia occurs in some cases but not others. Massive infections may result in intestinal obstruction. Migration of proglottids can cause cholecystitis or cholangitis.

Females cases are disproportionately reported, most likely due to the higher likelihood for them to be involved in meal preparation, rather than any morphological differences.

Diagnosis

Microscopic identification of eggs in the stool is the basis of specific diagnosis. Eggs are usually numerous and can be demonstrated without concentration techniques. Examination of proglottids passed in the stool is also of diagnostic value.

Diagnostic tool:

Microscopy
Morphologic comparison with other intestinal parasites

Though it is difficult to identify the eggs or proglottids to the species level, the distinction is of little medical importance because, like most adult tapeworms in the intestine, all members of this genus respond to the same drugs.

Treatment

Upon diagnosis, treatment is quite simple and effective. The standard treatment for diphyllobothriasis, as well as many other tapeworm infections is a single dose of Praziquantel, 5–10 mg/kg PO once for both adults and children. An alternative treatment is Niclosamide, 2 g PO once for adults or 50 mg/kg PO once.^[6] One should note that Praziquantel is not FDA approved for this indication and Niclosamide is not available for human use in the United States.^[7] Another interesting potential diagnostic tool and treatment is the contrast medium, Gastrografin, introduced into the duodenum, which allows both visualization of the parasite, and has also been shown to cause detachment and passing of the whole worm.^[8]

Prevention

Avoid ingestion of raw freshwater fish. Adequate cooking or freezing of freshwater fish will kill the encysted fish tapeworm larvae. Also, because human feces is an important mechanism for spreading eggs, proper disposal of sewage can cut down on infection of fish and thus of humans.

References

^ WaiSays: About Consuming Raw Fish Retrieved on April 14, 2009
^ For Chlonorchiasis: Public Health Agency of Canada > Clonorchis sinensis - Material Safety Data Sheets (MSDS) Retrieved on April 14, 2009
^ For Anisakiasis: WrongDiagnosis: Symptoms of Anisakiasis Retrieved on April 14, 2009
^ For Diphyllobothrium: MedlinePlus > Diphyllobothriasis Updated by: Arnold L. Lentnek, MD. Retrieved on April 14, 2009
^ For symptoms of diphyllobothrium due to vitamin B12-deficiency University of Maryland Medical Center > Megaloblastic (Pernicious) Anemia Retrieved on April 14, 2009
^ http://www.dpd.cdc.gov/dpdx/HTML/PDF_Files/MedLetter/TapewormInfection.pdf
^ http://www.cdc.gov/parasites/diphyllobothrium/health_professionals/index.html
^ Ko, S.B. “Observation of deworming process in intestinal Diphyllobothrium latum parasitism by Gastrografin injection into jejunum through double-balloon enteroscope.” (2008) from Letter to the Editor; American Journal of Gastroenterology, 103; 2149-2150.

External links

"DPDx - Diphyllobothriasis". CDC Division of Parasitic Diseases.

UpToDate Contents

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1. 腸管条虫 intestinal tapeworms
2. ビタミンB12および葉酸塩欠乏症の病因および臨床症状 etiology and clinical manifestations of vitamin b12 and folate deficiency
3. 微生物による食中毒疾患の鑑別診断 differential diagnosis of microbial foodborne disease

English Journal

Imported diphyllobothriasis in Switzerland: molecular methods to define a clinical case of Diphyllobothrium infection as Diphyllobothrium dendriticum, August 2010.

de Marval F, Gottstein B, Weber M, Wicht B.SourceDianalabs, Geneva, Switzerland.
Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin.Euro Surveill.2013 Jan 17;18(3). pii: 20355.
Following a first clinical case of infection by Diphyllobothrium dendriticum in Switzerland in 2006, we report a second case in the country. The species was identified by molecular methods. In the Swiss, French and Italian subalpine regions, human diphyllobothriasis has seen a comeback since the lat
PMID 23351654

Case report: Molecular diagnosis of subcutaneous Spirometra erinaceieuropaei sparganosis in a Japanese immigrant.

Tappe D, Berger L, Haeupler A, Muntau B, Racz P, Harder Y, Specht K, Prazeres da Costa C, Poppert S.SourceInstitute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany. dtappe@hygiene.uni-wuerzburg.de
The American journal of tropical medicine and hygiene.Am J Trop Med Hyg.2013 Jan;88(1):198-202. doi: 10.4269/ajtmh.2012.12-0406. Epub 2012 Nov 19.
We report a case of subcutaneous sparganosis in a 68-year-old female Japanese immigrant in Germany. The patient complained of a painless erythema caudal of the umbilicus with a palpable subcutaneous cherry-sized lump. Polymerase chain reaction on formalin-fixed parasite tissue identified Spirometra
PMID 23166198

Functional changes in regulatory T cells during an experimental infection with sparganum (plerocercofid of Spirometra mansoni).

Kim HR, Lee SM, Won JW, Lim W, Moon BI, Yang HJ, Seoh JY.SourceDepartment of Microbiology, Ewha Womans University School of Medicine, Seoul, Korea.
Immunology.Immunology.2013 Jan;138(1):57-67. doi: 10.1111/imm.12017.
Regulatory T (Treg) cells are important in the regulation of immune response, but the exact regulation of Treg-cell function in vivo is still not well known. In the present study, we investigated the functional activity of CD4(+) CD25(+) Treg cells as well as the frequency and number of CD4(+) CD25(
PMID 23078673

Japanese Journal

栃木県内地域中核病院における寄生虫・衛生動物関連疾患症例の検討

島田瑞穂,小松本悟,桐木雅史 [他],千種雄一,松岡裕之
自治医科大学紀要 34, 141-148, 2012-03-01
栃木県内の地域中核病院である足利赤十字病院において,寄生虫・衛生動物関連疾患の症例集積を行った。同院が移転開院した2011年7月以前の診療録を可能な限り過去に遡って検索し,最古1993年5月の診療録までを確認し,33例の寄生虫・衛生動物関連疾患を集積した。寄生虫症例として原虫症14例,蠕虫症13例を認めた。原虫症として,赤痢アメーバ症,ランブル鞭毛虫症,現在は真菌症に分類されるニューモシスチス肺炎 …
NAID 110008922668

自治医科大学医動物学教室で4年間(2007-2010)に経験した寄生虫・衛生動物関連症例の検討

松岡裕之,山本大介,早川枝李 [他],諏合輝子,佐野元市郎,平井誠,吉田栄人
自治医科大学紀要 34, 117-128, 2012-03-01
自治医科大学医動物学部門で4年間(2007-2010)に照会を受けた,寄生虫・衛生動物関連症例について検討を行なった。照会総件数は95件で,学内から34件(35.8%),学外から61件(64.2%)であった。うち実際に寄生虫の感染があった症例は27件であった。頻度の高かった疾患は,日本海裂頭条虫症13例,マラリア4例などであった。過去に照会数が多かった回虫症の照会は1例もなかった。いままで日本国内 …
NAID 110008922665