Diphyllobothriasis ( a tapeworm ) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

One of dangerous parasites, capable of human infection and transmitted through the fish, is a tapeworm.Fairly widespread among his fish pools many rivers of the world a matter of some concern and suspicion, and the disease itself requires careful consideration.

Diphyllobothriasis - a chronic intestinal worm infestations flow caused by tapeworm - tapeworm wide, and is characterized by lesions of the small intestine and the development of B12 - deficiency anemia.

diphyllobothriasis source of infection for humans

noted the connection between the frequency of prevalence diphyllobothriasis with many pools the world's rivers, lakes location, as well as temperate and cold climates.It spreads the disease in North America, Canada, France, Denmark, Sweden, Holland, Finland, Italy, Germany and other countries.In the Russian Federation diphyllobothriasis more common in the Krasnoyarsk region, the river basins - Ob, Lena, Yenisey, Amur.Revealed lesions in the reservoirs of Nizhny Novgorod, Volgograd, Samara,


Causes of diphyllobothriasis

Pathogen disease - Diphyllobothrium latum (broad tapeworm) tapeworm from 2 to 10 meters in length and over.It belongs to the class of Cestoda, family Diphyllobothriidae.It consists of a head (scolex) having two slit bothria to attach to the intestine's mucosa, cervix, and body consisting of segments in which the eggs are formed.The body length is due to the huge number of segments - up to 4000 pieces, the eggs are allocated only mature segments.parasite eggs are oval, quite large by the standards of helminth eggs and up to 70 microns, surrounded 2hsloynoy shell and equipped with a single-pole cap.Parasitizing the intestine, tapeworm allocates only immature eggs, their further development takes place in the environment (in freshwater).

Diphyllobothriasis, the adult tapeworm a

cycle of broad tapeworm takes place with a change of 3 hosts:
- definitive host - man, cat, dog, pig, bear, fox;
- intermediate host - copepods Cyclops;
- additional host - freshwater fish.

Infection occurs by eating insufficiently cooked fish.

Parasite worms in the small intestine.With feces tapeworm eggs get into the environment, into the water.First inside the egg the embryo is formed, which is then under favorable conditions for themselves (temperature plus 15 °) goes into the pond after 6-16 days.Bud actively floats in water, remaining viable up to 6 months.Perniciously operates on embryos temperatures over + 20 °, the salt water.After ingestion of freshwater crustaceans in 2-3 weeks embryo turns into procercoids (invasive larvae).Crustaceans with procercoids swallowed predatory fish (ruff, perch, pike-perch, pike, burbot) or salmon fish (salmon, chum), the body which they overcome the intestinal wall, migrate to the muscles and other organs, which in turn for 4-5 weeksin plerocercoid (approx 1-3-5 cm bothria length).

plerocercoids - is invasive to the human stage.Already in the final host organism they become sexually mature parasite (plerocercoid attached to the mucosa of the small intestine and reach the adult stage after 15-30 days).

whole cycle lasts an average of 25 weeks.The lifespan of the parasite more than 20 years.

Diphyllobothriasis life cycle

Thus, the source of infection in diphyllobothriasis - the final host (people, pets - a cat and a dog, a pig, fox, bear), the body which can parasitize mature individuals broad tapeworm andexcrement which is released eggs (up to 2 million. eggs per day and more) into the environment.However, we must remember that for the invasion of the eggs must be some way to go before the development of invasive stage, so the final host directly to not infect others.

Diphyllobothriasis, tapeworm egg broad

mechanism infection - alimentary.Infestation occurs as a result of eating insufficiently cooked or raw fish (ruff, perch, pike-perch, pike, burbot, salmon, chum), the body which is plerocercoid - contagious for human parasite development stage.Plerocercoids can be both in the internal organs, as well as in fish muscle.Many of the sick ate salted fish and salted eggs cooked at home.In rare cases, infection occurs through the transfer factors (cutting board and knives, utensils, contaminated plerocercoids).Often sick fans of raw food (fish roe), cooking skewers of fish.

Susceptibility to diphyllobothriasis general.Sick more often adults compared to children.

Pathogenic action of broad tapeworm in the human body

1) mechanical impact of helminths on the intestinal wall at the point of attachment (the developing tissue necrosis and atrophy);
2) the stimulation of nerve endings of the mucosa with the development of neuro-trophic disorders, leading to dysfunction of the gastrointestinal tract;
3) allergic reactions due to sensitization of the organism vital activity products of the parasite;
4) hypo- and beriberi B12 and folic acid, as a result of this - megaloblastic anemia (broken binding gastromukoproteina - internal gastric factor with vitamin B12, resulting in vitamin is not absorbed and adsorbed tapeworm).It may also decrease levels of vitamins C, B1, B6 in the blood of patients.
Immunity after suffering helminthiasis unstable, may be re-infestation.

Symptoms diphyllobothriasis

incubation period (from the time of infection until the complaints of the patient) can last from 20 to 60 days.The most common manifestations of the disease are mild.Onset of the disease is gradual.

First, nausea, sometimes vomiting, pain around the abdomen, moderately severe fever, unstable stool, change in appetite (increased or decreased).Some patients may develop intestinal obstruction associated with the accumulation of tapeworm in the intestine.

characteristic development of B12-scarce anemia, manifested by weakness, dizziness, palpitations, fatigue, pale skin, swelling of the face or limbs, may develop glossitis (bright red spot, a crack, and then atrophy papillae, the tongue becomes "varnished").Such changes may be on the gums, mucosa of the cheek, pharynx, esophagus (food intake in pain).

may be damage to the nervous system (numbness, paresthesia - "the feeling of pins and needles", a violation of superficial and deep sensitivity, unsteady gait).Possible manifestations funicular myelosis (as in pernicious anemia Addissona-Birmera) - the patient has not expressed paresthesias, disturbances chuvstvitelnoyati.

blood count changes: decrease in the number of red blood cells, hemoglobin, but the color index increased.Can meet Jolly cells (blood cells with the remnants of cores) and rings Kebota (with basophilic punctuation polychromatophilia) megaloblasts, megalocytes.Also marked leukopenia (reduction in white blood cells), thrombocytopenia (platelet reduction).

The degree of anemia depends on the degree of infestation, the presence of comorbidities, patients' quality of supply.

Sometimes the disease is latent (secretly, without clinical symptoms).

Diagnostics diphyllobothriasis

Diagnosis is based on clinical and epidemiological data, as well as the results of laboratory tests.

1) epidemiological history (stay in endemic area, the fact that the use of 20-60 days ago, raw, salted, insufficiently cooked fish and its products, for example, eggs);
2) clinical data (the appearance of one or more groups of symptoms of varying severity), sometimes patients complain of separation of parts of the stool strobila (body) broad tapeworm;

Diphyllobothriasis segments or segments

3) paraclinical data: complete blood count (decrease in the number of red blood cells and hemoglobin in the normal or high color index, appearance modified blood cells - calf Jolly (blood cells with the remnants of the nuclei)and Kebota ring (with basophilic punctuation polychromatophilia), the occurrence of megaloblastic cells, reducing the number of white blood cells and platelets).
4) Specific parasitological studies: koproovoskopiya (detection of the parasite body fragments (segments) by microscopy).

The differential diagnosis is carried out with anemias of different genesis (hemolytic, iron, hyperchromic) and other parasitological diseases (trichocephalosis, hookworm).


Treatment Treatment is based on the use of antiparasitic agents.For the treatment used:
- fenasal (niclosamide) once from 1 to 3 grams, depending on the age of the patient.
- biltricid at a mean dose of 25 mg / kg once.
- seed extract of male fern : within 2 days easy diet devoid of fat, spicy food, on the eve of therapy in the evening light dinner at night saline laxative (magnesium sulfate), in the morning on an empty stomach put a cleansing enema, and then taking the drug 1 capsule every2 minutes (total dose depending on the age of 4 to 7 grams).After 30 minutes, again give a saline laxative, 1.5 hours - a light breakfast.If the chair is not present within 3 hours, do a cleansing enema.
- pumpkin seeds in an amount of 300 g, pour 50-60 ml of warm water, and triturated use fasting for 1 hour.After 3 hours, allow saline laxative and then after 30 minutes - enema.You can zaparivat seeds in a water bath (as in teniasis).

In severe anemia conducted its correction: orders the appointment of vitamin B12 or cyanocobalamin of 200 to 500 mg parenterally 3 times a week for 1-1.5 months, as well as iron supplements (ferropleks, Aktiferrin, ferronal, gemofer and others).

Symptomatic therapy (analgesics, probiotics preparations, normalizing bowel movements, if necessary, laxatives, etc.).

Weather favorable disease.

treatment monitoring is carried out at 1 and 3 months after the antiparasitic therapy.At negative analyzes koproovoskopii further medical examination is required.If the discharge of eggs and fragments strobila tapeworm continues, appointed a second course of treatment.

Prevention diphyllobothriasis

When fishing and the use of river and lake fish to prevent her raw food diet, carefully monitor its thermal treatment.Plerocercoids sufficiently stable.Die at -15 ° for one day (24 hours) at minus 10 ° in tchenie 3 days at minus 4-6 ° for 9-10 days.High temperatures are harmful to plerocercoid more - they are killed at a temperature of 55-60 °, in other words: it is recommended fish roast thoroughly for at least 20 minutes, and large pieces of fish - at least 30-40 minutes.The salt products are allowed to eat at a salt content in the end product is not less than 9%, in which case plerocercoids die.

Diphyllobothriasis, plerocercoids in the fish meat

Timely detection of symptoms and treatment diphyllobothriasis.Regular screening for helminthiasis fishermen before and after navigation, employees of fish processing plants.

infectious disease doctor Bykov NI