Diphyllobothrium

Diphyllobothrium is a genus of tapeworms

which can cause diphyllobothriasis in
humans through consumption of raw or
undercooked fish. The principal species
causing diphyllobothriasis is
Diphyllobothrium latum, known as the
broad or fish tapeworm, or broad fish
tapeworm. D. latum is a pseudophyllid
cestode that infects fish and mammals. D.
latum is native to Scandinavia, western
Russia, and the Baltics, though it is now
also present in North America, especially
the Pacific Northwest. In Far East Russia,
D. klebanovskii, having Pacific salmon as
its second intermediate host, was
identified.[1] Other members of the genus
Diphyllobothrium include Diphyllobothrium
dendriticum (the salmon tapeworm), which
has a much larger range (the whole
northern hemisphere), D. pacificum, D.
cordatum, D. ursi, D. lanceolatum, D. dalliae,
and D. yonagoensis, all of which infect
humans only infrequently. In Japan, the
most common species in human infection
is D. nihonkaiense, which was only
identified as a separate species from D.
latum in 1986.[2] More recently, a
molecular study found D. nihonkaiense and
D. klebanovskii to be a single species.[3]
 Diphyllobothrium

Proglottids of D. latum

Scientific classification

Kingdom: Animalia

Phylum: Platyhelminthes

Class: Cestoda

Subclass: Eucestoda

Order: Pseudophyllidea

Family: Diphyllobothriidae
Genus: Diphyllobothrium
Cobbold, 1858
Species

D. latum
D. pacificum
D. cordatum

Diphyllobothrium elegans
Diphyllobothrium latum Linnaeus, 1757

D. ursi
D. dendriticum
D. lanceolatum
D. dalliae
D. yonagoensis
D. nihonkaiense=D. klebanovskii
Synonyms

Cordicephalus Wardle, McLeod & Stewart,

1947

History
Diphyllobothrium latum scolex

The fish tapeworm has a long documented

history of infecting people who regularly
consume fish and especially those whose
customs include the consumption of raw
or undercooked fish. In the 1970s, most of
the known cases of diphyllobothriasis
came from Europe (5 million cases), and
Asia (4 million cases) with fewer cases
coming from North America and South
America, and no reliable data on cases
from Africa or Australia.[4] Despite the
relatively small number of cases seen
today in South America, some of the
earliest archeological evidence of
diphyllobothriasis comes from sites in
South America. Evidence of
Diphyllobothrium spp. has been found in
4,000- to 10,000-year-old human remains
on the western coast of South America.[5]
There is no clear point in time when
Diphyllobothrium latum and related species
were “discovered” in humans, but it is clear
that diphyllobothriasis has been endemic
in human populations for a very long time.
Due to the changing dietary habits in many
parts of the world, autochthonous, or
locally acquired, cases of
diphyllobothriasis have recently been
documented in previously non-endemic
areas, such as Brazil.[6] In this way,
diphyllobothriasis represents an emerging
infectious disease in certain parts of the
world where cultural practices involving
eating raw or undercooked fish are being
introduced.

Morphology
The adult worm is composed of three
fairly distinct morphological segments: the
scolex (head), the neck, and the lower
body. Each side of the scolex has a slit-like
groove, which is a bothrium for
attachment to the intestine. The scolex
attaches to the neck, or proliferative
region. From the neck grow many
proglottid segments which contain the
reproductive organs of the worm. D. latum
is the longest tapeworm in humans,
averaging ten meters long. Adults can
shed up to a million eggs a day.

In adults, proglottids are wider than they

are long (hence the name broad
tapeworm). As in all pseudophyllid
cestodes, the genital pores open
midventrally.

Life cycle
Life cycle of D. latum. Click the image to see full-size.

Adult tapeworms may infect humans,

canids, felines, bears, pinnipeds, and
mustelids, though the accuracy of the
records for some of the nonhuman
species is disputed. Immature eggs are
passed in feces of the mammal host (the
definitive host, where the worms
reproduce). After ingestion by a suitable
freshwater crustacean such as a copepod
(the first intermediate host), the coracidia
develop into procercoid larvae. Following
ingestion of the copepod by a suitable
second intermediate host, typically a
minnow or other small freshwater fish, the
procercoid larvae are released from the
crustacean and migrate into the fish's flesh
where they develop into a plerocercoid
larvae (sparganum). The plerocercoid
larvae are the infective stage for the
definitive host (including humans).

Because humans do not generally eat

undercooked minnows and similar small
freshwater fish, these do not represent an
important source of infection.
Nevertheless, these small second
intermediate hosts can be eaten by larger
predator species, for example trout, perch,
walleye, and pike. In this case, the
sparganum can migrate to the
musculature of the larger predator fish and
mammals can acquire the disease by
eating these later intermediate infected
host fish raw or undercooked. After
ingestion of the infected fish, the
plerocercoids develop into immature
adults and then into mature adult
tapeworms which will reside in the small
intestine. The adults attach to the
intestinal mucosa by means of the two
bilateral grooves (bothria) of their scolex.
The adults can reach more than 10 m (up
to 30 ft) in length in some species such as
D. latum, with more than 3,000 proglottids.
One or several of the tape-like proglottid
segments (hence the name tape-worm)
regularly detach from the main body of the
worm and release immature eggs in fresh
water to start the cycle over again.
Immature eggs are discharged from the
proglottids (up to 1,000,000 eggs per day
per worm) and are passed in the feces.
The incubation period in humans, after
which eggs begin to appear in the feces is
typically 4–6 weeks, but can vary from as
short as 2 weeks to as long as 2 years.[7]
The tapeworm can live up to 20 years.
Clinical symptoms, including
occasional parasite-induced
B12 deficiency
Symptoms of diphyllobothriasis are
generally mild, and can include diarrhea,
abdominal pain, vomiting, weight loss,
fatigue, constipation and discomfort.[8]
Approximately four out of five cases are
asymptomatic and may go many years
without being detected.[4] In a small
number of cases, this leads to severe
vitamin B12 deficiency due to the parasite
absorbing 80% or more of the host’s B12
intake, and a megaloblastic anemia
indistinguishable from pernicious
anemia.[9] The anemia can also lead to
subtle demyelinative neurological
symptoms (subacute combined
degeneration of spinal cord). Infection for
many years is ordinarily required to
deplete the human body of vitamin B-12 to
the point that neurological symptoms
appear.

Diagnosis
 

Diphyllobothrium latum proglottid

Diagnosis is usually made by identifying

proglottid segments, or characteristic
eggs in the feces.[7] These simple
diagnostic techniques are able to identify
the nature of the infection to the genus
level, which is usually sufficient in a
clinical setting.[4] However, when the
species needs to be determined (in
epidemiological studies, for example),
restriction fragment length polymorphisms
can be effectively used. PCR can be
performed on samples of purified eggs, or
native fecal samples following sonication
of the eggs to release their contents.[4]
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.[10]

Treatment
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.[11]
Praziquantel is not FDA approved for this
indication and Niclosamide is not available
for human use in the United States.[12]

Side effects of treatment

Praziquantel has few side effects, many of

which are similar to the symptoms of
diphyllobothriasis. They include malaise,
headache, dizziness, abdominal
discomfort, nausea, rise in temperature
and occasionally allergic skin reactions.[4]
The side effects of Niclosamide are very
rare, due to the fact that it is not absorbed
in the gastrointestinal tract.[4]

Epidemiology
People at high risk for infection have
traditionally been those who regularly
consume raw fish.[4] Many regional
cuisines include raw or undercooked food,
including sushi and sashimi in Japanese
cuisine, carpaccio di persico in Italian,
tartare maison in French-speaking
populations, ceviche in Latin American
cuisine and marinated herring in
Scandinavia. With emigration and
globalization, the practice of eating raw
fish in these and other dishes has brought
diphyllobothriasis to new parts of the
world and created new endemic foci of
disease.[4]

Public health strategies

The most viable interventions include:
prevention of water contamination both by
raising public awareness of the dangers of
defecating in recreational bodies of water
and by implementation of basic sanitation
measures; screening and successful
treatment of people infected with the
parasite; and prevention of infection of
humans via consumption of raw, infected
fish.[4] The last of these can most easily be
changed via education about proper
preparation of fish. Fish that is thoroughly
cooked, brined, or frozen at -10 °C for 24–
48 hours can be consumed without risk of
D. latum infection.
See also
List of parasites (human)

References
1. Muratov, IV; Posokhov, PS (1988).
"Causative agent of human
diphyllobothriasis--Diphyllobothrium
klebanovskii sp. n.". Parazitologiia. 22
(2): 165–70. PMID 3387122 .
2. Yamane, Y; Kamo, H; Bylund, G;
Wikgren, BJ (1986). "Diphyllobothrium
nihonkaiense sp. nov (Cestoda:
Diphyllobothriidae)---revised
identification of Japanese broad
tapeworm". Shimane J Med Sci. 10:
29–48.
3. Arizono, N; Shedko, M; Yamada, M;
Uchikawa, R; Tegoshi, T; Takeda, K;
Hashimoto, K (2009). "Mitochondrial
DNA divergence in populations of the
tapeworm Diphyllobothrium
nihonkaiense and its phylogenetic
relationship with Diphyllobothrium
klebanovskii". Parasitology
International. 58 (1): 22–8.
doi:10.1016/j.parint.2008.09.001 .
PMID 18835460 .
4. Scholz, T; et al. (2009). "Update on the
Human Broad Tapeworm (Genus
Diphyllobothrium), Including Clinical
Relevance" . Clinical Microbiology
Reviews. 22 (1): 146–160.
doi:10.1128/CMR.00033-08 .
PMC 2620636 . PMID 19136438 .
5. Reinhard, KJ (1992). "Parasitology as
an interpretive tool in archaeology" .
American Antiquity. 57 (2): 231–245.
doi:10.2307/280729 . JSTOR 280729 .
6. Llaguno, Mauricio M., et al.
“Diphyllobothrium latum infection in a
non-endemic country: case report.”
(2008) Revista da Sociedade Brasileira
de Medicina Tropical, 41 (3), 301-303
7. http://web.gideononline.com/web/epi
demiology/
8. "DPDx - Diphyllobothriasis" .
Dpd.cdc.gov. Retrieved 2012-12-30.
9. John, David T. and Petri, William A.
(2006)
10. 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.
11. "CDC - DPDx Homepage" (PDF).
www.dpd.cdc.gov. 6 March 2018.
Retrieved 7 April 2018.
12. "CDC - Diphyllobothrium - Resources
for Health Professionals" . Cdc.gov.
2012-01-10. Retrieved 2012-12-30.
"DPDx - Diphyllobothriasis" . CDC
Division of Parasitic Diseases. 2019-02-
04.
"UDiphyllobothrium spp" . Bad Bug Book.
Retrieved 2009-07-13.
Janovy, John; Roberts, Larry S. (2005).
Foundations of Parasitology (7th ed.).
McGraw-Hill Education (ISE Editions).
ISBN 978-0-07-111271-0.
 Bonsdorff, B von: Diphyllobothriasis in
Man. Academic Press, London, 1977
Keas, B. E: Microscopy -
Diphyllobothrium latum. Michigan State
University, East Lancing, 1999

External links
http://www.stanford.edu/class/humbio1
03/parasites.htm

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