Diphyllobothrium Latum - Fish Tapeworm

Diphyllobothrium latum, the fish tapeworm, is the biggest tapeworm in humans. It causes a
parasitic infection called diphyllobothriasis which is acquired by eating raw fish infected with
the parasite. Diphyllobothriasis is found in Chile, Peru, Uganda and in the Northern Hemisphere
(northern Asia, Europe and America) in areas of rivers and lakes. Diphyllobothrium species
include: D. cordatum, D. dalliae, D. dendriticum, D. lanceolatum, D. latum, D. pacificum, D.
ursi and D. yonagoensis. Diphyllobothrium latum is the most common and mostly found in
Scandinavia, the Baltics and western Russia.

The life cycle of Diphyllobothrium latum starts, when immature eggs are passed in the feces of
an infected human. The eggs mature in water within three weeks and form oncospheres. Larvae
called coracidia hatch and get eaten by freshwater crustaceans such as copepod. After ingestion
coracidia develop into procercoid larvae. If the copepod is eaten by a small fish (second
intermediate host) / FW crustacean, the procercoid larvae penetrate the gut and migrate to muscle
tissue where they develop into plerocercoid larvae (sparganum), the infective stage for humans.
Usually a third intermediate host is needed because humans do not usually eat raw fish this
small. If a trout, walleyed pike or perch eats the smaller fish, the plerocercoid larvae once again
penetrate the gut and migrate to fish flesh. If a human eats the infected fish raw or undercooked
the plerocercoid larvae develop into adults in the small intestine. The adults attach to the
intestinal mucosa with two shallow, bilateral grooves (bothria) of their scolex. The scolex is 3
mm long and 1 mm wide. The long, flat body consists of segments, proglottids, that are produced
by the neck. Full grown proglottids are about 10 mm wide and 3 mm long. The segments absorb
nutrients and have their own digestive systems. As proglottids mature, they release eggs and
eventually break off from the body. A Diphyllobothrium latum proglottid is characterized by a
rosette-shaped uterus at its center. The eggs are ellipsoidal or oval measuring 55–75 µm by 40–
50 µm. They are passed in the feces unembryonated (immature). From the start of the infection it
takes about six weeks for the eggs to appear in the feces. One adult tapeworm can shed up to a
million eggs per day. It can grow over 10 meters long and live up to 20 years.
People who eat raw fish are at risk of getting infected with the larvae that are sometimes present
in the fish flesh. Some fishermen eat their catches raw using salt to kill parasites. Salting the fish
is usually not enough to kill larval Diphyllobothrium latum. Some housewives taste fish as they
are preparing it and might ingest the tiny larva. Women get infected more often than men
because they usually prepare meals for the family. Raw fish is included in many regional
cuisines, for example, carpaccio di persico (Italy), ceviche (Latin America), marinated herring
(Scandinavia), sashimi and sushi (Japan) and tartare maison in (France).

Diphyllobothriasis is usually asymptomatic. In some cases it causes severe vitamin B12

deficiency because D. latum can absorb most of the B12 intake. In some cases it can lead to
neurological symptoms. Diphyllobothriasis symptoms include:

 constipation
 diarrhea
 fatigue
 obstruction of the bowel
 pernicious anemia (caused by vitamin B12 deficiency) which can lead to
 subacute combined degeneration of spinal cord
  stomach pain
 vomiting
 weight loss.

Migrating proglottids can cause inflammation of the bile duct or the gall bladder.

Diphyllobothriasis is diagnosed by examining a stool sample to find eggs or sometimes

proglottids. Identification is restricted to genus level which actually does not matter when
treating the disease since all Diphyllobothrium species respond to the same drugs. When doing
research the specific worm species can be identified by performing PCR on purified eggs.

Diphyllobothriasis was previously treated with praziquantel or niclosamide. Praziquantel has

some side effects that are very similar to diphyllobothriasis symptoms. Niclosamide is not
absorbed in the gastrointestinal tract and has usually no side effects. However, these drugs are
not reliable in cutting the scolex loose. If the head is left in the intestinal wall it will regrow. The
best method is a diatrizoic acid injection into the duodenal wall. The diatrizoic acid causes all
worms to detach leaving nothing behind. Niclosamide or praziquantel should only be used, if
endoscopic treatment is not available.

To prevent infection:

 Cook fish properly. If you eat sashimi or sushi, freeze it first at -10 °C (or below) for two
days to kill the tapeworm larvae.
 Do not defecate in water. If the fish tapeworm larvae cannot get in touch with the
intermediate hosts, they cannot infect humans.
 Enlighten people through health education about the parasite’s mode of transmission
 Treatment of the sick individuals to reduce the eggs in circulation
 Observe hygiene by proper disposal of feaces.