Successful Gastrografin Vermifugation for Taenia saginata-associated Appendicitis.

In Japan, public health improvements have lessened parasitic infections, but increased global travel has introduced new disease risks. We report the case a Japanese man who had previously resided in Vietnam, who experienced appendicitis and the presence of segments in his stool. Gastrografin led to the expulsion of Taenia saginata, as confirmed by scolex identification. Remarkably, the appendicitis symptoms subsided after deworming. This case underscores the importance of considering cestode infections in the differential diagnosis of appendicitis, particularly for patients with relevant travel histories, and highlights the evolving challenges in global health and the significance of acquiring detailed patient histories.

Molecular diagnosis of Taenia saginata from two patients in Palestine: two case reports.

BACKGROUND: Taeniasis, is a worldwide foodborne zoonotic disease caused by two principal species; Taenia saginata and Taenia solium. The tapeworm infects the intestine causing taeniasis in humans. Taeniasis is a very rare parasitic infection in Palestine with very few annual cases of unknown species. The infection rate and the disease status are not clear due to the lack of reports about the actual number of patients. CASE PRESENTATION: Two Palestinian patients; one male of 22 years old from Hebron and the other is female of 33 years old from Ramallah were referred to Palestinian Health Services in the West Bank, Palestine, complained of weight loss, abdominal pain and presence of motile segments of creamy color in the their stool. Microscopic analysis of the stool samples from infected cases revealed Taenia eggs and proglottids, confirmed taeniasis infection. The parasite species was identified as T. saginata by polymerase chain reaction (PCR) amplification and sequencing of the cytochrome oxidase -1 (COX-1) gene. CONCLUSION: Taeniasis is an unusual parasitic infection in Palestine, there is a growing concern that the actual numbers of infected individuals are much higher and the occurrence of human taeniasis is principally due to people's eating habits in consumption of raw or undercooked beef meat. This report highlighted for the first time the existence of taeniasis infection in the country; which necessitates the need to conduct further research and surveillance to reveal the actual infection rate and the available Taenia species.

Bovine cysticercosis epidemiology and the economic impact of the triceps brachii incision in a South African export abattoir.

Taenia saginata is a zoonotic tapeworm of humans with bovines as its intermediate host (bovine cysticercosis). Traditional meat inspection is the main measure to identify the larval stage in carcasses and prevent human infection, but has a notoriously low sensitivity, especially in low prevalence settings. The legislation in multiple African countries mandates an incision in both triceps brachii muscles to detect the parasite as part of the normal post-mortem inspection, but this has an economic cost and is not universally mandated in other countries. The primary aim of this study was to investigate the epidemiology of bovine cysticercosis at an export abattoir in South Africa and determine the validity and cost of the triceps incision. Risk factors were investigated, and the effect of additional heart incisions on the current inspection. Four incisions were made into the heart in addition to the normal post-mortem inspection in 3353 carcasses. The proportion of positive animals with and without the cardiac and triceps incisions were compared using McNemar's chi-square tests, while risk factors were assessed using binary logistic regression. The economic impact of the triceps incision was estimated using a stochastic economic cost model. Thirty-three positive carcasses were identified for an apparent prevalence of 0.98 % (95 %CI, 0.69-1.36 %), while the true prevalence was estimated at 6.6 % (95 %CI, 4.3-8.8 %). All cysts were confirmed as T. saginata on histopathology with 70 % (95 %CI, 53-83 %) located in the heart. The additional cardiac incisions resulted in the detection of significantly more cases compared to the normal inspection method prevalence of 0.72 % (95 %CI, 0.47-1.05 %; P < 0.001). The apparent prevalence of T. saginata when omitting the triceps incision was not significantly lower compared to the prevalence when included in the inspection (P = 0.480). External feedlots (OR= 4.17, 95 %CI: 2.04-8.54, P < 0.001) and older animals (OR=3.90, 95 %CI: 1.17-13.03, P = 0.027) were associated with a positive detection. The current median annual financial cost to the food business operator from the triceps incision was estimated at $30387 (95 %CI: $0-$130696), with the proportion of deboned meat exported identified as the most important factor affecting cost (Spearman's rho=0.853). The identification of risk factors could aid in the development of a more effective risk-based inspection system. The current inspection should be modified to increase exposure of the heart and remove the triceps incisions. The latter should especially be considered given the minimal contribution to cysticercosis detection, the unsupported requirement for its inclusion specifically in Africa, and its economic impact, especially as beef exports increase.

Prevalence of cysticercosis in cattle slaughterhouses in the western region of Minas Gerais, Brazil (2013-2020): Influence of sanitary regulations in reducing risks to human health.

Bovine cysticercosis is a foodborne zoonosis that has a worldwide distribution, and its highest prevalence is found in developing countries with a large volume of cattle production, such as Brazil. The objective was to evaluate the prevalence of cysticercosis during seven years in three slaughterhouses located in the western region of Minas Gerais state, Brazil, and the impacts of the legislation on the identification and destination of infected carcasses. Three slaughterhouses (Sl) were selected for this study with averages of 200 (SlA), 721 (SlB) and 1138 (SlC) bovines slaughtered per day. The monthly number of slaughtered cattle, infected carcasses with cysticercosis and destination were used to calculate the condemnation occurrence index (COI) and the adjusted seasonal index (ASI). To assess the impact of the legislation, the prevalence rate and destination of infected carcasses were subdivided into the PRE (January 2013 to March 2017) and POST (April 2017 to December 2020) period of Decree 9013 of 2017 and the results were compared by chi-square (P < 0.05). SlA recorded the highest cysticercosis rate with 1.54 % and SlC the lowest rate with 0.33 %. In addition, it was observed that in the POST period there was an increase in the identification of infected carcasses in SlA and B (P < 0.05). The POST period also resulted in a change in the relative frequency of infected carcasses destination in the three slaughterhouses (P < 0.05). The ASI identified an increase in infected carcasses in February and a decrease in November for SlB, proving to be an important tool for planning the inspection team trainings. These results show that the disease is still present in the studied region and highlight the benefits of using the One Health concept in the evaluation of a time series prevalence of bovine cysticercosis by: identifying seasonality of the disease, trends during the time period and impacts brought by updates in the national sanitary legislation.

Imported taeniasis in the context of colon hydrotherapy.

We report a case of imported taeniasis, under the modality of "visiting friends and relatives", in the context of colon hydrotherapy. This technique allows the detection of proglottids, diagnosed in this case as Taenia saginata based on the gravid proglottid that presented more than 13 uterine branches and showed active motility. Moreover, the patient did not consume pork for religious reasons. The treatment with paromomicin sulfate was effective. In this case, a trip to Ethiopia, together with the ingestion of raw beef, was the cause of parasitization. It is highly advisable to obtain detailed information from the patient on their background, especially their travel and dietary histories.

A rare case of human taeniasis caused by Taenia saginata with species undetermined cysticercosis.

Taeniasis and cysticercosis, which are caused by Taenia saginata, Taenia solium and Taenia asiatica, are zoonotic parasitic infections with a significant disease burden worldwide. There is consensus amongst experts that T. saginata is a common tapeworm that causes taeniasis in humans as opposed to cysticercosis. This case study of a middle-aged Tibetan man conducted in 2021 challenges the prevailing notion that T. saginata exclusively causes taeniasis and not cysticercosis by documenting symptoms and laboratory studies related to both taeniasis and multiple cysticercosis. The patient's medical record with the symptoms of taeniasis and cysticercosis was reviewed, and the tapeworm's proglottids and cyst were identified from the patient by morphological evaluation, DNA amplification and sequencing. The patient frequently experienced severe headaches and vomiting. Both routine blood screenings and testing for antibodies against the most common parasites were normal. After anthelmintic treatment, an adult tapeworm was found in feces, and medical imaging examinations suggested multiple focal nodules in the brain and muscles of the patient. The morphological and molecular diagnosis of the proglottids revealed the Cestoda was T. saginata. Despite the challenges presented by the cyst's morphology, the molecular analysis suggested that it was most likely T. saginata. This case study suggests that T. saginata infection in humans has the potential to cause human cysticercosis. However, such a conclusion needs to be vetted by accurate genome-wide analysis in patients with T. saginata taeniasis associated with cysts. Such studies shall provide new insights into the pathogenicity of T. saginata.

Application of Ziehl Neelsen Staining Method for Taenia spp. Eggs Differentiation.

Background: Three of Taenia species, named Taenia saginata, T. solium and T. asiatica can be found in Indonesia, but only T. solium can lead to neurocysticercosis. The morphology of those 3 Taenia spp. egg is indistinguishable by standard parasitology procedure. We aimed to use Ziehl Neelsen staining for differentiation of eggs of T. saginata and T. solium. Methods: As many as 40 containers of stool samples from the positive helminthiasis patients in Jakarta, Indonesia were collected during the year 2018. From each container, 10 slides prepared for staining with Kato-Katz technique as the preliminary examination. From those stool samples with positive taeniasis, we then once again made 10 slides/container for Ziehl Neelsen staining. Results: The first 400 slides stained with Kato-Katz technique as preliminary test were all positive for Taenia spp. The second 400 slides, we got 244 slides that gave good results as we could distinguished between the eggs of T. saginata and T. solium, meanwhile the remainder 156 slides gave unconfirmed results. From those 244 slides, 154 slides showed T. saginata eggs with magenta colored and 90 slides showed T. solium eggs with blue/purple colored. The eggs of T. solium slightly smaller if compared to Taenia saginata and had round shape, meanwhile T. saginata eggs were oval in shape. Conclusion: Ziehl Neelsen staining method can be used as an alternative parasitological method to differentiate the eggs of T. saginata and T. solium.

Taeniasis Presenting as Motile Worms in the Stools: An Emerging but Neglected Parasitic Disease.

Many parasitic infections essentially pose a significant public health problem throughout the world. However, the consequence of the issue is felt more among developing countries like India. This is majorly due to unsatisfactory hygienic practices and overcrowding, among others. Moreover, taeniasis caused by the parasites Taenia solium and Taenia saginata is a zoonotic infection transmitted via pigs and cattle, respectively. Even though the animals are the primary hosts where the parasite lives, humans also can suffer from infestation after consuming the eggs in contaminated food and water. Interestingly, there is a lower level of awareness regarding such types of Taenia infections in humans. On the contrary, most physicians and some people know that parasite transmission generally happens from the consumption of raw/undercooked pork and beef, which may result in a more serious consequence like neurocysticercosis. However, Taenia infestation in the intestines equally affects humans where people become reservoirs of infection, and suffer from severe morbidity. We present a case of worm infestation in a teenage girl who presented with severe peri-anal itching and motile worms in the stools.

Knowledge, attitude, and practices of the community and meat industry workers towards Taenia saginata taeniosis and bovine cysticercosis in and around Jimma and Ambo towns of Ethiopia.

Taenia saginata taeniosis and bovine cysticercosis are prevalent in Ethiopia, however, data on the knowledge/attitude, and practice (KAP) of the community and meat industry workers in this regard is scarce. The present study aimed to investigate the KAP of the community and meat industry workers about T. saginata taeniosis/cysticercosis in Jimma and Ambo towns of Ethiopia. A cross-sectional KAP survey was performed on 293 community members selected using multistage random sampling and 97 meat industry workers from the two study towns. A questionnaire was constructed to collect sociodemographic variables, knowledge/attitudes about taeniosis/cysticercosis, raw meat consumption, latrine usage, and taeniosis treatment practices. Mixed effect (generalized) linear models were used to assess the association of self-reported taeniosis as well as the KAP scores with the demographic variables. The predicted proportion of self-reported taeniosis was 54% and 75% for Jimma and 44% and 70% for Ambo community and meat industry workers, respectively. The odds of self-reported taeniosis was higher for men (ORadj, 1.68, 95%CI, 0.97-2.93), and elementary/illiterate (ORadj, 1.46, 95%CI, 0.75-2.86) and high school education level (ORadj, 2.65, 95%CI, 1.45-4.93) compared to their counterparts. Most of the community members and the vast majority of the meat industry workers were knowledgeable about taeniosis but less conscious about cysticercosis. The knowledge/attitude score of the community was positively associated with the Jimma community (ßadj= 1.20, 95%CI 0.60-1.80), age (ßadj=0.03 points higher per year, 95%CI 0.00- 0.04), and men (ßadj = 1.20, 95%CI 0.64-1.76), while it was lower in elementary education/illiterate (ßadj = -1.60, 95%CI -2.31 to -0.95) and secondary/high school (ßadj = -0.83, 95%CI -1.46 to -0.23). The good practice scores of the community within both towns were negatively associated with increasing age (ßadj=-0.01 per year, 95%CI, -0.02 to 0.00), elementary/illiterate (ßadj = -0.60, 95%CI -1.01 to -0.19) and secondary/high school education (ßadj = -0.09, 95%CI -0.45 to -0.28), and urban community (ßadj = -0.47 95%CI, -0.82 to -0.12), while protestant/other (ßadj = 0.76, 95%CI 0.36 1.16) religion had higher scores compared to Orthodox religion. In conclusion, the predicted self-reported taeniosis proportion was moderately high, and the knowledge/attitude was substantial whereas, the practice was inferior. The association between the knowledge/attitude score and practice score was very weak. Therefore, public education to improve hygienic practices, risky culinary habits, taeniosis treatment, and backyard slaughtering were suggested.

Intestinal Perforation Due to Adult Tapeworm of Taenia: A Case Report and Review of the Literature.

Taeniasis is an intestinal helminth infection due to adult tapeworms belonging to the genus Taenia. Taeniasis remains a major burden in low-income countries in Asia. We present a case of intestinal perforation caused by adult tapeworm of Taenia in a 50-year-old Nepali male. The patients presented to the hospital with severe abdominal pain and intermittent vomiting. Following clinical presentations and imaging features, gastrointestinal perforation was suspected. Surgical removal of adult tapeworm of Taenia, suspected to be T. saginata or T. asiatica, was carried out during exploratory laparotomy, which was followed by an uneventful postoperative period. In addition to case presentation, we systematically review published case reports on taeniasis-related intestinal perforation. A learning point from this case is clinician should maintain a clinical suspicion of taeniasis as a possible cause of intestinal perforation in endemic areas.

Genetic Variation of Taenia Saginata Cyst Isolates from Iraq Based on Mitochondrial COX1 Sequences.

The zoonotic parasite disease of economic and public health relevance is bovine cysticercosis, resulting from the larval stage of Taenia saginata. The presented research aims to identify intraspecific variation in T. saginata isolated from cattle in Iraq's Sulaymaniyah province using the mitochondrial cytochrome c oxidase subunit 1 (COX1) gene. Sequence analysis of the COX1 gene revealed that five distinct haplotypes were identified in 37 T. saginata specimens from Iraq. Four of the five T. saginata haplotypes may have been identified for the first time in the world. Phylogenetic research revealed that all T. saginata haplotypes had been clustered in a single clade, with Korean and Iranian isolates sharing a high degree of closeness. In addition, individual haplotypes related to COX1 had a pairwise evolutionary divergence of 0.005- 0.013, whereas the overall evolutionary divergence regarding all five haplotypes ranged between 0.000-0.018. It was concluded that added newly recorded data on T. saginata genetic variation could have substantial implications for taeniasis epidemiology and control.

Evolution of codon usage in Taenia saginata genomes and its impact on the host.

The beef tapeworm, also known as Taenia saginata, is a zoonotic tapeworm from the genus Taenia in the order Cyclophyllidea. Taenia saginata is a food-borne zoonotic parasite with a worldwide distribution. It poses serious health risks to the host and has a considerable negative socioeconomic impact. Previous studies have explained the population structure of T. saginata within the evolutionary time scale and adaptive evolution. However, it is still unknown how synonymous codons are used by T. saginata. In this study, we used 90 T. saginata strains, applying the codon usage bias (CUB). Both base content and relative synonymous codon usage (RSCU) analysis revealed that AT-ended codons were more frequently used in the genome of T. saginata. Further low CUB was observed from the effective number of codons (ENC) value. The neutrality plot analysis suggested that the dominant factor of natural selection was involved in the structuring of CUB in T. saginata. Further analysis showed that T. saginata has adapted host-specific codon usage patterns to sustain successful replication and transmission chains within hosts (Bos taurus and Homo sapiens). Generally, both natural selection and mutational pressure have an impact on the codon usage patterns of the protein-coding genes in T. saginata. This study is important because it characterized the codon usage pattern in the T. saginata genomes and provided the necessary data for a basic evolutionary study on them.

Risk Factors for Bovine Cysticercosis in North-West Italy: A Multi-Year Case-Control Study.

Taenia saginata is the causative agent of bovine cysticercosis, a zoonotic parasitic disease with a worldwide distribution. Bovine cysticercosis is considered to be an important food safety issue responsible for human taeniasis and a major economic concern since infected carcasses undergo condemnation, freezing and downgrading. The aim of the current investigation was to assess the presence of farm-level risk factors for bovine cysticercosis in an endemic area in North-West Italy. A questionnaire was designed to collect information relating to several farm structural features, as well as management practices, environmental characteristics and attitudes of farmers. The questionnaire was administered in two separate time intervals by direct interview to previously selected case and control farms. Overall, 32 case farms and 131 control farms were included between 2005 and 2011 and 50 case farms and 192 control farms were included between 2014 and 2020. The present survey showed a significant association between the detection of bovine cysticercosis cases at slaughter and farm proximity to picnic spots, closeness of wastewater treatment plant effluents, loose-housing systems and presence of employees along with the family members, highlighting the need for targeted awareness raising policies.

Taenia saginata Infection Misdiagnosed as Acute Cholecystitis in a Tibetan Patient, in China.

The present study reports a rare case of Taenia saginata infection, which was initially diagnosed as acute cholecystitis in a Tibetan patient at the Qinghai-Tibetan Plateau pastoral area, China. A 45-year-old female was initially diagnosed with acute cholecystitis at a hospital in China. She had a slight fever, weight loss and constipation and complained of pain in the upper abdomen and left back areas. Increase of monocyte, eosinophil and basophil levels were shown. Taenia sp. eggs were detected in a fecal examination. An adult tapeworm approximately 146 cm in length, whitish-yellow color, was collected from the patient after treatment with traditional Chinese medicine. The adult tapeworm had a scolex and proglottids with genital pores. The scolex was rectangular shape with 4 suckers and rostellum without hooklet. The cox1 gene sequence shared 99.5-99.8% homology with that of T. saginata from other regions in China. The patient was diagnosed finally infected with T. saginata by morphological and molecular charateristics.

Occurrence of a Hybrid Between Taenia saginata and Taenia asiatica Tapeworms in Cambodia.

Human infection with Taenia asiatica or a hybrid between Taenia saginata and T. asiatica has not been reported in Cambodia. We detected for the first time a hybrid form between T. saginata and T. asiatica in Preah Vihear Province, Cambodia. An adult tapeworm specimen, i.e., 75 cm long strobila without scolex, was expelled from a 27-year-old man after praziquantel medication and purging. It was morphologically indistinguishable between T. saginata and T. asiatica. Several proglottids were molecularly analyzed to confirm the tapeworm species. The mitochondrial gene encoding cytochrome c oxidase subunit 1 (cox1) and nuclear genes encoding elongation factor-1α (ef1) and ezrin-radixin-moesin (ERM)-like protein (elp) were sequenced, and a single-allele analysis was performed to confirm the haploid genotype. The results revealed that our sample showed a discrepancy between the mitochondrial and 2 nuclear genes. It possessed homozygous sequences typical of T. saginata at cox1 and ef1 loci. However, it was heterozygous at the elp locus, with 1 allele in T. asiatica (elpA) and 1 in T. saginata (elpC), which indicates that it is a hybrid between T. saginata and T. asiatica. The present results confirmed the presence of a hybrid between T. saginata and T. asiatica in Cambodia and strongly suggest the existence of also 'pure' T. asiatica in Cambodia.

Acute eosinophilic appendicitis caused by Taenia saginata: A case report.

INTRODUCTION: The role of parasites in the pathogenesis of appendicitis has been debated for a long time. To date, several gastrointestinal parasites have been reported as the causes of appendicitis in humans. Taenia infestation of the appendix is uncommon and few cases have been reported in the literature. PRESENTATION OF CASE: We reported a case of acute eosinophilic appendicitis (AEA) in a 42-year-old woman caused by T. saginata in northern Iran. The patient was admitted to the emergency department with a 2-day history of acute abdominal pain in her lower right quadrant. Abdominal ultrasonography showed intra-abdominal bleeding and endometrium cysts. Routine hematological tests showed increases in white blood cell (WBC) count of 19.8 × 103 per mcL with 3% eosinophilia. During abdominal laparotomy, peritoneal fluid was bulked with abdominal bleeding due to rupture of the uterine cyst. After investigation of inflammation in the appendix region, patient underwent appendectomy. Histopathological findings showed acute inflammation with eosinophils and a large number of round eggs with flattened segments of the genus Taenia. It is impossible to distinguish between T. saginata and T. solium based solely on egg morphology in the specimens. Therefore, based on history of the patient, which included no consumption of pork, the species was identified as T. saginata. At the three months follow-up, the patient was in good health. CONCLUSION: In the current study, a case of AEA by T. saginata was reported. However, this was not the first case of acute appendicitis by T. saginata. Further studies are necessary to show roles of parasites in pathogenesis of AEA.

Bovine cysticercosis in the State of São Paulo, Brazil: Prevalence, risk factors and financial losses for farmers.

Taenia saginata is the causative agent of bovine cysticercosis (BCC) and human taeniasis, two diseases that have economical and public health importance, respectively. This research focused on determining BCC prevalence in the state of São Paulo state, Brazil, in the period of 2017-2019, as well as associating risk factors related to disease occurrence and estimate the economic impact to beef producers. Data from 6,277,758 bovine carcasses originating from 571 municipalities and 15 different mesoregions in the state of São Paulo was gathered and analyzed. Cysticerci were detected in a total of 88,700 carcasses at meat inspection, resulting in an apparent prevalence of 1.41 % (C.I. 95 % 1.40-1.42 %). BCC was widespread in this state and its spatial distribution varied in municipalities and mesoregions. The variable number of milking cows in the municipality was significantly associated (OR = 1.48, p = 0.00) with BCC cases, conversely, the presence of peasant's settlements in the municipality was a protective factor (OR = 0.49, p = 0.02). Financial losses for cattle farmers were estimated at US$ 5,829,103.99. The results of this research show that there is still room for implementation of bovine cysticercosis control measures in endemic areas, aiming to reduce financial losses to farmers as well as reduction of human taeniasis cases in the population.

Cysticercus bovis in cattle slaughtered in North Egypt: Overestimation by the visual inspection method.

BACKGROUND AND AIM: The World Health Organization and the Food and Agriculture Organization list Taenia saginata, a foodborne cestode, as the most widely distributed human tapeworm worldwide. The larval stage of T. saginata, Cysticercus bovis, causes cysticercosis in bovines and infects humans who eat raw or undercooked beef. The existing detection methods of C. bovis in cattle depend on the visual inspection of meat. This study aimed to confirm the identification of C. bovis through visual inspection at the slaughterhouses in North Egypt with a molecular diagnosis. MATERIALS AND METHODS: A total of 687 locally bred cattle (Baladi), including 428 cows and 259 buffaloes, slaughtered in four slaughterhouses in North Egypt from April 2018 to February 2019 were inspected for C. bovis using the traditional meat inspection method. Positive samples were verified through polymerase chain reaction (PCR) amplification and HDP2 gene sequencing. RESULTS: Through visual inspection, C. bovis was detected in 4.2% and 12.4% of the slaughtered cows and buffaloes, respectively. Molecular analysis confirmed that 1.9% of the animals, all of which were cows, had C. bovis infection. DNA sequencing verified the identity of the PCR-amplified product. CONCLUSION: The rate of C. bovis infection in slaughterhouses detected through meat inspection is overestimated compared with that through PCR. Although meat inspection can be used as a primary screening tool for C. bovis, a more specific molecular method is required to achieve an accurate diagnosis.

An unexpected finding after robotic subtotal gastrectomy: Vomiting of Taenia Saginata.

INTRODUCTION: Most Human taeniasis are asymptomatic or associated with vague clinical manifestations, but cases of unusual migration of these parasites have been described. PRESENTATION OF A CASE: A case of challenging diagnosis of human Taenia Saginata infection is here presented: during COVID-19 pandemic we performed a mininvasive robotic subtotal gastrectomy for gastric angulus adenocarcinoma. 10 h after the end of the operation the patient presented an episode of vomiting with expulsion of a 5-meter-long adult form of Taenia Saginata. DISCUSSION: Parasitic infections are more frequent in the developing countries; in our case the transposition of small intestinal loop surely promoted the migration of Taenia Saginata through the gastro-jejunal anastomosis into the gastric stump.Preoperative evaluation (history, physical examination and imaging features) led to gastric cancer diagnosis and hindered the recognition of the taeniasis because of similar clinical presentations and the need to start quickly a therapeutic oncological strategy. CONCLUSION: Even if these cases are exceptional especially in Western Europe, it is important to obtain a detail clinical history and exclude parasitic infection as a cause of loss of weight and gastrointesinal abnormalities.