Molecular Identification of Diphyllobothrium latum from a Pediatric Case in Taiwan.

Human diphyllobothriasis is a parasitic disease caused by ingestion of larvae (plerocercoids) in raw or undercooked fish and commonly found in temperate areas. Rare cases were reported in tropical or subtropical areas especially in children. The first documented case of pediatric diphyllobothriasis in Taiwan had been reported 11 years ago. Here, we report another 8-year-old girl case who presented with a live noodle-like worm hanging down from her anus, with no other detectable symptoms. We pulled the worm out and found the strobila being 260 cm in length. Examination of gravid proglottids showed that they were wider than their lengths, containing an ovoid cirrus sac in the anterior side and the rosette-shaped uterus. Eggs extracted from the uterus were ovoid and operculated. Diphyllobothrium latum was confirmed by molecular analysis of the mitochondrial DNA cytochrome c oxidase subunit 1 (cox1) gene. The girl was treated with a single oral dose of praziquantel, and no eggs or proglottids were observed from her stool in the subsequent 3 months. The reemergence of human diphyllobothriasis in non-endemic countries is probably due to prevalent habit of eating imported raw fish from endemic areas. This pediatric case raised our concern that human diphyllobothriasis is likely underestimated because of unremarkable symptoms.

[A case of Diphyllobothrium nihonkaiense identified by virtual enterography and virtual enteroscopy].

In October 2007, a woman in her early 30s presented, complaining of worm discharge in her stool. We identified it as Diphyllobothrium nihonkaiense, and identified it by virtual enterography and virtual enteroscopy. It was treated by 1500 mg/day praziquantel orally. We think these methods, of pathology as well as capsule enteroscopy and enteroscopy, are useful for the searching of the small intestinal lesions. We hope these examinations will become more widespread with reference to these cases.

Successful treatment of Diphyllobothrium latum and Taenia saginata infection by intraduodenal 'Gastrografin' injection.

Tapeworm infections are very difficult to cure completely. Thirteen patients with tapeworm infection, seven with Diphyllobothrium latum and six with Taenia saginata, were treated by the introduction of a radio-opaque contrast medium, 'Gastrografin', into the duodenum through a duodenal tube. The whole tapeworm with the scolex was expelled unfragmented within 1 h in eleven cases. One patient expelled a tapeworm 3 days after treatment; the peristalsis of his intestine had been severely disturbed after an attack of cerebral apoplexy. The tapeworm could not be expelled by the remaining patient, probably because she had severe intestinal adhesion. The injection of gastrografin allowed clear visualisation of the tapeworm, the diagnosis of the infection could be confirmed, and the descent of the tapeworm could be observed serially. This treatment had no serious adverse effects in any of out patients.

Method for ejecting cestodes: duodenal tube injection of gastrografin.

Most of the conventional anthelmintics for cestodiasis are known to destroy the worm body. The risk of cysticercosis and recurrence of cestodiasis will be avoided only if tapeworms are ejected with intact bodies and scoleces . Two cases with Diphyllobothrium latum and two with Taenia saginata were treated by administration of 200-300 ml of Gastrografin through a duodenal tube. The worm bodies were confirmed by fluoroscopy, and the expelled worms were alive and had intact scoleces . No adverse effects were noted in the patients during or after the treatment.