Parasitic Diseases
Fish Tapeworm
Diphyllobothrium latum
(Linnaeus 1758)
Presented by:
Dickson Despommier, PhD
and
Daniel Griffin, MD, PhD
Vincent Racaniello, PhD Producer
Sponsored by:
Parasites without Borders
Funded in part by a grant from The Donald and Barbara Zucker Family Foundation
Introduction
• Diphyllobothrium latum usually achieves a length of 2-15 meters, but has
achieved a length of 25 meters, making it the longest parasite to infect
humans.
• It is estimated that as many as 20 million people may be infected
worldwide by fish tapeworms.
• It is acquired by eating raw or under-cooked fish and for that reason it is
commonly referred to as the fish or broad tapeworm. As with all other adult
tapeworms, it lives in the lumen of the small intestine and usually does little
harm to its host.
• It has a unique affinity for absorbing vitamin B12, and as a result the
infection can have pathological consequences for some infected individuals.
• All species in this group of tapeworms have similar complex life cycles. In
most cases they use invertebrates (e.g., copepods) and freshwater fish as
intermediate hosts. Most carnivores are susceptible to infection with D.
latum, including dog, bear, cat, fox, martin, mink, and other wild mammals.
Some of these hosts are important reservoirs for the human infection.
• D. latum, the major fish tapeworm of humans, will be the model in this
chapter for all the others.
Geographic Distribution
World-wide, northern hemisphere, temperate to sub-arctic environments
History of Discovery
In 1609, the Swiss
physician Félix Plater
observed and
reported that
Diphyllobothrium
latum infected
humans.
Linnaeus Plater
In 1751, Carl Linnaeus classified
Diphyllobothrium latum.
Life Cycle
Scolex of Diphyllobothrium latum
Mature Proglottid of Diphyllobothrium latum
Embryonated Egg of Diphyllobothrium latum
Ciliated Free-swimming Coricidium of Diphyllobothrium latum
Diaptimus spp. Copepod intermediate
Host of Diphyllobothrium latum
Procercoid Stage of Diphyllobothrium latum
in a Copepod Intermediate Host
Pleurocercoids of Diphyllobothrium spp.
Cellular and Molecular Pathogenesis
• Fish tapeworms absorb large quantities of vitamin B12 and their analogues.
They employ a tegumental cyanocobalamin receptor that has a high affinity
for several analogues of this compound, including cobalamin, and mediate
dissociation of the vitamin B12-intrinsic factor complex.
• Cobalamin is converted to adenosyl-cobalamin, a coenzyme for methyl-
malonyl-CoA mutase. Anaerobic energy metabolism relies on the production
of propionate and these two enzymes are integral to that metabolic pathway.
• These tapeworms have the ability to absorb B12 at an absorption rate of
100:1 relative to that of the infected host.
• Almost half of all patients infected with D. latum develop decreased B12
levels, but only a minority develop clinically apparent anemia.
• It appears that host factors, the number of infecting worms, and the specific
tapeworm involved determines the risk of developing B12 deficiency and
macrocytic hypochromic anemia.
Chronic infections can lead to megaloblastic anemia.
Adult tapeworm absorbs all dietary vitamin B12
Clinical Disease
History of Present Illness (HPI)
A male in his 30s presents to his physician with
several days of stomach upset an uncomfortable feeling
in his legs. He initially did not think anything of this until
he noticed odd motile objects in his stool.
This individual was in Vancouver and British
Columbia and reports eating a significant amount of
salmon. He reports that all the salmon was either dried
through a smoking process or had been marinated in a
dill marinade.
His physician obtains these objects from the
patient to send off for testing and treats the patient with
praziquantel.
Clinical Disease
• In most individuals, infection with the fish tapeworm
results in no obvious symptoms.
• Infections with multiple worms may cause nonspecific
symptoms such as watery diarrhea, fatigue, and rarely
mechanical obstruction of the small bowel.
• Exhaustion of vitamin B12 is a slow process, taking
many months to years.
• Eosinophilia has been reported in a number of cases.
Diagnosis
• Segments of worm in stool sometimes
alert patients to the fact that they harbor a
tapeworm but most proglottids break up in
the intestinal tract before exiting the host.
• Diagnosis is typically made by microscopic
identification of non-embryonated eggs in
stool.
• Molecular tests are available for diagnosis
that also allow for species determination,
but most diagnosis is done using visual
microscopy.
Diagnosis
Treatment
• Praziquantel 5-10 mg/kg PO x1
• (alternative) Niclosamide 2 grams PO x1
Drug of Choice:
Praziquantel
Mode of Action:
Interferes with invertebrate Ca 2+ ion channels
Our Patient’s Outcome
The patient reports that by two days later
he feels better with resolution of symptoms and
reports no further object seen in his stool.
The objects are identified as partial
proglottids and working with a reference lab
partial 18S rRNA gene sequence showed 100%
identity with all Diphyllobothrium nihonkaiense
reference sequences.
Prevention and Control
Prevention and Control:
Sanitary disposal of feces
Rural Urban
Prevention and Control (cont’d)
Cook thoroughly or freeze solidly all fish before eating
Learn More:
Microbiol Spectr. 2015 Oct;3(5). doi: 10.1128/microbiolspec.IOL5-0010-
2015.
Infections Associated with Exotic Cuisine: The Dangers of Delicacies.
Hochberg NS, Bhadelia N.
Next Time:
Tapeworms of Minor Importance
