Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 7
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 
     


 
 Table of Contents  
DISPATCHES
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 145-147  

A case of Hymenolepis diminuta in a young male from Odisha


1 Department of Microbiology, Hi Tech Medical College and Hospital, Bhubaneswar, OdishaDepartment of Microbiology, Hi Tech Medical College and Hospital, Bhubaneswar, Odisha, India
2 Department of General Medicine, M.K.C.G. Medical College, Berhampur, Ganjam, Odisha, India

Date of Submission20-Sep-2013
Date of Web Publication26-Nov-2013

Correspondence Address:
T Karuna
Department of Microbiology, Hi Tech Medical College and Hospital, Block 3, Flat 1, Pandara, Rasulgarh, Bhubaneswar, Odisha
India
Login to access the Email id


DOI: 10.4103/2229-5070.122145

PMID: 24471000

Rights and Permissions
   Abstract 

Hymenolepis diminuta also known as rat tapeworm rarely causes hymenolepiasis in humans. We report a case of H. diminuta infection in an 18-year-old male farmer who presented with intermittent pruritic maculopaular rashes and dull aching left iliac fossa pain for 6 months. Patient was cured with 2 doses of praziquantel 20 mg/kg on day 0 and 7.

Keywords: Hymenolepis diminuta, niclosamide, praziquantel


How to cite this article:
Karuna T, Khadanga S. A case of Hymenolepis diminuta in a young male from Odisha. Trop Parasitol 2013;3:145-7

How to cite this URL:
Karuna T, Khadanga S. A case of Hymenolepis diminuta in a young male from Odisha. Trop Parasitol [serial online] 2013 [cited 2018 Dec 13];3:145-7. Available from: http://www.tropicalparasitology.org/text.asp?2013/3/2/145/122145


   Introduction Top


Hymenolepis diminuta, the rat tapeworm is a common parasite of mice and rats. It causes occasional infection in humans. Mice, rats and occasionally humans are the definitive hosts harboring adult worms in their small intestine. Eggs are passed in their faces. Coprophilic arthropods are the intermediate hosts. The cysticercoid (larval stage) is found in these hosts. Rodents become infected by ingestion of these arthropod hosts. Foods such as grains and cereals contaminated with infected insects are the chief sources of infection. [1] Man acquires infection by ingestion of these infected arthropods harboring the cysticercoid larvae accidentally, which on release in the intestine develop into adult worms. [2] Worms are found in the small intestine and the eggs are passed in the stool. Presence of eggs in the stool specimen indicates infection. [3] H. diminuta infection in human beings is rather uncommon typically occurring as isolated cases. Different surveys have reported parasitization rates ranging between 0.001% and 5.5%. [3] The infection is most common in children. The condition is usually asymptomatic. Mild diarrhea, abdominal pain, vague gastrointestinal manifestations, arthromyalgias, transient thoracic rashes, irritability and generalized pruritus are the noted symptoms. [4] Almost all cases documented until date are in children. [5],[6] We present this case because of its rarity in adults, for development of uniform treatment protocol in future and for the purpose of documentation, which will enable us to understand this disease better.


   Case Report Top


An 18-year-old male, farmer by profession presented to the out-patient department (OPD), for intermittent generalized maculopapular pruritic rash with vague left iliac fossa pain for 4-6 months. Patient had been evaluated by many physicians and dermatologists during this period, but without a final diagnosis. Many attributed this as food allergy (to sea foods). He had received albendazole, ivermectol, cetirizine and even short course oral corticosteroid (prednisolone 1 mg/kg for 10 days). At the time of admission temperature was 98°F, pulse 90/min, blood pressure 130/90 mm Hg and respiratory rate was 18/min. Examination of chest and heart did not reveal any specific abnormality. Abdominal examination did not reveal any significant objective finding. Patient was conscious without any focal neurological deficit. A provisional diagnosis of urticaria was made and thoroughly investigated. The initial laboratory investigation revealed hemoglobin was 10.6 g/dl, otal leukocyte count - 8.8 × 103/cmm, differential count - P68%, L26%, E4% and absolute eosinophil count - 380/cmm, total platelet count 220 × 103/cmm. Erythrocyte sedimentation rate - 46 1 st h. Random plasma glucose was 118 mg/dl, blood urea nitrogen - 18 mg/dl, serum creatinine - 0.8 mg/dl, serum Na + - 146 mmol/l, serum K + - 4.6 mmol/l. Urine examinations did not reveal any abnormality. Stool examination revealed numerous bile stained spherical eggs, 70-80 μm in diameter, which lacked polar filaments and presented a thick shelled outer membrane and a thin inner membrane containing six hooklets suggesting H. diminuta [Figure 1], [Figure 2] and [Video 1]. Urine and blood culture were sent for aerobic culture. Allergen challenge test result was awaited. Ultrasonography of the abdomen and pelvis did not reveal any abnormality. At the end of this initial evaluation, we were at a dilemma whether to accept the diagnosis of hymenolepiasis and if at all we accept the diagnosis then how to treat it. We again ordered for the stool test for parasite and the second sample also showed eggs of H. diminuta. Three days later both the urine and blood culture did not grow any organisms and computed tomography scan of abdomen did not provide us any further information. Finally we started treatment in the line of hymenolepiasis and the patient was given praziquantel 1000 g (20 mg/kg) with breakfast on day 0. Post-treatment period was uneventful for 24 h. We discharged the patient with advice to repeat the dose after 7 days and visit the OPD after 1 month. Patient turned up after around 5 weeks and there was no relapse of the symptoms. We again searched for H. diminuta eggs in stool for two consecutive days but both the samples were found negative for any parasite. We followed-up the patient for 6 months at varying intervals and there was no sign of relapse both symptomatically and parasitologically in stool.
Figure 1: Egg of Hymenolepis diminuta in stool sample of patient

Click here to view
Figure 2: Thin inner membrane of Hymenolepis diminuta egg with six hooklets

Click here to view




   Discussion Top


H. diminuta is prevalent world-wide, but only a few 100 human cases have been reported. [7],[8],[9] In developed countries, H. diminuta infection is very rare. On Medline search 48 cases of H. diminuta cases have been reported since 1965 in the United States. [10] In Spain 7 cases have been reported. [8] Isolated cases have been reported from other parts of the world like Australia, Italy, India, Malaysia, Thailand, Jamaica and Indonesia. [3] Most of the cases are documented in children and predominantly in lower socioeconomic status probably emphasizing that their food is contaminated with arthropods and there is proximity to rodents. In India a survey of 10,000 stool samples was carried out by Chandler and 23 cases of H. diminuta were found in this series. [3] Contrary to the other cases we report a case of hymenolepiasis in an 18-year-old male farmer who presented with features of intermittent pruritic maculopapular rash and dull aching pain abdomen in left iliac region. Even on extensive investigation we could not get any clue other than documenting H. diminuta in the concentrated stool sample on two occasions. Many physicians have used as many different doses. In the literatures praziquantel has been used 10 mg/kg single dose to as high as 25 mg/kg for 5 consecutive days. [4],[10] Niclosamide was used in the doses of 1-2 g ranging from 5 to 15 days. [4],[10] Many have repeated the dose after a variable time period. Since niclosamide was not available in our setup we preferred to use praziquantel in the dose of 20 mg/kg single dose. We repeated the dose after 7 days. There was no significant side-effect in this case except mild colicky pain abdomen on the following day. Even after following the case up to 6 months the stool sample was negative for any parasite and the patient was free of symptoms.


   Conclusion Top


Humans are infected accidentally by the food contaminated by the arthropods. Though this infection is more commonly documented in children but adults are not immune. Though both praziquantel and niclosamide have been used in variable dose we used praziquantel in the dose of 20 mg/kg with breakfast and repeated the same dose on day 7. Patient was asymptomatic until 6 months and the stool samples did not reveal H. diminuta eggs after 1, 3 and 6 months of completion of treatment. There were no significant side-effects of praziquantel at this dose except mild colicky abdominal pain on the following day.

 
   References Top

1.Parija SC. Cestodes: Cyclophyllidean tapeworms. Textbook of Medical Parasitology. 4 th ed. Ch. 11. Newdelhi: All India Publishers and Distributors; 2013. p. 212.  Back to cited text no. 1
    
2.Elminti DC. Classe Cestoda. Ordine Cyclophillidea. Famiglia Hymenolepididae. Parassitologia generale e umana. 13 th ed. Milano, Italy: Casa Editrice Ambrosiana; 2004. p. 307-9.  Back to cited text no. 2
    
3.Watwe S, Dardi CK. Hymenolepis diminuta in a child from rural area. Indian J Pathol Microbiol 2008;51:149-50.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Patamia I, Cappello E, Castellano-Chiodo D, Greco F, Nigro L, Cacopardo B. A human case of Hymenolepis diminuta in a child from eastern Sicily. Korean J Parasitol 2010;48:167-9.  Back to cited text no. 4
[PUBMED]    
5.Verghese SL, Sudha P, Padmaja P, Jaiswal PK, Kuruvilla T. Hymenolepis diminuta infestation in a child. J Commun Dis 1998;30:201-3.  Back to cited text no. 5
[PUBMED]    
6.Sane SY, Irani S, Jain N, Shah KN. Hymenolepis diminuta a rare zoonotic infection report of a case. Indian J Pediatr 1984;51:743-5.  Back to cited text no. 6
[PUBMED]    
7.Lo CT, Ayele T, Birrie H. Helminth and snail survey in Harerge region of Ethiopia with special reference to schistosomiasis. Ethiop Med J 1989;27:73-83.  Back to cited text no. 7
[PUBMED]    
8.McMillan B, Kelly A, Walker JC. Prevalence of Hymenolepis diminuta infection in man in the New Guinea highlands. Trop Geogr Med 1971;23:390-2.  Back to cited text no. 8
[PUBMED]    
9.Mercado R, Arias B. Taenia sp and other intestinal cestode infections in individuals from public outpatient clinics and hospitals from the northern section of Santiago, Chile (1985-1994). Bol Chil Parasitol 1995;50:80-3.  Back to cited text no. 9
[PUBMED]    
10.Tena D, Pérez Simón M, Gimeno C, Pérez Pomata MT, Illescas S, Amondarain I, et al. Human infection with Hymenolepis diminuta: Case report from Spain. J Clin Microbiol 1998;36:2375-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Case Report: A Symptomatic Case of Hymenolepis diminuta Infection in an Urban-Dwelling Adult in Malaysia
Yvonne A. L. Lim,Romano Ngui,Zurainee Mohamed Nor,Hasidah Omar,Arine Fadzlun Ahmad,Wan Hafiz Wan Ismail,Jaxinthe Ong,Amirah Amir,Farikha Sarip,Rohela Mahmud
The American Journal of Tropical Medicine and Hygiene. 2017; 97(1): 163
[Pubmed] | [DOI]
2 Prevalence of Hymenolepis nana and H. diminuta from Brown Rats (Rattus norvegicus) in Heilongjiang Province, China
Di Yang,Wei Zhao,Yichi Zhang,Aiqin Liu
The Korean Journal of Parasitology. 2017; 55(3): 351
[Pubmed] | [DOI]
3 Survey of Hymenolepis spp. in pet rodents in Italy
D. d’Ovidio,Emilio Noviello,P. Pepe,L. Del Prete,G. Cringoli,L. Rinaldi
Parasitology Research. 2015; 114(12): 4381
[Pubmed] | [DOI]
4 Clinico-pathology, diagnosis and management of Cysticercus fasciolaris and Hymenolepis diminuta co-infection in wistar rats
Y. Damodar Singh,Rahul Singh Arya
Veterinary World. 2015; 8(1): 116
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed1833    
    Printed50    
    Emailed0    
    PDF Downloaded94    
    Comments [Add]    
    Cited by others 4    

Recommend this journal