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Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 153-157  

Dipylidium caninum: First case in an adult female from uttarakhand and review of literature


1 Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Gastroneterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission06-May-2019
Date of Decision19-Feb-2020
Date of Acceptance23-Mar-2020
Date of Web Publication23-Jan-2021

Correspondence Address:
Suneeta Meena
Department of Microbiology, All India Institute of Medical Sciences, Dehradun, Rishikesh - 249 201, Uttarakhand
India
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DOI: 10.4103/tp.TP_22_19

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   Abstract 


Dipylidium caninum is a rare cestode infection in India, only previously reported in children. We herein report the case of a 50-year-old female from India who presented with a 1-year history of abdominal pain associated with vomiting, cough, and passing worm segments in stool. She had been treated with albendazole without benefit. A stool examination revealed proglottids and egg clusters of D. caninum. She was treated with praziquental 600 mg once daily for 5 days. At follow-up a month later, she had recovered completely, and repeat stool examination was negative for proglottids and eggs. Dipylidiasis can rarely occur among adults in India and present with abdominal pain and cough.

Keywords: Dipylidium caninum, dog tapeworm, proglottids


How to cite this article:
Meena S, Singh A, Kumar V P, Gupta R, Gupta P. Dipylidium caninum: First case in an adult female from uttarakhand and review of literature. Trop Parasitol 2020;10:153-7

How to cite this URL:
Meena S, Singh A, Kumar V P, Gupta R, Gupta P. Dipylidium caninum: First case in an adult female from uttarakhand and review of literature. Trop Parasitol [serial online] 2020 [cited 2021 Mar 9];10:153-7. Available from: https://www.tropicalparasitology.org/text.asp?2020/10/2/153/307785




   Introduction Top


Linnaeus was the first to describe Dipylidium caninum in 1758 and calling it Taenia canina.[1] In 1863, Leuckart named the genus Dipylidium.[2] In 1893 Diamere described the internal anatomy and life cycle of D. caninum.[3] D. caninum is a ubiquitous infestation cats, dogs, wild canids, felids, and rarely humans.[4] Humans are accidental hosts who acquire the infection by ingesting infected dog or cat fleas [Figure 1].[5],[6] D. caninum has only been reported in children from India.[7],[8] However, we report here a case of D. caninum infection in an adult female from India and review of D. caninum infections in humans.
Figure 1: Life cycle of Dipylidium caninum

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   Case Report Top


A 50-year-old home makers from Raiwala, Uttarakhand, India, presented with 1-year history of lower abdominal pain, passage of worm segments in the stool and dry cough for the past 1 year. The abdominal pain she described as spasmodic with bouts of increased severity. She also complained of 1–2 episodes of nonbillious and nonprojectile vomiting with vomitus containing mostly food particles. Her stools were normal in frequency but were occasionally loose. She described worm segments as 2–10 segments per stool, nonmotile, white in color, the size of a cucumber seed. She said her cough was nonproductive and intermittent. She denied any weight change. She denied any history of fever. She admitted to a habit of feeding stray dogs daily.

The patient had taken Albendazole 6 months previously without improvement in symptoms.

The physical examination was normal, and there was no abdominal tenderness, and the lungs were clear.

Ultrasonography of the abdomen and chest X-rays were both normal.

A complete blood count revealed white blood cells (WBC) count of 6300/μL, a hemoglobin of 10.3 g/dl, the hematocrit value was low at 34.2%, and platelet count was low at 114,000/μL. The WBC differential revealed 62% polymorphonuclear neutrophils, 32% lymphocytes, 3% monocytes, and 3% eosinophils. The erythrocyte sedimentation rate was elevated at 35 mm/h.

The stool was yellow in color, solid inconsistency, and not foul-smelling. There was no mucus or blood in stool on gross examination. There were small ivory-colored worm segments (proglottids) measuring about 0.5–1.0 cm long and 0.1–0.2-cm wide [Figure 2]. Wet preparation of stool revealed egg clusters/packets [Figure 3]. A crushed proglottid saline preparation showed eggs in clusters 8–15 eggs per cluster surrounded by a thin membrane. The eggs had the characteristic envelope, an embryophore surrounding the oncosphere (hexacanth embryo) with three pairs of hooklets [Figure 4]. Based on the morphology of eggs, the presence of egg clusters and cucumber seed shaped of the proglottids, the parasite was identified as D. caninum.
Figure 2: Proglottid segment of Dipylidium caninum

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Figure 3: Eggs of Dipylidium caninum in clusters(×100)

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Figure 4: Eggs of Dipylidium caninum with the hexacanth embryo (×400)

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The patient was given praziquantel 600 mg daily for 5 days. At follow-up 1 week later, her abdominal pain and other symptoms had resolved completely. A repeat stool examination at 1 week and 1 month were negative for any parasites.


   Discussion Top


D. caninum occasionally infest humans. At least 352 cases, including this one, have been reported in literature. In India, only five human cases have been reported in the literature three from South India, one from Eastern India in Kolkata and one case from the capital region of Delhi.[7],[8],[9] Our case is the first to be reported from the northern hilly region of India. Overall, human dipylidiasis is infrequently reported, and thus, the precise incidence remains unknown.

Mostly dipylidium infests infants, toddlers and do not vary by gender. Cases have been found in both sexes and mostly in infants and toddlers. Of the 8 cases reported only one was adult, 7 were children; the children were aged between 6 months and 2 years. D. caninum has also been reported to be cause of diarrhea in renal transplant patients[4],[10],[11],[12],[13],[14],[15],[16] [Table 1]. To the best of our knowledge, this is the first case to be reported in an apparently immunocompetent adult female from India. This condition may be noticed more often in young children since the worm segments in the stool are noticed by the mother; however, adults may not check their stools carefully. In our patient, she only noticed worm segments in stool later in the course of infection. Other symptoms reported to be associated with D. caninum infestation include diarrhea, vomiting, and colicky abdominal pain.[14] The probable source of infection in our case is the ingestion of a dog flea due to her habit of feeding stray dogs daily.
Table 1: Case reports of dipyllidium caninum

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Eosinophilia is sometimes associated with parasitic infestations, especially those that have tissue invasion phase.[17] but in our subject did not have eosinophilia, similar to the findings of Ramana et al.[7]

In our case, the diagnosis was made by identifying unique proglottids and finding egg packets in the stool. These are the usual findings that lead to the diagnosis. Therefore, laboratory workers need to be familiar with these characteristics to accurately diagnose this condition.

Other reports also found patients with D. caninum infestation had been previously treated with albendazole without improvement. D. caninum infestation is best treated by praziquantel/niclosamide, not albendazole.[18] Previous studies reported treatment of children with praziquantel using single dose of 10 mg/kg body weight.[8],[13],[19]

Our patient was successfully treated with praziquantel 600 mg daily for 5 days, which was a dose of 10 mg/kg body weight. D. caninum infestation is rare in humans in adults in India; however, the case showed it can occur. It may cause abdominal or stool complaints and can be diagnosed by finding specific proglottids and egg packets. It does not respond to albendazole treatment but does respond to praziquantel at a dose of 10 mg/kg bodyweight for 5 days. A high index of suspicion needs to be maintained in patients who present with specific risk factors for the disease along with abdominal and stool complaints.

In conclusion, D. caninum infection is a rare cestode infection that is occasionally reported in India and elsewhere. History of dog or cat pets or bites may be important clues to the diagnosis. Macroscopic examination of proglottids resembling cucumber seeds and microscopic examination of the stool to identify characteristic features of the eggs can resolve the diagnostic dilemma. These tapeworms do not respond to albendazole deworming doses, but the clinical response is good with praziquantel/niclosamide.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Fanta Nunez E. Dipylidium caninum (Linneo, 1758) as a parasite in man. Rev Chil Pediatr 1952;23:393-6.  Back to cited text no. 1
    
2.
Leuckart R. Die Parasiten des Menschen und die von ihnen herrührenden Krankheiten. Leipzig u. Heidelberg 1863;1879-86.  Back to cited text no. 2
    
3.
Venard CE. Morphology, bionomics, and taxonomy of the cestode Dipylidium caninum. Ann N Y Acad Sci 1938.;37:273-328.  Back to cited text no. 3
    
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Samkari A, Kiska DL, Riddell SW, Wilson K, Weiner LB, Domachowske JB. Dipylidium caninum mimicking recurrent enterobius vermicularis (pinworm) infection. Clin Pediatr (Phila) 2008;47:397-9.  Back to cited text no. 4
    
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Georgi JR and Georgi ME. 1992. Canine Clinical Parasitology. In: Georgi JR, Georgi ME. Canine Clinical Parasitology. Philadelphia: Lea and Febiger; 1992. p. 138-41.  Back to cited text no. 5
    
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Bogitsh BJ, Carter CE, Oeltmann TN. Chapter 13 - Intestinal Tapeworms, Editor(s): Burton J. Bogitsh, Clint E. Carter, Thomas N. Oeltmann, Human Parasitology (Fourth Edition), Academic Press; 2013. p. 237-49.  Back to cited text no. 6
    
7.
Ramana KV, Rao SD, Rao R, Mohanty SK, Wilson CG. Human dipylidiasis: A case report of Dipylidium caninum infection in teaching hospital at karimnagar. Online J Health Allied Sci 2011;10:28.  Back to cited text no. 7
    
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Narasimham MV, Panda P, Mohanty I, Sahu S, Padhi S, Dash M. Dipylidium caninum infection in a child: A rare case report. Indian J Med Microbiol 2013;31:82-4.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Chatterjee KD. Parasitology Protozoology and Helminthology. 13th ed. New Delhi: CBS Publishers and Distributors Pvt. Ltd; 2009. p. 168-70.  Back to cited text no. 9
    
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Sahin I, Köz S, Atambay M, Kayabas U, Piskin T, Unal B. A rare cause of diarrhea in a kidney transplant recipient: Dipylidium caninum. Transplant Proc 2015;47:2243-4.  Back to cited text no. 10
    
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García-Agudo L, García-Martos P, Rodríguez-Iglesias M. Dipylidium caninum infection in an infant: A rare case report and literature review. Asian Pac J Trop Biomed 2014;4:565-7.  Back to cited text no. 11
    
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Szwaja B, Romański L, Zabczyk M. A case of Dipylidium caninum infection in a child from the southeastern poland. Wiad Parazytol 2011;57:175-8.  Back to cited text no. 12
    
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Cabello RR, Ruiz AC, Feregrino RR, Romero LC, Feregrino RR, Zavala JT. Dipylidium caninum infection. BMJ Case Rep 2011;2011. pii: bcr0720114510.  Back to cited text no. 13
    
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Neira O P, Jofré M L, Muñoz S N. Dipylidium caninum infection in a 2 year old infant: Case report and literature review. Rev Chilena Infectol 2008;25:465-71.  Back to cited text no. 14
    
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Tsumura N, Koga H, Hidaka H, Mukai F, Ikenaga M, Otsu Y, et al. Dipylidium caninum infection in an infant. Kansenshogaku Zasshi 2007;81:456-8.  Back to cited text no. 15
    
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Molina CP, Ogburn J, Adegboyega P. Infection by Dipylidium caninum in an infant. Arch Pathol Lab Med 2003;127:e157-9.  Back to cited text no. 16
    
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Schulte C, Krebs B, Jelinek T, Nothdurft HD, von Sonnenburg F, Löscher T. Diagnostic significance of blood eosinophilia in returning travelers. Clin Infect Dis 2002;34:407-11.  Back to cited text no. 17
    
18.
Chai JY. Praziquantel treatment in trematode and cestode infections: An update. Infect Chemother 2013;45:32-43.  Back to cited text no. 18
    
19.
Jiang P, Zhang X, Liu RD, Wang ZQ, Cui J. A Human case of zoonotic dogtapeworm, Dipylidium caninum (eucestoda: dilepidiidae), in China. Korean J Parasitol 2017;55:61-4.  Back to cited text no. 19
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
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