Tropical Parasitology

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

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


Suneeta Meena1, Arpana Singh1, V Pradeep Kumar1, Rohit Gupta2, Pratima Gupta1,  
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

Correspondence Address:
Suneeta Meena
Department of Microbiology, All India Institute of Medical Sciences, Dehradun, Rishikesh - 249 201, Uttarakhand
India

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.



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;10:153-157


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 Apr 17 ];10:153-157
Available from: https://www.tropicalparasitology.org/text.asp?2020/10/2/153/307785


Full Text



 Introduction



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}

 Case Report



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}{Figure 3}{Figure 4}

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



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}

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.

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