The Brazilian Journal of Infectious Diseases The Brazilian Journal of Infectious Diseases
Braz J Infect Dis 2017;21:355-6 - Vol. 21 Num.3 DOI: 10.1016/j.bjid.2016.10.015
Clinical image
An unusual imported case of diphyllobothriosis in Mexico
Elba G. Rodríguez-Péreza,, , Kevin Escandón-Vargasb, Jenniffer A. Castellanosc
a Parasitología Clínica, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, México
b Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia
c Departamento de Morfología, Facultad de Salud, Universidad del Valle, Cali, Colombia
Received 04 October 2016, Accepted 08 October 2016

A 7-year-old Mexican male presented to a hospital in Monterrey, Mexico with a 1-week history of persistent abdominal discomfort and loose stools. One month before presentation, the patient had traveled on vacation to Cuba and recalled eating ceviche (a popular raw fish dish in Latin America). He denied vomiting, anorexia, fever or weight loss, and had no other significant medical history. Physical exam was unremarkable. Routine blood and biochemical tests were normal.

An upper endoscopy detected a larva attached to the duodenal wall. After endoscopic extraction of the worm, symptoms were relieved. Further examination of the larva allowed identification of a plerocercoid larva of Diphyllobothrium sp. (Fig. 1) based on the morphological and histological features described in previous publications.1,2 The larva measured 2.8cm in length. The epithelial morphology of the dorso-ventrally flattened larva's body was typical, with apparent segmentation, traces of the bothria in the anterior end, and invagination at the posterior end. The mid-body presented a single poorly developed layer of subtegumentary longitudinal musculature. Diagnosis of the worm at the species level was not achieved because the adult stage was needed and molecular confirmation was not possible.

Fig. 1.

Longitudinal histological section of the Diphyllobothrium sp. plerocercoid larva recovered from the patient (hematoxylin–eosin stain). (A) Anterior end. (B) Mid-body and posterior end.

Here, we report the first diphyllobothriosis case in Mexico, which was imported from Cuba. Diphyllobothriosis is a widespread fish-borne zoonosis acquired by eating raw or undercooked fish contaminated with plerocercoid larvae of the tapeworm Diphyllobothrium.3,4 Common raw or poorly cooked fish dishes include sushi, sashimi, ceviche, carpaccio, and others. The disease is endemic in the Arctic regions and several parts of Europe, Asia, and the Americas. Given that the disease is usually caused by the adult form of Diphyllobothrium spp., we consider this to be an unusual case presentation in which the larva, attached with its scolex to the intestinal epithelium, was found before becoming an adult.

Author contributions

Elba G. Rodríguez-Pérez took part in conception of the manuscript and data acquisition. Kevin Escandón-Vargas drafted the manuscript and reviewed the literature. Jenniffer A. Castellanos contributed to the analysis and interpretation of data.

Conflicts of interest

The authors declare no conflicts of interest.

References
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A marine Diphyllobothrium plerocercoid (Cestoda, Pseudophyllidea) from blue whiting (Micromestius poutasson)
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K.I. Andersen,D.I. Gibson
A key to three species of larval Diphyllobothrium Cobbold, 1858 (Cestoda: Pseudophyllidea) occurring in European and North American freshwater fishes
Syst Parasitol, 13 (1989), pp. 3-9
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T. Scholz,H.H. Garcia,R. Kuchta,B. Wicht
Update on the human broad tapeworm (genus Diphyllobothrium), including clinical relevance
Clin Microbiol Rev, 22 (2009), pp. 146-160 http://dx.doi.org/10.1128/CMR.00033-08
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R. Kuchta,T. Scholz,J. Brabec,B. Narduzzi-Wicht
Chapter 17. Diphyllobothrium, Diplogonoporus and Spirometra
Biology of foodborne parasites. Section III important foodborne helminths, pp. 299-326
Corresponding author.
Copyright © 2017. Sociedade Brasileira de Infectologia
Braz J Infect Dis 2017;21:355-6 - Vol. 21 Num.3 DOI: 10.1016/j.bjid.2016.10.015