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OJHAS Vol. 10, Issue 2:
(Apr-Jun 2011) |
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| Human
Dipylidiasis: A Case Report of Dipylidium caninum Infection from Karimnagar |
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KV Ramana, Dept.
of Microbiology, Prathima
Institute of Medical Sciences, Karimnagar,
Sanjeev D Rao, Dept. of
Microbiology, Prathima
Institute of Medical Sciences, Karimnagar,
Ratna Rao, Dept. of
Microbiology, Apollo Health City, JubileeHills, Hyderabad,
SK Mohanty, Dept.
Of Microbiology, KIMS,
Bhubaneswar, Orissa,
CG Wilson, Dept of Paediatrics, Kamineni
Institute of Medical sciences, Narketpally. |
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Address for Correspondence |
Assistant Professor,
Department of Microbiology,
Prathima Institute of Medical
Sciences,
Karimnagar,
Andhra Pradesh, India.
E-mail:
ramana_20021@rediffmail.com |
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Ramana KV, Rao SD, Rao R, Mohanty SK, Wilson CG. Human Dipylidiasis: A Case
Report of Dipylidium caninum Infection from Karimnagar. Online J Health Allied Scs.
2011;10(2):28 |
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Submitted: Jun 7,
2011; Accepted: Jul 16, 2011; Published: Jul 30, 2011 |
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| Abstract: |
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Dipylidium caninum also
refered to as the double-pored tapeworm is a cyclophyllidean cestode
that commonly infects dogs and cats. Mammals act as definite hosts with
intermediate hosts being dog and cat flea, the Ctenocephalides canis
and Ctenocephalides catis respectively. The dog lice, Trichodectes
canis and human flea (Pulex irritans) also transmit Dipylidium
caninum infection. Infants and young children are at high risk of
acquiring infection. Majority of the infections are due to close association
with pet dog and cats. Humans are accidental hosts who acquire infection
by ingestion of infected dog and cat fleas. We report a rare case of
Dipylidium caninum infection in a 9 year old girl who could have
acquired infection by consuming food contaminated with infected fleas.
Key Words:
Dipylidium
caninum; Distribution; Pediatric age
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Dipylidium caninum, commonly
called as dog tape worm, is a monoecious or hermaphrodite cestode. A parasite
of dogs and cats, it accidentally infects humans. Mammals act as definite
hosts with intermediate hosts being dog and cat flea, the Ctenocephalides
canis and Ctenocephalides catis respectively, which acquire
parasite by ingesting animal faeces. The dog lice, Trichodectes canis
and human flea (Pulex irritans) also transmit Dipylidium caninum
infection.1 Young and crawling children due to their playing
behaviour and proximity to animals are at higher risk of contracting
infection with Dipylidium caninum.2 The adult worm
of Dipylidium caninum measures around 18 inches long with scolex,
the neck and the double pore proglottids which resemble cucumber seeds.
The scolex is rhomboid in shape with four suckers and an apical rostellum
with 4-6 crowns of hooks. The gravid proglottids release up to 50 packs
of eggs which are packed in a thin embryonic membrane. Eggs measure
up to 20-40 µm in diameter which later develops inside a hexacanth embryo.3
A 9 years old girl child was
brought to the casualty of Prathima Institute of Medical Sciences, Nagunoor,
Karimnagar with complaints of nausea, vomiting and diarrhoea since
three days. The vomitus was not foul smelling and contained no blood
and mucus. Undigested food material was observed in the vomitus. The
patient gave a history of persistent low grade fever since three days
with recurrent abdominal pain. No history of similar complaints was
given by the patient. The patient was staying in a social welfare hostel
and going to school. General
physical examination revealed patient to be moderately built and dull
looking with a temperature of 990 F, pulse rate of 100/min
and a respiration rate of 21/min. Blood pressure recorded on admission
was found to be 100/70 mmHg.
The haematological profile of the
patient showed haemoglobin of 9.3gm/dL, total Red blood cell count of 3.62 cells/cu mm. Hematocrit value was reduced to 25.6 vol%
(Normal:37-47 vol%). A below normal MCV 70.3 (Normal: 82-92), MCH 23.3
(Normal: 27-32), MCHC 35.6 (Normal : 32-36) were observed. No eosinophilia
(3%) was observed and ESR was found to be 10mm.
Stool for Ova and Cyst examination
was sent to microbiology laboratory. Simultaneously blood was sent for
culture. Macrroscopy of stool revealed undigested material without any
foul smell and was semi formed. White to creamish specks were observed
in stool indicating the probable presence of worms. A wet mount showed
the presence of egg cluster (Figure-1). Adult worm with
characteristic cucumber seed shaped segments was observed (Figure-2).
On repeated wet mounts single egg of the worm was demonstrated (Figure-3). Based on the morphology of eggs along with the presence of egg
balls or egg clusters as well as the adult worm of the parasite with
double-pore segments and cucumber seed shape of the proglottids the
parasite was identified as Dipylidium caninum.
Blood culture was found to be negative. The patient was successfully
treated with praziquantel the choice of drug for tape worm infections.
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Fig. 1: Wet mount
showed the presence of egg cluster |
Fig. 2: Adult
worm with characteristic cucumber seed shaped segments |
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Fig. 3: Wet mount showing single egg of the worm |
Dipylidiasis, the infection caused
by Dipylidium caninum, is an uncommon infection
in human beings. Natural infection happens to be in mammals like dogs
and cats. Humans are the accidental hosts who acquire infection by ingestion
of infected fleas or contact with saliva of pet animals. Young and crawling
Children are at high risk of getting infected with Dipylidium caninum. The
pet dogs bite the fleas and the larval forms of the dog tape worm stick
to the teeth and contaminate the saliva. Children may get in contact
with the saliva and may accidentally ingest the infective larval forms.
The probable source of infection in the present case could be the food
contaminated with the infected dog and cat fleas or accidental swallowing
of the infected fleas while playing in the areas where there are abundant
fleas. Humans though are not natural hosts there have been growing reports
of Dipylidiasis in recent times. There have been only two such reports
from India and in both the cases the patients were less than five years.4,5
Epidemiological studies revealed that geography of pet animals
and flea infestation as the principal risk factors for humans.6
Screening for prevalence of such infections and assessing the transmissibility
and pathogenecity to humans has to be recommended. Eradication of the
dog and cat fleas and dog lice can reduce the risk of infection to humans.
Though many of the infected humans remain asymptomatic the cause of
concern is the morbidity it results in the paediatric age group which
needs to be addressed. The clinical microbiologists and the paediatricians
must recognise the significance of such parasitic infections that are
transmitted from pets to humans.
- Craig P, Ito A. Intestinal
cestodes. Curr Opin Infect Dis 2007;20:524-532.
- Marx MB. Parasites, Pets,
and People. Prim Care 1991;18(1):153-165.
- Patricia NO, Leonor JM, Nelson
MS. Dipylidium caninum infection infection
in a 2 year old infant. Case report and literature review. Rev. Cil.
Infectol. 2008;25(6):465-471.
- Gadre DV,
Kumar A, Mathur M. Infection by Dipylidium caninum through
pet cats. Indian J Pediatr. 1993;60(1):151-152.
- Reddy SB. Infestation
of a five-month-old infant with Dipylidium caninum. Del Med J
1982;54:455.
- Guillot J, Bouree PA.
Zoonotic worms from carnivorous pets: risk assessment and prevention.
Bull Acad Natl Med. 2007;191(1):67-78.
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