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

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.

Dipylidium caninum in the twenty-first century: epidemiological studies and reported cases in companion animals and humans

“…Adults may also become infected, with factors such as an immunosuppressive condition, bad hygiene habits and contact with animals without veterinary care being contributing factors [ 21 , 59 – 61 ]. Contact with animals, either household animals or those outside the home, is considered a risk factor for infection [ 21 , 62 – 64 ].…”

“…In humans, as in animals, infection with D. caninum can be asymptomatic [ 21 , 58 , 65 , 85 , 86 ], or non-specific symptoms may be observed, such as abdominal pain and discomfort [ 58 , 59 , 61 , 62 , 64 , 87 – 89 ], bloating [ 64 , 90 ], diarrhoea [ 17 , 58 , 59 , 64 , 90 , 91 ], difficulty in defecation [ 60 ], anal itching [ 62 – 64 , 92 ] that may lead to scratching of the perianal area and the development of abrasions and dermatitis [ 92 ], loss of appetite and less weight gain [ 58 , 87 ] and occasional vomiting [ 17 , 61 ] and fever [ 90 ]. Sleep disturbances, sadness, hyperactivity and irritability are also described [ 87 , 88 , 90 , 92 ].…”

“…Sleep disturbances, sadness, hyperactivity and irritability are also described [ 87 , 88 , 90 , 92 ]. A few studies have reported haematological changes, namely leucocytosis [ 58 ], eosinophilia [ 58 , 88 ], low haematocrit and/or haemoglobin [ 61 , 64 , 91 ], thrombocytopaenia, an increased erythrocyte sedimentation rate [ 61 ] and higher level of serum IgE [ 91 ]. It is also hypothesised that in humans it may be a self-limiting disease, with spontaneous cure [ 60 ].…”

“…It is also hypothesised that in humans it may be a self-limiting disease, with spontaneous cure [ 60 ]. In most of the clinical cases (Additional file 1 : Table S2), proglottids were observed in the stool or perianal region, and described as grains of rice or as cucumber or other vegetable seeds, appearing individually or forming a chain [ 6 , 21 , 58 , 60 , 61 , 63 – 65 , 85 – 89 , 91 , 92 ]. In some cases, worm mobility was observed [ 65 , 89 , 92 ].…”

“…The detection of proglottids in the stool is one of the most frequent findings in infants and children due to caregivers observing the stool and the perianal region of children, particularly during diaper changes or bathing [ 60 , 87 , 89 ]. Since adults do not normally inspect their own stool, or at least not as often as they do their own children’s stool, more infections may go undetected in adults [ 59 – 61 ]. The lower prevalence of disease in adults is also likely to be related to their stronger immune system and fewer risk behaviours for acquiring the infection [ 58 ].…”