Diphyllobothrium Latum (wide tapeworm): structure of the parasite, life cycle of development and treatment

Diphyllobothriasis is a chronic disease caused by Diphyllobothrium latum (broad tapeworm) . The parasite refers to tapeworms that enter the human body when eating infected fish.

It is one of the most common helminths in temperate countries. Infestation with the broad tapeworm threatens the development of various side symptoms. To avoid infection, it is important to familiarize yourself with all the features of Diphyllobothrium latum.

What to do in such a situation? To get started, we recommend reading this article. This article describes in detail methods of controlling parasites. We also recommend that you consult a specialist. Read the article >>>

Life cycle of development of the broad tapeworm

The wide tapeworm has a fairly characteristic structure, thanks to which it can be easily distinguished from other worms. It is the largest tapeworm in the parasitic world. The worm can reach up to 10 meters in length. It has a suction device made of two parts in the form of a slit, with the help of which it is fixed on the walls of the colon. The body of this tapeworm consists of a scolex (head) with a diameter of 3–5 mm and a large number of segments (proglottids) of the hermaphroditic type. There are about 4 thousand such segments; they mate with each other either crosswise or within one segment. The reproduction process begins when the segments become more than 60 segments from the head.

As the parasite multiplies, eggs are formed in the segments, ready for further development. The eggs are located in the uterus, which has an opening for exit. Every day, this parasite releases several million of these eggs into the environment.

The wide tapeworm has a rather complex development cycle. It needs two intermediate and one final host.

Together with the feces, the eggs of the broad tapeworm enter the environment. There they can remain viable for up to 30 days, but the next stage of their life cycle must necessarily take place in water. If the eggs manage to get into the water, they continue their development, otherwise they die. Once in a freshwater body of water, the eggs of the tapeworm release embryos (coracidia), which are swallowed by copepods. They are the first intermediate hosts of this helminth. In the body of crustaceans, the embryos are transformed into a procercoid and enter the body of another intermediate host - a freshwater predator (pike, pike perch, ruffe, perch, burbot), or salmon fish (chum salmon, pink salmon). Most often, crustaceans are swallowed by larger fish.

The development cycle of this helminth is completed in the body of the final host, which can be either a person or any mammal that feeds on fish. Most often these are bears, cats, foxes and dogs. Humans become infected by eating infected fish or coming into contact with raw fish flesh.

The causative agent of diphyllobothriasis

Diphyllobothrium latum (wide tapeworm) is the most common species of tapeworm, known to science since 1758.

Scientific classification:

Type - Plathelmintes (flatworms)
Class - Cestoidea (cestodes)
Order - Pseudophyllidea (tapeworms)
Family - Diphyllobothriidae (diphyllobothriidae)
Genus - Diphyllobothrium (tape tapeworm)

There are 10 species of diphyllobothriids: broad tapeworm (Diphyllobothrium latum), small tapeworm (Diphyllobothrium minus), narrow tapeworm (Diphyllobothrium strictum), Tunguska tapeworm (Diphyllobothrium Tungussicum), Diphyllobothrium klebanovskii, Diphyllobothrium Dendriticum, etc.

In medical practice, the broad tapeworm is of particular importance.

Structure

The broad tapeworm is a fairly large helminth. Its length is from 2 to 10 meters, sometimes reaching 20 - 25 meters. It has a head, neck and body. The respiratory, digestive and circulatory systems are absent.

The head (scolex) is elongated and flattened laterally, ranging from 3 to 5 mm in length. On the head there are bothria (suction slits), with the help of which the parasite attaches to the mucous membrane of the small intestine. Bothria are located on the dorsal and ventral sides of the helminth.

The neck is short, up to 10 mm in length, non-segmented.

The body (strobila) consists of segments (proglottids), the number of which ranges from 3 to 4 thousand. At the head, the segments are short and wide, then as they mature, they lengthen. In the middle part of the strobilla, the width of the segments exceeds the length, which distinguishes this type of helminth from the tapeworm. The width of the segments is 1.5 cm. Proglottids are covered with special cells that have outgrowths that perform the function of nutrition and special openings through which enzymes are released that protect the parasite from the aggressive external environment. The muscular system is represented by circular and longitudinal layers.

Rice. 2 and 3. The photo shows the head of the broad tapeworm (on the left) and young and mature segments (on the right).

Rice. 4 and 5. The photo shows mature segments of the parasite. The brown color indicates the uterus with eggs that are released through a small hole.

Reproduction

The tapeworm is a wide hermaphrodite. There are no genital organs in the initial part of the body. In mature segments the reproductive apparatus is already present. It is represented by a rosette-shaped uterus filled with parasite eggs and testes located on the lateral surfaces of the segments. In the helminth, self-fertilization of each segment is observed, as well as cross-fertilization of 2 neighboring segments of the same or different individuals.

The testes are round in shape. The vas deferens opens on the lateral surfaces of the segments. The cirrus (copulation apparatus) is enclosed in a bursa (muscular sac).

The ovary has a bilobed shape and is located at the posterior edge. A straight vaginal tube stretches along the midline of the penis, which opens next to the male genital opening. The zheltochniki are located on the sides of the segments. The uterus is tubular, unclosed. Its loops are concentrated in the center of the segment. As the eggs mature, they enter the lumen of the small intestine and are excreted with the intestinal contents. One individual produces more than 2 million eggs per day.

Eggs

The eggs of the tapeworm are wide oval in shape, large, their size is 68 - 71 mm in length and 45 mm in width. The color is grayish-yellow. The surface is smooth and double-circuited. There is a cap on one of the poles, and a small tubercle on the other. An egg contains a large number of yolk cells. The formation of eggs occurs in the segments of the tail. Eggs are released into the external environment in an immature state. Their ripening occurs in freshwater bodies of water. A coracidium (embryo) is formed in the egg, which is released into the water after 6–16 days. The formation of the embryo occurs at temperatures above +150C. At lower temperatures, the embryo does not emerge from the egg, but remains viable for up to 6 months, in cesspools - up to 7 weeks. The development of eggs is possible in slightly salted water (river mouths). UV rays and disinfectants are harmful to eggs.

Rice. 6, 7 and 8. Diphyllobothrium latum eggs.

Rice. 9. The photo shows the release of the coracidium (embryo) from the egg of Diphyllobothrium latum

special instructions

Special instructions when taking the drug:

The use of Biltricid does not require the use of laxatives.
In patients with hepatosplenic schistosomiasis and impaired liver function, a slowdown in the metabolism of praziquantel is noticed (inpatient treatment under medical supervision is required).
In patients with schistosomiasis of the brain, no contraindications to the use of the drug were identified.
Patients with trematodiasis and schistosomiasis should be treated in a hospital.
Treatment with praziquantel requires mandatory cessation of breastfeeding (during the course of treatment for 2 days).
The product reduces concentration - vehicle drivers should know this.

Biltricide is an inexpensive and powerful medicine against trematodes, and opisthorchiasis, which is very common in our time. The main thing is to adhere to dosages to avoid side effects and allergic reactions. If you have heart pathologies, you should not be afraid to undergo treatment in the hospital.

Treatment of diphyllobothriasis

Treatment is mainly carried out on an outpatient basis; patients with severe forms of helminthiasis are treated in a hospital setting. No special diet required. If there is difficulty in bowel movement, laxatives are prescribed. Specific treatment consists of taking antiparasitic drugs. Treatment is carried out for 1 day: Praziquantel (Biltricid, domestic analogue of Azinox) 60 - 75 mg/kg in 3 doses with an interval of 4-6 hours.

After treatment, you should make sure that the helminth is excreted in the feces.

In case of development of B12 deficiency anemia, diet, use of iron supplements, cyanocobalamin and folic acid are indicated.

After recovery, those who have recovered from the disease are subject to dispensary observation for 3 - 6 months with monthly 2-fold monitoring of stool analysis for worms.

Rice. 20. Externally, the wide tapeworm is similar to the tapeworm, but unlike it, in the middle part of the body the width of the segments exceeds the length.

Broad tapeworm in the human body

In the human body, this type of tapeworm can live and reproduce for a long time, up to 10 years or more. In this case, no symptoms from the body may be observed. It can be detected in the body only after certain laboratory tests.

When it enters the body, the wide tapeworm penetrates the large intestine, where it is fixed to the intestinal mucosa with the help of suction cups. As a result, the intestinal walls are pinched and ulcers form, as a result of which the mucous membrane is injured and atrophies. With massive infestation, intestinal obstruction may develop, since the helminths are quite large and can cause closure of the intestinal lumen. Metabolic products of the parasite cause increased sensitivity to parasite antigens, which leads to an increase in eosinophils in the blood.

Thus, a person may develop vitamin deficiency, acute deficiency of vitamin B12 and folic acid, which can lead to the development of diphyllobothriasis megaloblastic anemia. If the tapeworm is in the body for a long time, up to 10 or even 20 years, then anemia is accompanied by pathologies of the peripheral nervous system and spinal cord.

The broad tapeworm has the following effects on the body:

mechanical – when the parasite attaches to the intestinal walls, they are damaged, resulting in necrosis and tissue atrophy;
irritating - when the parasite attaches to the intestinal mucous membranes, irritation of the nerve endings occurs with the subsequent development of neurotrophic disorders, which inhibits the functions of the gastrointestinal tract;
sensitizing - as a result of metabolic products secreted by the tapeworm, increased sensitivity of the body develops.

Epidemiology

Prevalence of the disease

Diphyllobothriasis is most common in regions with large freshwater bodies of water in countries with temperate and cold climates - the Great Lakes regions of the USA, Canada, Alaska and Northern Europe.

Foci of helminthiasis are registered in the same way:

In the Eastern Mediterranean.
In the Baltics.
In Russia: Karelia, the Gulf of Finland region, Krasnoyarsk Territory, Kola Peninsula, Volga region.
In Ukraine: the Danube delta, the zones of the Kakhovka and Kremenchug reservoirs.
In Moldova: lower reaches of the Dniester and Prut.

Foci of helminthiasis appear where cool lakes are polluted with wastewater. In wastewater treatment, infection is much less common. The presence of a fresh reservoir, a sufficient concentration of oxygen in the water, shallow water (well warmed by the sun) and a high number of crustaceans contribute to the spread of invasion. Salt water and water temperatures above +200C are destructive for crustaceans.

Of primary importance are:

Sanitary condition of reservoirs.
Food habits of the population.

Human infection

Infection occurs when a person eats freshwater predatory fish infected with larvae:

raw (planed),
poorly thermally processed (insufficiently boiled or fried),
poorly salted fish and caviar (often freshly prepared pike).

Particularly dangerous are ruffes, perches, pike, burbot, grayling, pike perch, trout, eel, whitefish, omul, etc., as well as salmon fish (chum salmon, salmon, humpback salmon).

A person is not a source of infection for other people and does not pose an epidemiological danger.

Plerocercoids die at low temperatures: after 24 hours at -150C, after 3 days at -100C, at -4 -60C after 5 - 9 days. Survive at high temperatures. The protein coagulation zone is from +50 to +55°C.

At-risk groups

Susceptibility to the disease is universal. Those most often affected are fishermen, cannery workers, tourists, and lovers of raw fish kebabs.

Rice. 15. Wide tape. Plerocercoids in the liver and intestines of trout.

Pathogenesis

After the larva (plerocercoid) has entered the small intestine of a person, it attaches to its wall (mucous membrane) with the help of bothria (suction cups) and, feeding on the contents of the intestine, begins to develop. Having reached sexual maturity, the helminth begins to discard mature segments filled with eggs into the intestinal lumen. The pathogenic effect of tapeworm is mechanical action, the development of neuro-reflex and toxic-allergic reactions, the development of vitamin B12 and folic acid deficiency.

Mechanical impact. Suction of the parasite to the intestinal wall leads to disruption of the integrity of the mucous membrane, resulting in impaired blood circulation, nerve conduction and digestion. The mucous membrane ulcerates, its atrophy and necrosis develop.

Accumulations of helminths during intensive infestation in some cases lead to intestinal obstruction.

Endogenous hypovitaminosis. The absorption of a large amount of nutrients, vitamins and microelements (including iron) by the helminth leads the patient’s body to nutritional depletion of varying degrees of severity in the body (strobila) of the parasite. In severe cases, the development of megaloblastic anemia is recorded, which is associated with vitamin deficiency B12 (cyanocobalamin) and B9 (folic acid). Immature forms of red blood cells enter the peripheral blood. The number of red blood cells and their saturation with hemoglobin decreases in the blood.

Nervous-reflex influence. With helminthiasis, irritation of interoreceptors occurs, which leads to the formation of viscero-visceral reflex reactions and neurotrophic disorders. The functioning of the digestive tract is disrupted, paresthesia and gait instability appear.

Toxic-allergic influence. The waste products of the tapeworm are absorbed from the intestines and enter the blood, which leads to a toxic-allergic restructuring of the body and suppression of the immune response. Eosinophilia is recorded in the blood, significantly expressed at the early stage of helminthiasis.

Patient reviews about the medicine

In most cases, people who have taken Biltricide give positive reviews about it:

The drug relieves allergic manifestations caused by parasites.
This medicine allows you to easily and quickly cure opisthorchiasis. The treatment regimen for opisthorchiasis is here.
It is better to combine Biltricid tablets with the use of folk remedies. This will help avoid some of the side effects caused by the medicine.

Experts in the field of helminthology say this:

Biltricide is an indispensable tool for the treatment of helminthic infestations. It copes with a wide variety of helminths.
This remedy is also prescribed to children after 4 years of age.
Although this drug can cause side effects, patients can easily tolerate its effects.
Doctors often recommend that treatment be carried out in a hospital setting, under their direct supervision.

How does infection occur?

What routes of infection lead to dangerous helminthiasis? Most often this is the consumption of dishes made from raw (stroganina, balyk) or poorly prepared fish, poorly salted caviar and the liver of freshwater fish. Poor temperature treatment preserves the larvae of the tapeworm and can lead to disastrous results - after all, there is always a risk that the fish is infected with a helminth. In addition, one should not lose sight of the possibility of plerocercoids getting into food through contact with infected fish during cutting, from the surface of poorly treated cutting boards and utensils, or when storing raw and cooked food together.

The main route of invasion is food. More often, one sexually mature individual of the parasite develops in the intestines of a sick person, less often - several. As a rule, due to eating habits, adults get sick more often than children. If the question arises whether to eat untested fish caught from fresh water, it would not hurt to pay attention to such risk factors as:

the presence of crustaceans in a nearby body of water;
the fish was caught in shallow water;
low sanitary and hygienic condition of the reservoir;
poor heat treatment of a fish dish.

If you have the slightest doubt about the quality of fish products, then you should not risk the health of yourself and your loved ones. It is better to be overly cautious than to pay for carelessness with an unpleasant disease.

Routes of infection

You can become infected with tapeworm only through intermediate hosts – fish. Coracidia, which live in fresh water bodies, are not dangerous to humans. If such a larva enters the human body, then, as a rule, it will die without developing into an adult. For the survival of the parasite, all stages of development with intermediate hosts are necessary. Another route of infection is contact with infected fish flesh. Cleaning fish should be done with protective gloves, and the knife and cutting board should be thoroughly washed with hot water and disinfectant.

The source of infection does not become a sick person or animal, since the parasite eggs must go through all stages of development. To do this, they need to get into water and change two intermediate hosts. For the same reason, the process of self-infection (reinvasion) with diphyllobothriasis is impossible.

Pathogenesis

There are several aspects of the pathogenic influence of tapeworms:

local mechanical damage to the wall of the small intestine, increasing with increasing intensity of invasion (can cause intestinal obstruction, since attachment occurs in the mucous membranes and due to pinching, which entails microulcerations, catarrhal inflammation and atrophy );
nervous and reflex irritation of interreceptors of neuronal endings localized in the intestinal wall leads to disruption of the functioning of the stomach and other parts of the gastrointestinal tract;
a toxic allergic reaction of the body leads to fundamental manifestations of the disease and sensitization as a result of toxic-allergic influences possessed by the waste products of helminths , their antigens, which causes the development of exhaustion, jaundice , decreased immunity , bone marrow hyperplasia, dystrophic changes in the liver, myocardium and blood eosinophilia , most pronounced at the onset of the disease;
lack of cobalamin or folic acid due to their absorption by strobili of parasites.

Photo and video

Larvae in fish:

Infected char

Cysts (encysted larvae) in the intestines

Cysts on the outside of the intestine

Also in the intestines

Unencapsulated larva. In fact, this is not a broad tapeworm, but its close relative, also from the genus Diphyllobothrium. But only a specialist can distinguish them, since they look the same.

Adult live worm:

A wide tapeworm inside a person during a colonoscopy

Diagnostic methods

To diagnose diphyllobothriasis, a detailed questioning of the patient is of no small importance. What matters is the person’s place of work, the nature of the food consumed, in particular fish, and fishing trips in the next few months. Patients should also be asked about the appearance of helminth segments in the feces. To do this, doctors usually show on preparations what the worm segments look like.

If the survey is positive, patients are asked to bring the discharged segments to the laboratory for a final diagnosis. It is worth noting that some people may hide the fact of penis discharge. These include children and adolescents, older people and workers in the fishing industry.

The gold standard in diagnosing helminthiasis is the detection of helminth eggs in feces by microscopy of a “thick” Kato smear, as well as the Kalantaryan method (level of evidence - A). Since stool contains a large number of eggs, diagnosis is not difficult.

Sometimes the diagnosis is made without the use of stool microscopy, by macroscopic assessment of the proglottids of the worm's strobili.

A complete blood count in the initial stages of the disease reveals eosinophilia and leukocytosis. With a long chronic course, these blood parameters are replaced by manifestations of B12-folate deficiency anemia.

Severe megaloblastic anemia develops in approximately 2% of patients with diphyllobothriasis and is diagnosed based on a survey of the patient, clinical manifestations and hematological data. The level of hemoglobin, hematocrit, red blood cells, leukocytes and platelets decreases from normal.

The shape and content of substances in red blood cells changes. Various inclusions appear in red blood cells, such as Joly bodies and Cabot rings. The erythrocyte sedimentation rate increases. A biochemical blood test reveals a decrease in vitamin B12 (cyanocobalamin) in approximately 40% of patients.

Symptoms of the disease

The most common is the latent asymptomatic form of diphyllobothriasis. Also quite common is the erased form, when the symptoms are mild. But even in these cases, it is possible to observe the release of the parasite in the feces. After the parasite invades the body, about 2 months must pass before the first signs of the disease appear.

With a severe form of the disease, the symptoms manifest themselves quite clearly. In this case, the patient experiences the following symptoms:

cramping abdominal pain with a feeling of nausea;
active secretion of saliva;
loss of appetite: its decrease alternates with increase;
weight loss even with a good appetite;
development of anemia;
inflammatory processes in the tissues of the tongue (glossitis).

When the parasite first enters the body, as a rule, only dyspeptic digestive disorders are observed. Pain may occur during eating and swallowing food. With massive infestations, the liver and spleen may increase in size.

After a long stay of the parasite in the body, signs of anemia are observed:

weakness;
prostration;
increased fatigue;
heartbeat;
headaches and dizziness;
decreased blood pressure;
decreased performance;
pallor of the skin and mucous membranes;
fainting.

The main cause of anemia is a lack of vitamin B12, which is involved in the formation of hemoglobin. In addition, the level of basophils and neutrophils in the blood decreases, as well as the concentration of other vital elements, which negatively affects a person’s overall well-being.

During this same period, symptoms of neurological disorders are observed:

numbness;
ataxia;
paresthesia;
nervousness;
irritability;
depressed state of mind;
depression.

Clinic of diphyllobothriasis

The incubation period for the disease ranges from 20 to 60 days. The clinical picture of diphyllobothriasis depends on the number of parasites and the time they remain in the patient’s body. Most cases of helminthiasis are asymptomatic or minimally symptomatic. Such patients are identified accidentally by the presence of segments or “ribbons” of helminths in the feces. During the survey, complaints such as nausea, belching and abdominal pain are recorded.

In the case of a typical course of helminthiasis, complaints appear indicating pathology of the digestive tract, nervous and hematopoietic systems:

Signs of astheno-neurotic syndrome appear: increased fatigue and decreased performance, headaches, dizziness, sleep disturbance.
Appetite worsens, nausea and vomiting, abdominal pain, flatulence, stool instability (diarrhea or constipation), salivation, perversion of taste and a metallic taste in the mouth appear. In 80 - 90% of patients, a decrease in the secretion of gastric juice is recorded, up to achylia.
Paresthesia appears in the absence of an external stimulus.
Skin rashes of an allergic nature (urticaria).
Lack of effect from treatment for chronic diseases.
Possible causeless low-grade fever.
Epileptiform seizures (rare).

In severe cases of diphyllobothriasis, the following are noted:

Increasing signs of astheno-neurotic syndrome.
Enlarged liver and spleen.
Increased sensitivity disorders (paresthesias).
Decreased blood pressure, increased heart boundaries and tachycardia.
With a long course of helminthiasis, obstruction of the small intestine sometimes develops, associated with the accumulation of parasites.
In 2 - 3% of cases, B12 deficiency anemia develops. Weakness, fatigue and drowsiness increase, dizziness, tinnitus and palpitations appear. The face becomes puffy and pale, and sometimes swelling appears in the legs. The number of red blood cells and hemoglobin sharply decreases.
With fresh invasion, eosinophilia is detected in the blood
Glossitis may develop: bright red spots and extremely painful cracks appear on the tongue (“scalded tongue”). Over time, the severity of the phenomena decreases, the papillae atrophy, the tongue becomes shiny and smooth (“varnished”). In some cases, the same changes appear on the mucous membrane of the palate, cheeks, pharynx and esophagus.
The phenomena of paresthesia are increasing. Unsteadiness of gait is noted. Funicular myelosis sometimes develops.

Diphyllobothriasis is somewhat more severe in pregnant women:

Signs of severe anemia are often recorded.
The risk of developing toxicosis increases.
An increased risk to the fetus is observed in the first trimester: malnutrition, oxygen starvation, delayed development of the nervous system and general development.

Rice. 19. With diphyllobothriasis, glossitis may develop.

How does the drug work?

The principle of action of this anthelmintic drug is to improve the permeability of helminth cell membranes to calcium ions.

Active substance praziquantel:

leads to generalized muscle spams of parasites;
promotes the uptake of glucose by helminth cells;
reduces glycogen levels and stimulates the release of various lactic acid compounds;
ensures long-term paralysis and inevitable death of parasites.

Complications

Of the complications of diphyllobothriasis, the following are especially important:

Intestinal obstruction (mechanical obstruction) associated with a large number of helminths. The condition requires surgical intervention.
Migration of proglottids into the gallbladder with subsequent development of inflammation of the organ.
Development of B12 deficiency anemia.
Funicular myelosis.

The prognosis of the disease is generally favorable. Worsens with severe pneumonia. Timely detection and adequate treatment leads to complete recovery.

Diagnostics

A reliable diagnosis of diphyllobothriasis can only be made using modern serological blood tests. It is impossible to accurately determine the presence of the disease based on symptoms, since the symptoms observed with this infection can also be attributed to other diseases. Even contact with raw fish is not always the determining factor in the diagnosis of this disease.

To accurately determine the presence of a tapeworm in the body, you need to resort to laboratory tests.

Diagnosis of the disease is carried out using the following methods;

PCR - diagnostics. This research method is based on the principles of molecular biology. The principle of the study is to replicate the DNA and RNA of the parasite in the material being studied (in this case, blood). This method is very informative because it allows you to detect the DNA of parasites in the material, which indicates their presence in the body.
Stool analysis (coprogram). Fragments of the tapeworm, its segments or eggs can be found in the feces, which eloquently indicates the presence of the parasite in the body.
ELISA is a test based on immunological principles that allows you to identify specific proteins (antibodies) to parasite antigens in the body.

Additional non-specific research methods include:

a blood test in which thrombocytopenia, anemia, eosinophilia, neutropenia and increased ESR (erythrocyte sedimentation reaction) are observed;
biochemical blood test, which reveals a decrease in protein and albumin levels.

It is possible to defeat parasites!

Antiparasitic Complex® - Reliable and safe removal of parasites in 21 days!

The composition includes only natural ingredients;
Does not cause side effects;
Absolutely safe;
Protects the liver, heart, lungs, stomach, skin from parasites;
Removes waste products of parasites from the body.
Effectively destroys most types of helminths in 21 days.

There is now a preferential program for free packaging. Read expert opinion.

Read further:

Gull tapeworm: life cycle of development and is the parasite dangerous for humans

Life cycle of development of the human roundworm, stages of development of the parasite in the body

Ascariasis: development cycle, treatment and symptoms

Azotobacter: what the bacterium feeds on, structure and functions

Acanthocephalans: types and class of worms, life cycle of development

Roundworms in dogs: signs, life cycle of the parasite and how to treat it

Diagnosis

Diagnosis of infection
Diagnosis of infection with broad tapeworm is based on obtaining data from the patient and laboratory tests. At the first stage, the attending physician interviews the patient, records the facts of eating fish that have not undergone sufficient heat treatment, and staying in areas where the risk of infection is increased.

At the second stage, it is determined which symptoms of the disease have already manifested themselves and the degree of their intensity. Often, when visiting a doctor, patients complain about the presence of tapeworm segments in their stool.

At the next stage, the patient is sent for a general blood test, followed by copro-ovoscopy, which makes it possible to detect fragments of the parasite and confirm the presence of the disease.

Classification of the disease

The disease is classified according to its course, the presence of complications and the severity of helminthiasis.

According to the variants of the course, latent (hidden) and manifest forms of diphyllobothriasis are distinguished.
According to the presence of complications - uncomplicated and complicated forms.
By severity - mild, moderate and severe.

Rice. 17 and 18. Plerocercoids of the broad tapeworm in the body of freshwater fish.

Treatment of broad tapeworm

To treat helminths, narrow-spectrum drugs are used aimed at destroying the worm:

biltricide 25 mg per 1 kilogram of weight 1 time per day;
niclosamide (phenasal) from 1 to 3 grams 1 time per day.

The following are prescribed as additional funds:

Male fern seed extract. Treatment is carried out according to the following scheme: take a laxative at night, give a cleansing enema in the morning on an empty stomach, then take the drug 1 capsule every 2 minutes, the total dose, depending on age, should be from 4 to 7 grams. Then, after 30 minutes, take the laxative again, after an hour and a half, have a light breakfast. If within 3 hours there is no urge to defecate, you should do a cleansing enema again.
Pumpkin seeds. 300 grams of pumpkin seeds are poured into 60 ml of warm water, ground and taken on an empty stomach for an hour. After 3 hours they take a laxative, and after 30 minutes they do a cleansing enema. There is another recipe in which pumpkin seeds are steamed in a water bath.
If symptoms of anemia are observed, vitamin B12 or cyanocobalamin is prescribed from 200 to 500 mcg three times a week for 1–1.5 months. Iron supplements are also prescribed to improve hemoglobin levels (ferroplex, actiferrin, ferronal, hemofer).
Symptomatic therapy. Symptoms of lesions of the digestive and nervous system are relieved. For this purpose, probiotics, enzymes, sorbents, painkillers, and hepatoprotectors are prescribed.

Sometimes the head of the tapeworm may remain fixed to the intestinal mucosa and begin producing segments and eggs again. Therefore, after some time (this is individual for each person), it is necessary to carry out control testing to determine the presence of the parasite in the body. If fragments of broad tapeworm are observed in the stool, then a second course of treatment is prescribed.

Of course, you should not treat helminthiasis on your own. The broad tapeworm is a formidable parasite that can develop asymptomatically in the human body for a long time. Its development and reproduction have a detrimental effect on the functioning and general condition of the body. A tapeworm can cause a lot of unpleasant situations, one of which may be acute intestinal obstruction. It is also dangerous to self-medicate and prescribe the dosage of an anthelmintic yourself. This is fraught with many dangerous consequences. Immunity after suffering from diphyllobothriasis is not stable, repeated cases of the disease are possible.

What are the symptoms of infection in a person?

It may take 20-60 days from the moment of infection to the first symptoms. Signs of infestation develop gradually, are mild over a long period of time, and are easily confused with other diseases.

The main signs of infection include:

nausea, vomiting;
pain, abdominal cramps;
increased salivation;
increased fatigue;
increase in body temperature;
weight loss;
worsening or increased appetite;
unstable stool;
white tapeworm segments are present in the stool;
intestinal obstruction;
anemia with vitamin deficiency;
dysfunction of the nervous system;
change in blood composition.

Take the broad tapeworm test

Depending on the level of invasion, the accompanying symptoms and their intensity also change.

What types of parasites does Biltricide help with?

It is recommended to take the drug Biltricid:

For various ailments caused by trematode and cestode parasites.
For pathogens of opisthorchiasis, cat fluke, various schistos.

Affected by Biltricide:

Chinese fluke;
Siberian fluke;
liver fluke;
cat fluke;
wide tape;
dwarf tapeworm;
Menson's intestinal schistosome;
giant fluke;
pulmonary fluke.

To more accurately determine which parasite the infection occurred, you need to undergo a series of necessary tests. Only after identifying a specific parasitic infection can a medicine be prescribed.

How to get rid of an uninvited guest?

From the moment the diagnosis is established, treatment for tapeworm should begin as early as possible. To completely get rid of the parasite, a course of treatment is carried out, which is usually carried out on an outpatient basis. The patient is prescribed pathogenetic and specific drugs. If the anemia is significant, the doctor will prescribe folic acid tablets and intramuscular injections of vitamin B12 (cyanocobalamin) before choosing an anthelmintic medication. Specific therapy for tapeworm is drugs aimed at eliminating the parasite. Medicines in this group paralyze the neuromuscular system of helminths, which is why the parasite loses its ability to cling to the intestinal walls and is expelled by peristaltic waves.

Anthelmintics acting on tapeworm include:

biltricide;
fenisal;
niclosamide;
praziquantel;
plant-based preparations (male fern seed extract, pumpkin seeds).

Of course, the drug, its dosage and timing of treatment should be chosen by a medical specialist based on the individual condition of the sick person, taking into account contraindications, since a number of drugs are contraindicated at certain stages of pregnancy, concomitant diseases, and young children.

We should not forget that in rare cases, part of the worm may remain in the intestines and begin to develop again, so after six months you should be tested again to ensure a final cure. If eggs and fragments of the broad tapeworm are again found in the biological material, then another course of treatment will have to be carried out. If the test results are negative, then further observation is not necessary.

To restore the body and correct the condition of the digestive system, enzymes, pro- and prebiotics, multivitamins, and antihistamines are used.

In general, the prognosis with timely diagnosis and adequate therapy is favorable.

Prevention

The prognosis of the disease is favorable. Preventive measures are very simple:

When preparing and cleaning fish, use protective gloves;
do not touch raw fish, its meat and caviar with your hands;
carry out high-quality heat treatment of fish;
Avoid eating raw, salted, dried and smoked fish.

The larvae of the broad tapeworm die at a temperature of -15°C for 24 hours, as well as at -10°C for 3 days, and at a temperature of -4-6°C for 9-10 days. High temperatures reliably kill the larvae; they die already at a temperature of + 55°. Therefore, fish should be fried for 10 minutes on one side, and large pieces of fish should be fried for 30–40 minutes. When salting fish, the salt content in the final product must be at least 9%.

Treatment

Before starting therapy, the doctor conducts diagnostics to identify the exact cause of the disease. After collecting anamnesis, the patient is referred for laboratory tests, which include:

stool analysis;
blood analysis;
general blood analysis;
blood chemistry.

After receiving the results, the doctor selects the most effective and safe medications, taking into account all the individual characteristics of the body and the form of the disease.

In addition to antihelminthics, the patient is prescribed iron supplements and vitamin B12 injections. For the treatment of diphyllobothriasis, the following anthelmintic drugs are usually prescribed:

Praziquantel;
Biltricide;
Niclosamide.

Treatment may also include taking antihistamines and sedatives. In rare cases, it is possible to use traditional recipes - only in consultation with a doctor and as an aid.

If you follow all the doctor’s recommendations, treatment has an optimistic prognosis. However, the immune system weakens due to the invasion, so there is a possibility of relapse.

To reduce the likelihood of infection with Diphyllobothrium latum, it is necessary to adhere to preventive standards and eat only fish that have undergone high-quality heat treatment.

Frying fish takes at least 30 minutes, salting – 10 days. It is also better to deep freeze the fish before cooking - this will help destroy the helminth larvae. If, when cutting fish, parasite larvae were found in it, it is better to dispose of it and not eat it.

If any negative symptoms appear, immediately contact a medical facility and do not self-medicate.

Side effects

Negative phenomena after Biltricide are very rare; if the correct dosage is observed, they do not occur. Side effects, as a rule, are so insignificant that they do not cancel further treatment with the drug.

The following unpleasant effects are likely:

Nausea, nagging pain in the lower abdomen, poor digestion, decreased appetite, diarrhea.
Drowsiness, migraine, physical weakness, chills, cardiac arrhythmia.
In rare cases, skin allergies (urticaria, rashes, redness) occur.

General information

Diphyllobothriasis or otherwise called dibothriocephalosis of the helminthic group and refers to cestodosis diseases, code assigned to ICD-10: B70.0 , while larval diphyllobothriasis is assigned its own separate code: B70.1 .
The disease is usually caused by mature forms of Diphyllobothrium pacificum, latum, and in more rare cases - dendriticum and klebanovskii. sparganosis develops .

Most often, the disease leads to dyspeptic disorders and diphyllobothriasis megaloblastic cobalamin-deficiency anemia .

Diphyllobothriasis

Having entered the human intestine with the fish, the plerocercoid turns its head outward. With bothria it sticks to the walls, and the worm begins to grow. It becomes a sexually mature individual in 3-4 weeks. The disease diphyllobothriasis is an infection (invasion) of a person caused by the broad tapeworm. Symptoms at the first stage may be absent or very mild. These include:

nausea;
belching;
pain in the abdomen.

Later the symptoms become more pronounced. This:

nausea to vomiting;
problems with stool;
lack of appetite;
weakness, dizziness;
drowsiness;
numbness or tingling of the tongue when taking salty or sour foods, certain medications;
painful changes in the tongue (cracks, spots, atrophy of the papillae);
enlarged liver, spleen;
damage to the nervous system.

Some patients experience hives on the skin and seizures.

Symptoms of diphyllobothriasis

The pathological effect of the helminth is formed from the following components:

1Mechanical impact. Attaching to the intestinal wall with the help of bothria, the parasite infringes on the mucous membrane, which leads to its thinning and death.
2Consumption of nutrients, B vitamins, including B12, folic acid from the host’s food, which the helminth is not able to produce independently in its body.
3Toxic effect on the patient of the decay products and vital activity of the worm through the destruction of blood cells. As a result, the manifestations of the disease can be quite diverse, masquerading as other diseases of various organs and systems.

Diphyllobothriasis is often asymptomatic, or the symptoms are so weak that they do not attract the patient’s attention.

With a symptomatic course, the disease begins gradually and progresses over time. Patients experience the following symptoms: unstable changes in body temperature (low-grade fever), loss of appetite, profuse salivation, stomach discomfort, diffuse pain in all parts of the abdomen, rumbling, bloating, nausea, less commonly vomiting, unstable stools and diarrhea. At the same time, malaise, fatigue, dizziness, sleep disturbances, sudden mood swings, and headaches appear and increase.

In medical practice, cases have been described in which several tapeworms were parasitized in the intestines of a sick person at once. A large number of worms in the intestine caused intestinal obstruction at various lengths of the intestine with further surgical treatment.

Due to the fact that the broad tapeworm does not have the ability to independently produce vitamin B12 (cyanocobalamin), it absorbs it from the human body. Thus, the patient experiences a clinical deficiency of cyanocobalamin and associated folic acid. This condition gradually leads to the development of megaloblastic anemia.

B-12 deficiency anemia is characterized by the following symptoms and syndromes:

1Circulatory-hypoxic syndrome develops as a response of the body to a decrease in the delivery of oxygen by blood to organs and tissues. Manifestations of this syndrome include: pallor of the mucous membranes and skin, general malaise, increased fatigue, dizziness, shortness of breath during habitual physical activity, decreased blood pressure, rapid heartbeat. With further development of the disease, a so-called systolic murmur appears at the apex of the heart, which can be heard during auscultation of the heart. Myocardial dystrophy may develop, signs of which can be detected on the electrocardiogram.
2Gastroenterological syndrome is characterized by lack of appetite, nausea, vomiting, diarrhea-type bowel movements, pain and discomfort in the tongue. As the condition worsens, Gunther's glossitis develops. Bright red spots and cracks form on the tongue, the tongue begins to hurt, soon the papillae of the tongue completely disappear (atrophy), the tongue becomes smooth and shiny (“varnished” tongue). The infected person develops atrophy of the mucous membrane of the esophagus and stomach and its secretory function decreases; the size of the liver may increase.
3Hematological syndrome is manifested by changes in red blood parameters, detected in a general blood test. Immature forms of red blood cells are detected, whose function is insufficient to enrich the body with oxygen.
4 Neuropsychiatric disorders are manifested by disturbances of various types of sensitivity (tactile, temperature, pain), while the patient experiences tingling sensations, goosebumps (paresthesia), and a decrease in muscle strength is observed. In severe cases of vitamin B 12 deficiency, urinary and fecal incontinence occurs. Patients experience depression, hallucinations, insomnia, and paranoia.

In severe cases, a condition develops called funicular myelosis, in which degeneration of the myelin sheath of the spinal cord cords occurs, leading to paresthesia of the upper and lower extremities, as well as the upper half of the body. Patients experience a feeling of numbness, tingling, and pins and needles (paresthesia).

Pathological reflexes also develop: Babinski reflex - when the outer edge of the sole is irritated, the first toe extends; Rossolimo reflex - flexion of the second to fifth toe with a light blow to the tips of the toes; Bekhterev-Mendel reflex - when hitting the sole with a hammer, all fingers bend, except the first.

Later, movement disorders and disorders of other nerves occur (vision and memory decrease, tinnitus appears).

Morphology

The adult worm is composed of three fairly distinct morphological segments: the scolex (head), the neck, and the lower body. Each side of the scolex has a slit-like groove, which is a bothrium for attachment to the intestine. The scolex attaches to the neck, or proliferative region. From the neck grow many proglottid segments which contain the reproductive organs of the worm. D. latum

is the longest tapeworm in humans, averaging ten meters long. Adults can shed up to a million eggs a day.

In adults, proglottids are wider than they are long (hence the name broad tapeworm

). As in all pseudophyllid cestodes, the genital pores open midventrally.

KEMREZH BKHPNYKHI Diphyllobothrium latum.

PEKEBYUMRMSHE MYUSVMSHE HYARNVMHYH:

PSYAYAYHE TPYUGENKNTSKHGLSH I YNLONMEMRYULH ⌠TSNKNBU■, ⌠PSYU■, ⌠YAEPJE■ MU TNME YHRYIYYYNTSN ЪGSHYU with yS-USYu |
dHYAYAYEPRYUZHH MU YANHYAYUMHE SVEMNI YAREOEEMH YUMDHDYURYU THKNKNTSKHVEYAYHU MYUSY. JYUMYR-oEREPASPTs – 2007 | dHYAYAEPRYUZHH | 2007 | pNYAYAH | docx/pdf | 5.17 lA yaOJHYUKEMNYARE 02/10/01 - PSYAYAYKHI ЪGSHY. YYUFDUYU ЪGSHYNBUYU YAHYARELYU KHLEER YABNCH ЪПИСЧ ЯОЭжХТХИС, YNRNPYU NRPYUFYUER PYUGMSHE YYAOEYRSH YSKERSPSH, YATEPSH FKHGMKH, KHYARNPKHCH, GMYUMHЪ H LEMRYUKHRER MYUPNDYU - YAN GDUREK X
LYUPNSCHYNMNLHYU nKHBEE AKYUMYUP |
sVEAMHY. oEPEBND I YUMTSKKHIYYINTSN OND MYUSVMNI PEDYUYZHHEI k.k.kCHAHLNBU. xGDUREKEYAYKHI DNL TsNYASDYUPYARBEMMNTSN SMHBEPIAHRRRYU ≈ bSHYAYEI YINKSH SCHYNMNLHYH. Juneteenth, 2010 | sVEAMHY | 2010 | docx/pdf | 17.39 lA xGDYUMKHE NYASYYARBKEMN B PYULYUU KHMMNBYUZHNMMNI NAPYUGNBUREKEMNI OPNTsPYULLSH tss bsch ╚tNPLKHPPNBYUMKHE YAHYARELSH YUMYUKHRHVEYAYKHU YNLOEREMZHHI DK KHMMNBYU ZHKHI B AKHGMEYAE X TSNYASDYUPYARBEMMNL SOPYUBKEMXX╩ ntsKYUBKEMKHE
ІОУПЦУКУКУ ОПХХХХИМНЛС ОПУБС НИЯХХХ |
ІОУПЦУКУКУІ | 2021 | pNYAYAH | docx | 0.08 lA 1. YANDEPFYUMKHE OPYUBYU MU FHKKHYE 2. fHKKHYMNE OPYUBN LNFMN NOPEDEKHRE YUY YAHYARELS OPYUBNBSHU MNPL, PETSKHPSSCHYHU NAYYARBEMMSHE NRMNYEMKH, YABGYUMMSHE I SDNB KERBNPEMKHE FKHKHYMSHU ONRPEAMNYAREI CP-M. 5. fHKKHY
BYODONBYODYO DN YYAOKHRS G ╞YARNPYO ONKYORKHVMKHU RYU OPYUBNBKHU BVEME |
nRBERSH Y GUVERS/SHYGULEMS | 2021 | sYPYUHMYU | docx | 1.48 lA 1.БЯЭЯБЁБРМЪ ЁЯРНПЁЪ BVEME OPN OPYUBN Ё DEPFYUBS oPHMZHHO, YUAN GYUTSYUKEMHI LERND DYUKEIRKHYH 3.s dPEBMENLS yHRYU TSMDYULEMRYUKEMS PNKE S BYAYOI YYARNPYO ONKYORKHVMN AND ERKHVMN DSLYKH GOTSPYUKN MYUBVYUMMM yNMTSZHYO
nRBERSH Y SHYGULEMS ON SCNKNBMN-OPNZHEYAYASYUKEMNLS OPYUBS |
nRBERSH Y GUVERS/SHYGULEMS | 2021 | pNYAYAH | docx | 0.15 lА хЯРНПХЪ OPNZHEYAYASYUKEMNTSN OPYUBYU nyanaeMMNYARH YUPYUYUHVEYAYNTSN OPNYUBU: nYAMNBMSHE VEPRSH KETSKHYUYZHNMMNTSN OPNZHEYAYU. shYYARPYUNPDHMYUPMSHI OPNZHEYAYA YAHARELYU YNPONPYURKHBMNTSN OPYUBYU. yYUMNMHVEYAYNE, ZHEPEINBMNE OPYUBN.
BYODONBYODYO DN YYAOKHRS G EYNKNTSEVMNTSN OPYUBYU |
nRBERSH Y GUVERS/SHYGULEMS | 2021 | sYPYUHMYU | docx | . _ ONMYRRR EINKNTSEVMNTSN OPYUBYU B BUHPNYNLS Yo BSGAINLS PNGSLOMMY. YAMMNBMY YPHREPE YAYULNYARYIMNYARYO EINKNTSEVMNTSN OPYUBYU. oPHMZHOX
EINKNTSEVME OPYUBN SYYYUMH |
nRBERSH Y GUVERS/SHYGULEMS | 2021 | sYPYUHMYU | docx | 0.31 lA 1 oPKHPNDU ЪY YASYSOMYARE NPTSYUMOVMKHU Ё MENPTSYUMYUMOVMKHU SRBN╜PCHBYUME 2. EYNKNTSYOVMYU YPHGYU 3. ONMYRRY EYNKNTSVMNTSN OPYUBYU BKHPNY NLS Yo BSGAINLS PNGSLOMMY: YASVYUYAMYO YNMZHEOZHE EINKNTSEVMNTSN OPYUBYU: NDMNPYODMYARE Yo
YANBPELEMMSHE KEVEAMSHE REUMNKNTSKHH |
ІОУПЦУКУКУІ | 2021 | docx | 0.12 lA 1.bHDSH HYAYAKEDNBYUMHI, HU YUYUPYYREPHYARHYU. dKHGYUIM PYUMDNLHGKHPNBUMMNTSN YKKHMKHVEYAYNTSN HYAOSHRYUMKH. 2.nAKYUYARKH YKHMKHVEYAYKHU HYAOSHRYUMKHI. oPEDONVHRREKEMSHI DHGYUIM HYAYAKEDNBYUMHI. dKHGYUIM YNTsNPRMNTSN HYAYAKEDNBYUMKH.
nRBERSH MU SHYGYULEMYUZHNMMSHE BNOPNYASH ON TYUPLYYYNKNTSXX Fri |
nRBERSH Y GUVERS/SHYGULEMS | 2021 | pNYAYAH | docx | 6.19 lA bNOPNYASH I VYUYARKH AKHKERNB bNOPNYASH II VYUYARKH AKHKERNB bNOPNYASH III VYUYARKH AKHKERNB l-UNKHMNLHLERHYCH. oKHKNYYUPOHMYU TKKHDPNUKNPKHD (Pilocarpini hydrochloridum) YuZHEIKKHDHM (Aceclidinum) YAHLORNLSH NRPYUBKEMKH
nAYYU TYUPLYUYNKNTSKH |
nRBERSH Y GUVERS/SHYGULEMS | 2021 | pNYAYAH | docx | 0.14 lA ╚nopedekemhe tupl-tskhkh. yabge x leyarn yapedkh ice x akhnk.myusy╩ ╚nyamnbmshe shryuosh pyugbhrkh tyuplyuynkntskhkh╩ ╚tyupluynykhmerhyu kay b-b, her yanaryubmshe schkelemrsh╩ 11. gmyuvemhe onkyu x bngpyuyaryu dk d- ъ

Life cycle

Life cycle of D. latum.

Click the image to see full-size.

Adult tapeworms may infect humans, canids, felines, bears, pinnipeds, and mustelids, though the accuracy of the records for some of the nonhuman species is disputed. Immature eggs are passed in feces of the mammal host (the definitive host, where the worms reproduce). After ingestion by a suitable freshwater crustacean such as a copepod (the first intermediate host), the coracidia develop into procercoid larvae. Following ingestion of the copepod by a suitable second intermediate host, typically a minnow or other small freshwater fish, the procercoid larvae are released from the crustacean and migrate into the fish's flesh where they develop into a plerocercoid larvae (sparganum). The plerocercoid larvae are the infective stage for the definitive host (including humans).

Because humans do not generally eat undercooked minnows and similar small freshwater fish, these do not represent an important source of infection. However, these small second intermediate hosts can be eaten by larger predator species, for example trout, perch, walleye, and pike. In this case, the sparganum can migrate to the musculature of the larger predator fish and mammals can acquire the disease by eating these later intermediate infected host fish raw or undercooked. After ingestion of the infected fish, the plerocercoids develop into immature adults and then into mature adult tapeworms which will reside in the small intestine. The adults attach to the intestinal mucosa by means of the two bilateral grooves (bothria) of their scolex. The adults can reach more than 10 m (up to 30 ft) in length in some species such as D. latum,

with more than 3,000 proglottids. One or several of the tape-like proglottid segments (hence the name tape-worm) regularly detach from the main body of the worm and release immature eggs in fresh water to start the cycle over again. Immature eggs are discharged from the proglottids (up to 1,000,000 eggs per day per worm) and are passed in the feces. The incubation period in humans, after which eggs begin to appear in the feces is typically 4–6 weeks, but can vary from as short as 2 weeks to as long as 2 years. The tapeworm can live up to 20 years.