Diphyllobothrium nihonkaiense (Yamane et al., 1986) in Switzerland: First molecular evidence and case reports

Diphyllobothriasis Caused by the Sanada Tapeworm: A Case Report

The incidence of human diphyllobothriasis is expected to rise amidst the current global popularity of Japanese cuisine, such as sushi, which contains raw fish. We report a case of a 10-year-old boy with a diphyllobothriasis infection acquired via sushi consumption. The patient was otherwise healthy, exhibited no symptoms, and was successfully treated with a single dose of 10 mg/kg praziquantel. In Japan, this parasite is known as "Sanada-mushi" because it resembles a Sanada cord. Prompt recognition of this parasite by evoking the Sanada cord's appearance may facilitate early diagnosis and treatment and increase public awareness to prevent diphyllobothriasis.

Unique genetic structure of the human tapeworm Dibothriocephalus latus from the Alpine lakes region - a successful adaptation?

Dibothriocephalus latus is the most frequent causative agent of fish-borne zoonosis (diphyllobothriosis) in Europe, where it is currently circulating mainly in the Alpine lakes region (ALR) and Russia. Three mitochondrial genes (cox1, cob and nad3) and 6 microsatellite loci were analysed to determine how is the recently detected triploidy/parthenogenesis in tapeworms from ALR displayed at the DNA level. A geographically distant population from the Krasnoyarsk Reservoir in Russia (RU-KR) was analysed as a comparative population. One or 2 alleles of each microsatellite locus was detected in plerocercoids from RU-KR, corresponding to the microsatellite pattern of a diploid organism. In contrast, 1–3 alleles were observed in tapeworms from ALR, in accordance with their triploidy. The high diversity of mitochondrial haplotypes in D. latus from RU-KR implied an original and relatively stable population, but the identical structure of mitochondrial genes of tapeworms from ALR was probably a consequence of a bottleneck typical of introduced populations. These results indicated that the diploid/sexually reproducing population from RU-KR was ancestral, located within the centre of the distribution of the species, and the triploid/parthenogenetically reproducing subalpine population was at the margin of the distribution. The current study revealed the allelic structure of the microsatellite loci in the triploid tapeworm for the first time.

Parasites of zoonotic interest in selected edible freshwater fish imported to Australia

Australia imports a significant amount of edible freshwater fish. The safety of the imported product is therefore of great importance. Previous research has shown that certain types of edible freshwater fish imported into Australia are not compliant with Australian importation guidelines and additionally are contaminated with many species of parasites, some of which may cause illness in humans if consumed. The present study, to the best of authors knowledge, is the first to publish the occurrence of zoonotic parasites in edible fish imported into Australia. Eustrongylides sp. Jägerskiöld, 1909 (P. 15.5%), family Dioctophymidae; Euclinostomum sp. Travassos, 1928 (P. 4.8%), family Clinostomidae, were recovered from imported edible and consumer ready Channidae fish and Isoparorchis sp. Southwell, 1913 (P. 11%), family Isoparorchiidae, from imported edible Bagridae fish. Euclinostomum sp. and Isoparorchis sp. were identified using morphological method. Molecular identification of Eustrongylides sp. was achieved through sequencing of the 18S ribosomal RNA gene sequence. Eustrongylides sp. and Isoparorchis sp. have been identified as the causative agent in cases of human infection and are a recognised zoonosis. Euclinostomum sp. is considered to have zoonotic potential and for this reason this species has been included in the importation risk assessments for freshwater fish from certain countries. This study confirmed the presence of zoonotic parasite species in edible imported fish. Whilst this fish product was frozen and parasites therefore inactivated, both fish species according to importation commodity codes, at the time this manuscript was written, are permitted entry into Australia chilled. Further study using a greater sample size is required to understand the human health risks.

Ups and downs of infections with the broad fish tapeworm Dibothriocephalus latus in Europe from 1900 to 2020: Part I

The broad fish tapeworm, Dibothriocephalus latus (Diphyllobothriidea), is the most frequent causative agent of diphyllobothriosis, a fish-borne zoonosis, in Europe. Diphyllobothriosis is characterized by the transmission of D. latus larvae to humans via the consumption of raw, marinated, smoked or inadequately cooked fish products. The most important European foci of diphyllobothriosis have been Fennoscandia, the Baltic region, the Alpine lakes region, the Danube River region, and several endemic regions in Russia. This review provides basic data on the biology, life cycle, host specificity, methods of identification of D. latus, and a detailed summary of its occurrence in intermediate and definitive hosts in Fennoscandia and the Baltic, Alpine, and Danube regions during the last 120 years (1900-2020). Deeper insight into the unique pattern of distribution of D. latus in endemic regions is provided. The numbers of records are associated with several milestones of particular time periods. The first milestone (historical), which influenced studies on D. latus in Europe, was the period during and after World War II (1941-1950). The second milestone (epidemiological) was the decade 1981-1990, when previous massive health campaigns led to a marked decline of diphyllobothriosis in Europe and less published data on D. latus. Based on recent data, the broad fish tapeworm is either absent or present at very low prevalences in Fennoscandia and the Baltic and Danube regions, but the Alpine lakes region represents a continuous ongoing circulation of the parasite in the natural environment and humans.

Biology, Epidemiology, Clinical Features, Diagnosis, and Treatment of Selected Fish-borne Parasitic Zoonoses

Fish-borne parasites have been part of the global landscape of food-borne zoonotic diseases for many decades and are often endemic in certain regions of the world. The past 20 years or so have seen the expansion of the range of fish-borne parasitic zoonoses to new geographic regions leading to a substantial public health burden. In this article, we summarize current knowledge about the biology, epidemiology, clinical characteristics, diagnosis, treatment and control of selected fish-borne helminthic diseases caused by parasitic roundworm (Anisakis), tapeworm (Dibothriocephalus), and fluke (Metagonimus). Humans acquire infection via consumption of raw or improperly cooked fish or fish products. The burden from these diseases is caused by morbidity rather than mortality. Infected patients may present with mild to severe gastrointestinal (eg, abdominal pain, diarrhea, and indigestion) or allergic manifestations. Patients are often admitted to the hospital or clinic with acute symptoms and no prior health problems and no travel history. Diagnosis is often established based on the detection of the diagnostic parasite stages (eg, eggs or tapeworm segments) in the patient's feces. Sometimes imaging is required to exclude other causes and avoid unnecessary surgery. Dibothriocephalus and Metagonimus are mainly treated with praziquantel. Extraction of adult Dibothriocephalus or Anisakis larvae from the bowel ensures complete elimination of the parasites and prevents a relapse of infection. The development and implementation of more efficient food safety and public health strategies to reduce the burden of zoonotic diseases attributable to fish-borne parasites is highly desirable.

Global analysis of cytochrome c oxidase subunit 1 (cox1) gene variation in Dibothriocephalus nihonkaiensis (Cestoda: Diphyllobothriidae)

The cestode Dibothriocephalus nihonkaiensis (syns. Diphyllobothrium nihonkaiense and Diphyllobothrium klebanovskii), the broad fish tapeworm, is a parasitic agent of intestinal infection acquired by consumption of raw or undercooked Pacific salmon, Onchorhynchus spp. Sequencing studies conducted about a decade ago revealed the presence of two major lineages (A and B) in the broad fish tapeworm population within Asian coastal areas. However, in spite of the accumulation of sequence data on GenBank recently, no further genetic analyses of D. nihonkaiensis have been attempted. The present study assessed for the first time the global cox1 variation in D. nihonkaiensis. Novel partial cox1 sequences of 14 isolates of D. nihonkaiensis from 12 patients were generated, and a global genetic analysis was performed using the 14 novel and 79 previously published sequences for isolates from definitive and second intermediate hosts of this species was performed. A total of 48 haplotypes of three haplotype groups (Types A, B and C) were identified, and co-infections with genetically different D. nihonkaiensis were highlighted in humans and Pacific salmon.

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First global analysis of cox1 variation in Dibothriocephalus nihonkaiensis.

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First application of haplotype network analysis for a D. nihonkaiensis population.

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A total of 48 haplotypes of three haplotype groups (Type A, B and C) are identified.

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Co-infections with heterogenic isolates in definitive and intermediate hosts are highlighted.

A Critical Appraisal of Global Testing Protocols for Zoonotic Parasites in Imported Seafood Applied to Seafood Safety in Australia

It is not suggested that any country is intentionally exporting seafood which does not comply with Codex seafood-safety guidelines/codes/standards. However, with an open access resource such as fisheries, there is vast potential for errors to occur along convoluted supply chains, spanning multiple countries, which may negatively impact the safety of edible seafood products imported into Australia. Australian importation policy and inspection procedures are founded upon a bedrock of trust in the integrity, reliability and safety of the global seafood supply chain. In order for seafood imported to Australia to be considered safe the non-mandatory international health standards, governed by Codex Alimentarius, for seafood must be predicated upon the most efficacious methods and stringently governed by each exporting provenance. Currently, tests for zoonotic parasites are not applied to imported edible seafood products on arrival into Australia. Therefore, this critical analysis is aimed at discussing the effectiveness of current testing protocols for zoonotic parasites in edible seafood advised by Codex Alimentarius which may impact the safety of the product imported into Australia.

Locally acquired infection with Dibothriocephalus nihonkaiense (=Diphyllobothrium nihonkaiense) in France: the importance of molecular diagnosis

Diphyllobothriasis is a parasitic fish-borne disease caused by tapeworms of the genus Dibothriocephalus (=Diphyllobothrium). The majority of reported cases are attributed to D. latum, based on morphological identification of eggs or proglottids. However, numerous reports in recent years suggested that other Dibothriocephalus species could be involved in human infections, mainly after consumption of salmonid fish. Among these, D. nihonkaiense has been predominantly reported from Eastern Asia and probably underestimated in the rest of the world. We report here a clinical case of D. nihonkaiense in a French patient (without history of travel abroad) after consumption of salmon. Suspected on morphological characteristics, the final identification of D. nihonkaiense was performed using molecular methods by sequencing nad1, cox1, and 5.8S rRNA (containing ITS1 and 2) genes sequences. The patient was successfully treated by a single dose of praziquantel. Reports of diphyllobothriasis due to D. nihonkaiense are rare outside Asia, but worldwide demand of seafood could lead to the globalization of cases and reflect the need to monitor the distribution of Dibothriocephalus species. Thus, clinical parasitologists should be aware of this risk and able to raise the possibility of infections by non-endemic Dibothriocephalus species in order to use the proper molecular tools.

Improving the specific diagnosis of trematode, cestode and nematode infections by a multiplex single-tube real-time PCR assay

AIMS

Helminth infections are becoming uncommon in high-income countries and laboratory staff may lose expertise in their morphological identification, especially in histological sections where speciation of helminths is challenging. Commercially available molecular diagnostic panels for faecal specimens only offer tests for protozoa but not helminths. We aim to improve the identification accuracy of helminths using a multiplex PCR assay.

METHODS

We designed three pairs of PCR primers and probes targeting multicopy genes for a multiplex single-tube real-time PCR assay which covers 16 trematode (28S rRNA gene), 24 cestode (cox1 gene) and 33 nematode (cox1 gene) species. Helminths (n=27) from faecal samples (n=10), fresh parasites (n=11), formalin-fixed specimens (n=4), cerebrospinal fluid (n=1) and bile (n=1) were examined morphologically and tested by PCR. Fifty stool samples negative for parasites by microscopy were also tested.

RESULTS

The PCR assay correctly identified the genera of all tested helminths. Agarose gel electrophoresis and sequencing of the purified PCR amplicons confirmed that the PCR products were of correct sizes with 100% correlation with the respective species. Sequencing of the cox1 gene failed to identify Capillaria spp. in one sample owing to the lack of corresponding sequences in GenBank. PCR and sequencing of the nematode 18S rRNA gene using consensus primers showed 100% homology with Capillaria spp. sequence. No positive PCR products were found in the negative stool samples.

CONCLUSIONS

The highly specific test correctly identified all helminths in our cohort. It is a useful adjunct to helminth identification in difficult situations such as histological sections.

Clinical characteristics and epidemiology of intestinal tapeworm infections over the last decade in Tokyo, Japan: A retrospective review

BACKGROUND

Tapeworm (cestode) infections occur worldwide even in developed countries and globalization has further complicated the epidemiology of such infections. Nonetheless, recent epidemiological data on cestode infections are limited. Our objectives were to elucidate the clinical characteristics and epidemiology of diphyllobothriosis and taeniosis in Tokyo, Japan.

METHODOLOGY/PRINCIPAL FINDINGS

We retrospectively reviewed 24 cases of human intestinal cestode infection from January 2006 to December 2015 at a tertiary referral hospital in Tokyo, Japan. The patients included were diagnosed with cestode infection based on morphological and/or molecular identification of expelled proglottids and/or eggs and treated in our hospital. Fifteen and 9 patients were diagnosed with diphyllobothriosis and taeniosis, respectively. The median patient age was 31 years (interquartile range [IQR]: 26-42 years), and 13 (54%) were male. Most of the patients (91.7%) were Japanese. All patients were successfully treated with praziquantel without recurrence. Diphyllobothriosis was caused by Diphyllobothrium nihonkaiense in all patients. Taeniosis was due to infection of Taenia saginata in 8 [88.9%] patients and T. asiatica in 1 [11.1%] patient. All patients with taeniosis were infected outside Japan, as opposed to those with diphyllobothriosis, which were domestic. The source locations of taeniosis were mostly in developing regions. The median duration of the stay of the patients with taeniosis at the respective source location was 1 month (IQR: 1-8).

CONCLUSIONS/SIGNIFICANCE

The cestode infection, especially with D. nihonkaiense, has frequently occurred, even in Japanese cities, thereby implicating the probable increase in the prevalence of diphyllobothriosis among travelers, as the number of travelers is expected to increase owing to the Tokyo Olympics/Paralympics in 2020. In addition, medical practitioners should be aware of the importance of providing advice to travelers to endemic countries of taeniosis, including the potential risks of infection and preventive methods for these infections.

Four Human Cases of Diphyllobothrium nihonkaiense (Eucestoda: Diphyllobothriidae) in China with a Brief Review of Chinese Cases

We described 4 human infection cases of zoonotic fish-tapeworm, Diphyllobothrium nihonkaiense, identified with morphological and molecular characters and briefly reviewed Chinese cases in consideration of it as an emerging parasitic disease in China. The scolex and mature and gravid proglottids of some cases were seen, a rosette-shaped uterus was observed in the middle of the mature and gravid proglottids, and the diphyllobothriid eggs were yellowish-brown in color and displayed a small knob or abopercular protuberance on the opposite end of a lid-like opening. The average size of the eggs was recorded as 62-67×42-45 μm. The parasitic materials gathered from 4 human cases were morphologically identified as belonging to the genera Diphyllobothrium and Adenocephalus. The phylogenetic analysis based on the nucleotide sequences of cytochrome c oxidase subunit 1 gene of the etiologic agents confirmed that the 4 cases were D. nihonkaiense infection. The finding of 4 additional D. nihonkaiense cases suggests that D. nihonkaiense might be a major causative species of human diphyllobothriasis in China. A combined morphological and molecular analysis is the main method to confirm D. nihonkaiense infection.

Prevalence of Diphyllobothrium latum (Cestoda: Diphyllobothriidae) plerocercoids in fish species from four Italian lakes and risk for the consumers

In recent years there has been a re-emergence of diphyllobothriasis by Diphyllobothrium latum (Cestoda: Diphyllobothriidae) in Italy, France and Switzerland, where in the past this fish-borne zoonosis was widespread and then virtually disappeared. A change in eating habits such as the consumption of raw/undercooked freshwater fish, has led to an increased risk for consumers of ingesting infective larvae of D. latum. A survey on the factors responsible for the re-emergence of human diphyllobothriasis in Italy was carried out from March 2013 to December 2014. The aim of this study was to assess the diffusion of D. latum plerocercoids in the fish populations of the sub-alpine lakes of Maggiore, Como, Iseo and Garda, updating the scarce historical data and assessing a preliminary "risk level" of the lacustrine environments and fish species under investigation. A total of 2228 fish belonging to 5 species, 690 from Lake Maggiore, 500 from Lake Como, 655 from Lake Iseo and 383 from Lake Garda were submitted to parasitological examination. The presence of D. latum plerocercoid larvae was detected in 6.6%, 25.4% and 7.6% of perch (Perca fluviatilis) from Lakes Maggiore, Como and Iseo respectively. The parasite was also present in pike (Esox lucius) with prevalence values ranging from 71.4 to 84.2% and in 3.6-3.8% of burbot (Lota lota) from Lakes Iseo and Como. Fish from Lake Garda were negative as well as sampled whitefish (Coregonus lavaretus) and shad (Alosa fallax lacustris). The results of this survey showed a widespread presence of D. latum plerocercoid larvae in Maggiore, Como and Iseo fish populations. Urban fecal contamination of water is still a key issue to be resolved, together with the improvement of communication with consumers regarding the best dietary habits and the most effective processes of parasite inactivation, required for the consumption of raw/undercooked fish caught in high-risk areas.

Molecular Identification of Diphyllobothrium nihonkaiense from 3 Human Cases in Heilongjiang Province with a Brief Literature Review in China

Human diphyllobothriasis is a widespread fish-borne zoonosis caused by the infection with broad tapeworms belonging to the genus Diphyllobothrium. In mainland China, so far 20 human cases of Diphyllobothrium infections have been reported, and the etiologic species were identified as D. latum and D. nihonkaiense based on morphological characteristics or molecular analysis. In the present study, proglottids of diphyllobothriid tapeworms from 3 human cases that occurred in Heilongjiang Province, China were identified as D. nihonkaiense by sequencing mitochondrial cytochrome c oxidase subunit I (cox1) and NADH dehydrogenase subunit 5 (nad5) genes. Two different cox1 gene sequences were obtained. One sequence showed 100% homology with those from humans in Japan. The remaining cox1 gene sequence and 2 different nad5 gene sequences obtained were not described previously, and might reflect endemic genetic characterizations. D. nihonkaiense might also be a major causative species of human diphyllobothriasis in China. Meanwhile, the finding of the first pediatric case of D. nihonkaiense infection in China suggests that infants infected with D. nihonkaiense should not be ignored.

Helminths of grizzly bears (Ursus arctos) and American black bears (Ursus americanus) in Alberta and British Columbia, Canada

Between May 2011 and June 2013, we collected the carcasses and gastrointestinal tracts of 40 American black bears (Ursus americanus Pallas, 1780) and 13 grizzly bears (Ursus arctos L., 1758) from populations of Alberta and British Columbia, Canada. Specimens were examined for helminths, which were identified to the species level by applying an integrated morphological and molecular approach. Our goal was to investigate parasite biodiversity and infection parameters in the sampled grizzly and black bears. We found seven parasite taxa: Dirofilaria ursi Yamaguti, 1941, Baylisascaris transfuga (Rudolphi, 1819), Uncinaria rauschi Olsen, 1968, Uncinaria yukonensis (Wolfgang, 1956), Taenia arctos Haukisalmi, Lavikainen, Laaksonen and Meri, 2011, Diphyllobothrium dendriticum (Nitzsch, 1824), and Diphyllobothrium nihonkaiense Yamane, Kamo, Bylund and Wikgren, 1986. The statistical significance of infection prevalence, intensity, and abundance for each helminth species was assessed relative to host species, gender, age class, sampling season, and location. This is the first unequivocal report of the potentially zoonotic tapeworms D. dendriticum and D. nihonkaiense in North American bears. Furthermore, we provide insight into the biology and ecology of the nematodes B. transfuga, D. ursi, and species of Uncinaria Frölich, 1789, and enrich the information available on the recently described tapeworm T. arctos.

Human Diphyllobothrium nihonkaiense infection in Washington State

A patient in Washington State harbored a fish tapeworm most likely acquired from eating raw salmon. Diphyllobothrium nihonkaiense was identified by cox1 sequence analysis. Although this is the first documented human D. nihonkaiense infection in the United States, the parasite may have been present earlier but misidentified as Diphyllobothrium latum.

Diphyllobothrium nihonkaiense: wide egg size variation in 32 molecularly confirmed adult specimens from Korea

The eggs of Diphyllobothrium nihonkaiense were reported to be smaller than those of the classical Diphyllobothrium latum in general. However, verification using a large number of adult tapeworms is required. We assessed the egg size variation in 32 adult specimens of D. nihonkaiense recovered from Korean patients in 1975-2014. The diagnosis of individual specimens was based on analysis of the mitochondrial cytochrome c oxidase 1 gene sequence. Uterine eggs (n = 10) were obtained from each specimen, and their length and width were measured by micrometry. The results indicated that the egg size of D. nihonkaiense (total number of eggs measured, 320) was widely variable according to individual specimens, 54-76 μm long (mean 64) and 35-58 μm wide (mean 45), with a length-width ratio of 1.32-1.70 (mean 1.46). The worm showing the smallest egg size had a length range of 54-62 μm, whereas the one showing the largest egg size had a length range of 68-76 μm. The two ranges did not overlap, and a similar pattern was observed for the egg width. Mapping of each egg size (n = 320) showed a wide variation in length and width. The widely variable egg size of D. nihonkaiense cannot be used for specific diagnosis of diphyllobothriid tapeworm infections in human patients.

Diphyllobothrium nihonkaiense infections in a family

Diphyllobothrium latum and Diphyllobothrium nihonkaiense are morphologically similar to each other, and only genetic method can differentiate clearly between the 2 species. A strobila of diphyllobothriid tapeworm discharged from a 7-year-old boy was analyzed to identify the species by mitochondrial cytochrome c oxidase subunit 1 (cox1) gene sequencing. He and his family (total 4 persons) ate slices of 3 kinds of raw fish 16 days before visiting our outpatient clinic. All family members complained of abdominal pain and watery diarrhea. They all expelled tapeworm strobilae in their stools. They were treated with a single oral dose of praziquantel and then complained of no more symptoms. The cox1 gene sequencing of the strobila from the boy revealed 99.9% (687/688 bp) similarity with D. nihonkaiense and only 93.2% (641/688 bp) similarity with D. latum. Thus, we assigned this tapeworm as D. nihonkaiense. This is the first report of D. nihonkaiense infection in a family in Korea, and this report includes the 8th pediatric case in Korea. The current report is meaningful because D. nihonkaiense infection within a family is rare.

Four additional cases of Diphyllobothrium nihonkaiense infection confirmed by analysis of COX1 gene in Korea

Most of the diphyllobothriid tapeworms isolated from human samples in the Republic of Korea (= Korea) have been identified as Diphyllobothrium nihonkaiense by genetic analysis. This paper reports confirmation of D. nihonkaiense infections in 4 additional human samples obtained between 1995 and 2014, which were analyzed at the Department of Parasitology, Hallym University College of Medicine, Korea. Analysis of the mitochondrial cytochrome c oxidase 1 (cox1) gene revealed a 98.5-99.5% similarity with a reference D. nihonkaiense sequence in GenBank. The present report adds 4 cases of D. nihonkaiense infections to the literature, indicating that the dominant diphyllobothriid tapeworm species in Korea is D. nihonkaiense but not D. latum.

Extracorporeal worm extraction of Diphyllobothrium nihonkaiense with amidotrizoic acid in a child

Infection cases of diphyllobothriid tapeworms are not much in the below teen-age group. We report a case of Diphyllobothrium nihonkaiense infection in a 13-year-old boy. He presented with severe fatigue, occasional abdominal pain at night time. He also had several episodes of tapeworm segment discharge in his stools. By his past history, he had frequently eaten raw fish including salmon and trout with his families. Numerous eggs of diphyllobothriid tapeworm were detected in the fecal examination. We introduced amidotrizoic acid as a cathartic agent through nasogastroduodenal tube and let nearly whole length (4.75 m) of D. nihonkaiense be excreted through his anus. After a single dose of praziquantel, the child's stool showed no further eggs, and his symptoms disappeared. The evacuated worm was identified as D. nihonkaiense by mitochondrial cox1 gene analysis. Here we report a successful extracorporeal worm extraction from an infection case of D. nihonkaiense by the injection of amidotrizoic acid.

Two human cases of Diphyllobothrium nihonkaiense infection in Korea

Diphyllobothrium latum and Diphyllobothrium nihonkaiense are the 2 reported main causes of human diphyllobothriasis in the Republic of Korea. However, the differentiation of these 2 species based on morphologic features alone is difficult. The authors used nucleotide sequencing of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene to diagnose Diphyllobothrium spp. Two patients visited the emergency room at Kyungpook National University Hospital on 3 April and 12 April 2013, respectively, with fragments of parasites found while defecating. The parasites were identified as Diphyllobothrium spp. based on morphologic characteristics, and subsequent cox1 gene sequencing showed 99.9% similarity (1,478/1,480 bp) with D. nihonkaiense. Our findings support the hypothesis that D. nihonkaiense is a dominant species in Korea.

Tapeworm Diphyllobothrium dendriticum (Cestoda)--neglected or emerging human parasite?

Background

A total number of 14 valid species of Diphyllobothrium tapeworms have been described in literature to be capable of causing diphyllobothriosis, with D. latum being the major causative agent of all human infections. However, recent data indicate that some of these infections, especially when diagnosed solely on the basis of morphology, have been identified with this causative agent incorrectly, confusing other Diphyllobothrium species with D. latum. Another widely distributed species, D. dendriticum, has never been considered as a frequent parasite of man, even though it is found commonly throughout arctic and subarctic regions parasitizing piscivorous birds and mammals. Recent cases of Europeans infected with this cestode called into question the actual geographic distribution of this tapeworm, largely ignored by medical parasitologists.

Methodology and Results

On the basis of revision of more than 900 available references and a description and revision of recent European human cases using morphological and molecular (cox1) data supplemented by newly characterized D. dendriticum sequences, we updated the current knowledge of the life-cycle, geographic distribution, epidemiological status, and molecular diagnostics of this emerging causal agent of zoonotic disease of man.

Conclusions

The tapeworm D. dendriticum represents an example of a previously neglected, probably underdiagnosed parasite of man with a potential to spread globally. Recent cases of diphyllobothriosis caused by D. dendriticum in Europe (Netherlands, Switzerland and Czech Republic), where the parasite has not been reported previously, point out that causative agents of diphyllobothriosis and other zoonoses can be imported throughout the world. Molecular tools should be used for specific and reliable parasite diagnostics, and also rare or non-native species should be considered. This will considerably help improve our knowledge of the distribution and epidemiology of these human parasites.

A case of Diphyllobothrium nihonkaiense infection as confirmed by mitochondrial COX1 gene sequence analysis

Diphyllobothrium nihonkaiense has been reported in Korea as Diphyllobothrium latum because of their close morphologic resemblance. We have identified a human case of D. nihonkaiense infection using the mitochondrial cytochrome c oxidase subunit I (cox1) gene sequence analysis. On 18 February 2012, a patient who had consumed raw fish a month earlier visited our outpatient clinic with a long tapeworm parasite excreted in the feces. The body of the segmented worm was 2 m long and divided into the scolex (head) and proglottids. It was morphologically close to D. nihonkaiense and D. latum. The cox1 gene analysis showed 99.4% (340/342 bp) homology with D. nihonkaiense but only 91.8% (314/342 bp) homology with D. latum. The present study suggested that the Diphyllobothrium spp. infection in Korea should be analyzed with specific DNA sequence for an accurate species identification.

Multiplex PCR for differential identification of broad tapeworms (Cestoda: Diphyllobothrium) infecting humans

The specific identification of broad tapeworms (genus Diphyllobothrium) infecting humans is very difficult to perform by morphological observation. Molecular analysis by PCR and sequencing represents the only reliable tool to date to identify these parasites to the species level. Due to the recent spread of human diphyllobothriosis in several countries, a correct diagnosis has become crucial to better understand the distribution and the life cycle of human-infecting species as well as to prevent the introduction of parasites to disease-free water systems. Nevertheless, PCR and sequencing, although highly precise, are too complicated, long, and expensive to be employed in medical laboratories for routine diagnostics. In the present study we optimized a cheap and rapid molecular test for the differential identification of the most common Diphyllobothrium species infecting humans (D. latum, D. dendriticum, D. nihonkaiense, and D. pacificum), based on a multiplex PCR with the cytochrome c oxidase subunit 1 gene of mitochondrial DNA.

Detection and identification of Diphyllobothrium nihonkaiense plerocercoids from wild Pacific salmon (Oncorhynchus spp.) in Japan

We investigated the risk of diphyllobothriasis from ingestion of wild Pacific salmon in Japan by surveying Diphyllobothrium plerocercoids in 182 salmon samples obtained from Japan. The plerocercoids were not detected in chum salmon (Oncorhynchus keta) (0/26), called Akizake in Japan, caught between September and November. However, the detection rate of plerocercoids in chum salmon, called Tokishirazu in Japan, caught between early April and June, was 51.1% (24/47) with an average of two plerocercoid larvae per fish. The detection rates of cherry salmon (Oncorhynchus masou) and pink salmon (Oncorhynchus gorbuscha) were 12.2% (10/82) and 18.5% (5/27), respectively, and the average number of plerocercoids per fish was 0.45 (37 larvae/82 fishes) and 0.22 larvae (6 larvae/27 fishes), respectively. Plerocercoids isolated from O. keta and O. masou were identified as Diphyllobothrium nihonkaiense on the basis of molecular analysis of the cox1 and nad3 genes. Moreover, four tapeworms (three from O. keta and one from O. masou) were obtained by infecting golden hamsters with plerocercoids. The morphological features of these tapeworms were similar to those of D. nihonkaiense isolated from humans. Therefore, we think that O. keta and not O. masou is the most important source of plerocercoid infections in Japan.

Anomalous segmentation of Diphyllobothrium nihonkaiense

An anomalous tapeworm with abnormal segmentation was obtained from a 6-year-old boy in Japan. The tapeworm consisted of proglottids with slanted anterior and posterior margins of proglottids and 4-6 sets of reproductive organs arranged between the margins. The morphology of the tapeworm did not correspond to any of the described cestodes. However, molecular identification based on nuclear and mitochondrial genes clearly showed the tapeworm was Diphyllobothrium nihonkaiense.

Morphologic and genetic identification of Diphyllobothrium nihonkaiense in Korea

Diphyllobothrium nihonkaiense was first described by Yamane in 1986 but the taxonomical features have been obscure due to lack of critical morphologic criteria in its larval and adult stages. In Korea, this tapeworm had long been known as Diphyllobothrium latum. In this study, we observed 62 specimens collected from Korean residents and analyzed them by morphological features and nucleotide sequences of mitochondrial cox1 gene as well as the ITS1 region. Adult tapeworms were examined after carmine or trichrome stain. Longitudinal sections of the gravid proglottids showed an obtuse angle of about 150 degree between the cirrus sac and seminal vesicle. This angle is known as a major differential point compared with that of D. latum. Nucleotide sequence differences between D. latum and the specimens from Koreans represented 17.3% in mitochondrial DNA cox1 gene. Sequence divergence of ITS1 among 4 Korean isolates was 0.3% and similarity was 99.7% with D. nihonkaiense and D. klebanovskii. All of the Korean specimens analyzed in this study were identified as being D. nihonkaiense (n = 62). We propose its Korean name as "Dong-hae-gin-chon-chung" which means 'long tapeworm of the East Sea' for this newly analyzed diphyllobothriid tapeworm in Korea.

Inter- and intra-specific characterization of tapeworms of the genus Diphyllobothrium (Cestoda: Diphyllobothriidea) from Switzerland, using nuclear and mitochondrial DNA targets

Human diphyllobothriosis is caused by at least 14 species of cestodes belonging to the genus Diphyllobothrium. Molecular analysis by sequencing of nuclear and mitochondrial targets identifies some species at inter- and intra-specific level, and helps to reconstruct their phylogenetic relationships. Nevertheless, the suitability of further molecular targets deserves to be widened, and the comparison of samples of different geographical origin could allow their intra-specific characterization, which could also be useful for epidemiological purposes. In this study, we investigated inter- and intra-specific variability among tapeworms of the genus Diphyllobothrium, with focus on Diphyllobothrium latum, originated from Switzerland. Samples were analyzed by comparing the sequences of two nuclear and two mitochondrial DNA targets. We analyzed 27 samples belonging to 4 species (D. latum, Diphyllobothrium nihonkaiense, Diphyllobothrium dendriticum and Diphyllobothrium ditremum), 15 of which isolated from clinical cases (adults and eggs), 2 from wild canines, and 2 from fish of Swiss lakes (plerocercoid larvae); 8 samples of homologous species from other geographic origins were also sequenced and compared with the Swiss ones. Sequences of partial small subunit ribosomal RNA (18S rRNA) gene and partial internal transcribed spacers 1 and 2 (ITS1-2) were not useful even in inter-specific identification, whereas sequences of complete cytochrome c oxidase subunit 1 (cox1) and cytochrome b (cob) genes allowed us to assess inter- and intra-specific variations among the samples. Cox1 and cob could differentiate 3 and 5 haplotypes within the species D. latum. The results are discussed in the light of the anamneses provided by part of the patients.

Diphyllobothriasis associated with eating raw pacific salmon

The incidence of human infection with the broad tapeworm Diphyllobothrium nihonkaiense has been increasing in urban areas of Japan and in European countries. D. nihonkaiense is morphologically similar to but genetically distinct from D. latum and exploits anadromous wild Pacific salmon as its second intermediate host. Clinical signs in humans include diarrhea and discharge of the strobila, which can be as long as 12 m. The natural life history and the geographic range of the tapeworm remain to be elucidated, but recent studies have indicated that the brown bear in the northern territories of the Pacific coast region is its natural final host. A recent surge of clinical cases highlights a change in the epidemiologic trend of this tapeworm disease from one of rural populations to a disease of urban populations worldwide who eat seafood as part of a healthy diet.

Update on the human broad tapeworm (genus diphyllobothrium), including clinical relevance

SUMMARY

Tapeworms (Cestoda) continue to be an important cause of morbidity in humans worldwide. Diphyllobothriosis, a human disease caused by tapeworms of the genus Diphyllobothrium, is the most important fish-borne zoonosis caused by a cestode parasite. Up to 20 million humans are estimated to be infected worldwide. Besides humans, definitive hosts of Diphyllobothrium include piscivorous birds and mammals, which represent a significant zoonotic reservoir. The second intermediate hosts include both freshwater and marine fish, especially anadromous species such as salmonids. The zoonosis occurs most commonly in countries where the consumption of raw or marinated fish is a frequent practice. Due to the increasing popularity of dishes utilizing uncooked fish, numerous cases of human infections have appeared recently, even in the most developed countries. As many as 14 valid species of Diphyllobothrium can cause human diphyllobothriosis, with D. latum and D. nihonkaiense being the most important pathogens. In this paper, all taxa from humans reported are reviewed, with brief information on their life history and their current distribution. Data on diagnostics, epidemiology, clinical relevance, and control of the disease are also summarized. The importance of reliable identification of human-infecting species with molecular tools (sequences of mitochondrial genes) as well as the necessity of epidemiological studies aimed at determining the sources of infections are pointed out.

Diphyllobothriasis nihonkaiense: possibly acquired in Switzerland from imported Pacific salmon

A 5-year-old Japanese boy passed tapeworm strobila while he was living in Switzerland. During a short visit to Japan, he was successfully treated with a single dose of praziquantel. DNA sequences of ITS1, cox1 and nd3 genes from the tapeworm were compatible with those of Diphyllobothrium nihonkaiense rather than Diphyllobothrium latum, which is prevalent in Europe. The patient consumed imported salmon in Switzerland. This case highlights the globalization of D. nihonkaiense, which was once restricted to the Far East, and reflects the worldwide demand for seafood.

Intestinal cestodes

PURPOSE OF REVIEW

This review summarizes the biology, clinical aspects, diagnosis, treatment and epidemiology for the common and rarer (zoonotic) intestinal cestodes of humans.

RECENT FINDINGS

Mass drug application to eliminate Taenia solium carriers may have only temporary effects on cysticercosis transmission. At least two major world genotypes of T. solium have been identified and greater genetic heterogeneity may occur at the regional level. A new human taeniid T. asiatica has been confirmed which occurs sympatrically with T. saginata and T. solium in Southeast Asia. Coproantigen and PCR tests for Taenia spp. have greatly improved diagnostic efficacy and epidemiological studies. There appears to be an increase in human diphyllobothriasis in Europe, Japan and the Americas.

SUMMARY

Human intestinal cestode infections are globally primarily caused by species in three genera: Taenia, Hymenolepis or Diphyllobothrium. Sporadic zoonotic infections caused by nontaeniids are usually food-borne or due to accidental ingestion of invertebrate hosts. Intestinal cestode infections generally result in only mild symptoms characterized chiefly by abdominal discomfort and diarrhoea. Most human intestinal cestode infections can be treated with a single oral dose of praziquantel or niclosamide.

Imported diphyllobothriasis in Switzerland: molecular evidence of Diphyllobothrium dendriticum (Nitsch, 1824)

We report for the first time in Switzerland a clinical case because of Diphyllobothrium dendriticum, identified by molecular methods. We discuss the potential for this imported species to infect local intermediate hosts and thus to achieve autochthonous cyclic transmission.