Diagnosis and therapy

The diagnosis of Diphyllobothrium infection is based upon detection of the characteristic egg in the stool of the worm carrier. Due to the enormous production of eggs the diagnosis is usually rapid and egg concentrations techniques are usually not needed. There is evidence for short-term periodicity, however, in the egg production by the parasite and the egg release may temporarily cease (Kamo et al. 1986). In suspected cases, therefore, faecal samples should be taken and examined with intervals. As the morphology of the Diphyllobothrium egg is very characteristic, there is no problem with differential diagnosis from other human parasites. It is impossible, however, to distinguish between different Diphyllobothrium species on the basis of egg size and morphology. The tapeworm anaemia is diagnosed from changes in the blood picture and bone marrow. For differential diagnosis genuine pernicious anaemia has to be considered.

Expulsion of the parasite is easily achieved in diphyllobothriasis. Efficient drugs against the parasite, with minor side effects, have been available for decades (desaspidine-derivatives, niclosamide, Praziquantel®, etc.).

Substitution therapy with B12 vitamin is needed in cases with pronounced anaemia.

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