Page 181 - Medical Parasitology_ A Textbook ( PDFDrive )

174 14 Case Reports

similar illness. The specimen passed out by the child was brought along to the clinic.
The attending physician sent it to a private laboratory and the result was reported as
‘normal’. Six weeks later, the child returned with the same complaints and again
another specimen sent for examination came back as ‘normal’. On her third visit, a
similar specimen retrieved from the faeces of the child was sent to a diagnostic labo-
ratory for a second opinion. When the specimen, which looked like proglottids
reached the laboratory, it was ruptured and microscopic examination demonstrated
numerous spherical eggs measuring approximately 76 μm in diameter. The egg had
thick shell with striated outer membrane and thin inner membrane containing 6
hooklets which is distinctive of tapeworm egg with absence of polar filaments.
Although the eggs of Hymenolepis diminuta are similar to H. nana, they can be eas-
ily differentiated as H. nana eggs are smaller (40–60 μm × 30–50 μm) and have 2
evident polar thickenings, from each of which arise 4 to 8 polar filaments. Based on
the bigger egg size and absence of polar filaments, they were identified as H.
diminuta eggs. The infected child was prescribed with a single-dose praziquantel
(20 mg/kg of body weight) and a stool examination carried out 2 weeks after treat-
ment was negative for H. diminuta eggs and at the same time, her symptoms
subsided.

Source: Rohela, M. T., Rl Ngui, Y. A. Lim, B. Kalaichelvan, W. I. Wan Hafiz, and
A. N. Mohd Redzuan. “A case report of Hymenolepis diminuta infection in a
Malaysian child.” Tropical Biomedicine 29, no. 2 (2012): 224–30.

Learning Points
1. Helminthic infections are common among children in rural communities.
2. History of pica should be sought in a child suspected of having helminthic
infection.
3. When there is a high index of suspicion, repeat samples should be sent to the
diagnostic laboratory for species identification so that patient can be given proper
treatment.

Case 17: Diphyllobothriasis
Case report 1: A 62-year-old Chinese male presented with a 4-day history of pass-
ing loose stools with no mucus or blood. The patient had slight abdominal discomfort
and no fever. Clinical examination was normal. Charcoal and imodium tablet were
prescribed. Two days later, the patient passed off white proglottids in his stool which
was sent to the diagnostic laboratory for identification. A diagnosis of
Diphyllobothrium latum was confirmed by examination of the gravid proglottids that
had been expelled with typical operculated eggs seen after rupturing the gravid pro-
glottids. The patient was given 750 mg praziquantel as a single dose. The patient has
been well since his treatment. The patient admitted a fondness for sashimi (Japanese
raw fish) which he ate regularly; none of his dining companions had been unwell.
Even though most cases of D. latum infection are asymptomatic, manifestations
may include transient abdominal discomfort, diarrhoea, vomiting, weakness, and