Page 182 - Medical Parasitology_ A Textbook ( PDFDrive )

14 Case Reports 175

weight loss. Occasionally, infection can cause acute abdominal pain and intestinal
obstruction; rarely cholangitis or cholecystitis may be produced by migrating pro-
glottids. This patient presented with diarrhoea and slight abdominal discomfort.
With globalization, more Malaysians are exposed to different cuisines including
raw fish. Clinicians should be aware of the likelihood of D. latum infection.

Source: Rohela, M., I. Jamaiah, K. W. Chan, and W. S. Yusoff. “Diphyllobothriasis:
The first case report from Malaysia.” The Southeast Asian Journal of Tropical
Medicine and Public Health (2002) Jun; 33(2):229–30.

Case report 2: A 37-year-old Chinese male was seen with a complaint of pass-
ing white flat worms in his stool. He had no abdominal symptoms. He was not
anaemic. The rest of his physical examination was normal. The specimen received
was identified as Diphyllobothrium latum. The diagnosis was confirmed after exam-
ination of the gravid proglottids which came out in chains and the typical oval oper-
culated eggs that were expelled after rupturing the gravid proglottids. The egg
measures 71 μm by 50 μm. The eggs are broadly ovoid, operculated with moder-
ately thick-shelled. The segments or proglottids are greater in breadth than in length.
Laboratory investigations showed a haemoglobin level of 13.3 g/dL, an eosinophil
of 4%, serum vitamin B 12 of 217 pmol/L, and serum folate of 21.4 nmol/L. The
laboratory results were within normal limits. A single dose of praziquantel 10 mg/
kg was given to the patient and discharged. Stool examinations of his family mem-
bers were negative. The patient revealed that he travelled to Thailand quite often and
enjoyed eating raw fish there. In Malaysia, he frequently ate raw fish in Japanese
restaurants and had been consuming raw fish for years.

Source: Rohela M, Jamaiah I, Goh KL, Nissapatorn V. A second case of diphyl-
lobothriasis in Malaysia. The Southeast Asian Journal of Tropical Medicine and
Public Health (2006) Sep; 37(5): 896–8.

Learning Points
1. Being a connoisseur of raw fish is a well-known risk factor for this parasitic
infection.
2. A patient with diphyllobothriasis often remains asymptomatic for a long time.
3. It is necessary to check vitamin B 12 level of infected patients as infection with
this parasite can cause vitamin B 12 deficiency.

Case 18: Liver Cirrhosis and Splenomegaly Associated with Schistosomiasis
mansoni
Case report: A 52-year-old Sudanese woman was admitted with a complaint of left
hypochondrium pain a day prior to admission. She denied fever, jaundice, vomiting,
bleeding tendency, diarrhoea and dysuria. Systemic review was unremarkable. Her
vital signs were normal. There were no stigmata of chronic liver disease and infec-
tive endocarditis. She was anicteric. She had no evidence of skin itching, fever or