Diphyllobothriasis laboratory tests: Difference between revisions

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==Overview==
==Overview==
Diphyllobothriasis can be diagnosed with the morphological identification of ''[[diphyllobothrium]]'' eggs and adults in the stool exam. Molecular diagnosis can also be made with the [[PCR]]. Blood tests may show megaloblastic anemia, eosinophilia, and low vitamin B12 level.
Diphyllobothriasis can be diagnosed with the morphological identification of [[Diphyllobothrium]] eggs and adults in the stool exam. Molecular diagnosis can also be made with the [[PCR]]. Blood tests may show [[Macrocytic anemia|megaloblastic anemia]], [[eosinophilia]], and [[Vitamin B12 deficiency|low vitamin B12 level]].


==Laboratory Findings==
==Laboratory Findings==
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Microscopic identification of eggs in the stool [[Stool examination|(stool examination)]] is the basis of specific diagnosis. Eggs are usually numerous and can be demonstrated without concentration techniques.  Examination of [[Proglottid|proglottids]] passed in the stool is also of diagnostic value.<ref name="pmid19136438">{{cite journal |vauthors=Scholz T, Garcia HH, Kuchta R, Wicht B |title=Update on the human broad tapeworm (genus diphyllobothrium), including clinical relevance |journal=Clin. Microbiol. Rev. |volume=22 |issue=1 |pages=146–60, Table of Contents |year=2009 |pmid=19136438 |pmc=2620636 |doi=10.1128/CMR.00033-08 |url=}}</ref><ref name="pmid24386497">{{cite journal |vauthors=Kuchta R, Brabec J, Kubáčková P, Scholz T |title=Tapeworm Diphyllobothrium dendriticum (Cestoda)--neglected or emerging human parasite? |journal=PLoS Negl Trop Dis |volume=7 |issue=12 |pages=e2535 |year=2013 |pmid=24386497 |pmc=3873255 |doi=10.1371/journal.pntd.0002535 |url=}}</ref><ref name="Medical microbiology">{{cite book | last = Baron | first = Samuel | title = Medical microbiology | publisher = University of Texas Medical Branch at Galveston | location = Galveston, Tex | year = 1996 | isbn = 0-9631172-1-1 }}</ref>
Microscopic identification of eggs in the stool [[Stool examination|(stool examination)]] is the basis of specific diagnosis. Eggs are usually numerous and can be demonstrated without concentration techniques.  Examination of [[Proglottid|proglottids]] passed in the stool is also of diagnostic value.<ref name="pmid19136438">{{cite journal |vauthors=Scholz T, Garcia HH, Kuchta R, Wicht B |title=Update on the human broad tapeworm (genus diphyllobothrium), including clinical relevance |journal=Clin. Microbiol. Rev. |volume=22 |issue=1 |pages=146–60, Table of Contents |year=2009 |pmid=19136438 |pmc=2620636 |doi=10.1128/CMR.00033-08 |url=}}</ref><ref name="pmid24386497">{{cite journal |vauthors=Kuchta R, Brabec J, Kubáčková P, Scholz T |title=Tapeworm Diphyllobothrium dendriticum (Cestoda)--neglected or emerging human parasite? |journal=PLoS Negl Trop Dis |volume=7 |issue=12 |pages=e2535 |year=2013 |pmid=24386497 |pmc=3873255 |doi=10.1371/journal.pntd.0002535 |url=}}</ref><ref name="Medical microbiology">{{cite book | last = Baron | first = Samuel | title = Medical microbiology | publisher = University of Texas Medical Branch at Galveston | location = Galveston, Tex | year = 1996 | isbn = 0-9631172-1-1 }}</ref>
====Eggs:====
====Eggs:====
*[[Diphyllobothrium]] sp. eggs are oval or ellipsoidal and range in size from 55 to 75 µm by 40 to 50 µm.  
*[[Diphyllobothrium|Diphyllobothrium]] sp. eggs are oval or ellipsoidal and range in size from 55 to 75 µm by 40 to 50 µm.  
*There is an operculum at one end that can be inconspicuous, and at the opposite (abopercular) end is a small knob that can be barely discernible.  
*There is an operculum at one end that can be inconspicuous, and at the opposite (abopercular) end is a small knob that can be barely discernible.  
*The eggs are passed in the stool un-embryonated.
*The eggs are passed in the [[stool]] un-embryonated.


====Adults:====
====Adults:====
*Adults of [[Diphyllobothrium]] sp. ranges from 3-12 meters in length.   
*Adults of [[Diphyllobothrium|Diphyllobothrium]] sp. ranges from 3-12 meters in length.   
*The scolex is elongated, 1mm by 3mm, with two shallow, longitudinal grooves. As proglottids mature, they may break off from the stroblia, in lengths containing few to many segments.   
*The scolex is elongated, 1mm by 3mm, with two shallow, longitudinal grooves. As proglottids mature, they may break off from the stroblia, in lengths containing few to many segments.   
*Proglottids are broader than they are long and range from 2 to 4 mm long by 10 to 12 mm wide.   
*Proglottids are broader than they are long and range from 2 to 4 mm long by 10 to 12 mm wide.   
*The uterus is coiled in rosette appearance and the genital pore is at the center of the proglottid.
*The uterus is coiled in rosette appearance and the genital pore is at the center of the [[proglottid]].


===Molecular Diagnosis===
===Molecular Diagnosis===
Molecular diagnosis of [[diphyllobothriasis]] is based on the identification of nucleotide sequences on cox-1 gene. It is the sensitive method to identify the [[Diphyllobothrium]] to the species level. PCR is used to amplify the sequences for the diagnosis of [[diphyllobothriasis]].<ref name="pmid24386497">{{cite journal |vauthors=Kuchta R, Brabec J, Kubáčková P, Scholz T |title=Tapeworm Diphyllobothrium dendriticum (Cestoda)--neglected or emerging human parasite? |journal=PLoS Negl Trop Dis |volume=7 |issue=12 |pages=e2535 |year=2013 |pmid=24386497 |pmc=3873255 |doi=10.1371/journal.pntd.0002535 |url=}}</ref>
Molecular diagnosis of [[diphyllobothriasis]] is based on the identification of nucleotide sequences on cox-1 gene. It is the sensitive method to identify the [[Diphyllobothrium|''Diphyllobothrium'']] to the species level. [[PCR]] is used to amplify the sequences for the diagnosis of [[diphyllobothriasis]].<ref name="pmid24386497">{{cite journal |vauthors=Kuchta R, Brabec J, Kubáčková P, Scholz T |title=Tapeworm Diphyllobothrium dendriticum (Cestoda)--neglected or emerging human parasite? |journal=PLoS Negl Trop Dis |volume=7 |issue=12 |pages=e2535 |year=2013 |pmid=24386497 |pmc=3873255 |doi=10.1371/journal.pntd.0002535 |url=}}</ref>


===Blood tests===
===Blood tests===
Blood tests usually show:
Blood tests usually show:
*Megaloblastic anemia
*[[Macrocytic anemia|Megaloblastic anemia]]
*Low Vitamin B12 level
*[[Vitamin B12 deficiency|Low Vitamin B12 level]]
*Eosinophilia
*[[Eosinophilia]]


===Images===
===Images===
<gallery>
<gallery>
Image:D latum CAP1.jpg|Egg of Diphyllobothrium latum with an operculum.
Image:D latum CAP1.jpg|Egg of Diphyllobothrium latum with an operculum.<SMALL><SMALL> '''Source:''' https://www.cdc.gov/dpdx/diphyllobothriasis/index.html </SMALL></SMALL>
Image:Pinworms in the Appendix (1).jpg|Pinworms are sometimes diagnosed incidentally by [[pathology]]. [[Micrograph]] of pinworms in the [[vermiform appendix|appendix]]. [[H&E stain]].
Image:Pinworms in the Appendix (1).jpg|center|thumb|250px|Pinworms are sometimes diagnosed incidentally by [[pathology]]. [[Micrograph]] of pinworms in the [[vermiform appendix|appendix]]. [[H&E stain]].<SMALL><SMALL>('''By Ed Uthman, MD''' - http://www.flickr.com/photos/euthman/2395977781/, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=3850238)</SMALL></SMALL>
Image:Dlatum proglottid FL 1.jpg|Proglottids and the rosette-shaped uterus at the center of each proglottid.
Image:Dlatum proglottid FL 1.jpg|center|thumb|250px|Proglottids and the rosette-shaped uterus at the center of each proglottid.<SMALL><SMALL> '''Source:''' https://www.cdc.gov/dpdx/diphyllobothriasis/index.html </SMALL></SMALL>
Image:Dlatum whole worm FL.jpg|Adult D. latum containing many proglottids (Image courtesy of the Florida State Public Health Laboratory).
Image:Dlatum whole worm FL.jpg|center|thumb|250px|Adult D. latum containing many proglottids.<SMALL><SMALL> '''Source:''' https://www.cdc.gov/dpdx/diphyllobothriasis/index.html (Image courtesy of the Florida State Public Health Laboratory). </SMALL></SMALL>
Image:Dlatum proglottid.jpg|Carmine-stained proglottids of D. latum, showing the rosette-shaped ovaries.
Image:Dlatum proglottid.jpg|center|thumb|250px|Carmine-stained proglottids of D. latum, showing the rosette-shaped ovaries.<SMALL><SMALL> '''Source:''' https://www.cdc.gov/dpdx/diphyllobothriasis/index.html </SMALL></SMALL>
Image:Dlatum proglottid2.jpg|Carmine-stained proglottids of D. latum, showing the rosette-shaped ovaries.
Image:Dlatum proglottid2.jpg|center|thumb|250px|Carmine-stained proglottids of D. latum, showing the rosette-shaped ovaries. <SMALL><SMALL> '''Source:''' https://www.cdc.gov/dpdx/diphyllobothriasis/index.html </SMALL></SMALL>


</gallery>
</gallery>
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
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{{WS}}


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Latest revision as of 21:24, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Diphyllobothriasis can be diagnosed with the morphological identification of Diphyllobothrium eggs and adults in the stool exam. Molecular diagnosis can also be made with the PCR. Blood tests may show megaloblastic anemia, eosinophilia, and low vitamin B12 level.

Laboratory Findings

Eosinophilia may develop in the early stages of worm growth but the diagnosis is made by microscopy and molecular techniques.

Microscopy

Microscopic identification of eggs in the stool (stool examination) is the basis of specific diagnosis. Eggs are usually numerous and can be demonstrated without concentration techniques. Examination of proglottids passed in the stool is also of diagnostic value.[1][2][3]

Eggs:

  • Diphyllobothrium sp. eggs are oval or ellipsoidal and range in size from 55 to 75 µm by 40 to 50 µm.
  • There is an operculum at one end that can be inconspicuous, and at the opposite (abopercular) end is a small knob that can be barely discernible.
  • The eggs are passed in the stool un-embryonated.

Adults:

  • Adults of Diphyllobothrium sp. ranges from 3-12 meters in length.
  • The scolex is elongated, 1mm by 3mm, with two shallow, longitudinal grooves. As proglottids mature, they may break off from the stroblia, in lengths containing few to many segments.
  • Proglottids are broader than they are long and range from 2 to 4 mm long by 10 to 12 mm wide.
  • The uterus is coiled in rosette appearance and the genital pore is at the center of the proglottid.

Molecular Diagnosis

Molecular diagnosis of diphyllobothriasis is based on the identification of nucleotide sequences on cox-1 gene. It is the sensitive method to identify the Diphyllobothrium to the species level. PCR is used to amplify the sequences for the diagnosis of diphyllobothriasis.[2]

Blood tests

Blood tests usually show:

Images

References

  1. ↑ Scholz T, Garcia HH, Kuchta R, Wicht B (2009). "Update on the human broad tapeworm (genus diphyllobothrium), including clinical relevance". Clin. Microbiol. Rev. 22 (1): 146–60, Table of Contents. doi:10.1128/CMR.00033-08. PMC 2620636. PMID 19136438.
  2. ↑ 2.0 2.1 Kuchta R, Brabec J, Kubáčková P, Scholz T (2013). "Tapeworm Diphyllobothrium dendriticum (Cestoda)--neglected or emerging human parasite?". PLoS Negl Trop Dis. 7 (12): e2535. doi:10.1371/journal.pntd.0002535. PMC 3873255. PMID 24386497.
  3. ↑ Baron, Samuel (1996). Medical microbiology. Galveston, Tex: University of Texas Medical Branch at Galveston. ISBN 0-9631172-1-1.

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