Alternative Names: Fish tapeworm infection

Causes, incidence, and risk factors:

The fish tapeworm, scientifically named Diphyllobothrium latum, represents one of the giant tapeworm species. Humans become infected when they eat raw or undercooked fish that contain tape worm larvae (sparganum).

The infection is seen in many areas where humans consume uncooked or undercooked fish from rivers or lakes. Diphyllobothriasis is seen in Eastern Europe, North and South America, African countries in which freshwater fish are eaten, and in some Asian countries.

After a person has eaten infected fish, the larva begin to grow in the intestine. The adult worm, which is segmented, may attain a length of 30 feet. Eggs are formed in each segment (proglottid) of the worm and are passed in the stool. Occasionally, a string of proglottids may be passed in the stool.

Fish tapeworm infection may lead to Vitamin B-12 deficiency and the subsequent development of megaloblastic anemia (pernicious anemia ).

Symptoms:

The vast majority of infected individuals have no symptoms. Symptoms seen with heavy infections may include:

• vague abdominal discomfort
• nausea, vomiting, or diarrhea
• loss of appetite and weight loss
• abdominal pain due to intestinal blockage by worms
• individuals with vitamin B-12 deficiency may suffer:
  • fatigue due to anemia
  • numbness and tingling in their limbs
  • confusion or dementia

Signs and tests:

• infected individuals sometimes pass visible segments of worm (proglottids) in stool
• stool smear for tapeworm eggs
• CBC may reveal anemia with large red blood cells (macrocytic anemia)

Treatment:

Niclosamide or praziquantel are given in a single dose to treat the tapeworm infection. Vitamin B-12 injections or supplements may be needed for the treatment of megaloblastic anemia.

Support Groups:

Expectations (prognosis):

Fish tapeworms can be eradicated with a single treatment dose. There are no lasting effects.

Complications:

• megaloblastic anemia
• intestinal blockage by worms

Calling your health care provider:

Call your health care provider if you have noticed a worm or segments of a worm in the stool. Also call if any family members have symptoms suggestive of pernicious anemia.

Prevention:

Avoiding raw freshwater fish and cooking fish sufficiently will prevent infection with the fish tapeworm.