History

Fact Explanation
Abdominal pain Dipylidiasis is a common tapeworm (cestode) infection of dogs and cats caused by Dipylidium caninum. Dipylidiasis is a proved zoonosis. Humans are occasional hosts. The disease has a worldwide distribution and it is common among children who plays with pet cats and dogs often. Human infection is usually accidentally occurs by swallowing adult fleas who are infested with Dipylidium caninum cysticercoids (larva). Patients are usually asymptomatic. Symptoms of dipylidiasis are related to the worm burden. Abdominal pain may attributed to the trauma caused by adult worm to the intestinal wall. Rarely, patients may develop intestinal obstruction with severe mechanical occlusion of the lumen. In such cases severe abdominal pain in the periumbilical area. [1,2,3,4,5,6]
Diarrhea Diarrhea is insidious and watery in type. This is not very common compared to abdominal pain. Diarrhea may be accompanied with nausea, vomiting and loss of appetite. [2,4,6]
Restlessness at night Migration of gravid segments to the perianal region causes restlessness and pruritus ani at night. [2,3,4]
Itchy rash Generalized toxic and allergic reactions causes red, itchy, raised areas of skin that appear in varying shapes and sizes. [1,2]
References
  1. NARASIMHAM MV, PANDA P, MOHANTY I, SAHU S, PADHI S, DASH M. Dipylidium caninum infection in a child: a rare case report. Indian J Med Microbiol [online] 2013 Jan-Mar, 31(1):82-4 [viewed 31 July 2014] Available from: doi:10.4103/0255-0857.108738
  2. MIN DY. Cestode infections in Korea. Kisaengchunghak Chapchi [online] 1990 Dec:123-44 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2133417
  3. CABELLO RR, RUIZ AC, FEREGRINO RR, ROMERO LC, FEREGRINO RR, ZAVALA JT. Dipylidium caninum infection. BMJ Case Rep [online] 2011 Nov 15 [viewed 31 July 2014] Available from: doi:10.1136/bcr.07.2011.4510
  4. WONG MH. Multiple infestation with Dipylidium caninum in an infant. Can Med Assoc J [online] 1955 Mar 15, 72(6):453-5 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14352116
  5. BUDKE CM, WHITE AC JR, GARCIA HH. Zoonotic larval cestode infections: neglected, neglected tropical diseases? PLoS Negl Trop Dis [online] 2009, 3(2):e319 [viewed 31 July 2014] Available from: doi:10.1371/journal.pntd.0000319
  6. ESLAMI A, RANJBAR-BAHADORI SH, MESHGI B, DEHGHAN M, BOKAIE S. Helminth infections of stray dogs from garmsar, semnan province, central iran. Iran J Parasitol [online] 2010 Dec, 5(4):37-41 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22347264

Examination

Fact Explanation
Stool examination Direct examination of the stools may help to observe white motile segments of Proglottids of Dipylidium caninum. Examination of the peri anal area may also useful as segments can be found as they crawl out of the anus. These are important findings in terms of diagnosis. [1,2,3]
Abdominal tenderness This may or may not be demonstrated in the epigastric region and is due to local allergic reaction of the intestine. [2,3]
Urticaria Red, itchy raised areas (hives) occur all over the body due to allergy. [1,2]
References
  1. NARASIMHAM MV, PANDA P, MOHANTY I, SAHU S, PADHI S, DASH M. Dipylidium caninum infection in a child: a rare case report. Indian J Med Microbiol [online] 2013 Jan-Mar, 31(1):82-4 [viewed 31 July 2014] Available from: doi:10.4103/0255-0857.108738
  2. BUDKE CM, WHITE AC JR, GARCIA HH. Zoonotic larval cestode infections: neglected, neglected tropical diseases? PLoS Negl Trop Dis [online] 2009, 3(2):e319 [viewed 31 July 2014] Available from: doi:10.1371/journal.pntd.0000319
  3. ESLAMI A, RANJBAR-BAHADORI SH, MESHGI B, DEHGHAN M, BOKAIE S. Helminth infections of stray dogs from garmsar, semnan province, central iran. Iran J Parasitol [online] 2010 Dec, 5(4):37-41 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22347264

Differential Diagnoses

Fact Explanation
Gastroenteritis Viral gastroenteritis is the most common cause of watery diarrhea.It is associated with abdominal pain,nausea and vomiting. Bacterial gastroenteritis usually results in watery diarrhea and sometimes blood and mucous diarrhea.Dehydration is common . Bacterial disease responds to antibacterial agents. [1]
Hymenolepiasis Hymenolepiasis is caused by cestodes called Hymenolepis nana (dwarf tapeworm) and Hymenolepis diminuta (rat tapeworm). H.diminuta rarely cause human infestation while H. nana causes most of Hymenolepiasis cases. It is commonly found in warm countries in Africa, South America, Asia and Europe. Humans become infected with H. nana by ingesting infective eggs, most commonly through fecal-oral exposure. Patients present with abdominal pain, diarrhea and urticarial. [2]
Diphyllobothriasis Diphyllobothriasis is the infection caused by the tapeworm Diphyllobothrium. Diphyllobothriasis can last for decades if untreated. Most infections are asymptomatic. Manifestations may include abdominal discomfort, diarrhea, vomiting and weight loss. Vitamin B12 deficiency with subsequent megaloblastic anemia may occur. [3]
Ascariasis Ascariasis is caused by Ascaris lumbricoides (large roundworm of humans) It is extremely common infection worldwide and associated with poor sanitation (lack of latrines) in slum areas and estate line rooms. Ascariasis affects more in children than in adults. Mild infection of adult worms does not show symptoms or signs. Increasing worm loads result in worsening of chronic malnutrition especially in children with a poor diet, poor weight gain and stunting. Symptoms may include shortness of breath and fever in the beginning of the disease. These may be followed by symptoms of abdominal swelling, abdominal pain and diarrhea. [4]
References
  1. GODANA W, MENGISTIE B. Determinants of acute diarrhoea among children under five years of age in Derashe District, Southern Ethiopia. Rural Remote Health [online] 2013, 13(3):2329 [viewed 27 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24016301
  2. ROHELA M, NGUI R, LIM YA, KALAICHELVAN B, WAN HAFIZ WI, MOHD REDZUAN AN. A case report of Hymenolepis diminuta infection in a Malaysian child. Trop Biomed [online] 2012 Jun, 29(2):224-30 [viewed 28 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22735844
  3. NAKAJI K, NAKAE Y, KUMAMOTO M, SUZUMURA S. Diphyllobothriasis. Intern Med [online] 2009, 48(16):1479 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19687603
  4. WANG J, PAN YL, XIE Y, WU KC, GUO XG. Biliary ascariasis in a bile duct stones-removed female patient. World J Gastroenterol [online] 2013 Sep 28, 19(36):6122-4 [viewed 27 July 2014] Available from: doi:10.3748/wjg.v19.i36.6122

Investigations - for Diagnosis

Fact Explanation
Full blood count Parasitic infestation is characterized by high degree of eosinophilia in half of the cases. [1,2]
Microscopic stool examination Stool specimen examination may show the characteristic egg packets and proglottids of Dipylidium caninum. [1,2,3]
References
  1. NARASIMHAM MV, PANDA P, MOHANTY I, SAHU S, PADHI S, DASH M. Dipylidium caninum infection in a child: a rare case report. Indian J Med Microbiol [online] 2013 Jan-Mar, 31(1):82-4 [viewed 31 July 2014] Available from: doi:10.4103/0255-0857.108738
  2. MIN DY. Cestode infections in Korea. Kisaengchunghak Chapchi [online] 1990 Dec:123-44 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2133417
  3. CABELLO RR, RUIZ AC, FEREGRINO RR, ROMERO LC, FEREGRINO RR, ZAVALA JT. Dipylidium caninum infection. BMJ Case Rep [online] 2011 Nov 15 [viewed 31 July 2014] Available from: doi:10.1136/bcr.07.2011.4510

Management - General Measures

Fact Explanation
Prevention Regular de-worming and insecticidal treatment of pets and restriction of fondling of pets by children are important preventive measures. [1,2]
References
  1. CABELLO RR, RUIZ AC, FEREGRINO RR, ROMERO LC, FEREGRINO RR, ZAVALA JT. Dipylidium caninum infection. BMJ Case Rep [online] 2011 Nov 15 [viewed 31 July 2014] Available from: doi:10.1136/bcr.07.2011.4510
  2. WONG MH. Multiple infestation with Dipylidium caninum in an infant. Can Med Assoc J [online] 1955 Mar 15, 72(6):453-5 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14352116

Management - Specific Treatments

Fact Explanation
Praziquantel Single dose of 10-20 mg/kg after a light breakfast is recommended. Frequently occurring side effects are dizziness, headache, and malaise. Approximately 90% of all patients have abdominal pain or cramps with or without nausea and vomiting. [1,2,3]
Niclosamide Niclosamide should be chewed thoroughly and be taken with water. 2g for adults as a single dose after a light breakfast is recommended. Dosage for children up to 2 years is 500mg and 1g for those between 3 to 6 years. Other drug are not effective. [1,2,3]
References
  1. WONG MH. Multiple infestation with Dipylidium caninum in an infant. Can Med Assoc J [online] 1955 Mar 15, 72(6):453-5 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/14352116
  2. ESLAMI A, RANJBAR-BAHADORI SH, MESHGI B, DEHGHAN M, BOKAIE S. Helminth infections of stray dogs from garmsar, semnan province, central iran. Iran J Parasitol [online] 2010 Dec, 5(4):37-41 [viewed 31 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22347264
  3. BUDKE CM, WHITE AC JR, GARCIA HH. Zoonotic larval cestode infections: neglected, neglected tropical diseases? PLoS Negl Trop Dis [online] 2009, 3(2):e319 [viewed 31 July 2014] Available from: doi:10.1371/journal.pntd.0000319