Вы находитесь на странице: 1из 11

Rhianna Pedwell 42370730 1.#Classification## ! Phylum!Platyhelminthes! Class!Cestoidea/Cestoda! Subclass!Eucestoda! Order!Pseudophyllidea!! Family!Diphyllobothriidae! Genus!Diphyllobothrium! =!important!species!in!order!is!Diphyllobothrium!latum! =!others!include!D.!dendriticum,!D.!nihokaiense,!D.!ditremum! =!rare!ones!include!D.!monsoides/erinacei! ! 2.#Morphology## =!adult!worm!appearance!flat!or!described!also!as!ribbon=like!

=like! =!length!highly!variable! =!up!to!30m!recorded! =!usually!from!2=30!m! =!one!smaller!species!D.!datum!only!60!cm! =!able!to!live!for!years!in!human!host! ! scolex! ! =!anterior!end!or!head! ! =!two!bothria!1=2mm!long! ! =!used!to!attach!to!gut!mucosa!! ! =!attachment!is!a!weak!sucking!one! ! neck! ! =!follows!the!scolex! ! =!made!of!undifferentiated!stem!cells! ! proglottids! ! =!also!called!segments! ! =!are!between!2=7mm!wide!by!10=12mm!long! ! =!adults!can!have!up!to!4000! ! =!because!there!are!multiple!proglottids,!the!worm!is!called!polyzoic! ! =!the!proglottid!chain!is!called!the!strobila! ! =!actually!continuous;!muscle!and!tegument! ! ! ! ! ! ! =!each!proglottid!is!hermaphroditic! ! ! =!distinguishing!uterine!pore! ! ! =!there!is!no!digestive!tract! =!relies!on!host!to!digest!food!! ! ! =!worm!has!tegument! ! ! =!nutrient!exchange!passes!over!tegument! ! ! =!tegument!covered!with!tiny!micotriches! ! ! =!function!like!that!of!villi! ! ! =!coated!in!glyocalyx!tip!for!binding!specific!molecules! ! ! =!digestion!is!mainly!anaerobic! ! ! =!the!muscle!layer!is!found!under!the!tegument! ! ! =!new!proglottids!develop!from!the!neck! ! ! =!older!proglottids!mature!along!the!strobila! ! ! =!eventually!fill!with!eggs,!mature!and!gravid! ! ! =!will!then!detach!and!be!eliminated!! ! =!eggs!are!released!form!uterine!pore!of!gravid!segments! =!up!to!1million!a!day!possible!

Rhianna Pedwell 27/10/13 11:06 AM Comment [1]: This!assignment!was!a! literature!review,!where!no!in=text! referencing!was!required.!After!initial! research!I!created!this!dot6point#plan!for! the!information!in!each!paragraph.!!

Rhianna Pedwell 27/10/13 11:15 AM Comment [2]: The!plan!is!organised!into! the!sub=sections!outlined!in!the!criteria.!

Rhianna Pedwell 27/10/13 11:16 AM Comment [3]: Within!each!outline,!sub! headings!are!used!to!organise!the!important! information!about!a!particular!detail.!!


Rhianna Pedwell 42370730 =!anapolysis!occurs!where!the!gravid!segments!discharge!eggs!and!then!detach! =!eggs!yellowish=brown,!operculate!and!with!a!small!knob!at!the!end!opposite!to! the!operculum!which!is!a!knob!or!lid=like!form!!! =!are!nonembryonated!when!laid!! =!they!are!35=80um!long,!and!25=65um!wide!!species!dependant!! =!coracidium!hatches!from!the!egg,!the!embryo! ! =!called!an!oncoshpere! ! =!ciliated!! ! =!has!6!hooks!on!scolex! =!proceroid!! =!05mm!long! ! =!elongated!! ! =!mainly!parenchyma!tissue!no!real!form! ! =!distinguished!by!a!cercomer!on!the!anterior!end! ! =!this!is!where!the!6!hooks!now!found! ! =!hooks!temporary! =!pleroceroid! ! =!the!larva!is!wormlike! ! =!can!be!between!5=20cm!long!depending!on!species! =! D.! latum! usually! less! than! 5cm,! while! D.! dendtriticum! is! usually! twice! this! length,!10=12cm! ! =!scolex!appears!closest!to!adult! =! species! difference! in! proceroids! and! pleroceroids! morphology! difficult! to! differentiate! ! 3.!Host#Range! ! =!first!intermediate!hosts!! =!these!are!planktonic!crustaceans! ! copepod!species! ! =!are!Diaptomus!or!Cyclopes! ! =!over!40!species!are!involved!plus!several!genus! =!second!intermediate!hosts!! =!these!are!fish!that!eat!the!copepod! =!in!rare!cases!a!paratenic!host!that!is!a!carnivourous!predatory!fish!that!eats!the!initial!2nd! ! D.!latum! ! ! Holarctic!or!Freshwater!predatory!fish! ! ! Pike,! Perch! and! Burbot! species! (Eso! Lucius,! Peca! fluviatilis,! Lota! lota),! pikeperch!and!walleye!in!America!too! In! Europe! found! in! cold! lakes! and! rivers! e.g.! Poland,! Estonia,! Russia! and! once!prominent!in!Finland/Scandinavia! Some!cases!known!in!Italy,!Switzerland!! Not!reported!in!Africa!or!Australia! Thought!that!immigration!brought!it!to!South!America!in!Argentina!or!Chile! ! D.!dendtriticum! Salmonid!Coregonidae!type!fish! ! ! Very!similar!to!D.!latum!incl!immigration! Found! in! the! Great! Lakes! area! in! Northern! America,! Canada! and! Alaska! more! so! than!latum! ! ! ! D.!nihokaiense! Samonid! fish! that! are! andromous,! their! life! cycle! includes! fresh! and! saltwater!environments! ! ! Onchorynchus!species,!e.g.!

Rhianna Pedwell 26/10/13 11:54 PM Comment [4]: The!points!are!roughly! what!the!sentence!of!the!completed!work! sounded!like.!!


Rhianna Pedwell 42370730 ! ! North!Pacific!Ocean!region!most!common! ! ! Mainly!in!Asia;!Japan,!Russia,!China,!Korea!thought!Japan!is!where!it!is!most! at! =!definitive!hosts! =!all!of!these!species!infect!humans!but!these!are!not!the!only!definitive!hosts!known! D.!latum! =!most!important!human!tapeworm!infection! ! D.!dendtriticum! ! =!also!infects!humans!and!other!fish0eating!or!piscovourous!mamals!like!bears,!dogs,! fozes!and!also!birds!such!as!gulls! ! D.!nihokaiense! ! =!a!parasite!of!humans!and!brown!bears! =!D.!monsoides/erinacei! ! these!are!rarer!and!are!more!known!for!causing!sparganosis! ! they!are!found!in!frogs!or!snakes,!and!cats!respectively! ! 4.#Site#of#Infection## # =!in!humans! ! the!normal!place! ! =!worm!will!attach!to!the!mucosa!of!the!small!intestine! ! =!usually!the!ileum!but!also!the!jejunum! ! =!rarely!it!will!attach!to!a!bile!duct! ! the!abnormal!place! ! ! D.!monsoides/erinacei! =!pleroceroids!of!these!species!migrate!under!the!skin!and!can!find!their!way! into!tissues!including!the!eyes! ! 5.#Pathogenesis! # =!Diphyllobothriasisis!main!outcome!of!infection! ! symptoms! ! =!nonspecific!or!absent! ! =!mild!symptoms!include!abbominal!pain,!anorexia!or!weight!loss,!diarrhoea!! =!rarely!a!multiple!infection!can!cause!obstruction!in!the!intestines! =!if!lodged!in!the!jejunum!vomiting!can!result! 6#Pernicious#Anemia# 6#also#called#megablastic#anemia## 6#major#health#problem#in#Finland#for#many#years# # cause# # 6#gradual#onset#as#the#tapeworm#absorbs#vitamin#b12#from#the#host# # 6#the#higher#position#of#the#worm#in#the#jejunum#may#be#the#cause# # 6#also#thought#to#be#a#possibly#genetic#factor#concerning#an#instrinsic#factor#in# the#gut## =!Sparganosis! ! =! larval! forms! of! D.! monsoides! or! D.! erinacei! are! responsible! for! subcutaneous! bulges!indicating!presence!of!parasite!laravla! ! =!here!it!can!cause!inflammation,!unitcaria!and!painful!edema,!fibrosis!! ! =!in!eyes,!swelling!of!eye!or!eyelid!and!ulcers! ! =!the!pleroceroid!mimics!human!growth!factor!hormone!to!allow!its!migration! ! =!but!the!larva!can!live!in!the!tissues!for!extended!periods!of!time! ! =!sometimes!the!infected!tissue!can!be!severly!damaged! ! 6.#Transmission#


Rhianna Pedwell 42370730 # =!life!cycle! =! Diphyllobothrium! relies! on! a! first! and! second! intermediate! host,! as! well! as! an! aquatic! environment!to!complete!its!life!cycle!in!addition!to!the!definitive!host!where!it!reproduces! ! eggs! ! ! transmission/develop!(T)! ! ! =!eggs!are!passed!in!the!faeces!of!the!definitive!host! =! after! 12! days! to! 2! weeks! in! a! suitably! fresh,! aquatic! environment! ! an! embryo!hatches! ! ! coracidium! ! ! ! in!water/in!host! ! ! ! =!these!can!only!live,!swimming,!in!the!water!for!2!days!! =!it!must!be!consumed!within!2!days!by!the!1st!intermediate!copepod! host! ! proceroid! ! ! transmission/develop!(T)! ! ! =!the!coracidium!is!ingested!by!the!copepod! =!over!the!next!2=3!weeks,!it!will!burrow!through!the!intestinal!tract!of!the! crustacean! =!here!it!matures!into!the!proceroid! =!here,!if!the!sopepod!is!accidentally!ingest!by!the!definitive!host,!there!is!a!risk!for! developing!sparganosis! ! pleroceroid! =! onece! the! proceroid=infected! copepod! is! ingested! by! the! 2nd! intermediate! fish!host!and!within!4!hours!of!this! =!again!it!burrows!through!the!intestinal!tract!to!mature!to!the!pleroceroid! =!from!here!it!forms!a!cyst!in!the!tissue!and!can!remain!there!for!the!lifetime! of!the!fish! =!it!does!take!3=5!weeks!to!be!mature!enough!to!infect!the!definitive!host! =! sometimes,! a! paratenic! host! will! be! responsible! for! this! transmission!where!the!freshwater!fish!is!eaten!by!another!fish! =! often! these! paratenic! fish! are! the! ones! commonly! consumed! by! humans!aka!food!fishes! ! adult! =!once!infected!tissue!is!consumed!by!a!human,!the!pleroceroid!matures!and!begins! the!production!of!proglottids!in!the!small!intestine!(strobilation)! ! ! maturation! ! ! ! egg!production! ! ! ! the!proglottids!mature!to!gravid!and!release!eggs! =! the! eggs! in! faeces! can! transmit! to! the! copepod! through! sewage! contamination! of! freshwater! =!the!fish!containing!the!pleroceroid!cysts!are!transmitted!most!commonly!through!raw!or! parcooked!fish,!often!in!cultural!dishes! =!these!include!most!commonly!sushi!and!sashimi!in!Japan,!!ceviche!in!Latin!America,!and! similar!raw,!flavoured!slices!of!fish!in!Italy!(carpaccio),!Scandinavia!in!Europe! =!however,!smoked!and!pickled!fish,!or!fish!that!is!improperly!cooked!can!also!transmit!the! parasite! =! consumption! of! the! D.! monsoides! pleroceroid! or! direct! application! of! the! frog! or! snake! flesh!to!an!open!wound!or!orifice!can!transmit!the!sparganum! ! 7.#Differential#Diagnosis! ! =! the! symptoms! of! Diphyllobothrium! infection! being! nonspecific! often! mean! that! the! infections!go!undiagnosed!


Rhianna Pedwell 42370730 =!physiology! =! if! segments! or! parts! of! the! worm! begin! to! be! evacuated! with! the! faeces,! it! can! cause! distress!! ! eggs! ! =!are!a!good!diagnostic!tool!for!general!infection,!found!in!faeces! ! =!they!can!also!be!used!to!differentiate!species!! ! pleroceroids! ! =!D.!latum!and!D.!dentriticum!can!be!differentiated!if!found!in!the!source!fish! ! =! the! surface;! smooth! or! wrinkled,! and! length! of! micotriches! can! help! distinguish! them! ! challenges! =!clearly!this!does!not!help!the!patient!who!is!currently!infected!with!tehe!adult!of! these!species! ! ! morpho!similarity/trema! ! ! =! trematodes! can! add! a! confusion! to! diagnosis! due! to! similarity! of! some! stages! ! ! =!in!fact,!differentiating!species!based!on!morphology!is!a!real!challenge! =!three!species,!D.!latum,!dentriticum!and!a!third!ditremum!are!believed!to! make!up!a!clade! =! in! areas! where! a! case! or! outbreak! occurs! where! not! usually! endemic,! diagnosing!the!species!is!especially!important;!the!genus!is!not!enough! =!molecular/genetics! ! success!in!differentiation! ! =!use!of!RFLP!has!been!successful!in!differentiating!D.!latum!and!nihokaiense!! =!two!mitochondrial!genes!are!identified!as!genetic!markers!for!distinguishing!these! species! =! the! nad3! but! particularly! cox1! genes! (higher! mutation! rate)! are! such! diagnostic! markers! ! 8.#Treatment#and#Control! it!is!agreed!that!interruption!of!the!life!cycle!at!almost!any!stage!is!the!bet!way!to!control! the!parasite,!and!there!are!several!strategies!for!this! ! =! sewage! treatment! is! a! good! way! to! prevent! this! and! has! already! shown! to! be! effective! ! =!this!stops!the!life!cycle!at!the!egg!stage,!as!Diphyllobothria!require!a!definitive!host! drugs!that!target!adult!worms!in!infected!humans!include! praziquantel! =!see!written!notes! ! ! ! ! ! !


Rhianna Pedwell 42370730

Parasitology Pages: Diphyllobothrium 1. Classification Diphyllobothrium spp. are flatworms of the Phylum Platyhelminthes, Class Cestoda and Subclass Eucestoda. In the Order Pseudophyllidea, the Diphyllobothriidae Family includes several species of Genus Diphyllobothrium. From a human health perspective, the most important species is Diphyllobothrium latum (D. latum). Other species that commonly cause disease in humans include Diphyllobothrium dendtriticum (D. dendtriticum) and Diphyllobothrium nihokaiense (D. nihokaiense). Species also known to be human pathogens are Diphyllobothrium monsoides (D. monsoides) or Diphyllobothrium erinacei (D. erinacei), and Diphyllobothrium pacificum (D. pacificum). Several other species with non-human definitive hosts exist, and are not known to regularly infect humans. 2. Morphology Adult flatworms are described as having a ribbon-like appearance. Their length is variable between species, between <2-30m recorded. These parasites can live in the host for years. Adults utilise the anterior scolex organ to attach, weakly, to gut mucosa using two 1-2mm bothria. Following the scolex is a neck region, where stem cells develop into proglottids or segments. These form the body or strobila, and each proglottid is 2-7mm wide, and 10-12mm long. The strobila is continuous in the muscle and tegument layers. The outer layer of the strobila consists of microtriches, which provide the digestive function where there is otherwise no gut. The microtriches absorb nutrients from the host, regulating exchange of these and waste products. Individual proglottids are hermaphroditic with a distinguishing uterine pore. In a process called anapolysis, posterior end mature gravid proglottids become filled with and release eggs, and then detach. Eggs released from the uterine pore are unembryonated, and are 35-80m long and 25-65m wide. They have an operculum and narrow to the opposite end. Once developed the embryo hatches as a coracidium. Also called an oncoshpere this ciliated form has six hooks where the scolex eventually develops. The next developmental stage is the procercoid. This 500m long larval form is mostly parenchymal tissue, with a cercomer mass surrounding the six temporary hooks. The final larval stage is the plerocercoid, with lengths varying for example in D. latum at <5cm, to 10-20cm in D. dendtriticum. It most closely resembles the adult in terms of scolex and morphology. 3. Host Range Diphyllobothrium spp. rely on two intermediate hosts, before the definitive host can be infected. Apart from humans, additional definitive hosts are infected by Diphyllobothrium spp. D. dendtriticum infects fish-eating vertebrates, including bears, dogs, foxes and gulls. D. nihokaiense can also infect the brown bear, and D. pacificum ! 6!
Rhianna Pedwell 27/10/13 11:14 AM Comment [7]: Topic#sentence.#Where! appropriate!for!this!kind!of!assignment,!a# topic#sentence!for!the!paragraph!has!been! included.!This!introduces!what!the! paragraph!is!going!to!be!about.#

Rhianna Pedwell 27/10/13 11:17 AM Comment [5]: Throughout!the!final!draft,! sentences!were!concise.#The#jargon!used! clear#and!is!also!appropriate!for!the! audience.!!

Rhianna Pedwell 27/10/13 11:17 AM Comment [6]: Sentences!are!below!30! words,!or!even!20!words.!This!less6than6 30#concept!comes!from!the!Media!module.! I!used!this!to!help!develop!my!writing!in!a! more!concise,!clear!way.!!

Rhianna Pedwell 42370730

seals and sea lions. The first intermediate host for all species is a copepod, commonly genus Diaptomus spp. or Cyclops spp. The second intermediate host, a fish, affects the geographical prevalence of Diphyllobothrium species. D. latum is found in freshwater fish such as perch, pike, walleye and burbot. It is found in Poland, Estonia, Russia and Finland, and other European or global regions. D. dendtriticum is found in salmonid Coregonidae spp. and its geographical distribution is similar to that of D. latum. D. dendtriticum is more common in northern America regions of Canada and Alaska. Both species prefer the cool, freshwater river and lake systems of these regions. The two species were likely introduced to Argentina and Chile in South America through immigration. D. pacificum is also found in South America, in marine fish. D. nihokaiense is found in salmon with an anadromous (part freshwater, part saltwater) lifecycle. Onchoryhnchus spp. are the main second intermediate hosts, with distribution in the north Pacific Ocean. This species is most endemic in Japan, but also in China, Korea and Russia and other parts of the world. 4. Site of Infection Diphyllobothrium spp. infect the small intestine in humans, usually the ileum. Sometimes the jejunum or more rarely a bile duct may form the site of attachment. The atypical larval infection by D. monsoides or D. erinacei enters through the skin to infect underlying tissue. 5. Pathogenesis The main outcome of Diphyllobothrium sp. infection is diphyllobothriasis. The adult worm attaches and begins developing in the ileum. The infection is typically asymptomatic. Nonspecific symptoms include abdominal pain, anorexia, weight loss, diarrhoea, and vomiting accompanied by acute pain - if the worm attaches in the jejunum. A multiple adult worm infection may cause obstruction of the intestine. A less typical outcome of some Diphyllobothrium species infection is pernicious or megaloblastic anaemia, once a serious health problem in Finland. The adult worm aggressively sequesters vitamin B12 away from the host, depriving red blood cells. Other factors including site of infection, disease burden, and host genetics may affect the severity. Plerocercoids of D. monsoides or D. erinacei may enter the skin and migrate through tissues, including to the eye, causing sparganosis. The plerocercoid may form a visible lump at the infection site. This results in inflammation, urticaria, oedema, and fibrosis at the site. The tissues can become damaged as the plerocercoids use a mimic of a human growth factor, to aid migration, possibly persisting in the host for a long time.

Rhianna Pedwell 27/10/13 11:14 AM Comment [8]: #Topic#sentence.!!

Rhianna Pedwell 27/10/13 11:09 AM Comment [9]: While!part!of!the!same! section,!these!paragraphs!have!been! separated!so!they!deal!with!only!one!topic! (normal!disease!outcome,!abnormal!disease! outcome)!!1#message#per#paragraph.#!


Rhianna Pedwell 42370730

6. Transmission The developmental stages in the lifecycle of Diphyllobothrium spp. are mainly aquatic. Eggs are passed in the definitive host faeces. After 12 days to 2 weeks in a cool, fresh, aquatic environment the coracidium hatches. The coracidium can survive and swim in the water, though must be ingested by a copepod host within 2 days. It burrows through the intestinal wall and enters the hemocoel cavity of the crustacean. Here it develops over 2-3 weeks into the procercoid. The second intermediate fish host ingests the copepod. The procercoid will again burrow through the intestine, taking 35 weeks to mature to the infective plerocercoid stage. The plerocercoid forms a cyst in the fish tissue, and the definitive host consumes the fish. Here it matures and attaches to the gut mucosa, growing strobila and releasing eggs to begin the cycle again. Alternate transmission routes include ingestion of infected copepods, possibly resulting in sparganosis. Additionally, paratenic transmission occurs where the definitive host consumes a fish, which had previously ingested the second intermediate host. In human infection, it is egg-contaminated sewage water where the transmission begins. There is also an important cultural aspect to the transmission of the plerocercoid. In regions where Diphyllobothrium spp. are common, the consumption of traditional fish dishes are implicated in its transmission. These include sushi and sashimi in Japan, and Latin American ceviche, and similar Scandinavian and Italian dishes. All are comprised of raw fish, however, any dish where the fish is not completely or properly cooked can transmit the parasite, including smoked and pickled fish. In the more unique case of D. erinacei sparganosis, it is infected tissue of frogs and snakes used as a topical medicine in Asian cultures that transmits the larva. In America, cats are implicated in transmission of the similar D. monsoides. 7. Differential Diagnosis The ambiguous symptoms of diphyllobothriasis cause many cases to be undiagnosed or diagnosed at the genus level only. Morphological characteristics may be used to diagnose the infection. The presence of eggs in the faeces correctly identifies a Diphyllobothrium infection, even down to species. If strobila is also released in faeces, the proglottid pore is a diagnostic feature. The plerocercoids of species such as D. latum and D. dendtriticum are differentially diagnosable, based on a smooth or wrinkly surface, or length of microtriches. Morphology of the remaining developmental stages is typically too similar to distinguish a species. However, molecular techniques have been shown to successfully differentiate between D. latum and D. nihokaiense. Using restriction fragment length polymorphism, two mitochondrial genes - cox1 and nad3 - were identified as being suitable for species differentiation.

Rhianna Pedwell 27/10/13 11:12 AM Comment [10]: Topic!sentence!for! paragraph.!!

Rhianna Pedwell 26/10/13 11:58 PM Comment [11]: Separated!paragraphs!for! different!points!once!again.!! Rhianna Pedwell 27/10/13 11:12 AM
Comment [12]: Also!a!topic!sentence!


Rhianna Pedwell 42370730

8. Treatment and Control Treatment of an infected person is via the administration of Praziquantel. This is taken as a single oral dose, 10-30mg/kg. It is non-lethal or static, the strobila and scolex are unaffected, while Ca2+ influxes and damage to neck tegument paralyses the worm. Niclosamide is also used, though it is less available than Praziquantel. Two 1g doses over the space of an hour destroy the scolex. If this treatment fails to recover a scolex, Bithionol is administered. If pernicious anemia has been diagnosed, eliminating the worm with chemotherapy allows the anemia to resolve over months. Addition of more vitamin B12 as a preventative measure or after treatment is also possible. Control measures target the transmission of Diphyllobothrium eggs or plerocercoids. Eggs may be targeted by improved treatment of sewage. There is naturally a cultural hurdle to overcome when recommending persons in endemic regions avoid eating fish unless sufficiently heated or frozen first, or in the case of D. erinacei altering medicinal practices using sparganum infected frog and snake flesh. The lump indicating plerocercoid presence is generally excised to prevent further damage. Complete drying and pickling, and brining the flesh in 12% salt can stop plerocercoid transmission. Cooking at 55C for 5 minutes will kill the larva. Freezing fish over 15 days at -35C, 7 days at -20C or a quick freezing at -10C for 15 minutes to 24 hours have all be recognised as sufficient to ensure the fish is safe to eat raw.

Rhianna Pedwell 27/10/13 11:18 AM Comment [13]: Another!example!of!1! message!per!paragraph,!e.g.!the!first!deals! with!treatment,!the!second!with!control.!! Rhianna Pedwell 27/10/13 11:13 AM
Comment [14]: Topic!sentence.!


Rhianna Pedwell 42370730

9. Life Cycle

Figure: Life cycle of Diphyllobothrium spp. Shows developmental stages (blue), hosts and transmission (red). Includes sites of infection and symptoms of infection in definitive human host. Bibliography 1. Anderson, K.I., Gibson, D.I., 1989. A key to three species of larval Diphllobothrium Cobbold, 1858 (Cestoda: Pseudophyllidea) occurring in European and North American freshwater fishes. Syst Parasitol. 12: 3-9. DOI: 10.1007/BF00006946. 2. Arizono, N., Yamada, M., Nakamura-Uchiyama, F., Ohnishi, K., 2009. Diphyllobothriasis Associated with Eating Raw Pacific Salmon. Emerg Infect Dis. 15: 866-870. DOI: 10.3201/eid1506.090132. 3. Bush, A.O., Fernndez, J.C., Esch, G. W., Seed, J.R., 2001. Parasitism The diversity and ecology of animal parasites. Cambridge University Press, Cambridge and New York. 4. Bylund, G., Bng, B., Wikgren, K., 1977. Tests with a new compound (Praziquantel) against Diphyllobothrium latum. J Helminthol. 51: 155-119. 5. Craig, N., 2012. Fish tapeworm and sushi. Can Fam Physician. 58: 654-658. 6. Jiminez, J.A., Rodriguez, S., Gamboa, R., Rodriguez, L., Garcia, H.H., 2012. Diphyllobothrium pacificum Infection is Seldom Associated with ! 10!

Rhianna Pedwell 42370730

Megaloblasitc Anemia. Am J Trop Med Hyg. 8: 897-901. DOI: 10.4269/ajtmh.2012.12-0067. 7. Muller, R., 2002. Worms and Human Disease, Second Edition. CABI, New York. Access Online via The University of Queensland 22/08/13 http://www.cabi.org.ezproxy.library.uq.edu.au/CABeBooks/default.aspx?site= 107&page=45&LoadModule=PDFHier&BookID=81 8. Nakao, M., Abmed, D., Yamasaki, H., Ito, A., 2007. Mitochondrial genomes of the human broad tapeworms Diphyllobothrium latum and Diphyllobothrium nihokaiense (Cestoda: Diphyllobothriidae). Parasitol Res. 101: 233-236. DOI: 10.1007/s00436-006-0433-3. 9. Raether, W., Hnel, H., 2003. Epidemiology, clinical manifestations and diagnosis of zoonotic cestode infections: an update. Parasitol Res. 91: 412-438. DOI: 10.1007/s00436-003-0903-9. 10. Schmidt, G.D., Roberts, L.S., Janovy, J., 2009. Foundations of Parasitology, Eighth Edition. McGraw-Hill, Boston. 11. Scholz, T., Garcia, H.H., Kuchta, R., Wicht, B., 2009. Update on the Human Broad Tapeworm (Genus Diphyllobothrium), Including Clinical Relevance. Clin Microbiol Rev. 22: 146-160. DOI: 10.1128/CMR.00033-08

! ! ! # !