1. Department of Gastroenterology YGH 30.3.18
A rare human infection
Department of Gastroenterology
YGH

2. A 20-year old man living in a fish and chicken farm of suburban area around Yangon was referred to our unit with 6 months history of abdominal pain likely to be stomach in origin which was not relieved by empirical PPI therapy.
He had history of passing worms after deworming 4 months ago.
He was not pale nor icteric. His BMI was 25. There was no tenderness or organomegaly on abdominal examination.
Since the blood and Ultrasound examination was normal, we decided to do upper endoscopy with the concern of Peptic Ulcer disease.

6. The worm was sent to National Health Laboratory for parasitology identification.
The result revealed that the given 3 portions of alive worm measuring 6 cm, 15 cm and 17 cm in length (total 38 cm in length) were observed. These segments resembles morphologically as proglottids of Hymenolepis species.

7. Dx: Hymenolepis diminuta infestation
Praziquantel 1500 mg single dose (25 mg/kg) was prescribed and symptoms were significantly improved after 48 hours.

8. Literature Review

9. Hymenolepis diminuta is a cestode of rodents infrequently seen in humans.
Only a few hundred cases of this infection have been reported.
Various arthropods (flea, flour and grain beetles) act as the intermediate host.
Humans can be accidentally infected through the ingestion of insects in precooked cereals and directly from the environment (e.g., oral exploration of the environment by children)

11. Flour beetle

12. The disease is most prevalent in children 1-4 years of age
Most infected cases are asymptomatic but may present with non-specific abdominal pain, irritable behavior, itching and eosinophilia.
Death has not been reported in association with this infection

14. Treatment Praziquantel/ Nitazoxanide/ Niclosamide
Comparative study in Peru
3 day regimen of nitazoxanide and single dose of Praziquantel (25 mg/kg)
89% vs 96%

15. Further out-patient care
Follow-up stool examination 2 week and month for after treatment to determine whether reinfection or treatment failure

16. Discussion
Hymenolepis diminuta infection is very rare even in developing country and is limited to children living in rural or degraded areas.
The great majority of the reported human infections derive from mass stool screenings in different populations or field surveys in tropical and subtropical area

17. Our case is adult patient living in suburban area with fair socioeconomic status and diagnosed endoscopically.
This case is presented in order to improve our knowledge of the epidemiology, transmission routes and awareness of this rare infection.

18. References
Rohela M. et al. A case report of Hymenolepis diminuta infection in a Malaysian child, Tropical Biomedicine 29(2):224-30, June 2012
Centers for Disease Control and Prevention. Available at html
Crompton DW. How much human helminthiasis is there in the World?. J Parasitol. June (3):
Arora HS, Ang JY, Steele RW. Hymenolepiasis. Medscape. Updated: Apr, overview#a4
Marangi M et al. Hymenolepis diminuta infection in a child living in urban area of Rome, Italy. J Clin Microbiol 2003;41 :3994-5

19. THANK YOU SO MUCH