Diagnosic Dilemma No. 7 


Contributors: Emeritus Professor John Goldsmid, University of Tasmania

 
This 2 year old caucasian child lived with her parents in Harare in Zimbabwe. The mother noticed that for a couple of days the child had been passing small non-motile white rice grain-like particles in her faeces. The child was well and so the mother had not been too concerned. However, with the continued passage of the particles, the mother decided to seek medical advice to ensure that there was nothing wrong. A stool examination showed the presence of hard bodies rather like rice grains (Fig. 7.1) but no other abnormalities. On being squashed between two microslides, the structure ruptured to release the contents which can be seen in Fig. 7.2.
Small, rice grain-like particles seen in the faeces of the child.
Fig. 7.1 - Small, rice grain-like particles seen in the faeces of the child.
Fig. 7.2 - Photomicrograph of the contents of the squashed 'particle' in the child’s faeces.
Fig. 7.2 - Photomicrograph of the contents of the squashed “particle” in the child’s faeces.

What is your diagnosis?



 


The microscopic examination of the specimens showed the characteristic soft egg capsules of the tapeworm, Inermicapsifer madagascariensis. Each of these capsules contains 4 – 10 eggs. This is a tapeworm of rodents found in Central Africa. The intermediate hosts are probably oribatid plant mites found on grasses and other plant material. The mites are accidently ingested with the plant material by the feeding rodents and so transmission of the tapeworm occurs, Children become infected with the helminth when they swallow the mite while chewing on, or eating grass. I. madagascariensis was found to be the commonest tapeworm of caucasian children in Rhodesia (now Zimbabwe) by Goldsmid and Muir (1972) and Goldsmid and Fleming, (1977). Frean (2004) has reported on cases from South Africa. Fewer records have been noted from African children - an observation also made by Nelson, Pester and Rickman (1965) in East Africa, and it seems probable that this is because, not causing any apparent clinical discomfort, it did not justify medical consultation in the minds of the African mothers. It is interesting to note that this tapeworm was introduced into Cuba from Africa but does not seem to be a zoonosis there (Swellengrebel and Sterman, 1961; Beaver, Jung and Cupp, 1984)
 
References:
Frean, J. (2004) Unusual anoplocephalid tapeworm infections in South Africa. Annals of the ACTM; 5: 8 – 11.
Goldsmid, J.M. and Fleming, (1977). The tapeworm infections of children in Rhodesia. C.Afr.J.Med.; 23; 7-10
Goldsmid, J.M. and Muir, M. (1972) Inermicapsifer madagascariensis (Davaine, 1870) Baer, 1956 (Platyhelminthes” Cestoda) as a parasite of man in Rhodesia. C.Afr. J.Med. !8: 205-207.
Nelson, G.S., Pester, F.R.N and Rickman, R. (1965). The significance of wild animals in the transmission of cestodes of medical importance in Kenya. Trans. Roy. Soc. Trop.Med. Hyg. 59; 507-524.
Swellengrebel, N.H. and Sterman, M.M. (1961) Animal Parasites in Man. Van Nostrand. Princeton.



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