A case of Hymenolepis diminuta (rat tape worm) infestation in a child

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A five-year old boy presented with fever, watery stools and a febrile convulsion on day one of the illness. He has had on and off abdominal pain for 5 months. No urinary symptoms nor blood stained stools noted. He has had a febrile convulsion at 9 months. Growth and development were appropriate for the age. The immunisation was uptodate. Examination was unremarkable. Microscopic examination of faeces showed 10-12 pus cells and 15-16 red cells per high power field and eggs of H ym enolepis dim inuta (Figure 1). Stool culture did not yield any significant pathological organism. Stool virology could not be performed. Child was treated with praziquantal 10 mg/ kg as a single dose. A microenema was administered 2 hours later and a 24 hour stool collection was done to check the excretion of the worms which yielded numerous worm segments (Figure 2). A repeat stool examination was done one month later which did not show evidence of H. dim inuta infestation. The natural reservoir and definitive host of H. dim inuta are rodents. Coprophilic arthropods such as flea and beetle species act as intermediate hosts [1]. Humans act as definitive hosts only when they ingest cysticercoid larvae infected arthropods with food and fomites. This is the reason why H. dim inuta infestation is uncommon in humans [1 ]. Only a limited number of cases have been reported globally [ 1 ]. H. dim inuta is known to cause abdominal pain and loose stools in children [3], H. diminuta infestation has not been reported to cause seizures before. Praziquantel and niclosamide can be used for treatment of H. dim inuta infestations.