Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of consuming raw or undercooked freshwater fish. Reports symptoms of megaloblastic anemia, including fatigue, glossitis, and paresthesia. Gastrointestinal complaints include intermittent abdominal discomfort, nausea, and occasional passage of proglottids in stool. No history of autoimmune gastritis or dietary B12 deficiency.
Clinical Examination Findings
General: Pale conjunctiva, signs of glossitis (smooth, beefy-red tongue). Neurological: Possible diminished vibratory sense or proprioception due to B12 deficiency. Abdominal: Soft, non-tender, no organomegaly. Stool examination: Positive for Diphyllobothrium latum eggs or proglottids. Laboratory: CBC shows macrocytic anemia, elevated MCV, low serum B12 levels.
Treatment Protocol
1. Praziquantel 5-10 mg/kg as a single oral dose. 2. Niclosamide 2g orally as a single dose (alternative). 3. Parenteral Vitamin B12 supplementation (cyanocobalamin) to correct deficiency and address neurological sequelae. 4. Follow-up stool microscopy 2-4 weeks post-treatment to confirm clearance.