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Laboratory and Epidemiology Communications A Case of Imported asiatica Infection in Hiroki Namikawa1,2, Yasuhiko Takemoto1*, Ikuji Shimazaki1, Ayako Makuuchi1, Masanori Kobayashi1, Shigeki Kinuhata1, Koichi Yamada2, Hiroki Fujimoto2, Hiromitsu Toyoda1, Noriko Kamata1, Yoshihiro Tochino1, Isao Teramoto3, Niichiro Abe4, Mina Morimura1, Hiroshi Kakeya2, and Taichi Shuto1 1Department of Medical Education and General Practice; 2Department of Infection Control Science; 3Department of Parasitology, Osaka City University, Graduate School of Medicine, Osaka; and 4Department of Microbiology, Osaka City Institute of Public Health and Environmental Sciences, Osaka, Japan Communicated by Masayuki Saijo

Taeniasis in is a parasitic infection caused quantel (600 mg/day) and a cathartic were administered, by 3 tapeworm , such as Taenia asiatica, Taenia and many proglottids and a ’s scolex were excreted. saginata, and (1). T. asiatica infection is The patient was successfully dewormed as evidenced caused by eating raw or undercooked contain- by the excretion of the scolex, which was identified as ing the larvae (2) and is conventionally uncommon in T. asiatica using multiplex PCR testing (Fig. 2). Her di- Japan. However, between 2010 and 2011, several etary history was investigated, and she confidently con- cases of T. asiatica infections were reported in the Kanto firmed that she had always eaten broiled, but not raw, area (3), while another case was recently confirmed in meat in Japan. Therefore, we finally diagnosed this as a the Chiba Prefecture, Japan (4). However, studies on case of imported T. asiatica infection. imported T. asiatica infections in Japan remain limited Although T. saginata and T. solium are well-known (5). Herein, we report the case of a 47-year-old Filipina parasitic tapeworms in humans belonging to the genus who presented with an imported T. asiatica infection in Taenia, T. asiatica was first reported as a new species Japan. The patient was referred to our hospital with a 10-day A history of excreting proglottids through the anus. She complained of some discomfort in her lower abdomen but had no particular medical history or known allergies and did not take any medications or use illicit drugs. She had lived in Japan for 26 years with a Japanese partner and worked as a housekeeper. The partner did not show similar symptoms. Approximately 10 months previously, she returned to the for a month and had eaten raw pig liver during her visit. She brought a proglottid to our hospital (Fig. 1A). No palpable abdominal tumor or abdominal ten- derness was observed. Her physical examination was normal. Blood tests revealed a white blood cell count of 5,000/μL, eosinophil count of 150/μL, hemoglobin level of 13.2 g/dL, platelet count of 294,000/μL, C-reactive protein level of 0.13 mg/dL, and albumin level of 4.0 g/dL. Other test results were also within B normal limits. The proglottid was thick and opaque; the uteri stemmed out from the center forming ＞ 20 branches, and the scolex did not have any hooks (Fig. 1B). Based on these findings, clinical data, and her dietary history, T. saginata or T. asiatica infection was suspected. Prazi-

Accepted November 14, 2017. J-STAGE Advance Publication February 28, 2018. DOI: 10.7883/yoken.JJID.2017.082 *Corresponding author: Mailing address: Department of Medical Education and General Practice, Osaka City University Graduate School of Medicine, 1-4-3 Asahi- machi, Abeno-ku, Osaka 545-8585, Japan. Tel: +81-6-6645-3797, Fax: +81-6-6645-3796, E-mail: Fig. 1. (Color online) (A) The proglottids excreted naturally [email protected] through the anus. (B) The enlargement of the scolex.

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respectively (11). Accordingly, in the present case, the product of T. asiatica-specific size (i.e., 269 bp), was amplified by multiplex PCR, and its base sequence was further confirmed to match that of the same domain in T. asiatica. In conclusion, we describe a case of imported T. asiatica infection in Japan. We suggest that when examining patients suspected with parasitic diseases, detailed information on their backgrounds, especially their travel and dietary histories should be obtained to facilitate rapid confirmation of the final diagnosis. In addition, the genetic tests such as multiplex PCR testing may be useful in cases where differential diagnosis of parasitic infections is difficult. Finally, imported infections caused by T. asiatica may increase because of the continuous increase in international travel between the Philippines or other Asian countries, which have a wide distribution of T. asiatica infection, and Japan. As Fig. 2. Differential diagnosis of taeniid tapeworms it is an imported infectious disease in Japan, T. asiatica by multiplex PCR. Lane 1, 100–1,500 bp DNA ladder; lane 2, the PCR product reveals molecular- infection should be routinely and closely monitored. weight size of 827 bp in T. saginata; lane 3, the PCR product reveals molecular-weight size of 269 Conflict of interest None to declare. bp that identified T. asiatica, in the present study. REFERENCES among human Taenia tapeworms in 1993 (6). T. asiatica 1. Chai JY. Human in the Republic of : hidden or gone? is distributed mostly in Asian countries, such as Korea, Korean J Parasitol. 2013;51:9-17. , Philippines, , , , and 2. Galán-Puchades MT, Fuentes MV. On the role of Taenia asiatica in (7). It is very similar to T. saginata and T. human cases of . Am J Emerg Med. 2016;34:2030. 3. Yamasaki H, Morishima Y, Sugiyama H, et al. Case of Taenia solium in regard to the morphology and the intermediate asiatica, possible emerging parasitic infestation reported from (i. e., pig), respectively (7). The larvae of T. asiatica Kanto area of Japan since June 2010. Infect Agents Surveillance are mainly parasitic in the pig liver, and humans become Rep. 2011;32:106-7. Japanese. infected on consuming the raw or undercooked liver (8). 4. Yamasaki H, Morishima Y, Sugiyama H, et al. Confirmation of In Japan, all reported human cases of T. asiatica Taenia asiatica infection in Japan in August 2016–Chiba Prefecture. Infect Agents Surveillance Rep. 2016;37:206. Japanese. infection in 2011 were considered as domestic infections 5. Hoshina T, Lee K, Nakaharai K, et al. Case of Taenia asiatica infec- (9), while studies on the imported infections have been tion possibly imported from Taiwan. Clin Parasitol. 2015;26:117- limited. In the Philippines, T. asiatica infections occur 20. Japanese. throughout the country (10) because many traditional 6. Eom KS, Rim HJ. Morphologic descriptions of Taenia asiatica sp. n. food are prepared from raw pig meat or liver. In this Korean J Parasitol. 1993;31:1-6. 7. Eom KS, Jeon HK, Rim HJ. Geographical distribution of Taenia case, the patient ate one of these traditional local food asiatica and related species. Korean J Parasitol. 2009;47:Suppl that was prepared using raw pig liver. Therefore, this S115-24. was a case of an imported T. asiatica infection in Japan. 8. Eom KS. What in Asian Taenia? Parasitol Int. 2006;55:Suppl S137- Imported cases of T. asiatica infection may gradually 41. increase because of the increased international travel 9. Yamasaki H. Current status and perspectives of cysticercosis and taeniasis in Japan. Korean J Parasitol. 2013;51:19-29. between the Philippines and Japan. 10. Ale A, Victor B, Praet N, et al. Epidemiology and geneticiversity of Multiplex PCR testing that targets the cytochrome c Taenia asiatica: a systematic review. Parasit Vectors. 2014;7:45. oxidase subunit 1 (cox1) gene has been established for 11. Yamasaki H, Allan JC, Sato MO, et al. DNA differential diagnosis identifying T. asiatica and related species (11). This of taeniasis and cysticercosis by multiplex PCR. J Clin Microbiol. technique can differentiate between the T. asiatica, T. 2004;42:548-53. saginata, and Asian genotypes of T. solium based on the molecular sizes of 269, 827, and 984 base pairs (bp),

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