LETTERS

Bertiella studeri was 0.1 cm, and the total length of all may exist in soil to maintain natural proglottids was 13 cm; each segment infection, and the definitive host is Infection, China was 0.68–1.10 cm in width. Eggs (N = infected by eating or otherwise com- To the Editor: Bertiella is a genus 53) were examined microscopically; ing into contact with contaminated of tapeworm in the family they were roundish or oval, an aver- soil or food. Animal infection has µ Anoplocephalidae, many species of age of 45.31 m diameter (range been recorded in some provinces in µ which exist as parasites of nonhuman 37.93–50.00 m), and clearly showed China, and human bertiellosis has primates. Two species of the genus, typical pyriform apparatus, with visi- been recorded in Sri Lanka (4), Saudi Bertiella studeri and B. mucronata, ble hooklets (Figure). Other laborato- Arabia (5), Vietnam (6), Japan (7), can infect humans (1). More than 50 ry examinations showed hemoglobin India (8), Thailand, Malaysia, and × cases of human infection have been level of 110 g/L, erythrocytes 3.9 other Asian countries. However, 12 × 9 recorded, and the geographic distribu- 10 cells/L, and leukocytes 8.0 10 according to the most recent Chinese tion of cases shows that the tapeworm cells/L. Although 2 species can para- authoritative text, Human Parasit- exists in countries in Asia, Africa, and sitize humans, the geographic distri- ology (9), no human bertiellosis has the Americas. We report a B. studeri bution and egg size of these species been recorded in China. Humans are infection in a person; to our knowl- differ (2). B. mucronata has smaller infected by unconsciously swallowing edge, this case of bertiellosis is the eggs and is found only in the New infected mites, and in Mauritius, chil- first in China. World. On the basis of the size of the dren were infected by eating guavas The patient was a 3.5-year-old proglottids (3), larger eggs with pyri- that had fallen on the soil (10). Other Chinese boy from Suzhou City, Anhui form apparatus and hooklets, and geo- human infections may have occurred, Province. The boy had a 6-month his- graphic distribution, the infecting ces- but infected persons may have had tory of frequent abdominal pain. His tode was identified as B. studeri. mild symptoms and not noticed parents had noticed living “parasites” The origin of infection was not expelling the segments, so local doc- in his feces for 3 months; a segment of confirmed; the only clue was that the tors may have considered the cases to the worm was expelled every 2 or 3 boy’s parents had once raised tame have been caused by a common ces- days. According to the symptoms, monkeys in a zoo. When the boy was tode. To prevent human bertiellosis, doctors at the local hospital diagnosed 2 years old, he often played in the the relationship between human cases his condition as Taenia solium infec- wildland, which is part of the zoo near and the natural host must be investi- tion and prescribed praziquantel, but the forest, and frequently fed and gated. no drug was available in the hospital played with the captured monkeys. or local drugstores. Consequently, the Further questioning showed that the Acknowledgments parents brought the child to Bengbu boy had also been in frequent contact We thank Guan-Ling Wu, Yong Medical College for further diagnosis with wild monkeys. We could not Wang, You-Fang Gu, Bai-Qing Li, Ze and treatment. confirm whether he had been infected Min, and Bei Yao for assisting with our lit- The patient appeared healthy; rou- by eating monkey food contaminated erature collection and manuscript writing. tine medical examination showed nor- with mites. mal heart, lung, liver, and spleen, and The lifecycle of the cestode Xin Sun,*† Qiang Fang,*† he had no fever. Though the patient requires 2 hosts; nonhuman primates Xing-Zhi Chen,*† Shou-Feng Hu,*† had intermittent epigastric pain, the are generally the final host, while ori- Hui Xia,*† and Xue-Mei Wang*† abdomen was soft and tender. A total batid mites are the intermediate host, *Bengbu Medical College, Bengbu, China; of 133 proglottids were collected in which the infective cysticercoid of and †Anhui Provincial Key Laboratory of from the feces. Their average length the cestode develops. Orbatid mites Infection and Immunity, Bengbu, China

References

1. Beaver PC, Jung RC, Cupp EW. Cyclophyllidean tapeworms. In: Beaver PC, Jung RC, Cupp EW, editors. Clinical parasitology. 9th ed. Philadelphia: Lea and Febiger; 1984. p 505–6. 2. Galan-Puchades MT, Fuentes MV, Mas- Coma S. Morphology of Bertiella studeri (Blanchard, 1891) sensu Stunkard (1940) Figure. Eggs collected from proglottids. Left panel shows the length of the egg, scale bar (Cestoda: Anoplocephalidae) of human ori- = 10µm; middle panel shows the hooklets in the egg; right panel shows the pyriform appa- gin and a proposal of criteria for the specif- ratus in the egg (under convert microscope).

176 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 1, January 2006 LETTERS

ic diagnosis of bertiellosis. Folia Parasitol 6. Xuan le T, Anantaphruti MT, Tuan PA, Tu 9. Bao H-E. In: Bertiella studeri. Guanling (Praha). 2000;47:23–8. le X, Hien TV. The first human infection WU, editor. Human parasitology. 3rd ed. 3. Frean J, Dini L. Unusual anoplocephalid with Bertiella studeri in Vietnam. Southeast Beijing: People’s Health Publishing House; tapeworm infections in South Africa. Asian J Trop Med Public Health. 2005. p. 569–70. Annals of the Australasian College of 2003;34:298–300. 10. Bhagwant S. Human Bertiella studeri (fam- Tropical Medicine. 2004;5:8–11. 7. Ando K, Ito T, Miura K, Matsuoka H, ily Anoplocephalidae) infection of probable 4. Gallella SD, Gunawardena GS, Chinzei Y. Infection of an adult in Mie Southeast Asian origin in Mauritian chil- Karunaweera ND. Bertiella studeri infec- Prefecture, Japan, by Bertiella studeri. dren and an adult. Am J Trop Med Hyg. tion: resistance to niclosamide. Ceylon Med Southeast Asian J Trop Med Public Health. 2004;70:225–8. J. 2004;49:65. 1996;27:200–1. 5. El-Dib NA, Al-Rufaii A, El-Badry AA, Al- 8. Panda DN, Panda MR. Record of Bertiella Address for correspondence: Xin Sun, Zoheiry AA, Abd El-Aal AA. Human infec- studeri (Blanchard, 1891), an anoplo- Department of Parasitology, Bengbu Medical tion with Bertiella species in Saudi Arabia. cephalid tapeworm, from a child. Ann Trop Saudi Pharmaceutical Journal. 2004;12: Med Parasitol. 1994;88:451–2. College, Anhui Provincial Key Laboratory of 168–9. Infection and Immunity, 801 Zhihuai Rd, The opinions expressed by authors contributing to this journal do not necessarily reflect the Bengbu 233003, China; fax: 86-552-317-1333; opinions of the Centers for Disease Control and Prevention or the institutions with which the email: [email protected] authors are affiliated.

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