A housewife from the Great Lakes area comes to her family physician with fatigue and malaise.Blood tests show that she has enlarged but pale red blood cells (RBCs) (megaloblastic anemia) along with a vitamin B₁₂ deficiency.Her history includes a dietary habit of making pickled fish, a family favorite.Because of this, an O&P is also requested and reveals the following parasite egg.What is the identity of this parasite?

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D.latum, the fish tapeworm, is found worldwide in areas where the population eats pickled or raw fresh water fish.In the United States, it is primarily seen in the areas around the Great Lakes.The organism may cause a vitamin B₁₂ deficiency, especially in persons of northern European descent, and long-term infection may lead to a megaloblastic anemia.The egg is operculated and yellow-brown, about 58 to 76 mm by 40 to 50 mm and has a small, knoblike protuberance at the end opposite the operculum.CDC PHIL #1541

A Housewife from the Great Lakes Area Comes to Her