Dipylidium caninum in the twenty-first century: epidemiological studies and reported cases in companion animals and humans

Background: Dipilidiosis is a parasitic disease caused by the tapeworm Dipylidium caninum. Fleas and, less frequently, lice act as an intermediate host, and their ingestion is required for infection to occur. While the disease mainly affects domestic and wild carnivores, it is also considered a zoonotic disease, with most human cases reported in children. Dipylidium caninum is considered to be the most common tapeworm infesting companion animals, but dipilidosis in humans is rare. The aims of this review were to improve current understanding of the epidemiology of this parasitosis and its management by the medical and veterinary community. Methods: A comprehensive review of the published literature during the last 21 years (2000-2021) on the epidemiology, clinical features, diagnosis, treatment and prevention measures of D. caninum infection and dipilidiosis in companion animals and humans was conducted. Results: Using predefined eligibility criteria for a search of the published literature, we retrieved and screened 280 publications. Of these, 161 (141 epidemiological studies, 20 case reports [16 human cases]) were considered for inclusion in this review. This parasitosis is present worldwide; however, despite being the most frequent cestode infection in animals, it is often underdiagnosed using common coprological techniques. Its diagnosis in humans has also proved challenging, being frequently confused with pinworm infection, leading to inappropriate treatment and to the persistence of the disease over time. Prevention measures include control of ectoparasites in animals and the environment, as well as regular deworming of animals, most commonly with praziquantel. Conclusions: The diagnosis of dipilidiosis remains challenging in both animals and humans, primarily due to the low sensitivity of the diagnostic methods currently available and a lack of knowledge of the morphological characteristics of the parasite. Although treatment with the appropriate anti-cestode compounds is well tolerated and results in resolution of the infection, indiscriminate use of these compounds may predispose to an increase in resistance. Given the worldwide distribution of this parasite, it is essential to act on several fronts, with a focus on health education for children and animal owners and the control of intermediate hosts, both in animals and in the surrounding environment.