OVERVIEW: What every clinician needs to know

Parasite name and classification

Cestodes, or tapeworms, include multiple species of flat worms that can reside in the
human gastrointestinal tract. The species that most commonly cause human disease
include Taenia saginatum, Taenia solium, Diphyllobothrium latum and Hymenolepis nana.

What is the best treatment?

Praziquantal is the treatment of choice at varying doses:

– T. saginatum, T. solium, D. latum – 10mg/kg orally once

– H. nana – 25mg/kg orally once, then repeated one week later

Albendazole or praziquantal can be used for neurocysticercosis.

What are the clinical manifestations of infection with this organism?

 Many infected patients are asymptomatic. The most common gastrointestinal
symptoms include nausea, diarrhea, epigastric discomfort or decreased appetite.
There can also be nonspecific complaints including anxiety, fatigue or dizziness.
 Whole adult worms, or segments (proglottids) may be seen in the stool.
 One of the classic, although rare, manifestations of D.latuminfection is vitamin B12
deficiency and megaloblastic anemia. In these cases, fatigue, and peripheral and
central neuropathy including parasthesias and ataxia may develop.
 Most of the time there are no key physical exam findings. Patients may appear
fatigued, or have mild to moderate abdominal pain on palpation.
 In patients with megaloblastic anemia, classic findings of this condition may be
present including glossitis, ataxia and decreased sensation, especially in the lower
extremities.

Do other diseases mimic its manifestations?

 Other infectious causes of gastroenteritis, including viral or mild bacterial infections,
can mimic cestode infection.

What laboratory studies should you order and what should you expect to find?
Results consistent with the diagnosis (provide discussion of interpretation):

 In some cases there can be a mild peripheral eosinophilia

 A classic finding in D. latum infection can be Vitamin B12 deficiency, caused by the
worm, and which in a minority of cases, results in megaloblastic anemia.

Results that confirm the diagnosis

 The diagnoses of these infections are made by identifying proglottids or eggs in the
stool using microscopy.
  Because shedding is intermittent, repeat sampling or concentrating the specimen
before examination is often necessary to increase sensitivity.
 The species of Taenia can be distinguished by proglottid morphology.

What imaging studies will be helpful in making or excluding the diagnosis of cestodes?
 Imaging studies are generally not helpful in making the diagnosis of intestinal
cestode (tapeworm) infection.
 If T. solium infection is complicated by cysticercosis (see complications section
below for details), plain X-ray ($) of the muscles may reveal calcifications.
 In cases of neurocysticercosis, brain computed tomography (CT) or magnetic
resonance imaging (MRI) can help elucidate the number and location of cysts ($$$-$
$$$).
 ($ = 60-125, $$ 125-500, $$$ 500-1,000, $$$$ > 1,000)

What complications can be associated with this parasitic infection, and are there
additional treatments that can help to alleviate these complications?
D. latum infection can result in vitamin B12 deficiency and resultant megaloblastic anemia
as noted above. Patients may need vitamin B12 replacement after infection is eradicated.

If the eggs of T. solium are ingested, cysticercosis results which manifests as calcified cysts
in the muscle and other tissues. If cysts occur in the central nervous system (CNS), they
can cause complications such as seizures if located in the brain parenchyma or
hydrocephalus if obstructing the ventricles.

Treatment of patients with cysticercosis depends on the clinical manifestations of the

disease. Different treatments will apply to cysts confined to non-CNS areas, such as
skeletal muscle, asymptomatic cases many not require treatment, and excision can be
performed for solitary lesions.

Central nervous system disease

Antiepileptic therapy should be initiated immediately if a patient presents with seizures due
to neurocysticercosis. Surgical shunting or other measures to decrease intracranial
pressure are required for patients with hydrocephalus. A combination of corticosteroids to
decrease inflammation and either albendazole 400mg po bid or praziquantel 33mg/kg orally
three times daily on day one, then 17mg/kg orally three times daily.

What is the life cycle of the parasite, and how does the life cycle explain infection in
humans?
Parasite life cycle
 Humans are the only definitive hosts in which T. saginatum and T. soliumcan
complete its life cycle.
 Eggs passed by infected humans can be ingested by cattle (T. saginatum) or pigs (T.
solium).
  The eggs then hatch and the organism migrates through the intestinal wall and
hematogenously to the muscles, forming cysterci.
 Humans then become infected by eating undercooked meat that contains cysterci.
 In the intestine, protoscolices are released from the cysts and attach to the intestinal
wall, gradually adding proglottids over time that contain eggs.
 The proglottids break off and are passed in the stool, releasing eggs.
 Direct ingestion of eggs from fecal-oral contamination or autoinoculation leads to
cysticercosis (see complications above)
 Taenia infections are found worldwide, and are increased in regions where cattle or
swine are kept in close proximity to human waste.
 Intestinal tapeworm infection is not present in communities that do not eat raw or
undercooked meat.
 Cysticercosis, another manifestation of T. soliuminfection described above (in
Complications), can occur from contamination with human feces, and can occur in
people who do not eat meat.

 D. latumis predominately seen in Northern Europe and Japan, in populations that eat
raw or undercooked freshwater fish (sushi, ceviche, smoked or pickled fish).
However, cases have been exported to other regions as fish are shipped worldwide.
 Adult parasites live in the intestinal tract and shed eggs and proglottids in the stool.
 Once in water, coracidia hatch from the eggs and enter small crustaceans
 The coracidia develop into larvae in the crustacean, which in turn is ingested by a
small freshwater fish.
 The larvae migrate to the muscles, and these fish are eaten by larger predator fish.
 The larvae can then migrate to the muscles of these larger fish.
 After humans ingest the raw or undercooked flesh of these fish, the parasite matures
into the adult tapeworm in the intestine.
 Cases are decreasing in some areas as sewage treatment separates human feces
from freshwater.
 The growing popularity of raw or undercooked fish dishes has at the same time
increased the pool of people at risk worldwide.

 H. nanais the most common human tapeworm.

 It is the only tapeworm that does not require an intermediate host.
 Infected humans pass eggs in their stool.
 If ingested by another person due to contaminated food or water the eggs develop
into larvae, and then adult tapeworms, in the ileum.
 Infection is most common in India, Thailand, Egypt, Sudan and Central and South
America.

Prevention and Infection control issues

 For all the intestinal cestodes (tapeworm infections) there is no effective prophylactic
treatment or vaccine.
 Good sanitation and thorough cooking of meat and fish are the primary prevention
measures.
How does this organism cause disease?
 Adult tapeworms in the intestine cause minimal inflammatory response.
 There may be mild elevations in peripheral eosinophils or intraluminal IgE, but this is
not sufficient to clear the organism or stimulate a brisk immune response.
 Cysts of T. solium in cysticercosis does provoke a stronger response initially with
neutrophils, eosinophils and macrophages. This becomes quiescent as the cysts
encapsulate and calcify, but can increase again as the cysts degenerate, leading to
sometimes very destructive local immune responses with dire clinical consequences
particularly for cysts located in the CNS.

MSD MANUAL
Professional Version

PROFESSIONAL / 

INFECTIOUS DISEASES / 

CESTODES (TAPEWORMS)/ 

OVERVIEW OF TAPEWORM INFECTIONS

Overview of Tapeworm Infections

By 

Richard D. Pearson

, MD, University of Virginia School of Medicine

CLICK HERE FOR PATIENT EDUCATION

All tapeworms (cestodes) cycle through 3 stages—eggs, larvae, and adults. Adults inhabit the
intestines of definitive hosts, mammalian carnivores. Several of the adult tapeworms that
infect humans are named after their intermediate host:
  The fish tapeworm  (Diphyllobothrium latum)
 The beef tapeworm  (Taenia saginata)
 The pork tapeworm  (Taenia solium)
An exception is the Asian tapeworm  (Taenia asiatica), which is similar to T. saginata in many
respects, but it is acquired by eating pork in Asia.
Eggs laid by adult tapeworms living in the intestines of definitive hosts are excreted with feces
into the environment and ingested by an intermediate host (typically another species), in
which larvae develop, enter the circulation, and encyst in the musculature or other organs.
When the intermediate host is eaten, the parasites are released from the ingested cysts in the
intestines and develop into adult tapeworms in the definitive host, restarting the cycle. With
some cestode species (eg, T. solium), the definitive host can also serve as an intermediate
host; that is, if eggs rather than tissue cysts are ingested, the eggs develop into larvae, which
enter the circulation and encyst in various tissues.
Adult tapeworms are multisegmented flat worms that lack a digestive tract and absorb
nutrients directly from the host’s small bowel. In the host’s digestive tract, adult tapeworms
can become large; the longest parasite in the world is the 40-m whale
tapeworm, Polygonoporus sp.
Tapeworms have 3 recognizable portions:

 The scolex (head) functions as an anchoring organ that attaches to intestinal mucosa.
 The neck is an unsegmented region with high regenerative capacity. If treatment does
not eliminate the neck and scolex, the entire worm may regenerate.
 The rest of the worm consists of numerous proglottids (segments). Proglottids closest
to the neck are undifferentiated. As proglottids move caudally, each develops
hermaphroditic sex organs. Distal proglottids are gravid and contain eggs in a uterus.

Treatment

 Anthelmintic drugs

The anthelmintic drug praziquantel is effective for intestinal tapeworm infections.

Niclosamide is an alternative that is not available in the US. Nitazoxanide can be used for H.
nanainfections.
Some extraintestinal infections respond to anthelmintic treatment
with albendazole and/or praziquantel; others require surgical intervention.
Prevention

Prevention and control involve the following:

 Thorough cooking of pork, beef, lamb, game meat, and fish (recommended
temperatures and times vary)
 Prolonged freezing of meat for some tapeworms (eg, fish tapeworm)
 Regular deworming of dogs and cats
 Prevention of recycling through hosts (eg, dogs eating dead game or livestock)
 Reduction and avoidance of intermediate hosts such as rodents, fleas, and grain
beetles
 Meat inspection
 Sanitary treatment of human waste

Smoking and drying meat are ineffective in preventing infection.

Parasites : Cysticercosis

Biology

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Causal Agent:
The cestode (tapeworm) Taenia solium (pork tapeworm) is the main cause of
human cysticercosis. In addition, the larval stage of other Taenia species
(e.g., multiceps, serialis, brauni, taeniaeformis, crassiceps) can infect humans
in various sites of localization including the brain, subcutaneous tissue, eye, or
liver.
Life Cycle:

Cysticercosis is an infection of both humans and pigs with the larval stages of
the parasitic cestode, Taenia solium. This infection is caused by ingestion of
eggs shed in the feces of a human tapeworm carrier   . Pigs and humans
become infected by ingesting eggs or gravid proglottids   ,   . Humans are
infected either by ingestion of food contaminated with feces, or by autoinfection.
In the latter case, a human infected with adult T. solium can ingest eggs
produced by that tapeworm, either through fecal contamination or, possibly,
from proglottids carried into the stomach by reverse peristalsis. Once eggs are
ingested, oncospheres hatch in the intestine   ,   invade the intestinal wall,
and migrate to striated muscles, as well as the brain, liver, and other tissues,
where they develop into cysticerci   . In humans, cysts can cause serious
sequellae if they localize in the brain, resulting in neurocysticercosis. The
parasite life cycle is completed, resulting in human tapeworm infection, when
humans ingest undercooked pork containing cysticerci   . Cysts evaginate and
attach to the small intestine by their scolex   . Adult tapeworms develop, (up
to 2 to 7 m in length and produce less than 1000 proglottids, each with
approximately 50,000 eggs) and reside in the small intestine for years   .

Cestodiasis, also called Tapeworm Infestation, infestation with cestodes, a group of flattened

and tapelike hermaphroditic worms that are intestinal parasites in humans and other animals,
producing larvae that may invade body tissues.

For humans there are two kinds of tapeworm infestations: (1) intestinal cestodiasis, in which the
mature worm lives in the lumen of the intestine, producing eggs that are evacuated in the feces
and develop further in other animal hosts, and (2) visceral and somatic cestodiasis, in which the
larvae form lesions in body organs. Thirty or more species of tapeworms cause intestinal
cestodiasis in humans. The more common ones include the following: Taenia saginata, or beef
tapeworm, about 4.5 to 6 m (15 to 20 feet) long; Taenia solium, or pork tapeworm, about 2 to 3
m long; and Diphyllobothrium latum, about 9 m long, acquired by the eating of undercooked
beef, pork, or fish that harbour larval forms of the worms. Hymenolepis nana, or dwarf
tapeworm, only a few centimetres long, releases eggs that require no intermediate hosts. It is
possibly the most common cestode found in humans, affecting chiefly children. Symptoms of
intestinal cestodiasis include abdominal pain that may be relieved by eating and that may be
associated with distention, flatulence, and nausea. Often, however, there are no symptoms, and
first notice of infestation may occur only when segments of the worms are passed in the stools.
Treatment may involve surgery or the use of antiparasitic drugs.

Visceral and somatic cestodiasis include the following infections: (1) Echinococcosis, or

hydatic disease, is caused by the larval stage of Echinoccocus granulosus or E.
multilocularis. In humans the first organism produces cystic, slowly expanding lesions principally
involving the liver and lungs; the second organism produces an alveolar (pitted) type of lesion
that progresses rapidly, may occasionally form lesions in the brain and bones, and is invariably
fatal. The symptoms of echinococcosis are generally those of a slowly growing tumour and vary
depending on the body structure involved. The adult worm lives mainly in dogs, and human
infestation is contracted by the ingestion of eggs present in dog excreta. Surgical removal of the
lesions is the only cure. (2) Sparganosis is caused by the Spirometra mansoni larva, which may
be acquired by drinking water that contains water fleas harbouring the first larval stage. The
larvae may grow to a length of 30 cm (12 inches) in the abdominal wall or in the region of the
eye socket; surgical removal of the larva is the current treatment.

Tapeworm infections

Overview
Tapeworm infection is caused by ingesting food or water
contaminated with tapeworm eggs or larvae. If you ingest certain
tapeworm eggs, they can migrate outside your intestines and form
larval cysts in body tissues and organs (invasive infection). If you
ingest tapeworm larvae, however, they develop into adult tapeworms
in your intestines (intestinal infection).

An adult tapeworm consists of a head, neck and chain of segments

called proglottids. When you have an intestinal tapeworm infection,
the tapeworm head adheres to the intestinal wall, and the proglottids
grow and produce eggs. Adult tapeworms can live for up to 30 years in
a host.

Intestinal tapeworm infections are usually mild, with only one or two
adult tapeworms. But invasive larval infections can cause serious
complications.

Symptoms
Many people with intestinal tapeworm infection don't have symptoms.
If you do have problems from the infection, your symptoms will depend
on the type of tapeworm you have and its location. Invasive tapeworm
infection symptoms vary depending on where the larvae have
migrated.

Intestinal infection

Signs and symptoms of intestinal infection include:

 Nausea

 Weakness

 Loss of appetite
  Abdominal pain

 Diarrhea

 Dizziness

 Salt craving

 Weight loss and inadequate absorption of nutrients from food

Invasive infection

If tapeworm larvae have migrated out of your intestines and formed

cysts in other tissues, they can eventually cause organ and tissue
damage, resulting in:

 Headaches

 Cystic masses or lumps

 Allergic reactions to the larvae

 Neurological signs and symptoms, including seizures

Causes
A tapeworm infection starts after ingestion of tapeworm eggs or
larvae.

 Ingestion of eggs. If you eat food or drink water contaminated

with feces from a person or animal with tapeworm, you ingest
microscopic tapeworm eggs. For example, a pig infected with
tapeworm will pass tapeworm eggs in its feces, which gets into
the soil.

If this same soil comes in contact with a food or water source, it

becomes contaminated. You can then be infected when you eat or
drink something from the contaminated source.

Once inside your intestines, the eggs develop into larvae. At this
stage, the larvae become mobile. If they migrate out of your
intestines, they form cysts in other tissues, such as your lungs,
central nervous system or liver.
  Ingestion of larvae cysts in meat or muscle tissue. When an
animal has a tapeworm infection, it has tapeworm larvae in its
muscle tissue. If you eat raw or undercooked meat from an
infected animal, you ingest the larvae, which then develop into
adult tapeworms in your intestines.

Adult tapeworms can measure more than 80 feet (25 meters) long
and can survive as long as 30 years in a host. Some tapeworms
attach themselves to the walls of the intestines, where they cause
irritation or mild inflammation, while others may pass through to
your stool and exit your body.

Risk factors
Factors that may put you at greater risk of tapeworm infection include:

 Poor hygiene. Infrequent washing and bathing increases the risk of

accidental transfer of contaminated matter to your mouth.

 Exposure to livestock. This is especially problematic in areas where

human and animal feces are not disposed of properly.

 Traveling to developing countries.Infection occurs more frequently in

areas with poor sanitation practices.

 Eating raw or undercooked meats.Improper cooking may fail to kill

tapeworm eggs and larvae contained in contaminated pork or beef.

 Living in endemic areas. In certain parts of the world, exposure to

tapeworm eggs is more likely. For instance, your risk of coming into
contact with eggs of the pork tapeworm (Taenia solium) is greater in
areas of Latin America, China, sub-Saharan Africa or Southeast Asia
where free-range pigs may be more common.

Complications
Intestinal tapeworm infections usually don't cause complications. If
complications do occur, they may include:

 Digestive blockage. If tapeworms grow large enough, they can block

your appendix, leading to infection (appendicitis); your bile ducts, which
carry bile from your liver and gallbladder to your intestine; or your
pancreatic duct, which carries digestive fluids from your pancreas to
your intestine.
  Brain and central nervous system impairment. Called
neurocysticercosis (noor-o-sis-tih-sur-KOE-sis), this especially dangerous
complication of invasive pork tapeworm infection can result in
headaches and visual impairment, as well as seizures, meningitis,
hydrocephalus or dementia. Death can occur in severe cases of
infection.

 Organ function disruption. When larvae migrate to the liver,

lungs or other organs, they become cysts. Over time, these cysts
grow, sometimes large enough to crowd the functioning parts of
the organ or reduce its blood supply. Tapeworm cysts sometimes
rupture, releasing more larvae, which can move to other organs
and form additional cysts.

A ruptured or leaking cyst can cause an allergy-like reaction, with

itching, hives, swelling and difficulty breathing. Surgery or organ
transplantation may be needed in severe cases.

Prevention
To prevent tapeworm infection:

 Wash your hands with soap and water before eating or handling food
and after using the toilet.

 When traveling in areas where tapeworm is more common, wash and

cook all fruits and vegetables with safe water before eating. If water
might not be safe, be sure to boil it for at least a minute and then let it
cool off before using it.

 Eliminate livestock exposure to tapeworm eggs by properly disposing

of animal and human feces.

 Thoroughly cook meat at temperatures of at least 145 F (63 C) to kill

tapeworm eggs or larvae.

 Freeze meat for as long as seven to 10 days and fish for at least 24
hours in a freezer with a temperature of -31 F (-35C) to kill tapeworm
eggs and larvae.

 Avoid eating raw or undercooked pork, beef and fish.

 Promptly treat dogs infected with tapeworm.

Diagnosis
To diagnose a tapeworm infection, your doctor may rely on one of the
following:

 Stool sample analysis. For an intestinal tapeworm infection, your

doctor may check your stool or send samples to a laboratory for
testing. A laboratory uses microscopic identification techniques to
check for eggs or tapeworm segments in your feces.

 Because the eggs and segments are passed irregularly, the lab
may need to collect two to three samples over a period of time to
detect the parasite. Eggs are sometimes present at the anus, so
your doctor may use a piece of transparent adhesive tape pressed
to the anus to collect eggs for microscopic identification.
 Blood test. For tissue-invasive infections, your doctor may also test
your blood for antibodies your body may have produced to fight
tapeworm infection. The presence of these antibodies indicates
tapeworm infestation.

 Imaging exam. Certain types of imaging, such as CT or MRI scans, X-

rays, or ultrasounds of cysts, may suggest invasive tapeworm infection.

Treatment
Some people with tapeworm infections never need treatment, for the
tapeworm exits the body on its own. Others don't realize they have it
because they have no symptoms. However, if you're diagnosed with
intestinal tapeworm infection, medication will likely be prescribed to
get rid of it.

Treatments for intestinal infections

The most common treatment for tapeworm infection involves oral

medications that are toxic to the adult tapeworm, including:

 Praziquantel (Biltricide)

 Albendazole (Albenza)

 Nitazoxanide (Alinia)

Which medication your doctor prescribes depends on the species of

tapeworm involved and the site of the infection. These drugs target
the adult tapeworm, not the eggs, so it's important to avoid reinfecting
yourself. Always wash your hands after using the toilet and before
eating.

To be certain that your tapeworm infection has cleared, your doctor

will probably have your stool samples checked at certain intervals
after you've finished taking your medication. Successful treatment —
meaning that your stool is free of tapeworm eggs, larvae or proglottids
— is most likely if you receive appropriate treatment for the type of
tapeworm causing your infection.

Treatments for invasive infections

Treating an invasive infection depends on the location and effects of

the infection.

 Anthelmintic drugs. Albendazole (Albenza) can shrink some tapeworm

cysts. Your doctor may monitor the cysts periodically using imaging
studies such as ultrasound or X-ray to be sure the drug is effective.

 Anti-inflammatory therapy. Dying tapeworm cysts can cause swelling

or inflammation in tissues or organs, so your doctor may recommend
prescription corticosteroid medication, such as prednisone or
dexamethasone, to reduce inflammation.

 Anti-epileptic therapy. If the disease is causing seizures, anti-epileptic

medications can stop them.

 Shunt placement. One type of invasive infection can cause too much

fluid on the brain, called hydrocephalus. Your doctor may recommend
placing a permanent tube (shunt) in your head to drain the fluid.

 Surgery. Whether cysts can be removed surgically depends on

their location and symptoms. Cysts that develop in the liver, lungs
and eyes are typically removed, since they can eventually threaten
organ function.

Your doctor might recommend a drainage tube as an alternative to

surgery. The tube allows aggressive rinsing (irrigation) of the area
with anti-parasitic solutions.
 CestodesTapeworms
Authored by Dr Nick Imm, Reviewed by Dr Adrian Bonsall | Last edited 10 Nov 2016 | Certified by The
Information Standard

This article is for Medical Professionals

Professional Reference articles are designed for health

professionals to use. They are written by UK doctors and
based on research evidence, UK and European Guidelines. You
may find the Worm Medicines (Anthelmintics)article more
useful, or one of our other health articles.
Taenia solium and Taenia saginata

Cestodes are tapeworms. There is a large variety but only those that
are pathogenic to humans will be discussed here.

These include:

 Taenia solium (pork tapeworm).

 Taenia saginata (beef tapeworm).
 Diphyllobothrium latum (fish or broad tapeworm).
 Hymenolepis nana and Hymenolepis diminuta(dwarf tapeworm and rat
tapeworm respectively).
 Echinococcus granulosus and Echinococcus multilocularis (cause
hydatid disease).
 Spirometra spp. plerocercoid tapeworm larvae (resulting in
sparganosis).

Taenia solium and Taenia saginata

These cause 'taeniasis'.

Epidemiology

 Present worldwide.

 Incidence is higher in developing countries - 10% of the population can

be affected.

 The pork tapeworm has a higher incidence.

 Morphology

T. saginata

 Usually less than 5 m long but can grow up to 25 m; 12 mm broad.

 The head, called the scolex, is pear-shaped.

 It has no hooks and no neck.

 It has four suckers in the head.

 The body is long and flat with several hundred segments called
proglottids - hermaphroditic, egg-producing sections.

 Each proglottid is 18 x 6 mm with a branched uterus.

 Eggs are round and yellow-brown in colour.

T. solium
 It has a variable size and can be up to 7 m long; it has a neck and a
long flat body.

 The scolex is globular in shape.

 There are four suckers and hooks.

 Proglottids are 5 x 10 mm and also have branched uteri.

Life cycle

Poorly cooked meat is ingested by humans who are the only definitive
hosts. The poorly cooked meat includes tapeworm larval cysts
 (cysticerci) which then release larvae. These attach to the small
intestine by the scolex suckers. The worm then matures over 3-4
months during which the proglottids develop. The worm can survive for
up to 25 years in humans during which time the gravid proglottids are
released into the faeces.

The excreted eggs which are excreted in the faeces can survive on
vegetation where they are then consumed by cattle or pigs. Once in
these animals the eggs hatch and cysticerci are released. These pass
into the animal circulation from the small intestine and reside in the
muscle. Humans are then infected by eating raw meat containing the
cysticerci.

Presentation

Taeniasis
 This results from either T. saginata or T. soliumand relates to the
adult worm in the gut.
 This depends on the load of the infectious agents.

 Light infection may be asymptomatic. Heavier infection leads to

epigastric pain, diarrhoea and vomiting.
Cysticercosis
T. solium can also lead to cysticercosis whereby larval cysts infiltrate
the lung, liver, eye or brain. This results in inflammation leading to
clinical features such as severe sight impairment and neurological
symptoms. In some countries (eg, Peru and Mexico)
[1]
neurocysticercosis accounts for 30% of seizures , making it an
important cause of morbidity and mortality worldwide.

Investigations

 Recover eggs or proglottids in stool or perianal area.

 Cysticercosis is confirmed by the presence of antibodies and imaging -

eg, CXR, CT scan of the brain.

Management

 Niclosamide or praziquantel (single dose) can be used (available on a

named-patient basis) .
[2]

 [3]
Treatment is very effective . Satisfactory treatment requires expulsion
of the scolex.
 There has been suggestion to use a purgative before and after to
[4]
improve expulsion of the tapeworm .

Prevention

 Inspect meat thoroughly.

 Adequate handling of food - eg, freezing or cooking.

 Cysticerci do not survive temperatures of <10°C and >50°C.

 The World Health Organization (WHO) advocates the periodic treatment

of tapeworms such as T. solium in endemic areas with albendazole. This
can prevent neurocysticercosis at a later stage .
[1]

Diphyllobothrium latum (fish or broad tapeworm)

Infection results from eating raw or improperly cooked freshwater fish.

Epidemiology

Present worldwide, especially in subarctic and temperate regions.

Morphology

 This is the longest tapeworm in humans - 3-10 m in length.

 It has >3,000 proglottids which are more broad than long.

 The scolex is shaped as two almond leaves.

 Eggs are 35-55 x 55-75 micrometres.

Life cycle

Man and some animals are infected. The plerocercoid larvae result in
infection in humans. The cycle begins by the ingestion of uncooked
fish containing plerocercoid larvae which attach to the small intestine.
In 3-5 weeks the worm matures to adult size. The adult worm releases
eggs that are passed into the faeces. These eggs hatch in fresh water,
releasing ciliated coracidia. These are subsequently ingested by the
water flea (cyclops) and release procercoid larvae. The cyclops are
then ingested by freshwater fish, forming plerocercoid larvae which
when ingested lead to infection.
 Presentation

This depends on the number of worms. Mild infection leads to:

 Abdominal discomfort.

 Loss of appetite.

 Loss of weight.

 Malnutrition.

 B12 deficiency, which may occur with heavier infections and may lead
to anaemia and even subacute combined degeneration of the spinal cord.

Investigations

Recover typical eggs or proglottids in stools.

Management
[5]
Praziquantel is first-line. Niclosamide can also be used .

Prevention

 Freeze fish for 24 hours.

 Thoroughly cook fish.

 Pickle fish.

 Prevent sewage contamination of fish reservoirs.

Hymenolepis nana (dwarf tapeworm)

This is a relatively small tapeworm (15-40 mm) and tends to infect

children. The reservoir is rodents and transmission is oro-faecal. Thus,
cross infection and auto-infection are common in children.

Life cycle

The eggs are ingested and invade the small intestine where they
mature into adult worms. These adults reside for several weeks.
Presentation

Light infection is associated with vague abdominal pain but enteritis

can occur with heavier infections.

Investigations

Presence of eggs in faeces.

Management

Niclosamide or a single dose of praziquantel are the drugs of choice.

Prevention

Good hygiene can effectively prevent spread.

Hymenolepis diminuta is the rat tapeworm. It is much longer than H.

nana and primarily affects rats but very rarely it can be accidentally
ingested by humans - eg, by ingestion of insects that carry the
parasite. Most interest in it relates to research. The presentation and
management are similar to those of H. nana.
Echinococcus granulosus and Echinococcus multilocularis
[6]

E. granulosus and E. multilocularis cause hydatid disease. Dogs and

other canids are the definitive hosts.
E. granulosus

Epidemiology

E. granulosus is common in Asia, Australia, East Africa, southern

regions of Spain, South America and North America. In these areas, 1-2
per 1,000 population are affected. Incidence rates are higher in some
rural areas.

Morphology

E. granulosus is the smallest of the tapeworms (3-9 mm long) and it

only has three proglottids.

Life cycle

The adult worms live in domestic and in wild carnivorous animals.

Infected animals pass eggs in their faeces, which are then ingested by
 grazing farm animals and humans. The eggs then localise in various
organs, resulting in a hydatid cyst which contains many larvae (called
'hydatid sand'). Other animals may then consume the infected organs
and the cysts then release proto-scolices. These pass into the small
intestine, leading to adult worms.

In humans, the echinococcus eggs invade the small intestine and then
enter the circulation. The cysts then locate and reside in organs
including the liver, bone, lung and brain. Cysts are usually 1-7 cm but
can be as big as 30 cm.

Presentation

Symptoms depend on the site where the cysts have located and are
similar to a growing tumour. Examples include:

 Large abdominal cysts which lead to discomfort.

 Liver cysts resulting in jaundice.

 Lung cysts which can lead to abscess formation.

 Brain cysts which can cause focal seizures and raised intracranial
pressure.

 Cyst content which can lead to anaphylaxis.

Investigations

 Eosinophilia.

 Abnormal LFTs.

 Antibodies against hydatid fluid.

 Imaging - eg, CXR, CT scan of the liver or abdomen, brain CT or MRI

scan.

Management

 Surgical removal of a cyst or inactivation of a cyst by injection of 10%

formalin followed by resection.

 Often, complete resection of the cyst is impossible due to close

[7]
proximity to major vessels .
 Medication may be necessary to keep the cyst from recurring. The drug
[8]
of choice is albendazole .

Prevention

 Avoid contact with infected animals.

 Eliminate the infection in domestic animals.

E. multilocularis
This is similar to E. granulosus with similar morphology and life cycle.
It tends to occur in parts of Asia and North America and in Europe too.
The intermediate host is rodents. The presentation is similar to E.
granulosus but the cysts are multilocular. Again, therapy involves
surgery.
E. multilocularis is resistant to praziquantel, although high doses of
albendazole or mebendazole may be effective. Prevention involves
rodent control measures.

Spirometra spp.

Plerocercoid tapeworm larvae of Spirometraspp.  can cause

[9]
sparganosis, which is rare but has a tendency to affect the following :
 Subcutaneous tissue

 Skeletal muscle

 Visceral organs

 Central nervous system

 Spinal cord

Epidemiology

It is found worldwide - most commonly in East Asia. Infection results

[9]
from :
 Ingesting contaminated water or raw or inadequately cooked flesh of
snakes or frogs.

 Applying skin of an infected animal to skin as a poultice.

 Presentation

This depends on which area of the body is affected - eg, spinal

involvement presents with weakness and paraesthesia.

Investigations

 Eosinophilia may not be present if the worm is localised to an organ.

 ELISA tests of serum or cerebrospinal fluids to detect antibodies to

sparganosis.

Management

 Treatment involves removal of the worm - eg, surgery.

 Any surrounding inflammation may require corticosteroids