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tapeworm Taenia solium, the fish tapeworm Diphyllobothrium latum, each of which can reach many meters in length, and the dwarf tapeworm Hymenolepis nana Taenia and Hymenolepis species are broadly distributed, especially in the tropics; D latum is most prevalent in temperate regions Other tapeworms that can cause noninvasive human disease include the rodent tapeworm Hymenolepis diminuta, the dog tapeworm Dipylidium caninum, and other Taenia and Diphyllobothrium species Invasive tapeworm infections, including T solium (when infective eggs, rather than cysticerci are ingested) and Echinococcus species, will be discussed separately

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tion follows ingestion of food contaminated with human feces Eggs hatch in the intestines, where oncospheres penetrate the mucosa, encyst as cysticercoid larvae, and then rupture after about 4 days to release adult worms Autoinfection can lead to amplification of infection Infection with H nana, the related rodent tapeworm H diminuta, or the dog tapeworm D caninum can also follow accidental ingestion of infected insects H nana are dwarf in size relative to other tapeworms but can reach 5 cm in length Heavy infection is common, especially in children, and can be accompanied by abdominal discomfort, anorexia, and diarrhea





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how to modify existing pdf · Issue #948 · MrRio/ jsPDF · GitHub
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Infection is most common in cattle breeding areas Humans are the definitive host Gravid segments of T saginata are passed in human feces to soil, where they are ingested by grazing animals, especially cattle The eggs then hatch to release embryos that encyst in muscle as cysticerci Humans are infected by eating raw or undercooked infected beef Most individuals infected with T saginata are asymptomatic, but abdominal pain and other gastrointestinal symptoms may be present Eosinophilia is common The most common presenting finding is the passage of proglottids in the stool Diagnosis is usually made based on the identification of characteristic eggs or proglottids in stool Egg release may be irregular, so examination of multiple specimens or concentration techniques may be needed

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The treatment of choice for noninvasive tapeworm infections is praziquantel A single dose of praziquantel (5 10 mg/kg) is highly effective, except for H nana, for which the dosage is 25 mg/kg Treatment of H nana is more difficult, as the drug is not effective against maturing cysts Therefore, with heavy infections with this parasite a repeat treatment after 1 week, and screening after therapy to document cure are appropriate Therapy can be accompanied by headache, malaise, dizziness, abdominal pain, and nausea The alternative therapy for these infections is niclosamide A single dose of niclosamide (2 g for adults, chewed) is effective against D latum, Taenia, and D caninum infections For H nana, therapy is continued daily for 1 week Niclosamide may cause nausea, malaise, and abdominal pain

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Chero JC et al Hymenolepis nana infection: symptoms and response to nitazoxanide in field conditions Trans R Soc Trop Med Hyg 2007 Feb;101(2):203 5 [PMID: 16814334] Flisser A et al Portrait of human tapeworms J Parasitol 2004 Aug;90(4):914 6 [PMID: 15357104] Garcia HH et al Combined human and porcine mass chemotherapy for the control of T solium Am J Trop Med Hyg 2006 May;74(5):850 5 [PMID: 16687692] Willingham AL et al Control of Taenia solium cysticercosis/ taeniosis Adv Parasitol 2006;61:509 66 [PMID: 16735172]

T solium is transmitted to pigs that ingest human feces Humans can be either the definitive host (after consuming undercooked pork, leading to tapeworm infection) or the intermediate host (after consuming food contaminated with human feces containing T solium eggs, leading to cysticercosis, which is discussed under invasive tapeworm infections) As with the beef tapeworm, infection with T solium adult worms is generally asymptomatic, but gastrointestinal symptoms may occur Infection is generally recognized after passage of proglottids Autoinfection with eggs can progress to cysticercosis

Infection with D latum follows ingestion of undercooked freshwater fish, most commonly in temperate regions Eggs from human feces are taken up by crustaceans, these are eaten by fish, which are then infectious to humans Infection with multiple worms over many years can occur Infections are most commonly asymptomatic, but nonspecific gastrointestinal symptoms, including diarrhea, may occur Diagnosis usually follows passage of proglottids Prolonged heavy infection can lead to megaloblastic anemia and neuropathy from vitamin B12 deficiency, which is due to infection-induced dissociation of the vitamin from intrinsic factor and to utilization of the vitamin by worms

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Exposure to T solium through fecal contamination of food Seizures, headache, and other findings of a focal CNS lesion Brain imaging shows cysts; positive serologic tests

H nana is the only tapeworm that can be transmitted between humans Infections are common in warm areas, especially with poor hygiene and institutionalized populations Infec-

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