Infectious Disease Compendium

Taenia

Microbiology

T. saginata. Beef tape worm.

T. solium. Pork tape worm.

Epidemiologic Risks

T. saginata: Eating beef with the tape worm in it. Bon appetite.

Taenia solium: Eating pork. 160 degrees, which is still pink, will kill it.

Syndromes

T. saginata. Occasionally abdominal pain, people are prone to freaking when then pass a long tape worm.

Taenia solium. Occ abdominal pain, people are prone to freaking when then pass a long tape worm and cysticercoses, cysts in the brain. In a literature review of the symptoms of neurocysticercosis patients 79% had seizures/epilepsy, 38% severe headaches, 16% focal deficits and 12% signs of increased intracranial pressure.

Treatment

T. saginata.

Praziquantel 5 to 10 mg/kg or niclosamide 2 gm po for adults both one time.

Taenia solium.

Gi disease: praziquantel 5 to 10 mg/kg or niclosamide 2 gm po one time only for adults.

CNS cysticercoses (Guidelines) perhaps problematic. If you treat single cysts, give albendazole 400 bid x 8 days, OR praziquantel 50 mg/kg/day x 15 to 30 days both WITH dexamethasone. It may " decrease the number of active lesions on brain imaging studies and reduce long-term seizure frequency. (PubMed)"

With multiple cysts, giving both albendazole and praziquantel increases killing without increased side effects (PubMed)(Pubmed).

With disease in the ventricles/arachnoiditis/subarachnoid disease need to treat with months to years, longer than disease in the brain.

The CDC has an antigen test that may be helpful to help determine an endpoint (PubMed).

Notes

A meta analysis in the Annals says "Cysticidal drug therapy results in better resolution of colloidal and vesicular cysticerci, lower risk for recurrence of seizures in patients with colloidal cysticerci, and a reduction in the rate of generalized seizures in patients with vesicular cysticerci" and that albendazole was better than praziquantel, but head to head trials needed to be done (PubMed). In patients with relapsing symptoms due to slowly dying parasites, methotrexate can lead to less steroid use (PubMed).

There is a strong association with seizures and perhaps a lack of treatment with cysticercoses (PubMed).

Interestingly, the risk for seizures may be genetic: TLR4 Asp299Gly and Thr399Ile polymorphisms in the Toll-Like receptor 4. Do not ask for whom the bell... hell, never mind.

Pateints with calicfied, and presumptively dead, lesions often have recurrent edema and seizures (PubMed). Whether they should get immunosuppresion is an unresolved issue.