Infectious Disease Compendium

Taenia

Microbiology

T. saginata. Beef tape worm.

T. solium. Pork tape worm.

Taenia asiatica with humans as definitive hosts but also infects pigs.

There are 100 others with their own animal host, most of which do not infect humans.

A cestode.

Epidemiologic Risks

T. saginata: Eating beef shit 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. Occasionally 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.

The cysts can show up in other organs, albeit rarely.

Treatment

T. saginata, Taenia asiatica.

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 (IDSA Guidelines) perhaps problematic.

  • For patients with 1–2 viable parenchymal cysticerci, albendazole monotherapy 15 mg/kg/day divided into 2 daily doses for 10–14 days with food. We recommend a maximum dose of 1200 mg/day.

  • For more than 2 viable parenchymal cysticerci albendazole (15 mg/kg/day) combined with praziquantel (50 mg/kg/day) for 10–14 days

both WITH dexamethasone. It may decrease the number of active lesions on brain imaging studies and reduce long-term seizure frequency. (PubMed)."

Calcified cysts are dead and do not require therapy.

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.

There was a an Orthodox Jewish community in New York City that became infected by way of housekeepers from Latin American countries, who were suspected to be source of the infections (PubMed).

Patients with calcified, and presumptively dead, lesions often have recurrent edema and seizures (PubMed). Whether they should get immunosuppression is an unresolved issue.

Curious Cases

Relevant links to my Medscape blog

My Least Favorite Nun

Worms

Last Update: 04/24/18.