WORM INFESTATION

PHARMAHUB
OUTLINE
 INTRODUCTION
 EPIDEMOLOGY
 HUMAN PARASITIC WORMS
o Ascaris lumbricoides (Round worm)
o Enterobius vermicularis (Pin Worm)
o Ancylostoma duodenale/Necator americanus
(Hook worm)
o Wuchereria bancrofti (Filariasis)
o Echinococcus granulosus (Echinococcosis)
o Taenia solium/Taenia saginata (Pork/Beef
Tapeworm
 Practise questions
 Case study
 INTRODUCTION
Worm infestation refers to the presence of parasitic worms in or on the body. These
parasites usually gain entry into the gut through the mouth, via contaminated food or
water. Some foods, specifically some animal meats, are more likely to transmit these
human intestinal worms.

Worms may live in it host for years without causing any symptoms, general symptoms
may appear few weeks or several months after infestation and include paleness,
weakness, tiredness (from anemia due to lost blood sucked by worms), restlessness,
disturbed sleep and weight loss (due to loss of nutrients used by worms). Abdominal
symptoms can last from weeks to months and include:

 Distended belly
 Foul smelling breath or gas
 Loss of appetite
 Vomiting
 Itchy anus
 Mucus in the stool
 Blood in the stool
 Loose bowel movements or diarrhea
 Worms, their parts or eggs can be sometimes found in the stool
 Itchy skin rash
 Swelling around the eyes
 Swollen itchy bump on the site of the parasite entry (usually on the foot).

Worm eggs, shed in the stool of humans or animals infected with adult worms, can
contaminate soil or water. Once outside the body, eggs need several days or weeks to
develop into the infective stage (cysts) or immature worms (larvae) that may be
ingested when you eat with soil-contaminated hands or when you eat raw unwashed
vegetables.

Another source of intestinal worms is undercooked infected meat of domestic pig,

freshwater fish or wild animals (bear, walrus, etc.).

Adult worms, which may be from 1 millimeter to several meters long, invade the bowel
wall and suck the blood from it, or live freely in the intestine and utilize nutrients from
the bowel content. The result are small intestinal or colonic inflammation and ulcers,
anemia, and protein, iron and vitamin (mainly A, C, B12) deficiency. Intestinal
obstruction may occur in severe cases. Larvae may migrate to other organs (liver, spleen,
bladder, muscles, lungs, brain), where they form cysts and trigger allergic inflammation.

EPIDEMOLOGY
The soil-transmitted helminths (Ascaris lumbricoides, hookworm and Trichuris trichiura)
are the most prevalent, infecting an estimated one-sixth of the global population.
Infection rates are highest in children living in sub-Saharan Africa, followed by Asia and
then Latin America and the Caribbean. In sub-Saharan Africa , it is estimated that
approximately a quarter of the total population is infected with one or more helminths. A
2006 estimates propose that of the then 181 million school-aged children in sub-Saharan
Africa, almost half (89 million) were affected by one or more of these parasitic worms.
While whole populations will be geographically at risk, children are observed to
disproportionally carry the greatest burden of infection. This disproportion has
behavioural, biological and environmental bases. Children tend to be more active in the
infected environment and rarely employ good sanitary behaviours. In Nigeria, the
occurrence of human parasitic worms is increasingly high and thrives in communities without
better housing, sanitation, water supplies, health care, education and low income.

HUMAN PARASITIC WORMS

 Ascaris lumbricoides (Round worm)

Ascariasis is an infection of the small intestine caused by Ascaris lumbricoides (A.

lumbricoides). It is the most common worm infestation of human. Adult worms live in the
lumen of small intestine. A female may produce up to 240,000 eggs per day which are
passed with the feces. Ascariasis is most common in places without modern sanitation.
People get it through unsafe food and water. The infection usually causes no symptoms,
but higher numbers of roundworms (heavier infestations) can lead to problems in the
lungs or intestines.

Children often become infected when they put their hands in their mouths after
playing in contaminated soil, according to WHO. Ascariasis can also be passed directly
from person-to-person.

After ingestion, the A. lumbricoides roundworm reproduces inside your intestine. The
worm goes through several stages:

 Swallowed eggs first hatch in the intestine.

 The larvae then move through your bloodstream to your lungs.

 After maturing, the roundworms leave your lungs and travel to your throat.

 You’ll either cough up or swallow the roundworms in your throat. The worms that
are swallowed will travel back to your intestine.

 Once they’re back in your intestine, the worms will mate and lay more eggs.

 The cycle continues. Some eggs are excreted through your feces. Other eggs
hatch and return to the lungs.

The roundworm is found worldwide, but it’s more frequently found in tropical and
subtropical regions, including Latin America and sub-Saharan Africa. It’s also more
common in areas where sanitation is poor.
Environmental risk factors for ascariasis include:

 lack of modern hygiene and sanitation infrastructure

 use of human feces for fertilizer
 living in or visiting a warm climate
 exposure to an environment where dirt might be ingested

Exposure can limit your exposure to roundworms by avoiding unsafe food and water.
Keeping immediate environment clean also helps. This includes laundering clothing
exposed to unsanitary conditions and cleaning cooking surfaces well.

One should make sure to take precautions if you’re visiting a remote area. It’s important
to:

 Always wash your hands with soap and water before eating or preparing food.
 Boil or filter your water.
 Inspect food preparation facilities.
 Avoid unclean common areas for bathing.
 Peel or cook unwashed vegetables and fruit in regions that lack sanitation
infrastructure or that use human faeces for fertilizer.

Ascariasis is most common in places without modern sanitation. People get it through
unsafe food and water. The infection usually causes no symptoms, but higher numbers of
roundworms (heavier infestations) can lead to problems in the lungs or intestines.

Children who are 3 to 8 years old are most likely to be infected because of their contact
with soil while playing.

People with ascariasis often have no symptoms. Symptoms become more noticeable when
the roundworm infestation grows.

Roundworms in your lungs can cause:

 coughing or gagging
 wheezing or shortness of breath
 aspiration pneumonia, rarely
 blood in mucus
 chest discomfort
 fever

Roundworms in your intestines can cause:

 nausea
 vomiting
 irregular stools or diarrhea
 intestinal blockage, which causes severe pain and vomiting
 loss of appetite
 visible worms in the stool
 abdominal discomfort or pain
 weight loss
  growth impairment in children due to malabsorption

Some people with a large infestation may have other symptoms, such as fatigue and
fever. A major infestation can cause extreme discomfort. You may have all or many of
the above symptoms if you don’t receive prompt treatment.

Complications of ascariasis

Most cases of ascariasis are mild and don’t cause major problems. However, heavy
infestations can spread to other parts of the body and lead to dangerous complications.
They can include:

 Intestinal blockage occurs when a mass of worms blocks your intestines causing
severe pain and vomiting. Intestinal blockage is considered a medical emergency
and requires treatment right away.
 Duct blockages occur when the worms block the small passageways to your liver or
pancreas.
 Infections that lead to loss of appetite and poor absorption of nutrients puts
children at risk of not getting enough nutrients, which can affect their growth.

Children are more likely to have gastrointestinal complications because their small
intestines increase their chances of having an intestinal blockage.

Diagnosis of Ascariasis

Diagnosis is usually by examining a stool sample for parasites and ova (eggs). However X-
rays, CT scans, ultrasounds, MRI scans and endoscopy are also used in diagnosis

Imaging tests can show: how many worms have grown to maturity and where major
groups of worms are inside the body.

TREATMENT

Ascariasis is treated with albendazole, mebendazole, or ivermectin. Dosage is the same

for children as for adults. Albendazole should be taken with food. Ivermectin should be
taken on an empty stomach with water. The safety of ivermectin for treating children
who weigh less than 15 kg has not been established.

Drug Dosage

Albendazole 400 mg orally once

Mebendazole 100 mg orally twice daily for 3 days or 500 mg orally once

Ivermectin 150-200 mcg/kg orally once

Levamisole 150 mg as a single dose (Adult), 3 mg/kg as a single dose (children)

Pyrantel pamoate 5 mg/ kg or 10 mg/kg as a single oral dose for single or mixed
 infection

Albendazole, Mebendazole and Ivermectin are pregnancy category C, (Pregnancy

Category C: Either studies in animals have revealed adverse effects on the fetus
(teratogenic or embryocidal, or other) and there are no controlled studies in women or
studies in women and animals are not available. Drugs should be given only if the
potential benefit justifies the potential risk to the fetus.). WHO allows use of
albendazole in the 2nd and 3rd trimesters of pregnancy. However, the risk of treatment
in pregnant women who are known to have an infection needs to be balanced with the risk
of disease progression in the absence of treatment.

Pyrantel pamoate 11mg (base)/kg PO daily for 3 days is the drug of choice in Pregnancy.

Medical anthelmintic therapy is usually not indicated during active pulmonary infection
because dying larvae are considered a higher risk for significant pneumonitis. Pulmonary
symptoms may be ameliorated with inhaled bronchodilator therapy or corticosteroid if
necessary.

 Enterobius vermicularis (Pin Worm)

Pinworms are tiny, narrow worms. They’re white in color and less than a half-inch long.
Pinworm infections are also known as enterobiasis or oxyuriasis.

Some individuals with pinworm infections may not experience any symptoms. However,
you may suspect that you or your child has a pinworm infection if you notice:

 frequent and strong itching of the anal area

 restless sleep due to anal itching and discomfort
 pain, rash, or other skin irritation around the anus
 the presence of pinworms in the area of your child’s anus
 the presence of pinworms in stools

Causes of Pin Worm infestation

 Pinworms infections are highly contagious. You become infected with pinworms by
unintentionally ingesting or inhaling pinworm eggs.
 These eggs are usually deposited onto a surface or object by a person who’s been
infected. The cycle of infection begins with the ingestion of these microscopic
eggs.
 Once the eggs enter your body, they remain in the intestine until they hatch and
mature. As adults, the female pinworms move into the colon and exit the body
through the anus at night.
 Female pinworms lay eggs in the folds of skin around the anus and then return to
the colon. The presence of these eggs often causes anal itching and irritation.
 When a person scratches the affected area, the pinworm eggs transfer to the
fingers. The eggs can survive for several hours on your hands.
 If a person who’s been infected touches household objects like bedding, clothing,
toilet seats, or toys, the eggs will transfer to these objects. Pinworm eggs can
survive on these contaminated surfaces for up to three weeks.
 Children transfer pinworm eggs easily because they may put infected toys or
 other objects directly into their mouths. The eggs can also transfer from
contaminated fingers directly to food or liquids.
 While uncommon, it’s also possible for adults to inhale airborne eggs when shaking
contaminated bedding, towels, or clothing.
 Pinworms generally live for up to 13 weeks. Scratching an affected area can lead
to unintentional ingestion, which can lead to reinfection and a restart of the
entire pinworm life process.
 Sometimes, eggs on the anus can hatch and the pinworm larvae can reinfect the
intestine that they came from. This can cause an infection to continue
indefinitely if it’s not treated

Pinworm infections affect people of all ages and geographical regions. Since the
pinworm eggs are microscopic, it’s impossible to avoid individuals or areas that have been
infected.

While anyone can get a pinworm infection, the following groups are more susceptible:

 children who attend day care, preschool, or elementary school

 family members or caregivers of people who have been infected
 individuals who live in institutions or other crowded accommodations, such as
dormitories
 children or adults who don’t practice regular and careful handwashing prior to
eating
 children who have a habit of sucking their thumbs

Diagnoses of Pin Worm

A tape test is the most reliable method for diagnosing a pinworm infection. This test
consists of taking a piece of cellophane tape and pressing the sticky, adhesive side
against the skin around the anus.

Pinworms often exit the anus while a person sleeps. Because of this, people who suspect
they’ve been infected should conduct a tape test upon waking in the morning. If eggs are
present, they’ll stick to the tape.

Take the tape to the lab, where it can place it on a slide and examine it under a
microscope to see if it contains pinworm eggs.

Routine morning activities, such as bathing or using the toilet, can remove eggs from
your skin. Therefore, the results of a tape test are most accurate if you perform the
test when you first wake up.

The CDC recommends that you conduct a tape test at least three times, on three
consecutive mornings, to increase your likelihood of finding pinworm eggs.

Treatment

The most common and effective medications to treat pinworm infection are:

 mebendazole
  albendazole
 pyrantel pamoate

One course of medication usually involves an initial dose, followed by a second dose two to
three weeks later. More than one course may be necessary to fully eliminate the pinworm
eggs. Creams or ointments can soothe itching skin in the area around the anus.

Since asymptomatic infestation of other members in a household is frequent,

simultaneously treating all household members may be reasonable.

Non-Pharmacological management

In addition to medication, a specific regimen of hygiene and household cleaning can help
you completely eliminate the pinworm eggs:

 Ensure that the person who’s been infected and other household members
practice thorough handwashing with warm water and soap. This is especially
important before eating.
 Encourage everyone in the household to shower and change their underwear every
morning.
 Clean everyone’s fingernails and cut them short.
 Instruct everyone to stop biting their nails.
 Tell the person who’s been infected to refrain from scratching the anal area.
 Use hot water to launder all bedding, towels, washcloths, and clothing in the
affected house. Dry these items using high heat.
 Avoid shaking clothing and bedding to keep pinworm eggs from spreading into the
air.
 Don’t allow children to bathe together, as this can cause pinworm eggs to spread
in the bath water.
 Thoroughly clean any surfaces that may be infected, including toys, floors,
countertops, and toilet seats.

Most people don’t experience serious complications as a result of pinworm

infections. In rare cases, if the infestation is left untreated, pinworm infections can
lead to a urinary tract infection (UTI) in women.

Pinworms can also travel from the anus into the vagina, affecting the uterus, fallopian
tubes, and other pelvic organs. This may result in other infections, including vaginitis and
endometritis. Endometritis is an inflammation of the uterine lining.

The presence of a significant number of pinworms can cause abdominal pain.

Substantial pinworm populations can rob your body of essential nutrients, which can
cause weight loss.

 Ancylostoma duodenale/Necator americanus (Hook worm)

Hookworms are parasites whose infestation affects the lungs, skin, and small intestine.
Humans contract hookworms through hookworm larvae found in dirt contaminated by
feces. It mainly affects people in developing nations in the tropics and subtropics due to
poor sanitation. Parasitic hookworms cause these infections. The two major types of
hookworms that cause infection are Necator americanus and Ancylostoma duodenale.

The eggs of these hookworms end up on the ground after passing through human feces.
They hatch into larvae, which stay in the soil until they have a chance to break through
human skin. The larvae can migrate through the dermis, entering the blood stream and
moving to the lungs, once in lungs they break into alveoli causing a mild and usually
asymptomatic alveoli with eosinophilia.

Symptoms generally start with itchiness and a small rash caused by an allergic reaction
in the area that the larvae entered your skin. This is generally followed by diarrhea as
the hookworms grow in your intestine. Other symptoms include:

 abdominal pain
 colic, or cramping and excessive crying in infants
 intestinal cramps
 nausea
 a fever
 blood in your stool
 a loss of appetite
 itchy rash

Treatment

Treatment for hookworm infections aims to get rid of the parasites, improve nutrition,
and treat complications from anemia. Medications that destroy parasites, such as
albendazole 400 mg PO once and mebendazole 100 mg PO 12 hourly for 3 days, levamisole
2.5 mg/kg as a single dose in adult and children . These medications are generally taken
once to treat the infection. Iron supplement can be given for anemia.

 Wuchereria bancrofti (Filariasis)

Filariasis is a disease group caused by filariae that affects humans and animals. Of the
hundreds of described filarial parasites, only 8 species cause natural infections in human
which includes Loa loa, Onchocerca volvulus, Wuchereria bancrofti, Mansonella
streptocera, Brugia malayi, Brugia timori, Mansonella ozzardi and Mansonella perstan.

Filarial parasite can be classified according to the habitat of adult worms in the
vertebrate host. Cutaneous group (Loa loa, Onchocerca volvulus and Mansonella
streptocera), Lymphatic group (Wuchereria bancrofti, Brugia malayi and Brugia timori)
and the body cavity group (Mansonella ozzardi and Mansonella perstan.)

Filariae have specific geographical distribution. For example Wuchereria bancrofti is

found in sub- Saharan Africa, South east Asia, India and the Pacific Island. Brugia
timori is found in similar location but not in sub-saharan Africa. Brugia malayi occurs on
Timor island in Indonesia.

A wide range of mosquitoes can transmit the parasite, depending on the geographic area.
In Africa, the most common vector is Anopheles and in the Americas, it is Culex
quinquefasciatus. Aedes and Mansonia can transmit the infection in the Pacific and in
Asia.

Lymphatic filariasis, is a parasitic disease caused by microscopic, thread-like worms.

The adult worms only live in the human lymph system. The lymph system maintains the
body’s fluid balance and fights infections. Lymphatic filariasis is spread from person to
person by mosquitoes. People with the disease can suffer from lymphedema and
elephantiasis and in men, swelling of the scrotum, called hydrocele.

The infection spreads from person to person by mosquito bites. The adult worm lives in
the human lymph vessels, mates, and produces millions of microscopic worms, also known
as microfilariae. Microfilariae circulate in the person’s blood and infect the mosquito
when it bites a person who is infected. Microfilariae grow and develop in the mosquito.
When the mosquito bites another person, the larval worms pass from the mosquito into
the human skin, and travel to the lymph vessels. They grow into adult worms, a process
that takes 6 months or more. An adult worm lives for about 5–7 years. The adult worms
mate and release millions of microfilariae into the blood. People with microfilariae in
their blood can serve as a source of infection to others. Many mosquito bites over several
months to years are needed to get lymphatic filariasis.

Although the parasite damages the lymph system, most infected people have no
symptoms and will never develop clinical symptoms. These people do not know they have
lymphatic filariasis unless tested. A small percentage of persons will develop
lymphedema. This is caused by fluid collection because of improper functioning of the
lymph system resulting in swelling. This mostly affects the legs, but can also occur in the
arms, breasts, and genitalia. Most people develop these symptoms years after being
infected.

The swelling and the decreased function of the lymph system make it difficult for the
body to fight germs and infections. These people will have more bacterial infections in
the skin and lymph system. This causes hardening and thickening of the skin, which is
called elephantiasis. Many of these bacterial infections can be prevented with
appropriate skin hygiene as well as skin and wound care.

Men can develop hydrocele or swelling of the scrotum due to infection with one of the
parasites specifically W. bancrofti.

Filarial infection can also cause tropical pulmonary eosinophilia syndrome, although this
syndrome is typically found in persons living with the disease in Asia. Eosinophilia is the
presence of higher than normal disease-fighting white blood cells in the body. Symptoms
of tropical pulmonary eosinophilia syndrome include dry nocturnal cough, shortness of
breath, and wheezing. The eosinophilia is often accompanied by high levels of
Immunoglobulin E ( IgE) and antifilarial antibodies.

Diagnosis

The standard method for diagnosing active infection is the identification of

microfilariae in a blood smear by microscopic examination. The microfilariae that cause
lymphatic filariasis circulate in the blood at night (called nocturnal periodicity). Blood
collection should be done at night to coincide with the appearance of the microfilariae,
and a thick smear should be made and stained with Giemsa or hematoxylin and eosin. For
increased sensitivity, concentration techniques can be used.

Serologic techniques provide an alternative to microscopic detection of microfilariae for

the diagnosis of lymphatic filariasis. Patients with active filarial infection typically have
elevated levels of antifilarial IgG4 in the blood and these can be detected using routine
assays.

Because lymphedema may develop many years after infection, lab tests are most likely
to be negative with these patients.

Treatment

Diethylcarbamazine (DEC) (6 mg/kg/day) for 12 days is the drug of choice. The drug
kills the microfilariae and some of the adult worms. In settings where onchoceriasis is
present, Ivermectin 6 mg PO single dose (M. ozzardi) and 150 mcg/kg as single dose (M.
streptocera) is the drug of choice to treat LF. Some studies have shown adult worm
killing with treatment with doxycycline (200mg/day for 4–6 weeks)

Traditionally, annual mass treatment with albendazole plus ivermectin or DEC has been
used to interrupt the transmission of W. bancrofti

 Echinococcus granulosus (Echinococcosis)

Echinococcosis is a parasitic disease caused by infection with tiny tapeworms of the

genus Echinocococcus. Echinococcosis is classified as either cystic echinococcosis or
alveolar echinococcosis.

Cystic echinocccosis (CE), also known as hydatid disease, is caused by infection with the
larval stage of Echinococcus granulosus, a ~2-7 millimeter long tapeworm found in dogs
(definitive host) and sheep, cattle, goats, and pigs (intermediate hosts). Although most
infections in humans are asymptomatic, CE causes harmful, slowly enlarging cysts in the
liver, lungs, and other organs that often grow unnoticed and neglected for years.

Alveolar echinococcosis (AE) disease is caused by infection with the larval stage of
Echinococcus multilocularis, a ~1-4 millimeter long tapeworm found in foxes, coyotes, and
dogs (definitive hosts). Small rodents are intermediate hosts for E. multilocularis.
Although cases of AE in animals in endemic areas are relatively common, human cases
are rare. AE poses a much greater health threat to people than CE, causing parasitic
tumors that can form in the liver, lungs, brain, and other organs. If left untreated, AE
can be fatal.

Risk Factor

Cystic echinococcosis (CE) is caused by infection with the larval stage of Echinococcus
granulosus. CE is found in Africa, Europe, Asia, the Middle East, Central and South
America, and in rare cases, North America. The parasite is transmitted to dogs when
they ingest the organs of other animals that contain hydatid cysts. The cysts develop
into adult tapeworms in the dog. Infected dogs shed tapeworm eggs in their feces which
contaminate the ground. Sheep, cattle, goats, and pigs ingest tapeworm eggs in the
contaminated ground; once ingested, the eggs hatch and develop into cysts in the
internal organs. The most common mode of transmission to humans is by the accidental
consumption of soil, water, or food that has been contaminated by the fecal matter of
an infected dog. Echinococcus eggs that have been deposited in soil can stay viable for
up to a year. The disease is most commonly found in people involved in raising sheep, as a
result of the sheep's role as an intermediate host of the parasite and the presence of
working dogs that are allowed to eat the offal of infected sheep.

Alveolar echinococcosis (AE) is caused by infection with the larval stage of Echinococcus
multilocularis. AE is found across the globe and is especially prevalent in the northern
latitudes of Europe, Asia, and North America. The adult tapeworm is normally found in
foxes, coyotes, and dogs. Infection with the larval stages is transmitted to people
through ingestion of food or water contaminated with tapeworm eggs.

The presence of a cyst-like mass in a person with a history of exposure to sheepdogs in

an area where E. granulosus is endemic suggests a diagnosis of cystic echinococcosis.
Imaging techniques, such as CT scans, ultrasonography and MRIs, are used to detect
cysts. After a cyst has been detected, serologic tests may be used to confirm the
diagnosis.

Alveolar echinococcosis is typically found in older people. Imaging techniques such as CT

scans are used to visually confirm the parasitic vesicles and cyst-like structures and
serologic tests can confirm the parasitic infection.

In the past, surgery was the only treatment for cystic echinococcal cysts. Chemotherapy,
cyst puncture, and PAIR (percutaneous aspiration, injection of chemicals and
reaspiration) have been used to replace surgery as effective treatments for cystic
echinococcosis. However, surgery remains the most effective treatment to remove the
cyst and can lead to a complete cure. Some cysts are not causing any symptoms and are
inactive; those cysts often go away without any treatment.

The treatment of alveolar echinococcosis is more difficult than cystic echinococcosis and
usually requires radical surgery, long-term chemotherapy, or both.

Mebendazole and Albendazole (400 mg bd for 28 days for patient >60 kg or 15 mg/kg in
2 divided doses for patient <60 kg) are the only anthelmintic effective against cystic
echinococcosis. Albendazole is significantly more effective than mebendazole in the
treatment of liver cysts. Praziquantel has recentely been suggested, administered
additionally once per week in dose of 40 mg/kg during treatment with albendazole.

 Taenia solium/Taenia saginata (Pork/Beef Tapeworm) (Taeniasis)

Taeniasis in humans is a parasitic infection caused by the tapeworm species Taenia

saginata (beef tapeworm) and Taenia solium (pork tapeworm). Humans can become
infected with these tapeworms by eating raw or undercooked beef (T. saginata) or pork
(T. solium). People with taeniasis may not know they have a tapeworm infection because
symptoms are usually mild or nonexistent.

Taenia solium tapeworm infections can lead to cysticercosis (Cysticercosis is a parasitic

tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts
infect brain, muscle, or other tissue, and are a major cause of adult onset seizures in
most low-income countries.)

The tapeworms that cause taeniasis (Taenia saginata and T. solium) are found worldwide.
Eating raw or undercooked beef or pork is the primary risk factor for acquiring
taeniasis.

Symptoms

Most people with tapeworm infections have no symptoms or mild symptoms. Patients with
T. saginata taeniasis often experience more symptoms that those with T. solium because
the T. saginata tapeworm is larger in size (up to 10 meters (m)) than T. solium (usually 3
m). Tapeworms can cause digestive problems including abdominal pain, loss of appetite,
weight loss, and upset stomach. The most visible symptom of taeniasis is the active
passing of proglottids (tapeworm segments) through the anus and in the feces. In rare
cases, tapeworm segments become lodged in the appendix, or the bile and pancreatic
ducts.

Infection with T. solium tapeworms can result in human cysticercosis, which can be a very
serious disease that can cause seizures and muscle or eye damage

Diagnosis

Diagnosis of Taenia tapeworm infections is made by examination of stool samples;

individuals should also be asked if they have passed tapeworm segments. Stool specimens
should be collected on three different days and examined in the lab for Taenia eggs
using a microscope. Tapeworm eggs can be detected in the stool 2 to 3 months after the
tapeworm infection is established.

Tapeworm eggs of T. solium can also infect humans, causing cysticercosis. It is important
to diagnose and treat all tapeworm infections.

Treatment

Praziquantel 5-10mg/kg as single dose (off label) or niclosamide are used in treatment
after accurate diagnosis.

In neurocysticerocosis, neurologic manifestations indicate the need for antihelminthic

agents and antiepileptics. The recommended antihelmintic agent to provide better
control and resolution of cysts or granuloma.

Practice Question

Tick the drug, blocking acetylcholine transmission at the myoneural junction of

helminthes:

a) Levamisole

b) Mebendazole

c) Piperazine
d) Niclosamide

021. Tick niclosamide mechanism of action:

a) Increasing cell membrane permeability for calcium, resulting in paralysis,

dislodgement and death of helminthes

b) Blocking acetylcholine transmission at the myoneural junction and paralysis of

helminthes

c) Inhibiting microtubule synthesis in helminthes and irreversible impairment of glucose

uptake

d) Inhibiting oxidative phosphorylation in some species of helminthes

022. Tick praziquantel mechanism of action:

a) Blocking acetylcholine transmission at the myoneural junction and paralysis of

helminthes

b) Inhibiting microtubule synthesis in helminthes and irreversible impairment of glucose

uptake

c) Increasing cell membrane permeability for calcium, resulting in paralysis,

dislodgement and death of

helminthes

d) Inhibiting oxidative phosphorylation in some species of helminthes

023. Tick piperazine mechanism of action:

a) Inhibiting microtubule synthesis in helminthes and irreversible impairment of glucose

uptake

b) Blocking acetylcholine transmission at the myoneural junction and paralysis of

helminthes

c) Inhibiting oxidative phosphorylation in some species of helminthes

d) Increasing cell membrane permeability for calcium, resulting in paralysis,

dislodgement and death of helminthes

024. Tick the drug, a salicylamide derivative:

a) Praziquantel

b) Piperazine

c) Mebendazole
d) Niclosamide

025. Tick mebendazole mechanism of action:

a) Inhibiting oxidative phosphorylation in some species of helminthes

b) Increasing cell membrane permeability for calcium, resulting in paralysis,

dislodgement and death of helminthes

c) Inhibiting microtubule synthesis in helminthes and irreversible impairment of

glucose uptake

d) Blocking acetylcholine transmission at the myoneural junction and paralysis of

helminthes

026. Tick the drug, inhibiting oxidative phosphorylation in some species of helminthes:

a) Niclosamide

b) Piperazine

c) Praziquantel

d) Mebendazole

027. Tick the drug for neurocysticercosis treatment:

a) Praziquantel

b) Pyrantel

c) Piperazine

d) Bithionol

028. Tick the drug for nematodosis (roundworm invasion) treatment:

a) Niclosamide

b) Praziquantel

c) Bithionol

d) Pyrantel

029. Tick the drug for cestodosis (tapeworm invasion) treatment:

a) Piperazine

b) Praziquantel
c) Pyrantel

d) Ivermectin

030. Tick the drug for trematodosis (fluke invasion) treatment:

a) Bithionol

b) Ivermectin

c) Pyrantel

d) Metronidazole

031. Tick the drug, a benzimidazole derivative:

a) Praziquantel

b) Mebendazole

c) Suramin

d) Pyrantel

032. Tick the broad spectrum drug for cestodosis, trematodosis and cycticercosis
treatment:

a) Piperazine

b) Ivermectine

c) Praziquantel

d) Pyrantel

033. Tick the drug for ascaridosis and enterobiosis treatment:

a) Bithionol

b) Pyrantel

c) Praziquantel

d) Suramin

034. Tick the drug for strongiloidosis treatment:

a) Niclosamide

b) Praziquantel
c) Bithionol

d) Ivermectin

035. Tick the drug for echinococcosis treatment:

a) Suramin

b) Mebendazole or Albendazole

c) Piperazine