Cestodes

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    Cestodes (adult forms)

    Parasites

    Clinical features/Laboratory

    Treatment

    Transmission/Prevention

    Taeniasis
    Taenia saginata
    Taenia solium

    (worldwide)

    Often asymptomatic

    Segments expelled in the stools, sometimes gastrointestinal disturbances (epigastric or abdominal pain, nausea, diarrhoea)

    Laboratory: eggs in stools or collected from perianal skin (scotch tape method), segments in stools

    praziquantel PO (a) Citation a. Praziquantel may be administered to pregnant women with T. solium taeniasis. For the other indications, treatment can usually be deferred until after delivery.
    Children 4 years and over and adults:
    5 to 10 mg/kg single dose

    Transmission by eating raw or under-cooked meat:

    • beef for T. saginata
    • pork for T. solium

    Prevention:

    • individual: cook meat thoroughly
    • collective: slaughterhouse monitoring

    Diphyllobothriasis
    Diphyllobothrium latum
    (temperate or cold lake areas)

    Often asymptomatic

    In the event of heavy infection: mild gastrointestinal disturbances, anaemia due to vitamin B12 deficiency associated with (rare) neurological sequelae

    Laboratory: eggs in stools

    praziquantel PO (a) Citation a. Praziquantel may be administered to pregnant women with T. solium taeniasis. For the other indications, treatment can usually be deferred until after delivery.
    Children 4 years and over and adults:
    5 to 10 mg/kg single dose

    If anaemia: vitamin B12 + folic acid

    Transmission by eating raw or under- cooked freshwater fish

    Prevention:

    • individual: cook fish thoroughly

    Hymenolepiasis
    Hymenolepis nana
    (worldwide)

    Often asymptomatic

    In the event of heavy infection: gastrointestinal disturbances (epigastric pain)

    Laboratory: eggs in stools

    praziquantel PO (a) Citation a. Praziquantel may be administered to pregnant women with T. solium taeniasis. For the other indications, treatment can usually be deferred until after delivery.
    Children 4 years and over and adults:
    15 to 25 mg/kg single dose

    Transmission by faecal-oral route or auto-infection

    Prevention:

    • individual: hand washing, nail cutting
    • collective: hygiene and sanitation (water, latrines, etc.)

    Cestodes (larvae)

    Parasites

    Clinical features/Laboratory

    Treatment

    Transmission/Prevention

    Cysticercosis
    Taenia solium
    (worldwide)

    • Muscular: asymptomatic or myalgia
    • Subcutaneous: nodules
    • Neurological (neurocysticercosis): headache, convulsions, coma, etc.
    • Ocular: exophthalmia, strabismus, iritis, etc.

    Laboratory: hypereosinophilia in blood and cerebrospinal fluid

    Neurological and ocular cysticercosis should be managed in specialized facilities.
    Antiparasitic treatment without diagnosis of location by computerirsed tomography and/or magnetic resonance imaging can worsen the symptoms even threat the life. Neurosurgical treatment can be required.

    Transmission by eating food contaminated with T. solium eggs or auto-infection

    Prevention:

    • individual: treat T. solium carriers, hygiene, cook meat thoroughly

    Hydatid cyst
    Echinococcus granulosus
    (South America, North, East and South Africa, Western Europe)

    Cysts located in the liver (60% of cases); lungs (30% of cases), and, less frequently, in other sites including the brain.

    Long asymptomatic period. The cyst becomes symptomatic when complications develop (biliary obstruction; anaphylactic shock in the event of rupture into peritoneal cavity, vessels or an organ; febrile painful jaundice in the event of rupture into the biliary tree, etc.).

    First-line treatment: surgical excision

    albendazole PO (b) Citation b. Albendazole is contra-indicated during the first trimester of pregnancy.  is useful in addition to, or instead of, surgery:
    Children over 2 years and adults under 60 kg:
    7.5 mg/kg 2 times daily
    Adults over 60 kg:
    400 mg 2 times daily

    Treatment duration:
    In addition to surgery (pre-operatively or post- operatively): continuous course of minimum 2 months or at least two 28-day courses with a drug-free interval of 14 days.
    Inoperable cases: 28-day courses with drug-free intervals of 14 days, for 3 to 6 months (on average), possibly up to 1 year.

    Transmission:

    • direct: contact with dogs
    • indirect: water and food contaminated by dog faeces

    Prevention:

    • individual: avoid contact with dogs
    • collective: eliminate stray dogs, monitor slaughterhouses
    • (a) Praziquantel may be administered to pregnant women with T. solium taeniasis. For the other indications, treatment can usually be deferred until after delivery.
    • (b)Albendazole is contra-indicated during the first trimester of pregnancy.