Cestodes

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(b)Citation b.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(c)Citation c.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.)

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(d)Citation d.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