Cestodes

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 PO1
Children over 4 years and adults:
5 to 10 mg/kg single dose
or
niclosamide PO
Children: 50 mg/kg single dose
Adults: 2 g single dose
Thoroughly chew the tablets before swallowing and wash down with as little water as possible.

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 PO1
Children over 4 years and adults:
10 to 25 mg/kg single dose
or
niclosamide PO
Children: 50 mg/kg single dose
Adults: 2 g single dose
Thoroughly chew the tablets before swallowing and wash down with as little water as possible.

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 PO1
Children over 4 years and adults:
15 to 25 mg/kg single dose
or
niclosamide PO
Adults: 2 g on D1, then 1 g once daily for 6 days
Thoroughly chew the tablets before swallowing and wash down with as little water as possible.

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 PO2 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



Footnotes
Ref Notes
1 Praziquantel may be administered to pregnant women with T. solium taeniasis. For the other indications, treatment can usually be deferred until after delivery. [ a b c ]
2 Albendazole is contra-indicated during the first trimester of pregnancy.