Tapeworm Infestation Medication

  • Author: Lisandro Irizarry, MD, MPH, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 2, 2011
 

Medication Summary

Anthelmintic drugs act locally to rid the GI tract of worms or systemically to rid the body of the helminth forms that invade organs and tissues. Much of the success of development of these medications is dedicated to the efforts of veterinarians because many cestodes have animal hosts.

Next

Anthelmintics

Class Summary

Parasite biochemical pathways are sufficiently different from the human host, which allows for selective interference by chemotherapeutic agents in relatively small doses.

View full drug information

Albendazole (Albenza)

 

Decreases ATP production in worm, causing energy depletion, immobilization, and finally death. To avoid inflammatory response in CNS, patient also must be started on anticonvulsants and high-dose glucocorticoids. DOC for some of the potentially fatal cestode infections, namely cysticercosis (for T solium) and hydatid cyst disease (from Echinococcus).

Patients with cysticercotic encephalitis develop intracranial hypertension with antihelmintic use and, thus, require a ventricular shunt prior to drug therapy.

View full drug information

Paromomycin (Humatin)

 

Alternative therapy for patients infected with Diphyllobothrium species, Hymenolepis species, T solium, and T saginata. Since action is mainly in adult worms, does not reach ova. Patients with T solium infections remain at risk of cysticercosis.

View full drug information

Praziquantel (Biltricide)

 

Acylated isoquinoline that increases cell membrane permeability in susceptible worms, resulting in a loss of intracellular calcium, massive contractions, and paralysis of their musculature. In addition, produces vacuolization and disintegration of the schistosome tegument. This is followed by attachment of phagocytes to the parasite and death. Tablets should be swallowed whole with some liquid during meals. Keeping tablet in the mouth may reveal a bitter taste that can produce nausea or vomiting.

Effective against cestodes (except Echinococcus species) and trematodes, but not nematodes. DOC in the treatment of hymenolepiasis.

In cysticercosis, this medication has the potential to provoke an inflammatory response in the CNS. Thus, the patient must also be started on high-dose glucocorticoids.

Patients with cysticercotic encephalitis develop intracranial hypertension with antihelmintic use and, thus, require a ventricular shunt prior to drug therapy.

Niclosamide (Niclocide)

 

A chlorinated salicylanilide. DOC; inhibits mitochondrial oxidative phosphorylation and glucose uptake in parasite. Cure rate of about 90% for Taenia species and a little less than 90% for Diphyllobothrium species.

View full drug information

Mebendazole (Vermox)

 

Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.

Previous
Next

Anticonvulsants

Class Summary

These agents are used to manage symptoms in patients being treated for neurocysticercosis.

View full drug information

Diazepam (Valium)

 

Depresses all levels of CNS, including limbic and reticular formation, possibly by increasing activity of GABA, which is a major inhibitory neurotransmitter.

Individualize dosage and increase it cautiously to avoid adverse effects.

Previous
Next

Glucocorticoids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, they modify the body's immune response to diverse stimuli.

View full drug information

Prednisone (Deltasone, Sterapred, Orasone)

 

Useful in treatment of inflammatory and allergic reactions. By reversing increased capillary permeability and suppressing PMN activity, may decrease inflammation.

If a safer alternative therapy is available, do not administer glucocorticoids.

View full drug information

Methylprednisolone (Solu-Medrol, Depo-Medrol, Medrol)

 

Decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.

Previous
Next

Vitamins

Class Summary

These agents are essential for normal DNA synthesis. Indicated for use in patients with megaloblastic anemia due to deficiency in vitamin B-12.

View full drug information

Cyanocobalamin (Cobex, Berubigen, Crystamine)

 

Deoxyadenosylcobalamin and hydroxocobalamin are active forms of vitamin B-12 in humans. Vitamin B-12 synthesized by microbes but not humans or plants.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Lisandro Irizarry, MD, MPH, FAAEM  Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine

Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Patricia Phan, MD, FACEP, FAAEM  Residency Program Director, Department of Emergency Medicine, Brooklyn Hospital Center

Patricia Phan, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard S Krause, MD  Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Raquel Mora, MD, to the development and writing of this article.

References

  1. Eom KS, Rim HJ. Morphologic descriptions of Taenia asiatica sp. n. Korean J Parasitol. March 1993;31:1-6. [Medline].

  2. Del Brutto OH. Neurocysticercosis. Semin Neurol. Sep 2005;25(3):243-51. [Medline].

  3. Del Brutto OH, Santibanez R, Noboa CA, Aguirre R, Diaz E, Alarcon TA. Epilepsy due to neurocysticercosis: analysis of 203 patients. Neurology. Feb 1992;42(2):389-92. [Medline].

  4. Del Brutto OH, Rajshekhar V, White AC Jr, Tsang VC, Nash TE, Takayanagui OM, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. Jul 24 2001;57(2):177-83. [Medline].

  5. Stefanic S, Shaikenov BS, Deplazes P, Dinkel A, Torgerson PR, Mathis A. Polymerase chain reaction for detection of patent infections of Echinococcus granulosus ("sheep strain") in naturally infected dogs. Parasitol Res. Mar 2004;92(4):347-51. [Medline].

  6. Craig P, Ito A. Intestinal cestodes. Curr Opin Infect Dis. Oct 2007;20(5):524-32. [Medline].

  7. Garcia HH, Del Brutto OH, Nash TE, White AC Jr, Tsang VC, Gilman RH. New concepts in the diagnosis and management of neurocysticercosis (Taenia solium). Am J Trop Med Hyg. Jan 2005;72(1):3-9. [Medline].

  8. Garcia HH, Gonzalez AE, Gilman RH. Diagnosis, treatment and control of Taenia solium cysticercosis. Curr Opin Infect Dis. Oct 2003;16(5):411-9. [Medline].

  9. Garcia HH, Pretell EJ, Gilman RH, Martinez SM, Moulton LH, Del Brutto OH, et al. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med. Jan 15 2004;350(3):249-58. [Medline].

  10. [Best Evidence] Del Brutto OH, Roos KL, Coffey CS, García HH. Meta-analysis: Cysticidal drugs for neurocysticercosis: albendazole and praziquantel. Ann Intern Med. Jul 4 2006;145(1):43-51. [Medline].

  11. Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis. A long-term follow-up review of 92 cases. J Neurosurg. May 1987;66(5):686-9. [Medline].

  12. Husain M, Rastogi M, Jha DK, Husain N, Gupta RK. Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis with an angiographic catheter. Neurosurgery. Apr 2007;60(4 Suppl 2):249-53; discussion 254. [Medline].

  13. Morar R, Feldman C. Pulmonary echinococcosis. Eur Respir J. Jun 2003;21(6):1069-77. [Medline].

  14. Chen W, Xusheng L. Laparoscopic surgical techniques in patients with hepatic hydatid cyst. Am J Surg. Aug 2007;194(2):243-7. [Medline].

  15. Ozturk G, Aydinli B, Yildirgan MI, Basoglu M, Atamanalp SS, Polat KY. Posttraumatic free intraperitoneal rupture of liver cystic echinococcosis: a case series and review of literature. Am J Surg. Sep 2007;194(3):313-6. [Medline].

  16. Barnett K, Emder P, Day AS, Selby WS. Tapeworm infestation: a cause of iron deficiency anemia shown by capsule endoscopy. Gastrointest Endosc. Sep 2007;66(3):625-7. [Medline].

  17. Bildik N, Cevik A, Altintas M, Ekinci H, Canberk M, Gulmen M. Efficacy of preoperative albendazole use according to months in hydatid cyst of the liver. J Clin Gastroenterol. Mar 2007;41(3):312-6. [Medline].

  18. Carpio A. Neurocysticercosis: an update. Lancet Infect Dis. Dec 2002;2(12):751-62. [Medline].

  19. Chrieki M. Echinococcosis--an emerging parasite in the immigrant population. Am Fam Physician. Sep 1 2002;66(5):817-20. [Medline].

  20. Christie JD, Garcia LS. Emerging parasitic infections. Clin Lab Med. Dec 2002;24(3):737-72.

  21. Cox FE. History of human parasitic diseases. Infect Dis Clin North Am. Jun 2004;18(2):171-88, table of contents. [Medline].

  22. Craig P. Echinococcus multilocularis. Curr Opin Infect Dis. Oct 2003;16(5):437-44. [Medline].

  23. Craig PS, McManus DP, Lightowlers MW, Chabalgoity JA, Garcia HH, Gavidia CM. Prevention and control of cystic echinococcosis. Lancet Infect Dis. Jun 2007;7(6):385-94. [Medline].

  24. Falagas ME, Bliziotis IA. Albendazole for the treatment of human echinococcosis: a review of comparative clinical trials. Am J Med Sci. Sep 2007;334(3):171-9. [Medline].

  25. Garcia HH, Del Brutto OH. Neurocysticercosis: updated concepts about an old disease. Lancet Neurol. Oct 2005;4(10):653-61. [Medline].

  26. Garcia HH, Gonzalez AE, Gilman RH. Diagnosis, treatment and control of Taenia solium cysticercosis. Curr Opin Infect Dis. Oct 2003;16(5):411-9. [Medline].

  27. Garcia HH, Pretell EJ, Gilman RH, Martinez SM, Moulton LH, Del Brutto OH. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med. Jan 15 2004;350(3):249-58. [Medline].

  28. Khuroo MS, Wani NA, Javid G, Khan BA, Yattoo GN, Shah AH, et al. Percutaneous drainage compared with surgery for hepatic hydatid cysts. N Engl J Med. Sep 25 1997;337(13):881-7. [Medline].

  29. Kolars JC, Fischer PR. Evaluation of diarrhea in the returned traveler. Prim Care. Dec 2002;29(4):931-45. [Medline].

  30. Kraft R. Cysticercosis: an emerging parasitic disease. Am Fam Physician. Jul 1 2007;76(1):91-6. [Medline].

  31. Loukas A, Hotez PJ. Chemotherapy of helminth infections. In: Brunton LL, Lazo JS, Parker KL, eds. Goodman & Gilman's Pharmacology. 11th ed. McGraw-Hill; 2006:1121-1141.

  32. McAdam AJ, Sharpe AH. Infectious diseases. In: Kumar V, Abbas AK, Fausto N, eds. Kumar, Robbins, and Cotran: Pathologic Basis of Disease. 7th ed. Philadelphia: Saunders; 2005:838-8.

  33. Moon TD, Oberhelman RA. Antiparasitic therapy in children. Pediatr Clin North Am. Jun 2005;52(3):917-48, viii. [Medline].

  34. Nash TE, Singh G, White AC, Rajshekhar V, Loeb JA, Proaño JV. Treatment of neurocysticercosis: current status and future research needs. Neurology. Oct 10 2006;67(7):1120-7. [Medline].

  35. Ong S, Talan DA, Moran GJ, Mower W, Newdow M, Tsang VC. Neurocysticercosis in radiographically imaged seizure patients in U.S. emergency departments. Emerg Infect Dis. Jun 2002;8(6):608-13. [Medline].

  36. Romig T. Epidemiology of echinococcosis. Langenbecks Arch Surg. Sep 2003;388(4):209-17. [Medline].

  37. Wallin MT, Kurtzke JF. Neurocysticercosis in the United States: review of an important emerging infection. Neurology. Nov 9 2004;63(9):1559-64. [Medline].

  38. White AC, Weller PF. Cestodes. In: Kasper DL, Braunwald E, Fauci AS, eds. Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill; 2005:1272-7.

 
Previous
Next
 
Adult tapeworm of Dipylidium caninum. Image courtesy of the Centers for Disease Control and Prevention (CDC).
Ultrasonographic appearance of echinococcal cysts (Gharbi type I, World Health Organization [WHO] standardized classification CE1).
Diagram of the Echinococcus life cycle. Image courtesy of the Centers for Disease Control and Prevention.
Table. Cestodes and Their Hosts
CestodePrimary HostIntermediate Host
T soliumHumansPigs, humans, dogs, cats, sheep
T saginataHumansCattle
DiphyllobothriumHumansFish
HymenolepisHumansHymenolepis nana: None; Hymenolepis diminuta: Rodents
D caninumHumans, dogs, catsFleas on dogs/cats
EchinococcusDogsHumans, sheep, cattle, goats, horses, camel
SpirometraHumans
T multicepsHares, rabbits, squirrels, humans (rarely)
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.