Tapeworm Infestation Treatment & Management

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

Emergency Department Care

Unless the parasite is detected (eg, presence of eggs, worm segments, cysts), definitive therapy in the ED is unlikely. Stabilization of any patient in the presence of a systemic disease such as seizure or organ failure is essential.

Intestinal tapeworm infestation

Recent reviews summarize that most intestinal tapeworm infections can be effectively treated with praziquantel or niclosamide.[6, 7] These antihelminths have effective rates of 85-98%.[8]

Administer parenteral vitamin B-12 if evidence of vitamin B-12 deficiency occurs with Diphyllobothrium infections.

Cysticercosis

If the patient is asymptomatic with calcified soft tissue or neural lesions, no treatment is required.

In neurocysticercosis, neurologic manifestations indicate the need for antiepileptics and antihelminths. The recommended treatment is albendazole or praziquantel. Albendazole is associated with 46% decreased in seizure.[9] These agents can provoke an inflammatory response in the central nervous system. Thus, if either drug is given, the patient must be started on dexamethasone. Meta-analysis has shown that cysticidal drug therapy results in better cyst resolution and less seizure risk and seizure recurrence.[10]

Effectiveness of therapy can be monitored via radiographic imaging. The size of the active lesions should decrease within 3-6 months.

Some patients still require surgery in addition to treatment with albendazole, praziquantel, and dexamethasone. For example, subarachnoid neurocysticercosis with hydrocephalus requires shunting surgery and intraventricular cysts require neuroendoscopical removal.[11, 12]

Echinococcosis

Echinococcosis is treated with albendazole and surgery or albendazole and PAIR (puncture, aspiration, injection, re-aspiration). Albendazole is recommended for 1-3 months before surgical intervention.[13]

Sparganosis and coenurosis treatment involves surgical excision for localized infections.

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Consultations

An infectious diseases specialist can secure the tracking and reporting of important epidemiologic and epidemic patterns.

Most patients' symptoms hasten the physician to notify the gastroenterologist for evaluation of their source of symptoms. After treatment, the passage of segments and eggs may continue for several days. Treatment is reevaluated for success by examining the stool at intervals allowing regrowth of worms: 3 months for Taenia species and 1 month for Hymenolepis, Diphyllobothrium, and other species. The difficulty arises with H nana, which can result in reinfection through internal autoinfection, causing patients to appear as though treatment has failed. Fortunately, the medications will reduce the worm burden, and the infections in children are usually spontaneously resolved in adolescence.

In the presence of apparent cysts in the brain, meninges, or spinal cord, consultation with a neurologist may be indicated. Aspiration may be needed for diagnostic purposes and for relief of compression that may cause severe or discomforting symptoms.

Some cestode infections require surgery not only for diagnostic purposes but also for therapy. Patients with hydrocephalus due to cysticercosis require placement of a ventricular shunt. This is needed prior to any recommended drug therapies because drug therapies typically result in further increases in intracranial pressures. In patients with neurocysticercosis, the rate of shunt dysfunctions requiring frequent revisions is high. These patients high mortality rate (50% in 2 y) is directly related to the number of surgeries involving their shunt.

Symptomatic echinococcosis infections require surgical treatment with perioperative medical interventions. The surgical resections that are usually performed have an operative mortality rate that has dropped from about 7-23% before 1980 to 0-5% in more recent years. The recurrence rate is between 3% and 10% after open surgery for patients with hepatic hydatid cyst. Special laparoscopic surgery technique for liver hydatid cysts has been described, with a result of 0% recurrence rate.[14]

The puncture of cysts percutaneously, aspiration of fluid, introduction of protoscolicidal agent, and reaspiration method, also known as the PAIR method, has been described as an alternative treatment for hepatic cysts. Currently, however, the efficacy and safety of the PAIR method has not been confirmed. Therefore, the PAIR method cannot be regarded as an established alternative to surgery.

The only treatment of sparganosis and coenurosis is surgical excision of the localized infections.

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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.

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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)
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