eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Hymenolepiasis: Treatment & Medication

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 22, 2009

Treatment

Medical Care

Supportive care is typically sufficient as an adjunct to drug therapy.

Consultations

In severe cases, consultation with an infectious diseases specialist or gastroenterologist may be appropriate.

Diet

The symptomatic child with severe infection may better tolerate a bland diet.

Medication

The 3 drugs that have been described for the treatment of hymenolepiasis are praziquantel, niclosamide, and paromomycin. Praziquantel, which is bacteriocidal in a single dose for all the stages of the parasite, is the drug of choice. It is available in the United States, well tolerated, and safe. Nitazoxanide has recently been studied as a new treatment option.2,3,4,5,6

Anthelmintics

Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. The mechanism of action varies within the drug class. Antiparasitic actions may include the following:

  • Inhibition of microtubules, which causes irreversible block of glucose uptake
  • Tubulin polymerization inhibition
  • Depolarizing neuromuscular blockade
  • Cholinesterase inhibition
  • Increased cell membrane permeability, resulting in intracellular calcium loss
  • Vacuolization of the schistosome tegument
  • Increased cell membrane permeability to chloride ions via chloride channels alteration

Praziquantel (Biltricide)

The DOC, praziquantel is 80-100% effective in cases in which the burden of tapeworms is not great. Although it is FDA approved and available in the United States, its use is considered investigational for this indication.

Adult

25 mg/kg PO as a single dose; tab should be taken with food and swallowed whole with liquids (do not chew)

Pediatric

Administer as in adults

Hydantoins may reduce serum praziquantel concentrations, possibly leading to treatment failures

Documented hypersensitivity; spinal or ocular cysticercosis

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution with severe hepatic disease; possible dizziness and drowsiness


Niclosamide (Niclocide)

Effective, but unavailable in the United States. Inhibits mitochondrial oxidative phosphorylation and glucose uptake in parasite. Treatment course is 7 d because it does not reach the cysticercoids in the lamina propria.

Adult

2 g PO as a single dose, followed by 1 g PO qd for 6d
Tab to be chewed completely at least 2 h before a meal

Pediatric

<11 kg: Not established
11-34 kg: 1 g PO as a single dose, followed by 500 mg PO qd for 6d
>34 kg: 1.5 g PO as a single dose, followed by 1 g PO qd for 6d
Tab to be chewed completely at least 2 h before a meal

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Associated with GI distress, anorexia, drowsiness, dizziness, headache, and rash


Paromomycin (Humatin)

An alternative to praziquantel, but requires a 7-d course of therapy. Amebicidal and antibacterial aminoglycoside obtained from a strain of Streptomyces rimosus, active in intestinal amebiasis. Recommended for Diphyllobothrium latum, Taenia saginata, Taenia solium, Dipylidium caninum, and Hymenolepis nana.

Adult

45 mg/kg PO qd for 7 d

Pediatric

Administer as in adults

Nephrotoxic potential may increase with concurrent administration of other aminoglycosides, penicillins, cephalosporins, amphotericin B, and loop diuretics

Documented hypersensitivity; intestinal obstruction

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Possible GI disturbances, hematuria, rash, ototoxicity, and hypercholesterolemia


Nitazoxanide (Alinia)

Inhibits growth of Cryptosporidium parvum sporozoites and oocysts and Giardia lamblia trophozoites. Elicits antiprotozoal activity by interfering with pyruvate-ferredoxin oxidoreductase (PFOR) enzyme-dependent electron transfer reaction, which is essential to anaerobic energy metabolism. Available as a 20-mg/mL oral susp. Off-label use for H nana.

Adult

Not established

Pediatric

<1 year: Not established
1-4 years: 100 mg (5 mL) PO q12h for 3 d with food
4-11 years: 200 mg (10 mL) PO q12h for 3 d with food
>11 years: Not established

Tizoxanide (nitazoxanide metabolite) is >99.9% bound to plasma protein and may potentially increase toxicity of other highly plasma protein-bound drugs

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May cause abdominal pain, diarrhea, vomiting, or headache; administer with food; caution when coadministered with other highly plasma protein-bound drugs with narrow therapeutic indices

More on Hymenolepiasis

Overview: Hymenolepiasis
Differential Diagnoses & Workup: Hymenolepiasis
Treatment & Medication: Hymenolepiasis
Follow-up: Hymenolepiasis
References

References

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

  2. Chero JC, Saito M, Bustos JA, Blanco EM, Gonzalvez G, Garcia HH. Hymenolepis nana infection: symptoms and response to nitazoxanide in field conditions. Trans R Soc Trop Med Hyg. Feb 2007;101(2):203-5. [Medline].

  3. Diaz E, Mondragon J, Ramirez E, Bernal R. Epidemiology and control of intestinal parasites with nitazoxanide in children in Mexico. Am J Trop Med Hyg. Apr 2003;68(4):384-5. [Medline][Full Text].

  4. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis. Apr 15 2005;40(8):1173-80. [Medline].

  5. Gilles HM, Hoffman PS. Treatment of intestinal parasitic infections: a review of nitazoxanide. Trends Parasitol. Mar 2002;18(3):95-7. [Medline].

  6. Pearson RD. Nitazoxanide As Treatment of Intestinal Parasites in Children. Curr Infect Dis Rep. Feb 2004;6(1):25-26. [Medline].

  7. AAP. Other tapeworm infections (including hydatid disease). In: Red Book: Report of the Committee on Infectious Diseases. 2006:646-7, 813.

  8. Heukelbach J, Winter B, Wilcke T, et al. Selective mass treatment with ivermectin to control intestinal helminthiases and parasitic skin diseases in a severely affected population. Bull World Health Organ. Aug 2004;82(8):563-71. [Medline].

  9. Juckett G. Common intestinal helminths. Am Fam Physician. Nov 15 1995;52(7):2039-48, 2051-2. [Medline].

  10. Kabani A, Cadrain G, Trevenen C, et al. Practice guidelines for ordering stool ova and parasite testing in a pediatric population. The Alberta Children's Hospital. Am J Clin Pathol. Sep 1995;104(3):272-8. [Medline].

  11. Katz M, Despommier DD, Gwadz RW. Tapeworms of minor medical importance. Parasit Dis. 1989;88-92.

  12. Maggi P, Brandonisio O, Carito V, et al. Hymenolepis nana parasites in adopted children. Clin Infect Dis. Aug 15 2005;41(4):571-2. [Medline].

  13. Marangi M, Zechini B, Fileti A, et al. Hymenolepis diminuta infection in a child living in the urban area of Rome, Italy. J Clin Microbiol. Aug 2003;41(8):3994-5. [Medline].

  14. Marseglia GL, Marseglia A, Licari A, Castellazzi AM, Ciprandi G. Chronic urticaria caused by Hymenolepis nana in an adopted girl. Allergy. Jul 2007;62(7):821-2. [Medline].

  15. Mehraj V, Hatcher J, Akhtar S, Rafique G, Beg MA. Prevalence and factors associated with intestinal parasitic infection among children in an urban slum of Karachi. PLoS ONE. 2008;3(11):e3680. [Medline].

  16. Olson PD, Yoder K, Fajardo L-G LF, et al. Lethal invasive cestodiasis in immunosuppressed patients. J Infect Dis. Jun 15 2003;187(12):1962-6. [Medline].

  17. Quihui L, Valencia ME, Crompton DW, et al. Role of the employment status and education of mothers in the prevalence of intestinal parasitic infections in Mexican rural schoolchildren. BMC Public Health. 2006;6:225. [Medline].

  18. Quihui-Cota L, Valencia ME, Crompton DW, et al. Prevalence and intensity of intestinal parasitic infections in relation to nutritional status in Mexican schoolchildren. Trans R Soc Trop Med Hyg. Nov 2004;98(11):653-9. [Medline].

  19. Richards FO Jr. Diphyllobothrium, Dipylidium, and Hymenolepis species. In: Principles and Practice of Pediatric Infectious Diseases. 2003:1351-4.

  20. Robertson J, Shilkofski N. Drug doses. In: The Harriet Lane Handbook: A Manual for Pediatric House Officers. Philadelphia, Pa: Mosby; 2005:679-1009.

  21. Rokni MB. The present status of human helminthic diseases in Iran. Ann Trop Med Parasitol. Jun 2008;102(4):283-95. [Medline].

  22. Schantz PM. Tapeworms (cestodiasis). Gastroenterol Clin North Am. Sep 1996;25(3):637-53. [Medline].

  23. Tanowitz HB, Wittner M. Hymenolepiasis. In: Hunter's Tropical Medicine. 1991:839-41.

  24. Turner JA. Cestodes. In: Textbook of Pediatric Infectious Diseases. 2004:2797-816.

  25. Weisse ME, Raszka WV Jr. Cestode infection in children. Adv Pediatr Infect Dis. 1996;12:109-53. [Medline].

  26. Wittner M, Tanowitz HB. Other cestode infections. In: Tropical Infectious Diseases: Principles, Pathogens, and Practice. 1999:1026-30.

Further Reading

Keywords

hymenolepiasis, abdominal pain, anal pruritus, diarrhea, dwarf tapeworm, gastrointestinal infection, GI infection, hand-to-mouth infection, Hymenolepididae, Hymenolepis diminuta, H diminuta, Hymenolepis nana, H nana, nasal pruritus, parasite, parasitic infection, rodent tapeworm, urticaria

Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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