eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Taenia Infection: 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
Coauthor(s): Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Contributor Information and Disclosures

Updated: Jan 23, 2009

Treatment

Medical Care

  • Most patients with intestinal Taenia infection are asymptomatic or mildly symptomatic. If adult tapeworms are detected in the stools, anthelmintic therapy usually suffices. Asymptomatic cysticercosis requires no treatment.
  • Treatment for symptomatic neurocysticercosis (NCC) is controversial. If anthelmintic therapy is chosen, albendazole7 or praziquantel is the drug of choice. Because these agents provoke an anti-inflammatory response in the CNS, start the patient on high-dose glucocorticosteroids.
  • Ocular, ventricular, and spinal lesions may require surgical treatment because treatment with anthelmintic drugs can provoke irreversible drug-induced inflammation.

Surgical Care

  • Surgery may be needed if intestinal taeniid infection causes complications such as acute surgical abdomen, appendicitis, or obstructed bile or pancreatic ducts.
  • Surgical intervention may also be required for cysticercosis and NCC (see Cysticercosis, Neurocysticercosis).
  • Surgical excision of ocular cysticercosis is the preferred method of treatment.

Consultations

  • Consult with an infectious diseases specialist for help with a questionable diagnosis, help eradicating the organism, and information on public health issues.
  • Consult a neurologist for the management of NCC manifestations.
  • Consult an ophthalmologist for cases involving ocular cysticercosis.

Diet

  • Other than adequately cooking pork and beef products to prevent reinfection, taeniid infections require no specific diet.

Activity

  • No activity restrictions are necessary.

Medication

Anthelmintics

Treatment of both tapeworm infections is similar; praziquantel is considered the drug of choice. Niclosamide can also be used. Both are administered as single-dose therapy. A new drug, tribendimidine, is being studied in China. With T solium infection, start treatment immediately because of the possibility of cysticercosis via autoinfection.


Praziquantel (Biltricide)

DOC for Taenia infection. Increases cell membrane permeability in susceptible worms, resulting in loss of intracellular calcium, massive contractions, and paralysis of musculature.

Adult

5-10 mg/kg PO once
Cysticercosis: 50 mg/kg/d PO divided q8h for at least 15-30 d

Pediatric

<4 years: Not established
>4 years: Administer as in adults

Hydantoins may reduce serum concentration, possibly leading to treatment failures

Documented hypersensitivity; ocular cysticercosis

Pregnancy

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

Precautions

Mild and transient adverse effects include dizziness, headache, abdominal pain, fatigue, malaise, and limb pain; patients should not drive during and 1 d after therapy because of dizziness; avoid in pregnancy when possible


Niclosamide (Niclocide)

Acts by causing necrosis of head and adjoining segments of tapeworm. Worm loses hold and is eliminated in pieces or intact with feces. Available as 500-mg tab. Should be chewed to fine pulp before swallowing with a little water or crushed in liquid and then swallowed.

Adult

2000 mg (4 tab) PO once as single dose

Pediatric

<2 years: 500 mg (1 tab) PO once as single dose
2-6 years: 1000 mg (2 tab) PO once as single dose
>6 years: Administer as in adults

Pregnancy

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

Precautions

Most adverse effects are mild and transient (eg, vomiting, nausea, abdominal distress)


Albendazole (Albenza)

Decreases ATP production in worm, causing energy depletion, immobilization, and finally death. To avoid inflammatory response in CNS, patient must also be started on anticonvulsants and high-dose glucocorticosteroids.

Adult

<60 kg: 15 mg/kg/d PO divided bid for 8-30 d; not to exceed 800 mg/d
>60 kg: 400 mg PO bid for 8-30 d

Pediatric

<2 years: 200 mg/d PO for 3 d; if needed, may repeat regimen after 3 wk prn
>2 years: Administer as in adults

Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity

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

Discontinue use if serum transaminase levels increase significantly (resume when levels decrease to pretreatment values); abdominal pain, nausea, vomiting, diarrhea, dizziness, vertigo, fever, increased intracranial pressure, and alopecia may occur

Glucocorticoids

These agents are useful in cases of primary increased intracranial pressure or cases resulting from anthelmintic-induced cyst death and resultant inflammation.


Dexamethasone (Decadron)

Adrenocortical steroid. Decreases inflammation by suppressing migration of PMNs and reducing capillary permeability.

Adult

Loading dose: 1-2 mg/kg PO/IV/IM initially, followed by 1-1.5 mg/kg/d divided q4-6h for 2-3 d; not to exceed 16 mg/d

Pediatric

Administer as in adults

Effects decrease with coadministration of barbiturates, phenytoin, or rifampin; decreases effects of salicylates and vaccines used for immunization

Documented hypersensitivity; active bacterial or fungal infection

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

Increases risk of multiple complications, including severe infections; monitor adrenal insufficiency when tapering drug; abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections are possible complications

More on Taenia Infection

Overview: Taenia Infection
Differential Diagnoses & Workup: Taenia Infection
Treatment & Medication: Taenia Infection
Follow-up: Taenia Infection
Multimedia: Taenia Infection
References
Further Reading
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References

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Further Reading

For more information, see the McGill Faculty of Medicine Web site images 16, 46, and 47.  An interesting case is available at The Gorgas Course in Clinical Tropical Medicine and another at Partners.org.

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Keywords

Taenia infection, appendicitis, beef tapeworm, cattle tapeworm, cerebral coenurosis, coenurosis, cysticercosis, edema, encephalitis, hemiparesis, hydrocephalus, intracranial hypertension, intracranial pressure, intraocular larva, muscular pseudohypertrophy, neurocysticercosis, NCC, ocular cysticercosis, papilledema, parasitic infections, pork tapeworm, pruritus ani, stroke, Taenia brauni, T brauni, Taenia multiceps, T multiceps, Taenia saginata, T saginata, Taenia serialis, T serialis, Taenia solium, T solium, taeniasis, taeniid infection

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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

Coauthor(s)

Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and 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

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, 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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