5-49
Differential Diagnosis:
Worms in stool - ascariasis (roundworm) can also be seen in the stool, although it is typically larger.
Seizures - there are many possible causes of seizures, to include epilepsy and meningitis. The presence of
seizures in a patient living in area endemic for pork tapeworm (Africa, South America, Eastern Europe, SE
Asia) should prompt the consideration of cysticercosis.
Plan:
Treatment:
Primary: Niclosamide 2 gm as one dose. Dwarf tapeworm requires daily doses for one week.
Alternative: Praziquantel 5-10 mg/kg as a one time dose or albendazole are alternative regimens. For the
dwarf tapeworm the dose of praziquantel is 25mg kg.
Patient Education
General: Avoid improperly prepared foods
Activity: As tolerated
Diet: As tolerated
Medications: Occasional gastrointestinal side-effects
Prevention and Hygiene: Avoid improperly cooked beef, pork or fish
No Improvement/Deterioration: Return for evaluation
Follow-up Actions
Return evaluation: As needed
Consultation Criteria: Failure to improve. For the diagnosis of cysticercosis, referral to a tertiary medical
center for CT or MRI scan of the head may show multiple calcified lesions.
Zoonotic Disease Considerations
Fish tapeworm disease
Agents: Diphyllobothrium latum, D. pacificum, D. dendriticum, D. ursi, D. dalliae, D. klebanovskii
Principal Animal Hosts: Dogs, bears, foxes, minks, cats, dogs, pigs, walruses, seals, other fish-eating
mammals
Clinical Disease in Animals: In fish, the larval stages encyst in the visceral organs and muscle while the
adults are found in the intestinal tract, leading to possible mechanical obstruction in fish or mammals.
Probable Mode of Transmission: Ingestion of raw or undercooked fish
Known Distribution: Northern Hemisphere lakes region and sub-arctic, temperate or tropical zones where
eating raw or undercooked fish is popular
Dwarf tapeworm disease
Agent: Hymenolepis nana (the only human tapeworm without an obligatory intermediate host)
Principal Animal Host: Humans, mice
Clinical Disease in Animals: Found in the small intestine of rats, mice and hamsters. Reduced growth
or weight loss in rodents.
Probable Mode of Transmission: Ingestion of eggs in contaminated food or water; directly from fecal
contaminated fingers
Known Distribution: USA, Latin America, Australia, Mediterranean countries, the Near East and India
Beef tapeworm disease
Agent: Taenia saginata, Cysticercus bovis (cyst form)
Principal Animal Hosts: Cattle, water buffalo
Clinical Disease in Animals: Fluid-filled vesicle in the skeletal and cardiac musculature
Probable Mode of Transmission: Ingestion of undercooked beef containing Cysticercus bovis
Known Distribution: Worldwide
Pork tapeworm disease
Agent: Taenia solium, Cysticercus cellulosae (cyst form)
Principal Animal Hosts: Swine, man