0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
Tapeworm Infections 1405■Hymenolepis nana: usually seen in children. Light infections: no
symptoms. Heavy infections: diarrhea, abdominal pain, irritability.
Passage of proglottids.
tests
■Basic tests: blood: normal
■Basic tests: urine: normal.
■Specific tests:
➣T saginataandsolium: identification of submitted proglottid is
diagnostic. O&P exam may be negative or if positive cannot dis-
tinguish between solium and saginata.
➣Diphyllobothriumspecies: Stool O&P usually finds eggs identify-
ing genus but not species. Whole segments occasionally passed
and are genus-specific. To speciate scolex is required (but not
needed for treatment).
➣Hymenolepis nana: Stool O&P finds diagnostic ova. Proglottids
not usually found.
■Other tests: B12 levels sometimes low inDiphyllobothriuminfec-
tions.differential diagnosis
■None
management
What to Do First
■Ascertain source of infection if possible. InT solium, assess for pres-
ence of cysticercosis (serology, presence of SQ nodules, possibly
brain imaging).General Measures
■Education of patient on epidemiology, to avoid future infections.
WithT solium, other household members should be evaluated for
cysticercosis.specific therapy
Indications
■All infected patients.
Treatment Options
■T saginataandsolium,Diphyllobothrium:
➣Praziquantel single dose. WithT solium, follow this with a saline
purge 2 hours later, instructing patient to exercise care disposing
of stool to avoid auto-infection.