5-48
Objective: Signs
Using Basic Tools: CLC rash, rales, wheezes, SOB and epigastric tenderness.
Using Advanced Tools: Lab: O&P of stool: identify Strongyloides larvae (see Color Plates Picture 14) in a
fresh stool sample (multiple tests may be needed). CBC: Eosinophilia.
Assessment:
Differential Diagnosis
Hookworm - CLC appears similar to cutaneous larva migrans rash but moves faster and may be perianal.
Diarrhea - multiple causes
Plan:
Treatment: Repeat stool O&P and re-treat as needed.
Primary: Ivermectin 200 mcg/kg/d x 2 days
Alternative: Thiabendazole 25 mg/kg/d po bid (max 3gm/d) x 2 days
Patient Education
General: Avoid contaminated soil.
Medications: Watch for occasional gastrointestinal side effects (diarrhea and abdominal pain).
Prevention and Hygiene: Avoid exposure to contaminated soil.
No Improvement/Deterioration: Return for reevaluation.
Follow-up Actions
Evacuation/Consultation Criteria: Evacuation usually not necessary, unless patient fails to improve.
Zoonotic Disease Considerations
Principal Animal Hosts: Dogs, cats
Clinical Disease in Animals: Bloody-mucoid diarrhea, emaciation, reduced growth rate.
ID: Tapeworm Infections (Taeniasis)
LTC Glenn Wortmann, MC, USAIntroduction: Tapeworms infection occurs through eating infected fish, beef, pork or other contaminated
food. Adult tapeworms (ranging from several millimeters to 25 meters long), live in the intestine. Encysted
larvae enter the human host through raw or undercooked beef, pork or fish, or by contact with human feces
(nightsoil) used as fertilizer.
Subjective: Symptoms
Most infections are asymptomatic. Heavy infections may result in abdominal pain, weight loss, nervousness,
diarrhea, and a sensation of the contracting worms leaving the anus. The larval form of pork tapeworm can
migrate to multiple areas of the body, to include the brain, causing seizures or death.
Focused History: Have you noticed worms in your stool? (may be tapeworm, pinworm or others) How large
are the worms? (tapeworm segments seen in the stool are usually <1 cm)
Objective: Signs
Using Basic Tools: Segments of worm in stool; in cysticercosis, seizures may occur.
Using Advanced Tools: Lab: O&P of stool: Egg release is variable, so examine stool samples from
several days.
Assessment: Diagnose by identifying eggs in the stool or identifying the proglottids (segments) in stool
or on anal swab.