History

Fact Explanation
Abdominal pain Taenia saginata taeniasis / Beef tapeworm infection is caused by a cestode called taenia saginata. It is found worldwide especially where beef is eaten raw or undercooked. Cattle acquire infection via grass contaminated with human stools by direct contamination or when infected human stools are used as fertilization. Humans acquire infection from eating undercooked beef. Taenia saginata can remain in intestine without causing any harm for up to 25 years. Most are asymptomatic. And taenia saginata infection is usually mild disease as it does not cause Cysticercosis as Taenia solium does. The abdominal pain is colicky in nature more common during the morning and characteristically relieved by eating small amounts of food. The abdominal pain is localized to the epigastric /umbilical areas and are accompanied with nausea and epigastric distension. These symptoms are more pronounced in infants and children than in adults. [1,2,3,4,5]
Diarrhea Diarrhea is accompanied by the abdominal pain. It is an insidiously onset, watery type of diarrhea. [1,2,4,5,6]
Passage of whitish segments with stools Most cases are asymptomatic, infection is noticed when white motile segments are seen in stools or when they crawl out of the anus. In fact, this is the most common and initial way of presentation. This may cause itching around the anus. [1,2,4,5,7]
Nonspecific symptoms Weakness, loss of appetite, increased appetite, headache, constipation and dizziness are the other rare nonspecific symptoms. [3,4,5,7]
Complications In rare cases, tapeworm segments become lodged in the appendix and tend to mimic Appendicitis. Pain first, vomiting next and fever last has been described as the classic presentation of acute appendicitis. The abdominal pain first appears in the peri umbilical area and then migrates to the lower right part of the abdomen. Other complications reported; include obstruction of pancreatic duct, bile ducts, and tapeworm growth in ectopic locations such as middle ear, adenoid tissue and uterine cavity. Taenia saginata does not cause Cysticercosis. [1,2,3,4,7]
Risk factors The tapeworms that cause taeniasis (Taenia saginata, T. solium, and T. asiatica) are found worldwide. Eating raw or undercooked beef or pork is the primary risk factor for acquiring taeniasis. The disease is relatively common in Africa, some parts of Eastern Europe, the Philippines, and Latin America. People who live in such countries and those who travel there are at higher risk. [2,4,5,6]
References
  1. WRIGHT EP, JAIN S. Human infestation by Taenia saginata lasting over 20 years. Postgrad Med J [online] 1984 Jul, 60(705):495-6 [viewed 29 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6463005
  2. JESUDOSS AV, KAYA M, LISA S, ROHATGI A. Wormy surprise! BMJ Case Rep [online] 2012 Jun 21 [viewed 29 July 2014] Available from: doi:10.1136/bcr.12.2011.5416
  3. JEON HK, YONG TS, SOHN WM, CHAI JY, MIN DY, YUN CH, RIM HJ, PONGVONGSA T, BANOUVONG V, INSISIENGMAY B, PHOMMASACK B, EOM KS. Current status of human taeniasis in Lao People's Democratic Republic. Korean J Parasitol [online] 2013 Apr, 51(2):259-63 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2013.51.2.259
  4. GONZáLEZ LM, MONTERO E, HARRISON LJ, PARKHOUSE RM, GARATE T. Differential diagnosis of Taenia saginata and Taenia solium infection by PCR. J Clin Microbiol [online] 2000 Feb, 38(2):737-44 [viewed 29 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10655377
  5. CHO J, JUNG BK, LIM H, KIM MJ, YOOYEN T, LEE D, EOM KS, SHIN EH, CHAI JY. Four cases of Taenia saginata infection with an analysis of COX1 gene. Korean J Parasitol [online] 2014 Feb, 52(1):79-83 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2014.52.1.79
  6. CHAI JY. Human taeniasis in the Republic of Korea: hidden or gone? Korean J Parasitol [online] 2013 Feb, 51(1):9-17 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2013.51.1.9
  7. LATEEF M, ZARGAR SA, KHAN AR, NAZIR M, SHOUKAT A. Successful treatment of niclosamide- and praziquantel-resistant beef tapeworm infection with nitazoxanide. Int J Infect Dis [online] 2008 Jan, 12(1):80-2 [viewed 29 July 2014] Available from: doi:10.1016/j.ijid.2007.04.017

Examination

Fact Explanation
Stool examination Direct examination of the stools may help to observe white motile segments of taenia on it. Examination of the peri anal area may also useful as segments can be found as they crawl out of the anus. These are important findings in terms of diagnosis. [1,2,3]
Abdominal tenderness This may or may not be demonstrated in the epigastric region. Sometime, when the taenia infestation gets complicated with acute appendicitis, rebound tenderness can be demonstrated in the right iliac fossa. [1,2,3]
References
  1. WRIGHT EP, JAIN S. Human infestation by Taenia saginata lasting over 20 years. Postgrad Med J [online] 1984 Jul, 60(705):495-6 [viewed 29 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6463005
  2. CHO J, JUNG BK, LIM H, KIM MJ, YOOYEN T, LEE D, EOM KS, SHIN EH, CHAI JY. Four cases of Taenia saginata infection with an analysis of COX1 gene. Korean J Parasitol [online] 2014 Feb, 52(1):79-83 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2014.52.1.79
  3. CHO J, JUNG BK, LIM H, KIM MJ, YOOYEN T, LEE D, EOM KS, SHIN EH, CHAI JY. Four cases of Taenia saginata infection with an analysis of COX1 gene. Korean J Parasitol [online] 2014 Feb, 52(1):79-83 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2014.52.1.79

Differential Diagnoses

Fact Explanation
Gastroenteritis Viral gastroenteritis is the most common cause of watery diarrhea.It is associated with abdominal pain,nausea and vomiting. Bacterial gastroenteritis usually results in watery diarrhea and sometimes blood and mucous. [1]
Cholecystitis Acute cholecystitis follows a stone impaction in the neck of the gall bladder which may cause continuous epigastric or right upper quadrant pain, vomiting, fever, local peritonism, or a gall bladder mass. Jaundice may present sometimes. [2]
Cysticercosis Cysticercosis is a parasitic tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts infect brain, muscle, or other tissue, and are a major cause of adult onset seizures in most low-income countries. Cysts in the brain or spinal cord result in neurocysticercosis which may be asymptomatic or cause serious complications such as seizures, confusion, difficulty with balance, brain swelling, stroke or death. Cysts in the muscles cause tender lumps. [3]
Giardiasis Giardiasis is caused by Giardia intestinalis, a flagellate protozoan which decreases expression of brush-border enzymes namely disaccharidases and lipase. It causes impairment of carbohydrate and lipid digestion resulting osmotic diarrhea.Travelers to countries where giardiasis is common, People in child care settings, those who are in close contacts with patients, people who swallow contaminated or untreated water,men who have sex with men have a greater risk of becoming infected. Diarrhea is the most common symptom in acute giardiasis. It is more specifically, a steatorrhoea which contains pale, bulky, frothy, foul smelling stools which are floating in the lavatory pan due to fat content. [4]
References
  1. GODANA W, MENGISTIE B. Determinants of acute diarrhoea among children under five years of age in Derashe District, Southern Ethiopia. Rural Remote Health [online] 2013, 13(3):2329 [viewed 27 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24016301
  2. GNASSINGBé K, KATAKOA G, KANASSOUA KK, ADABRA K, MAMA WA, SIMLAWO K, ETEH K, TEKOU H. Acute cholecystitis from typhic origin in children. Afr J Paediatr Surg [online] 2013 Apr-Jun, 10(2):108-11 [viewed 27 July 2014] Available from: doi:10.4103/0189-6725.115033
  3. ZAMMARCHI L, STROHMEYER M, BARTALESI F, BRUNO E, MUñOZ J, BUONFRATE D, NICOLETTI A, GARCíA HH, POZIO E, BARTOLONI A, COHEMI PROJECT STUDY GROUP. Epidemiology and management of cysticercosis and Taenia solium taeniasis in Europe, systematic review 1990-2011. PLoS One [online] 2013, 8(7):e69537 [viewed 27 July 2014] Available from: doi:10.1371/journal.pone.0069537
  4. VESY , PETERSON . Review article: the management of Giardiasis. Aliment Pharmacol Ther [online] 1999 July, 13(7):843-850 [viewed 27 July 2014] Available from: doi:10.1046/j.1365-2036.1999.00537.x

Investigations - for Diagnosis

Fact Explanation
Full blood count Parasitic infestation is characterized by high degree of eosinophilia in half of the cases. [1,2,3]
Microscopic examination of stools Diagnosis is made by microscopic examination of eggs (rarely) or segments (commonly) in stools. Segments are injected with Indian ink to highlight uterus and differentiation of T.saginata from T.solium can be done by the uterine pattern. There are 7-13 uterine branches for T solium whereas T. Saginata has 15-20 branches. Examining the scolex also helps in differentiating the species as a T. solium scolex has 4 suckers with armed rostellum whereas T.saginata has got 4 suckers but no hooks. Still, this is examination scolex for the differentiation is less commonly used as the difficulty of locating the scolex is difficult and it can only be done following the treatment. Determination of species on the basis of ova examination will be difficult because the eggs of the two (T. solium and T. saginata) are identical. An eggs composed of an outer shell with radial striations. The oncosphere in the inside cavity has got 3 pairs of hooklets. [1,2,3,4]
Enzyme-linked immunosorbent assay (ELISA) ELISA has a less importance in diagnosis and rarely performed. [1,2]
References
  1. WRIGHT EP, JAIN S. Human infestation by Taenia saginata lasting over 20 years. Postgrad Med J [online] 1984 Jul, 60(705):495-6 [viewed 29 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6463005
  2. GONZáLEZ LM, MONTERO E, HARRISON LJ, PARKHOUSE RM, GARATE T. Differential diagnosis of Taenia saginata and Taenia solium infection by PCR. J Clin Microbiol [online] 2000 Feb, 38(2):737-44 [viewed 29 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10655377
  3. JESUDOSS AV, KAYA M, LISA S, ROHATGI A. Wormy surprise! BMJ Case Rep [online] 2012 Jun 21 [viewed 29 July 2014] Available from: doi:10.1136/bcr.12.2011.5416
  4. CHO J, JUNG BK, LIM H, KIM MJ, YOOYEN T, LEE D, EOM KS, SHIN EH, CHAI JY. Four cases of Taenia saginata infection with an analysis of COX1 gene. Korean J Parasitol [online] 2014 Feb, 52(1):79-83 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2014.52.1.79

Management - General Measures

Fact Explanation
Prevention Beef should be well cooked before eating. (Critical temperature is 56 Celsius degrees). A food thermometer can be used to measure the internal temperature of cooked meat. Deep freezing below minus 10 Celsius degrees for 10 days will also kill cysticerci. All beef should be inspected for cysticerci or “measly beef”(white pin-head sized cysticerci) by public health officers. Prevention of unhygienic disposal of human stools is also important. [1,2,3]
References
  1. WRIGHT EP, JAIN S. Human infestation by Taenia saginata lasting over 20 years. Postgrad Med J [online] 1984 Jul, 60(705):495-6 [viewed 29 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6463005
  2. JESUDOSS AV, KAYA M, LISA S, ROHATGI A. Wormy surprise! BMJ Case Rep [online] 2012 Jun 21 [viewed 29 July 2014] Available from: doi:10.1136/bcr.12.2011.5416
  3. CHO J, JUNG BK, LIM H, KIM MJ, YOOYEN T, LEE D, EOM KS, SHIN EH, CHAI JY. Four cases of Taenia saginata infection with an analysis of COX1 gene. Korean J Parasitol [online] 2014 Feb, 52(1):79-83 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2014.52.1.79

Management - Specific Treatments

Fact Explanation
Praziquantel Single dose of 10-20 mg/kg after a light breakfast is recommended. Frequently occurring side effects are dizziness, headache, and malaise. Approximately 90% of all patients have abdominal pain or cramps with or without nausea and vomiting. [1,2,3]
Niclosamide Niclosamide should be chewed thoroughly and be taken with water. 2g for adults as a single dose after a light breakfast is recommended. Dosage for children up to 2 years is 500mg and 1g for those between 3 to 6 years. Albendazole is also very effective. [1,2,3]
References
  1. WRIGHT EP, JAIN S. Human infestation by Taenia saginata lasting over 20 years. Postgrad Med J [online] 1984 Jul, 60(705):495-6 [viewed 29 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6463005
  2. LATEEF M, ZARGAR SA, KHAN AR, NAZIR M, SHOUKAT A. Successful treatment of niclosamide- and praziquantel-resistant beef tapeworm infection with nitazoxanide. Int J Infect Dis [online] 2008 Jan, 12(1):80-2 [viewed 29 July 2014] Available from: doi:10.1016/j.ijid.2007.04.017
  3. CHO J, JUNG BK, LIM H, KIM MJ, YOOYEN T, LEE D, EOM KS, SHIN EH, CHAI JY. Four cases of Taenia saginata infection with an analysis of COX1 gene. Korean J Parasitol [online] 2014 Feb, 52(1):79-83 [viewed 29 July 2014] Available from: doi:10.3347/kjp.2014.52.1.79