Zaporozhyan state medical university departement of infectious diseases

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Treatment. Patients with Taeniosis have to be treated in hospital. The drug 

of choice is Extract of male fern (Filicis maris rhizoma) which has paralytic effect 

on muscles of parasite. Prescription the drugs which kill parasite may lead to 

digestion of parasite and releasing eggs from its segments that can result in 

development of Cysticercosis. Patient has to take easily digestible food during 2 

days. In the evening of the 2

nd

 day saline purgative (Magnesium Sulfate) has to be 

taken and next morning on an empty stomach cleansing enema has to be done. 

Then during 30 minutes patient has to take 4-7 g of Filicis maris rhizoma (1 

capsule which has 0.5 g every 3 minutes). In 30-60 minutes after taking the last 

capsule saline purgative has to be used. If patient doesn’t have stool during 3 hours 

after taking purgative, cleansing enema has to be done. Helminth excreted with the 

faeces has to be examined under the microscope to find scolex. If scolex is not 

found, 1-3 enemas have to be done.   

Filicis maris rhizome is very toxic. Pumpkin seeds are less toxic than Filicis 

maris rhizome but they have less antihelminthic activity. They can be prescribed if 

patient has contraindication to Filicis maris rhizome. Patient has to take easily 

digestible food and do enema every morning during two days before treatment 

starts. In the evening of the last day before treatment saline purgative has to be 

taken and next morning on an empty stomach enema has to be done. 500 grams of 

pumpkin seeds are chopped. Twice more amount of water is added. Put it in steam 

bath for two hours, filtrate through gauze then remove oily film. It should be taken 

on an empty stomach during 30 minutes. In 2 hours after taking decoction saline 

purgative has to be given.  

The recommended treatment for cysticercosis is albendazole, 15mg/kg in 2–

3 doses over 8–28 days, repeated as necessary. Praziquantel is also used in a 

dosage of 50mg/kg/day in three doses for 15 days. The cyst may also be surgically 

removed. Surgery (and not chemotherapy) is recommended for intraocular 

cysticercosis. 

Regular medical check-up. In two months after treatment of Taeniasis 

investigation of faeces has to be done 4 times with one month interval.  

Regular medical check-up of patient with Cysticercosis lasts during 1 year. 

One time in 6 months they have to be examined by neurologist and 

ophthalmologist, and control instrumental examinations such as ophthalmoscopy, 

computed tomography and other have to be done. 

 

DIPHYLLOBOTHRIOSIS is zoonotic biohelminthosis with chronic 

course. 

The causative agent is diphyllothrium latum. The adult worm is the longest 

tapeworm (up to 25 m). It attaches to the ileal and occasionally to the jejunal 

mucosa by its suckers (bothria), which are located on its elongated scolex. The 

adult worm has 3000–4000 hermaphroditic proglottids. The terminal mature 

segment has uterus, which is opened in human intestine and releases about 1-2 

million eggs daily into the faeces. Eggs are stable in environment especially in low 

temperature. They can survive in water or under snow during winter time.  

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Epidemiology. Diphyllobothriosis is spread in North Europe, East 

Mediterranean, USA, Canada, Alaska, Central Africa, Russia and Ukraine.  

The source of invasion is human, dog, cat, pig, bear, fox and other fish-

eating animals such us seal, mink, walrus. The adult worms inhabit in small 

intestine. In human body they can live up to 25 years. Infected human is not 

contagious for other people.  

D. latum is biohelminth which needs tree hosts for its lifecycle. With 

definitive host’s faeces egg reaches water. If temperature of water is 10-20 ºC and 

there is enough oxygen, egg hatches and releases a free-swimming embryo that can 

be eaten by small freshwater crustaceans (Cyclops or Diaptomus species), who are 

the fist intermediate host. After an infected crustacean containing a developed 

procercoid is swallowed by a fish, the larva migrates into the fish's flesh and grows 

into a plerocercoid, or sparganum larva. Consequently fish (pike, perch, burbot, 

chum salmon, hunchback salmon and other freshwater fish) is the second 

intermediate host, which has larva of D. latum in its body, liver, hardroe. Humans 

acquire the invasion by ingesting infected raw or not enough salted fish or caviar. 

Hot or cold smoking can destroy larva in fish. Frying fish within 20-40 min, 

heating it to 54°C for 5 min or freezing it at –18°C for 24 hours also kills larva. 

Susceptibility to Diphyllobothriosis is common.  

Pathogenesis. Negative influence on human body is result of mechanical, 

toxico-allergic affect of helminth. Because the tapeworm absorbs large quantities 

of vitamin B12 and interferes with ileal B12 absorption, vitamin B12 deficiency 

can develop. It leads to appearance of megaloblastic anemia. 

Clinical Manifestations. Most D. latum infections are asymptomatic, 

patients become aware of invasion by noting proglottids in faeces. Some patients 

complain about weakness, nausea, vomiting, transient abdominal discomfort, 

urticaria, diarrhea and weight loss. Occasionally, invasion can cause acute 

abdominal pain and intestinal obstruction; in rare cases, cholangitis or cholecystitis 

may be produced by migrating proglottids. Months or even years after invasion 

clinical features of anemia (such us pale skin) appear. 2-3 % of patients have B12 

deficiency anemia. They feel pain and paresthesia in tongue. Some of them have 

atrophic Hunter's glossitis with bright red painful spots and fissures on tongue. 

There are tachycardia and hypotonia. . There are decrease number of erythrocytes 

(to 1.5-2.0×10

12

/liter), low hemoglobin level, high colour index, megaloblasts, 

Jolly's bodies and Cabot's rings in general blood analysis. 

Specific diagnostics. The diagnosis can be confirmed by the detection of the 

characteristic eggs in the stool. The oval shaped eggs possess a single shell with an 

operculum at one end and a knob at the other. Discharged chains of gravid 

segments are also diagnostic. The width of proglottids (up to 1.5 cm) is longer then 

length. There is rosette shaped uterus in the middle of proglottid. 

Treatment.  Praziquantel, Niclosamide, Phenasalum, Mebendazole, 

pumpkin seeds and other medicine can be used. 

Praziquantel is used in a single dose of 10 mg/kg body weight. 

 

Praziquantel (5–10 mg/kg once) is highly effective.  

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