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Questions Answered: 215

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148
67

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Microbiology

Pathogens

Question 195 of 215

Regarding tapeworm, which of the following statements is CORRECT:

Answer:

Diagnosis of tapeworm is by direct visualisation of characteristic eggs in stool. Humans may be infected by pork or beef tapeworm. Treatment is with praziquantel or niclosamide. Specialist advice should be sought for the management of neurocysticercosis. Iron-deficiency anaemia is typically seen in hookworm infection. Threadworms migrate from the intestine at night to lay eggs on the perianal skin. Mebendazole is first line treatment for threadworms.

Tapeworm

Microbiology / Pathogens / Worms

Last Updated: 21st April 2019

Two Taenia spp. infect humans, the pork tapeworm and the beef tapeworm.

Infection is acquired by eating raw or undercooked contaminated meat from the intermediate host (pig or cow) that contains the tissue stages of the parasite. The larvae mature into the adult form in the small intestine and eggs are released and excreted in the faeces, continuing the infectious cycle.

Despite the size of the worm, tapeworms are often asymptomatic but may cause abdominal discomfort and diarrhoea and compete for nutrients.

Cysticercosis

The pork tapeworm, Taenia solium, can use humans as an intermediate host as well as the definitive host.

Infection occurs through ingestion of food or water contaminated with eggs.

The eggs hatch into larvae in the intestine which enter the bloodstream and disseminate, forming multiple cyst-like lesions (cysticercosis) in the muscles, skin, eye and brain (neurocysticercosis). Inflammatory responses to parasitic antigen found in the brain may lead to seizures.

Diagnosis

Diagnosis of tapeworm is by direct visualisation of characteristic eggs in stool. Cysticercosis is diagnosed by specific ELISA and confirmed by the demonstration of cysts with radiological imaging.

Treatment

Niclosamide [unlicensed] (available from ‘special-order’ manufacturers or specialist importing companies) is the most widely used drug for tapeworm infections and side-effects are limited to occasional gastro-intestinal upset, lightheadedness, and pruritus; it is not effective against larval worms.

Praziquantel [unlicensed] (available from ‘special-order’ manufacturers or specialist importing companies) is as effective as niclosamide.

Specialist advice should be sought for the management of neurocysticercosis.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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