Symptoms

• Cysticercosis: Larvae in muscle tissue may cause muscular pain, weakness, fever, and eosinophilia. Brain involvement may lead to hydrocephalus, meningoencephalitis, or epilepsy. Many cases are asymptomatic or manifest minor disease.
• Taeniasis: Mild gastrointestinal complaints.

Differential Diagnosis

• Cysticercosis: Tuberculosis (tuberculoma), brain tumor, and other neurologic or psychiatric disorders.
• Taeniasis: Other causes of gastroenteritis.

Diagnosis

Cysticercosis

1. Lab/Imaging Criteria:
   1. Confirmed: solium identified in excised cysticerci from tissues by microscopic examination; OR identification of cysticerci by CT scan, MRI or X-Ray AND positive immunoblot assay.
   2. Supportive: identification of calcified cystic lesions in tissue by CT scan, MRI, or X-ray; OR positive result on CDC immunoblot assay.
2. Case Classification:
   1. Confirmed: Clinically compatible case that is confirmed via laboratory test/imaging.
   2. Probable: Clinically compatible case that has supportive laboratory test/imaging evidence.
   3. Suspected: Clinically compatible case without laboratory test/imaging evidence that is epidemiologically associated with a Probable or Confirmed case.

Taeniasis

• Ova and parasite exam for proglottid (tapeworm segments) or eggs. The "scotch tape pinworm paddle" (Swube) impression of perianal area has also been used to detect eggs.

• Cysticercosis: Highly variable, from a few weeks to months or years.
• Taeniasis: 8-14 weeks for the adult tapeworm to mature after consumption of a larva.

• Cysticercosis: Individuals infected with the adult tapeworm shed eggs that are consumed by self or others. Humans are the definitive host for the adult worm.
• Taeniasis: Swine (T. solium, T. asiatica) or cattle (T. saginata).

• Cysticercosis: Feces containing eggs or proglottids of T. solium; eggs of T. solium are directly infectious to humans.
• Taeniasis: Raw or undercooked pork or beef containing larvae of any species.

• Cysticercosis: Fecal-oral transmission of eggs via contaminated food, possibly water. Direct person-to-person transmission may occur. Autoinfection from feces to hand to mouth.
• Taeniasis: Via consumption of larvae in raw or undercooked pork or beef.

Persons with T. solium tapeworm infections are infectious to others. Persons with cysticercosis (larval form) may also be infected with the adult worm and would then be infectious to others. An individual with cysticercosis without adult tapeworm infection is not infectious to others.

Cysticercosis: Dependent on clinical status and radiographic classification.

Anticonvulsants, steroids, analgesics are employed. Praziquantel (Biltricide7), an antihelminthic, and surgery are of value in some circumstances.

Taeniasis: Niclosamide (Niclocide) or praziquantel. Purging is not recommended.

Short lived.

Report within seven calendar days, California Code of Regulations, Title 17, Section 2500.

CYSTICERCOSIS/TAENIASIS CASE REPORT FORM (CDPH 8581)

CYSTICERCOSIS (TAENIASIS) CONTACT WORKSHEET (acd-cysticercosis_worksheet)

• Residence or travel in endemic
• Symptoms or other cases among household
• Consumption of raw or undercooked meat, especially outside of the US, or illegally imported

Investigate within 3 days.

Case should be evaluated for adult tapeworm infection via O&P exam on three stool specimens, each collected at least 24 hours apart. Food handlers with T. solium should be removed from work for one week after treatment.

If case is a food handler: Household and sexual contacts should be evaluated using O&P exam on three stool specimens obtained at least 24 hours apart.

If case is not a food handler and is symptomatic: Evaluate with three stool specimens obtained at least 24 hours apart, for O&P exam.

If not a food handler and is asymptomatic: Testing is not required. Consider testing if unknown source (e.g., travel) for case.

Food handlers with T. solium should be managed as a case described above.

• Explain transmission of disease.

• Emphasize personal hygiene and sanitary disposal of human excrement.

• Advise thorough cooking of pork and beef products.

For more info visit:

• LAC DPH: Cysticercosis
• CDC: Cysticercosis

Cysticercosis:

1. Biopsy
2. Computed tomographic (CT) or magnetic resonance imaging (MRI) scan.
3. Serologic testing (CDC Immunoblot). Contact PHL for instructions.

Taeniasis:

Microscopic examination of feces: Container: Feces-Parasite.
Laboratory Form: PARASITOLOGY (H- 383).
Examination Requested: Taenia eggs.
Submission Requirements: Follow instructions in container.

Worm or Segment Identification:

Container: Tuberculosis tube (50 ml centrifuge tube).
Laboratory Form: PARASITOLOGY (H- 383).
Examination Requested: Worm identification.
Submission Requirements: Place worm or worm segment in water or saline solution; seal lid securely and refrigerate until transport.