What is the treatment for Taenia solium (pork tapeworm) infection?

Treatment for Pork Tapeworm (Taenia solium)

For intestinal pork tapeworm infection (taeniasis), the first-line treatment is praziquantel 10 mg/kg as a single oral dose, taken with food. 1, 2

Critical Distinction: Intestinal vs. Tissue Infection

The treatment approach fundamentally depends on whether you are treating intestinal tapeworm infection (taeniasis) or tissue cysticercosis, particularly neurocysticercosis:

Intestinal Tapeworm (Taeniasis)

• Praziquantel 10 mg/kg as a single oral dose is the recommended treatment 1, 2
• Take with food to improve absorption 3
• Alternative: Niclosamide 2g as a single dose (though praziquantel is preferred) 4

Neurocysticercosis (Brain Involvement)

Before treating with antiparasitic drugs, you must exclude neurocysticercosis through neuroimaging and serology, as treating intestinal infection with praziquantel in the presence of undiagnosed neurocysticercosis can be dangerous. 1

For confirmed neurocysticercosis:

• Albendazole 15 mg/kg/day (up to 400 mg twice daily for patients ≥60 kg) for 8-30 days 3
• Corticosteroids must be started one day before albendazole to prevent cerebral edema and hypertensive episodes 1, 3
  • Dexamethasone 0.1 mg/kg/day or prednisone/prednisolone 1-2 mg/kg/day 1
  • Continue steroids for at least 7 days, longer if marked edema or clinical deterioration 1
• Anticonvulsant therapy should be initiated as required 3
• Take albendazole with food to enhance absorption 3

Essential Pre-Treatment Evaluation

Before initiating any treatment for T. solium:

1. Perform fundoscopic examination to exclude ocular cysticercosis, as antiparasitic treatment can cause irreversible retinal damage if ocular cysts are present 1
2. Obtain neuroimaging (MRI with contrast preferred) if any neurological symptoms or if treating T. solium specifically 1
3. Check cysticercosis serology when T. solium is identified or suspected 1
4. Pregnancy test for females of reproductive potential before albendazole, as it causes fetal harm 3

Monitoring During Treatment

For albendazole therapy (neurocysticercosis):

• Monitor complete blood counts at the beginning of each 28-day cycle and every 2 weeks during therapy, as fatal bone marrow suppression can occur 3
• Monitor liver enzymes at the beginning of each cycle and at least every 2 weeks, discontinuing if clinically significant elevations occur 3
• Monitor blood glucose if on corticosteroids and consider proton pump inhibitors for gastric protection 1
• Discontinue albendazole if clinically significant decreases in blood cell counts develop 3

Public Health Considerations

T. solium carriers pose a significant public health risk, especially food handlers, and local public health authorities should be notified. 1, 2

• Screen all household contacts with stool microscopy, as tapeworms were documented in 22% of close contacts in non-endemic areas 1
• Multiple stool examinations may be needed as eggs are eliminated intermittently 1, 2
• Neurocysticercosis is reportable in many states 1

Common Pitfalls to Avoid

• Never use praziquantel for intestinal T. solium until neurocysticercosis is excluded, as it can worsen cerebral edema 4
• Never start antiparasitic drugs without corticosteroids in neurocysticercosis, as treatment-induced inflammation can cause seizures, increased intracranial pressure, and cerebral edema 1, 3
• Never treat patients with ocular cysticercosis with antiparasitic drugs without ophthalmology consultation, as this can cause irreversible vision loss 1
• Do not use antiparasitic agents in patients with increased intracranial pressure from diffuse cerebral edema or untreated hydrocephalus 1
• Exclude strongyloidiasis before starting corticosteroids, as steroids can cause fatal hyperinfection syndrome 1

Species Identification Importance

Identifying the tapeworm species is crucial because T. solium (pork tapeworm) carries risk of neurocysticercosis, while T. saginata (beef tapeworm) does not. 1, 2

• Examine passed proglottids (worm segments) microscopically to distinguish species 1, 2
• If species cannot be identified, treat as T. solium and perform appropriate screening 1