Travel Health Tropical Medicine

Tapeworms and travel

Pork Tapeworm Head
Pork Tapeworm Head

A friend of mine recently returned from a surfing trip in Mexico, for several weeks.  While he was there, he had a great time and got some really good waves.  He also got sick when he came back and was diagnosed with having an intestinal tapeworm, he assumes he acquired during his travels.  He asked for some more information on the infection and here’s what I told him.

Basics: There are two main types of  “tapeworms” in humans.  Taenia Saginata is associated with undercooked beef and Taenia Solium is associated with undercooked pork.  Tapeworms like to live in the intestines of the host.  The eggs may be found anywhere in the body and can cause seizures if in brain tissue (neurocysticercosis).

 Location: Worldwide, prevalent in areas where undercooked beef or pork are eaten

Transmission/ Incubation: Acquired by the ingestion of undercooked beef or pork meat that is infected with the larval stage of either species. The patient may be asymptomatic for years before diagnosis.

Prevention: Adequately cooking beef and pork, education about fecal contamination of soil, water, livestock pens

Diagnosis: Demonstration of eggs or proglottids in fecal smear. The eggs of both species are indistinguishable, only proglottids are different
Treatment: Praziquantel is considered first-line and albendazole may be used for neurocysticercosis. Consider steroids for cerebral edema in neurologically symptomatic patient, especially during treatment, as the larvae die.
Taenia saginata (beef tapeworm)
Taenia saginata (beef tapeworm)
This infection is far more common than people believe and is actually a fairly common cause of “first time” seizures, in adults.  Typically, the infected person has minor bouts of diarrhea and vomiting, and after a few weeks, may notice some weight loss.  More serious problems an occur if the worm begins to obstruct the intestines, causing appendicitis or localized inflammation in the liver or pancreas.  The adult worms can get long…up to 10 meters!  The parasite pictured on the left is only about 4 meters in length.
Overall, travelers need to know that their food, especially beef and pork, should be completely cooked.  This generally kills the worms that may live in the flesh and is sufficient to prevent infection.  The incubation period is varied and patients may not show signs of infection for years, although a few weeks is common.  This means that most travelers will deal with the illness when they return back home, unless they are on extended travels or an expat
One of my favorite “home remedies” and the subject of myth is the use of a cigarette to kill the parasite.  One of my favorite books, the Special Forces Medical Handbook, discusses this method.  I certainly do not advise this method, as there are much better antibiotics that effectively kills the parasites.  However, the books section on primitive treatments lists several treatments of this nature.  The basic premise is too change the environment of the intestinal tract, thus causing the worm too de-attach and get passed out in feces. 
  • Four tablespoons of salt taken in one quart of warm water, as a one time dose
  • Tobacco, 1 to 1.5 cigarettes, uses the nicotine to stun the parasite, allowing the worm to be passed.  This treatment should not be repeated more than once in 48 hours and only tried twice
  • Hot peppers used as a steady and frequent part of the diet may offer some protection

I am interested in these “primitive remedies” but do not advocate their use, especially when safe and proper antibiotics can be easily obtained.

The best thing a travel can do, to prevent this, is to make sure their food is properly cooked.  A simple examination of the feces (under microscope) is usually good enough to diagnose the infection and antibiotic treatment is simple. 

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