What is the mortality/morbidity of tapeworm infestation?

Updated: Apr 15, 2021
  • Author: Lisandro Irizarry, MD, MBA, MPH, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Many cestode infestations are asymptomatic. However, once symptoms occur, they are usually vague GI complaints such as abdominal pain, anorexia, weight loss, or malaise.

Some of the more serious infestations result in symptoms from mass effects on vital organs, inflammatory responses, nutritional deficiencies, and the potential of fatal anaphylaxis.

Cysticercosis is a clinical syndrome of expanding embryonal cysts that occurs with T solium. The cysticerci that develop with T solium infestations can be found anywhere in the body, but they mainly occur in the central nervous system (neurocysticercosis) and skeletal muscles, causing local inflammatory responses and mass effects from the cystic growth. Cysticercosis is a common parasitic disease of the CNS. One of the most common manifestations is seizure. [3, 4] In endemic areas, it is a major cause of epilepsy. Neurocysticercosis may be the cause of death in many of these affected areas and may leave infected persons with irreversible brain damage.

The first study to systematically collect data on the frequency of neurocysticercosis worldwide found that one third of patients with epilepsy living in endemic communities showed neurocysticercosis brain lesions. [5]

Diphyllobothrium species absorb a large amount of vitamin B-12 and interfere with vitamin B-12 absorption from the ileum, resulting in vitamin B-12 deficiency (this can also occur with Taenia species). Severity depends on the proximity of the worm to the ileum, where vitamin B-12 is mainly absorbed in humans. Clinically, it resembles pernicious anemia (ie, hyperchromic, macrocytic, megaloblastic anemia) that responds well to vitamin supplementation therapy without long-term sequelae.

In Echinococcus infestations, humans ingest the eggs and the embryos escape, penetrate intestinal mucosa, and enter the portal circulation to invade other organs, mainly the liver (60%) and lungs (25%). The patient remains asymptomatic until the cysts cause a mass effect on the organ, which can be 5-20 years after the initial infestation.

Rupture or leakage of an Echinococcus cyst produces symptoms of fever, pruritus, urticaria, eosinophilia, and potentially fatal anaphylaxis.

Pulmonary hydatid cysts may rupture into the bronchial tree produce cough, dyspnea, chest pain, or hemoptysis. Pulmonary cysts rupture into the pleural space can result in abscess formation and pneumothorax, with or without pleural effusion. In addition, fever and acute hypersensitivity reactions ranging from wheezing to anaphylaxis can occur following cyst rupture.

If alveolar hydatid disease is left untreated, more than 90% of patients will die within 10 years from the onset of symptoms and almost 100% by 15 years.


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