Some issues in the treatment and management of Tapeworm found living inside a patient (Part 4‐End)

Because taeniasis is a rare parasitic infection in clinical practice, public health strategies do not consider it a priority health problem. Because of the direct dietary route of taeniasis, mainly through the ingestion of raw or undercooked snake or frog meat infected with asexual cysticercosis larvae as well as accidental infection with tiny water fleas infected with asexual cysticercosis larvae when drinking water.

Continued Part 3

PREVENTION STRATEGIES & PUBLIC HEALTH CONCERNS

Because cysticercosis is a clinically rare parasitic infection, public health strategies (PHS) do not consider it a priority health problem.

Because there is also a direct dietary route that causes tapeworm infection mainly through eating raw or undercooked snake or frog meat infected with asexual cysticercosis larvae as well as accidental infection with tiny water fleas infected with asexual cysticercosis larvae when drinking water.

Public health strategies that focus on providing access to clean water may help reduce future tapeworm infections.

Copidopods or freshwater mollusks are the first intermediate hosts and other amphibians and reptiles are the second intermediate hosts.

In a retrospective study of 25 cases of cerebral tapeworm disease, Song et al. found that 12 patients (48%) had a history of eating raw or undercooked frog or snake meat, which was associated with infection with tapeworm larvae, 5 patients (20%) had applied animal meat to open wounds, and 4 patients drank contaminated water, which caused infection in 4 patients. Based on the results of the study, Song et al. concluded that health education (HE) on tapeworm disease and the importance of food safety should be established in rural areas of endemic countries.

It is also recommended that drinking water in endemic areas should be boiled and that people avoid eating Cyclops or Spirometra spp.larvae. Particularly in areas where ponds or ditches are potential habitats for copepods, public health strategies should include communication about potentially contaminated water sources. Public health strategies should warn people against eating intermediate hosts (snakes, frogs) as eye poultices for pink eye. In terms of public health and prevention, in some areas where tapeworms are endemic, it is advised that there are dangers in drinking water from small ponds and jars that may contain small copepods. Public health infrastructure should be improved to provide access to clean water. The use of potentially contaminated animals should be very cautious. Prevention may be difficult because of some cultural and dietary practices associated with frogs and snakes. The content of public health disease prevention should focus on the following stages:

‐ Health education communication (HE), mobilizing the community not to drink unboiled water, not to eat uncooked frog, toad, and snake meat;

‐ In rural areas, it is necessary to abandon the backward practice of using the skin and meat of live frogs and toads to apply to the eyes to treat pink eye;

‐ In addition, clean water should be used in daily life;

‐ When eating at restaurants or preparing food at home, be careful with foods made from undercooked frogs, toads, and snakes, or limit contact with dishes made from frogs, toads, snakes, and birds if you suspect they are undercooked, especially dishes like stir‐fried sweet and sour frogs, stir‐fried water mimosa, stir‐fried bamboo shoots, or “semi” dishes like the Japanese or Thais;

‐ Be careful when buying frog meat, the type of frog meat prepared in the market is often bright red, that is because the seller dips the frog meat in pig’s blood to deceive the buyer, in fact, it is frozen frog meat. It is best, when buying frog meat, you buy live frogs and ask the seller to prepare it for you on the spot; if there are no live frogs, you can identify fresh frog meat by pressing on the frog’s thigh with your hand, if the meat is firm then buy it, fresh frog meat must be opaque white.

Once infected, the plerocercoid larvae migrate in and under the skin, where they develop into painful nodules. Migration to the brain results in cerebral sparganosis, and migration to the eye results in ocular sparganosis.

Bệnh do ký sinh trùng sán nhái lưu hành nhiều nhất ở các quốc gia Đông Á ( Trung Quốc, Hồng Kông, Ma Cao, Đài Loan, Nhật Bản, Mông Cổ, Triều Tiên và Hàn Quốc) and in Vietnam, the number of reported cases each year is less than 10 cases in specialized eye hospitals, although the number of cases has been described in countries around the world, about 300 cases were described in medical literature by the end of 2003 and currently many countries have compiled in the past 15 years the number has also reached nearly 1000 cases by 2018. Diagnosis is often not made until the sparganum larva is surgically removed and identified.

Praziquantel (PZQ) is the drug of choice for treating tapeworms, although its efficacy is not fully known and surgical removal of the tapeworm from the lesion is generally the best treatment. Public health interventions should focus on water and food hygiene, as well as health education about the disease in rural areas where frog poultices are commonly used.

(End)

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Author: Dr. Huynh Hong Quang
(IMPE Quy Nhon)