Tapeworm infection

Overview

A tapeworm is a parasite that can live and feed in human intestines. This is called a tapeworm infection.

A young and inactive form of the tapeworm is called a larval cyst. It can stay alive in other parts of the body. This is called a larval cyst infection.

A tapeworm in the intestines often causes mild symptoms. Moderate to severe symptoms may include stomach pain and diarrhea. Larval cysts can cause serious disease if they are in a person's brain, liver, lungs, heart or eyes.

Tapeworm infections are treated with anti-parasitic drugs. Treatments for larval cyst infections may include anti-parasitic drugs and surgery to remove the cyst. Other drugs may be used to treat symptoms.

Symptoms

Symptoms depend mostly on where the infection happens in the body.

Tapeworm infection in the intestines

A tapeworm in the intestines may cause no symptoms. The severity of symptoms depends in part on the number of tapeworms. Symptoms vary. And some symptoms are more likely with some species of tapeworm. Symptoms may include:

• Upset stomach, or feeling like you could throw up.
• Stomachache or stomach pain.
• Not wanting to eat.
• Loose stools.
• Diarrhea.
• Weight loss.
• Gas.
• Hunger pains.
• Cravings for salty food.

Larval cyst infection

Symptoms of larval cyst infection depend on where they are causing disease in the body.

• Larval cysts in the brain or spine. These may cause:
  • Headache.
  • Seizures.
  • Dizziness.
  • Nerve pain in the spine or limbs.
  • Muscle weakness.
  • Poor coordination.
  • Changes in thinking or behaviors.
• Larval cysts in other organs. These can affect how well the organ works. For example, larval cysts can cause severe disease in the liver, lungs or heart. Symptoms vary widely. In some cases, a lump can be felt. There also may be pain and swelling at the site of the larval cyst infection.

When to see a doctor

If you experience any of the symptoms of tapeworm or larval cyst infection, get medical care.

Causes

Most tapeworms need two different hosts to complete a life cycle. One host is the place where a parasite grows from egg to larva, called the intermediate host. The other host is where the larva become adults, called the definitive host. For example, beef tapeworms need cattle and humans to go through a complete life cycle.

The beef tapeworm eggs can survive in the environment for months or years. If a cow, the intermediate host, eats grass with these eggs on it, the eggs hatch in its intestines. The young parasite, called a larva, passes into the bloodstream and moves to muscles. It forms a protective shell, called a cyst.

When people, the definitive host, eat undercooked meat from that cow, they can develop a tapeworm infection. The larval cyst develops into an adult tapeworm. The tapeworm attaches to the wall of the intestine where it feeds. It produces eggs that pass in the person's stool.

In this case, the cow is called the intermediate host, and the person is the definitive host.

Tapeworm infections

Humans are the definitive hosts for some species of tapeworms. They may get a tapeworm infection after eating raw or undercooked:

• Beef.
• Pork.
• Fish.

Larval cyst infections

Humans may be the intermediate hosts for other tapeworm species. This usually happens when they drink water or eat food with tapeworm eggs. Humans also can be exposed to eggs in dog feces.

An egg hatches in the person's intestines. The larva travels through the bloodstream and forms a cyst somewhere in the body.

The larval cyst matures. But it won't become a tapeworm. Cysts vary by species. Some cysts have a single larva. Others have several larvae. Or they can make more. If a cyst bursts, it can lead to cysts forming in other parts of the body.

Symptoms usually show up years after the infection began. They happen when the immune system responds to the cyst shedding debris, breaking down or hardening. Symptoms also appear when one or more cysts keep an organ from working correctly.

Exceptions

There are two exceptions to the typical life cycle of tapeworms that can infect humans.

• Pork tapeworms. Humans can be a definitive host or an intermediate host for pork tapeworms. For example, a person can have adult pork tapeworms from eating undercooked pork. The eggs pass in the person's stool. Poor handwashing may lead to the same person or another person being exposed to the eggs. If this happens, a person can get a larval cyst infection.
• Dwarf tapeworm. The dwarf tapeworm enters humans as eggs from food or water. Exposure also may happen because of poor handwashing. The egg hatches in the intestines. The larva burrows into the wall of the intestines and forms a larval cyst. This becomes an adult dwarf tapeworm. Some eggs from the tapeworm pass in stool. Other eggs hatch in the intestine to make a repeating cycle.

Risk factors

Factors that may put you at greater risk of tapeworm or larval cyst infection include:

• Eating raw or undercooked meats. The main risk factor for tapeworm infection is eating raw or undercooked meat and fish. Dried and smoked fish also may have larval cysts in them.
• Poor hygiene. Poor handwashing increases the risk of getting and spreading infections. Unwashed fruits and vegetables also can carry tapeworm eggs.
• Lack of sanitation and sewage. Lack of sanitation and sewage for human waste increases the risk of livestock getting tapeworm eggs from people. This increases the risk of people eating infected meat.
• Lack of clean water. A lack of clean water for drinking, bathing and making food increases the risk of exposure to tapeworm eggs.
• High-risk regions. Living in or traveling to regions with high rates of infection is a risk factor.

Complications

From tapeworm infections

Tapeworm infections usually don't cause complications. Problems that may happen include:

• Anemia. Long-term infection with a fish tapeworm may lead to the body not making enough healthy red blood cells, also called anemia. This can happen because the tapeworm keeps the body from getting enough vitamin B-12.
• Blockages. In some cases, a part of a tapeworm can block a duct that connects another organ to the intestines.
• Anxiety. People may be anxious or stressed about having a tapeworm infection, seeing parts of tapeworms in stool or passing long tapeworms.
• Severe allergic reaction. Larval cysts may shed debris or break down. When the immune system reacts, it may cause symptoms of severe allergy. Symptoms may include difficulty breathing, fainting, fever and a drop in blood pressure.

From larval cyst infections

Complications from larval cysts vary depending on what organ is affected. Serious complications include the following.

• Larval cysts in the brain or central nervous system. These can cause:
  • Inflammation, or swelling, of the fluids and membranes surrounding the brain and spinal column, also called meningitis.
  • Buildup of fluid in the brain, also called hydrocephalus.
  • Pressure on the spinal cord.
  • Damage to nerves, blood vessels or the brainstem.
• Larval cysts in other organs. These can lead to:
  • Cyst growth that damages organ tissue.
  • Bacterial disease in cysts.
  • Bacterial disease related to blockages caused by cysts.

Prevention

These steps can help prevent infections with tapeworms or tapeworm larval cysts.

• Wash your hands. Wash your hands with soap and water for at least 20 seconds. This is very important after using the toilet, before eating, and before and after handling food.
• Wash fruits and vegetables. Rinse fruits and vegetables under running water before eating, peeling or preparing them.
• Wash kitchen utensils well. Wash cutting boards, knives and other utensils with soapy water after contact with raw meats or unwashed fruits and vegetables.
• Don't eat raw or undercooked meat or fish. Use a meat thermometer to make sure meat is cooked enough to kill larval cysts. Cook whole meats and fish to at least 145 degrees Fahrenheit (63 degrees Celsius) and let rest for at least three minutes. Cook ground meat to at least 160 degrees Fahrenheit (71 degrees Celsius).
• Freeze meat. Freezing meat and fish can kill larval cysts. Freeze at minus 4 degrees Fahrenheit (minus 20 degrees Celsius) or below for 7 days.
• Treat infected dogs. Treat dogs with tapeworms right away.

Diagnosis

Diagnosis of tapeworm infection

A health care provider tests for a tapeworm infection in the intestines using a test of a stool sample. A lab test may find pieces of tapeworms or eggs. You may give a sample on more than one day.

Diagnosis of larval cyst infection

• Imaging exam. Providers use imaging tests to find larval cysts. These may include CT scans, MRI scans or ultrasound. Larval cysts are sometimes found during an imaging exam for another illness before the cysts cause disease.
• Blood test. Providers may use a blood test to confirm a diagnosis. A lab exam may find immune system antibodies to the larval cysts in a blood sample.

Treatment

Treatment for tapeworm infection

Your health care provider treats a tapeworm infection in the intestines with anti-parasitic drugs. These include:

• Praziquantel (Biltricide).
• Albendazole.
• Nitazoxanide (Alinia).

These drugs kill the tapeworm but not the eggs. You need to wash your hands well with soap and water after using the toilet. This protects you and other people from the spread of tapeworm eggs.

Your health care provider will schedule follow-up appointments. They use tests of stool samples to see if the treatment has worked.

Treatments for larval cyst infection

Treating a larval cyst infection depends on the location or effects of the infection. Treatments often include:

• Anti-parasitic drugs. Albendazole and praziquantel are used to treat larval cysts in the brain or central nervous system.
• Corticosteroids. Corticosteroids can reduce swelling and other immune system activity that may damage organs, muscles or other tissues.
• Surgery. When possible, a surgeon removes a larval cyst.
• Surgery alternative. Sometimes, when surgery isn't possible, another treatment may be used. A specialist uses a fine needle to remove some fluid from the cyst. They inject a treatment into the cyst to kill it. Then they remove all of the fluid in the cyst.

Other treatments to manage complications and symptoms may include:

• Anti-epileptic medicine. These drugs help prevent or stop seizures caused by larval cysts in the brain.
• Shunt. A tube, called a shunt, may be used to drain excess fluid in the brain.

Preparing for an appointment

You'll likely see your health care provider first. You may be referred to a doctor who treats problems in the brain and central nervous system, called a neurologist. Or you may see a doctor who treats problems in the digestive system, called a gastroenterologist.

To prepare for your appointment, write down answers to the following questions.

• When did your symptoms begin?
• Does anything improve your symptoms or make them worse?
• Have you eaten any raw or undercooked meat or fish?
• Have you traveled recently? Where?
• Have you been around anyone with a tapeworm infection?
• What drugs, herbal remedies or dietary supplements do you take?