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A Patient with Complaints of Chronic Weight Loss and Melena


Authors: Taruna Kaura Ph.D., Kamran Zaman MD, Sivanantham Krishnamoorthi MD, Abhishek Mewara MD and Rakesh Sehgal MD

A 19-year-old previously healthy male presented with generalized weakness and chronic abdominal pain over a period of 2 years. The abdominal pain was characterized by dull aching confined to the lower abdomen and was occasionally associated with cramping. He endorsed indigestion, unintentional weight loss of 10 kilograms over the past two years, and intermittent passage of black tarry stools. He had visited several physicians for these symptoms and had been treated with antispasmodics, antacids and iron supplements, however, the complaints persisted. He had a history of frequently eating at restaurants, but otherwise, there was no history of travel or other known exposures. A careful history revealed occasional consumption of undercooked beef. The general physical examination was unremarkable except for pallor. The abdominal examination was within normal limits with no organomegaly and no localized tenderness.


Due to the presence of persistent gastrointestinal symptoms and prolonged illness, there was a strong clinical suspicion of helminthic infestation, therefore serial stool samples were collected. The stool microscopy showed embryonated eggs with a well-defined oncosphere of Taenia species but was negative for other parasites. Subsequently, he was treated with a single dose of praziquantel 600 mg orally. After 24 hours of therapy, he discharged a tapeworm in the stool measuring approximately 2.9 meters (See Image 1), excluding the scolex. A mature gravid proglottid stained with India Ink showed >23 lateral uterine branches with a well-defined genital pore (See Image 2), thus identifying it as Taenia saginata (beef tapeworm). At four weeks, the stool samples were negative for eggs. Two months later, the stool samples remained negative, and the patient was completely asymptomatic and recovered his appetite and weight.

Image-2_Kamran.doc.jpg


MCQ 1: What is the most characteristic feature helpful for identifying Taenia sp.?
A. Morphology of eggs
B. Number of uterine branches
C. Number of ovaries
D. Number of genital pores

MCQ 2: What is the most effective drug used in the treatment of intestinal taeniasis?
A. Metronidazole
B. Albendazole
C. Praziquantel
D. Chloroquine

Click here to view answers

References:


1. WHO. Taeniasis/cysticercosis: World Health Organization, 2015. http://www.who.int/mediacentre/factsheets/fs376/en/ (Accessed on August 20, 2016).

2. P. C. Fan, W. C. Chung, C. Y. Lin and C. H. Chan (1992). Clinical manifestations of taeniasis in Taiwan aborigines. Journal of Helminthology, 66, pp 118-123.

3. CDC. DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern. http://www.cdc.gov/dpdx/taeniasis/dx.html(Accessed on August 20, 2016).


Author Information:

  1. Taruna Kaura is a Senior Research Fellow.
  2. Kamran Zaman is a Senior Resident.
  3. Sivanantham Krishnamoorthi is a Senior Resident.
  4. Abhishek Mewara is an Assistant Professor.
  5. Rakesh Sehgal is a Professor.

All authors are affiliated with the Department of Medical Parasitology at the Postgraduate Institute of Medical Education and Research in Chandigarh, India.


 

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