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Scientific letter
Taeniasis in a Spanish girl
Teniasis en una niña española
Carla Muñoz-Antolí
Corresponding author
carla.munoz@uv.es

Corresponding author.
, Raimundo Seguí, M. José Irisarri-Gutiérrez, Rafael Toledo, José Guillermo Esteban
Departamento de Parasitología, Facultad de Farmacia, Universitat de València, Burjassot, Valencia, Spain
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which was repeated at two weeks by medical prescription against worm infestations&#46; This treatment was repeated in July and October 2015 without eliminating the structures&#46; Metronidazole 125<span class="elsevierStyleHsp" style=""></span>mg&#47;5<span class="elsevierStyleHsp" style=""></span>ml&#44; three times a day for one week was prescribed&#46; Given the persistence of the structures&#44; another paediatrician was consulted&#44; who recommended the administration of a single dose of pyrantel 11<span class="elsevierStyleHsp" style=""></span>mg&#47;kg for four days followed by coprological analysis&#46; The analysis&#44; which was performed in November 2015&#44; was positive for &#8220;dog tapeworm&#8221;&#44; or <span class="elsevierStyleItalic">Dipylidium caninum</span>&#44; infestation&#46; The paediatrician recommended treatment either with niclosamide or praziquantel&#46; Given the unusual and foreign nature of the medication requested&#44; the pharmacist referred the child to the Department of Parasitology of the University of Valencia&#39;s Pharmacy Faculty&#44; where three serial stool samples and three pieces of adhesive tape &#40;Graham&#39;s test&#41; were analysed on consecutive days&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The macroscopic observation of numerous isolated long whitish structures &#40;11&#46;4&#8211;13&#46;7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4&#46;0&#8211;4&#46;4<span class="elsevierStyleHsp" style=""></span>mm&#41; was suggestive of <span class="elsevierStyleItalic">Taenia</span> proglottids&#46; The faecal analysis revealed the presence of multiple yellowish-brown spherical eggs with a thick shell&#44; measuring 35&#46;0&#8211;37&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;m in diameter&#44; which were radially striated and contained a six-hooked embryo &#40;hexacanth&#41; known as an oncosphere&#46; Graham&#39;s test was negative for pinworm eggs &#40;<span class="elsevierStyleItalic">Enterobius vermicularis</span>&#41;&#44; although multiple <span class="elsevierStyleItalic">Taenia</span> eggs were identified &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The microscopic analysis of a proglottid&#44; mounted with Amann&#39;s lactophenol between two slides&#44; confirmed the presence of multiple &#40;more than 15&#41; primary lateral branches on either side of the central uterine axis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; with the genital pore located on the side&#44; confirming the diagnosis of <span class="elsevierStyleItalic">Taenia saginata</span>&#47;<span class="elsevierStyleItalic">Taenia asiatica</span>&#46; The girl&#39;s parents and her twin sister had no parasitic infestation&#46; The oral administration of 50<span class="elsevierStyleHsp" style=""></span>mg&#47;kg of paromomycin sulfate divided over three doses&#47;day was prescribed after identification of the cestode in December 2015&#46; The parasitology stool tests conducted in January and February after treatment were negative&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The eggs in the faeces were identified as the genus <span class="elsevierStyleItalic">Taenia</span>&#46; Specific identification was confirmed by analysis of the gravid proglottids with permanent staining or with lactophenol&#44; to reveal the number of lateral uterine branches or to ascertain whether the proglottids spontaneously emerged from the anal orifice or were eliminated with faeces&#46; The case in question without doubt concerns <span class="elsevierStyleItalic">T&#46; saginata</span>&#47;<span class="elsevierStyleItalic">T&#46; asiatica</span> as both species have the same morphological characteristics&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> and they can only be differentiated by molecular methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The child may have become infected during a stay in France&#44; as her parents said that they went to visit her grandparents in February 2015&#44; who regularly eat steak tartare &#40;raw beef mixed with raw egg yolk and spices&#41;&#46; This information may be relevant when it comes to establishing the epidemiological chain of the case given that the girl&#39;s French grandfather was treated for taeniasis two years previously&#46; Furthermore&#44; identifying France as the possible source of infection is not surprising given that the estimated mean annual prevalence of human taeniasis in the country is 0&#46;11&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The girl&#39;s lack of symptoms is consistent with other patients as the pathogenesis of taeniasis is very mild&#44; with symptoms associated with abdominal pain&#44; bloating&#44; diarrhoea&#44; nausea and anorexia&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> The finding of proglottids in the patient&#39;s underwear can be explained by the fact that <span class="elsevierStyleItalic">T&#46; saginata</span>&#47;<span class="elsevierStyleItalic">T&#46; asiatica</span> can move independently&#44; which means they can actively emerge without having to be passed&#46; When the proglottids crack open upon leaving the body&#44; their eggs can become adhered to the perianal area&#44; which explains their detection in Graham&#39;s test&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Praziquantel &#40;5&#8211;10<span class="elsevierStyleHsp" style=""></span>mg&#47;kg single-dose&#41; and niclosamide &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;kg single-dose&#44; up to a maximum of 2<span class="elsevierStyleHsp" style=""></span>g&#41; are the drugs of choice&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> The fact that both antiparasitics are considered to be foreign drugs meant that paromomycin sulfate had to be used as it is available in the pharmacies&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">It should be noted that cooking meat for longer or freezing it at &#8722;20<span class="elsevierStyleHsp" style=""></span>&#176;C for at least 12<span class="elsevierStyleHsp" style=""></span>h would be sufficient to prevent infection&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">Project No&#46; RD12&#47;0018&#47;0013&#44; <span class="elsevierStyleItalic">Red de Investigaci&#243;n Cooperativa en Enfermedades Tropicales</span> &#40;Tropical Diseases&#8217; Cooperative Research Network&#44; RICET&#41;&#44; 4th National R&#38;D&#38;I Programme 2008-2011&#44; <span class="elsevierStyleItalic">ISCIII-Subdirecci&#243;n General de Redes y Centros de Investigaci&#243;n Cooperativa</span> &#40;Carlos III Health Institute&#8212;Subdirectorate General of Cooperative Research Centres and Networks&#41; and FEDER &#40;Spanish Federation of Rare Diseases&#41;&#44; <span class="elsevierStyleItalic">Ministerio de Salud y Consumo</span> &#40;Ministry of Health and Consumer Affairs&#41;&#44; Madrid&#44; Spain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos