Unless the parasite is detected (eg, presence of eggs, worm segments, cysts), definitive therapy in the ED is unlikely. Stabilization of any patient in the presence of a systemic disease such as seizure, anaphylaxis, or organ failure is essential.
Intestinal tapeworm infestation
Recent reviews summarize that most intestinal tapeworm infections can be effectively treated with praziquantel or niclosamide. [11, 12] These antihelminthic agents have effective rates of 85-98%. [13] Praziquantel was found to be 100% effective in the treatment of Taenia and H nana infection. [14]
Administer parenteral vitamin B-12 if evidence of vitamin B-12 deficiency occurs with Diphyllobothrium infections.
Cysticercosis
In neurocysticercosis, neurologic manifestations indicate the need for antihelminthic agents and antiepileptics. The recommended antihelminthic agent is albendazole. In a meta-analysis of comparative trials, albendazole provides better seizure control and resolution of cysts or granuloma as compared with praziquantel. [15, 16] In trials of nonviable lesions, seizure recurrence is substantially lower with albendazole. [17]
Antihelminthic treatment may provoke an inflammatory response in the central nervous system. Steroids affect this inflammatory response and may influence outcomes such as headache, but further research is needed to test this. [17] In cases of viable intraparenchymal-neurocystercercosis, adjunctive corticosteroid therapy is recommended prior to beginning antiparasitic drugs.
Effectiveness of therapy can be monitored via radiographic imaging. The size of the active lesions should decrease within 3-6 months.
Neurosurgical interventions should be considered for patients with mass effect, cerebrospinal fluid obstruction, and fourth ventricular cysts. [18] Endoscopic approaches provide better outcomes than the traditional open approaches for intraventricular neurocysticercosis with hydrocephalus. [18] Among patients who had undergone surgical resection of a single intraventricular lesion, those who received postoperative antihelminthic therapy, most commonly albendazole, had significantly lower risk of developing delayed hydrocephalus. [19]
Echinococcosis
Cystic echinococcosis is treated with antihelminthics, cyst puncture, PAIR (puncture, aspiration, injection, re-aspiration) or surgery depending on severity of disease. Albendazole is recommended as first-line antihelminthic therapy, however Mebendazole can also be used as second-choice drug if Albendazole not available. Praziquantel has also been useful preoperatively or in case of cyst rupture during surgery.
Pulmonary echinococcosis is treated with antihelminthics such as albendazole +/- surgery depending on disease severity. Albendazole is recommended for 1-3 months before surgical intervention. [20]
Sparganosis and coenurosis treatment involves surgical excision for localized infections. Antihelminthics are not required as long as parasite is removed entirely.
