Page 179 - Medical Parasitology_ A Textbook ( PDFDrive )

172 14 Case Reports

He brought along a single worm specimen that was expelled in his stool to the
clinic. The specimen was identified to be that of a proglottid gravid of Taenia spp.
It was whitish in colour measuring 1.7 × 0.5 cm. From the size of the gravid proglot-
tid, the species was identified as Taenia saginata. The proglottid was active and was
still motile. It was observed to be stretching and contracting its body. Taenia spp.
eggs were recovered from the gravid proglottid. The egg measured 33 × 42 μm. The
larva (oncosphere) was enclosed in a thick, radially striated coat, dark brown in
colour. The 6 hooked larva was easily observed.
Upon diagnosis, the patient was treated with 1 dose of praziquantel, 600 mg.

Source: Rohela Mahmud, Jamaiah Ibrahim, Romano Ngui, Yvonne AL Lim,
Matvinder Singh, Khadijah Othman, Mohd Redzuan AN and Amirah Amir.
Taeniasis Saginata: A case report from Malaysia after 4 decades (unpublished
report).

Case report 2: A 23-year-old Malaysian man presented with a history of passing
out worms in his stools. He had a history of travelling to Madagascar to visit his
father. His last visit was for a total duration of 3 weeks, 4 months prior. During his
stay, he consumed undercooked beef. He claimed to have expelled worms in his
stools for 2 weeks. He took 3 doses of albendazole 400 mg in 10 days. Since the
passing out of worms persisted, he sought treatment at a private clinic and was given
3 tablets of ivermectin. On the day of presentation, he brought along a flat whitish
object which looked like proglottids of a tapeworm. His full blood count was nor-
mal without eosinophilia. The specimen was whitish in colour and identified as the
proglottids of Taenia spp. From the size of the gravid proglottid, the species was
identified as Taenia saginata. Taenia eggs recovered from the gravid proglottid
measured 20–40 μm and had 6 hooked larva (oncosphere) enclosed in a thick dark
brown radially striated shell. As the proglottid was kept in formalin, molecular
approach for species determination was not done on the specimen. The patient’s
father who was residing in Madagascar was asymptomatic while the patient’s
mother who did not travel to Madagascar, did not show any symptoms. The patient
received 600 mg Praziquantel and has been asymptomatic since then.
Case report 3: Taeniasis was diagnosed in a 56-year-old male native Sabahan
who was a veterinarian assistant. He presented with complaints of abdominal dis-
comfort, loss of appetite, and weight. For the past 6 years, he was passing loose
stools intermittently which contained worms. His stool was greyish in colour, mixed
with mucus. He lost a total of 6 kg over 3 years. He had been given a total of 13
courses of albendazole from various GPs which provided only a brief relief for his
symptoms each time. He was subsequently referred to a medical centre. An interest-
ing facet of his dietary history included the consumption of raw beef, the timing of
which coincided with the onset of his symptoms. His job scope over the years had
been to examine cow dung daily for worms. On examination, his vitals were stable
and he was afebrile. His blood serum biochemical and haematological parameters
were within the normal range. Oesophagogastroduodenoscopy (OGDS) and colo-
noscopy performed revealed pangastritis and an adenomatous rectal polyp,