Page 180 - Medical Parasitology_ A Textbook ( PDFDrive )

14 Case Reports 173

respectively. There were no worms noted endoscopically. However, a few gravid
proglottids were recovered from the stool measuring an average of 1.5 × 0.5 cm
each. The proglottid was subjected to PCR-based molecular diagnosis and con-
firmed to be Taenia saginata. He was given praziquantel (400 mg stat dose) and has
been asymptomatic since.
Case report 4: A 43-year-old, previously healthy ethnic Malay Muslim man
presented with an episode of generalized tonic-clonic seizure. There were no associ-
ated constitutional symptoms. He worked as a project director and travelled fre-
quently all these years, mostly to Southeast Asia and South Asia as per his job
requirements. He was admitted to a teaching hospital and brain MRI showed a par-
tially calcified enhancing lesion in the posterior occipital region with surrounding
oedema. CT scan of thorax and abdomen were unremarkable. He underwent stereo-
tactic right craniotomy excision of the brain lesion. Frozen section showed granulo-
matous inflammatory mass with parasitic parts. Further histopathological
examination showed changes in keeping with neurocysticercosis.. He was treated
with 1 month course of albendazole 400 mg bid and dexamethasone. He has been
well and seizure free since. A repeat MRI brain showed complete resolution of pre-
vious lesion.

Source: Chua, T. H., J. Emmanuel, K. T. Lee, F. K. Kan, K. S. Tee, Z. Abidin,
R. Ganeswrie et al. “Taeniasis and neurocysticercosis among Malaysians.”
Tropical Biomedicine 34, no. 1 (2017): 7–13.

Learning Points
1. Travellers to countries where hygiene and food preperation practices are not
optimal need to take precautions to reduce the risks of contracting infections.
2. Travel and occupational history should be obtained during history taking.
3. History of consuming undercooked/raw beef or pork should raise a suspicion of
taeniasis.
4. The first episode of seizure in an adult requires radiological imaging to rule out
space occupying lesions (in this case, lesion was due to neurocysticercosis).
5. Space occupying lesions in the brain often require biopsies to ascertain the
aetiology.
6. Radiologists can identify features of neurocysticercosis on MRI.

Case 16: Hymenolepis diminuta Infection in a Child
Case report: A 2-year-old Malay girl living in a semi-rural area of Selangor,
Malaysia was seen for abdominal discomfort and itchiness over the abdomen espe-
cially at night. She has been experiencing these symptoms for the last 3 months.
There was no history of fits, anuresis, vomiting, passing of worm or fever. The main
complaint was that the mother observed the intermittent passing of a ‘small white
paste-like structure’ from the anal region for the last 3 months which was never
resolved with deworming medication. The child is the youngest of 3 siblings. Other
family members and surrounding neighbours were healthy, showing no signs of