مريض الدودة الشريطية

A 38-year-old man presented with worsening abdominal pain, vomiting, anorexia, generalized weakness, and weight loss that had begun 3 days earlier. He had a history of eating raw beef. During the previous 2 years, he had been seen by several different doctors and had been given clinical treatment for stomachache, abdominal pain, and chronic anemia. Physical examination was largely unremarkable. Microscopic examination of stool showed an embryonated egg containing an oncosphere (Panel A). The patient was treated with praziquantel, administered orally at a dose of 60 mg per kilogram of body weight; approximately 40 minutes later, he received mannitol as a catharsis drug, administered orally at a dose of 300 ml in 20% aqueous solution. Two and one half hours after the administration of mannitol, the patient discharged a tapeworm that measured 6.2 m excluding the scolex (Panel B, arrow). A gravid proglottid was identified, with at least 23 lateral uterine branches on each side (Panel C) and a distinct genital pore containing a vaginal sphincter (Panel D, arrow). The patient received a diagnosis of Taenia saginata (beef tapeworm) infection. Humans become infected with T. saginata by ingesting cysticerci during consumption of raw or inadequately cooked beef. The tapeworm attaches to the small intestine and can grow to be several meters in length. Humans are the only definitive hosts. At a follow-up visit 3 months later, the patient was asymptomatic, with recovery of appetite and weight.


http://www.nejm.org/doi/full/10.1056/NEJMicm1504801#figure=f1