Taenia solium taeniasis — DTM&H MCQ

Correct answer: C — Praziquantel or niclosamide with hygiene and household risk counselling

The correct answer is C, praziquantel or niclosamide with hygiene and household risk counselling. This man has asymptomatic intestinal taeniasis (passing motile proglottids), most likely due to Taenia solium given his occupation as a pork butcher and Guatemalan origin, both classic risk factors for pork tapeworm exposure. As he has no seizures or focal neurology, there is no indication of neurocysticercosis, so treatment is simply for the adult intestinal worm using a single dose of praziquantel or niclosamide, as recommended by WHO for taeniasis. The critical additional step is counselling: because T. solium eggs (not larvae) are infective to humans by the faecal oral route, a carrier can transmit cysticercosis to close contacts, including a pregnant partner, particularly where sanitation is poor, so hygiene advice and household risk reduction are essential alongside treatment. Why the other options are wrong: B. Albendazole plus dexamethasone as inpatient therapy: this is the regimen for parenchymal neurocysticercosis with seizures or imaging evidence of viable cysts, not for uncomplicated intestinal taeniasis with a normal neurological exam. D. Metronidazole followed by paromomycin: this combination targets amoebic or protozoal infections such as Entamoeba histolytica, not cestodes, and has no activity against adult tapeworms. A. Ivermectin repeated after 2 weeks: ivermectin is used for strongyloidiasis or filarial and soil transmitted nematode infections; it has no efficacy against Taenia species. E. Diethylcarbamazine for 12 days: this is the regimen for lymphatic filariasis or loiasis, targeting microfilariae, and is inactive against tapeworms. Key point: uncomplicated T. solium taeniasis without neurological features is treated with a single dose of praziquantel or niclosamide, but household hygiene counselling is mandatory because the carrier, not the pork, is the source of cysticercosis risk to contacts.

Reference: World Health Organization, Taeniasis/cysticercosis fact sheet (treatment section), 2022, who.int/news-room/fact-sheets/detail/taeniasis-cysticercosis