Prevention and Control of Taeniasis and Cysticercosis in Peru

There is currently an effort to eliminate Taeniasis, a tapeworm disease, or helminth, found in most parts of the world, which is currently hyperendemic in Northern Peru. Taeniasis is a gateway disease to Cysticercosis, as the Taeniasis solium tapeworm can cause the buildup of cysts in the brain, causing epilepsy, drastically decreasing quality of life. Funded by the Bill and Melinda Gates Foundation, ways of eliminating this disease from this region and eventually the world are being researched, and various options are being considered as steps toward eradication. These options include types of chemotherapies in humans as well as pigs, which are vital to the life cycle of this helminth. This disease is prevalent in poorer parts of the world due to its propensity to occur as a result of poor conditions on pig farms. The main source of the continuation of this disease’s life cycle is farmers allowing their pigs to roam in the open and find their own food. This aids in continuing the part of the disease’s life cycle where the tapeworm’s eggs, found in human feces, are consumed by the pig. This occurs with much ease as this disease is endemic in places where open-air defecation is popular. A person infected with the Taeniasis solium tapeworm can excrete up to 100,000 Taenia Unknowneggs in their stool, which can spread far and wide in open air.

Many of the ways in which Taeniasis can be tested for using modern technology require heavy funding in efforts to eliminate the disease in neglected tropical areas. ELISA tests, ELISA reading machines, and trained operators in such an area are expensive, and CT and MRI imaging for diagnosis of Cysticercosis are by no means cheap or accessible methods for screening in this part of the world. Therefore, the financial backing of the Bill and Melinda Gates foundation proves paramount. With capital, the most practical method of treatment of this disease would be to properly screen for infected individuals and give them treatment in the form of one of two drugs that have proven highly effective in treating the disease: praz1472579078181.pngiquantel and niclosamide. Niclosamide is the preferred drug as it does not e
ntail absorption through the intestines, which can lead to the onset of intensified neurological symptoms if the person has already acquired Cysticercosis along with their tapeworm infection. Both are relatively expensive and not readily available in Peru.

Other possible methods of treatment include mass treatment of pigs, new measures to be taken during pork preparation, and mass, nonspecific treatment of humans. As for the pigs, a drug called oxfendazole is capable of killing the larvae-filled cysts (pictured below) form pigs’ muscles, making them clean for their eventual consumption. The proposition for mass treatment with this drug has been made as well, however the negative aspect of this is that the desired results of the drug, complete destruction of larvae-filled cysts, the direct source of the tapeworm growing inside the human after consumption, manifest after about three months of therapy. Other precautionary measures concerning the pigs are being considered as well, ones that are environmental rather than drug-related. Slaughterhouse control and the examination of meat post-slaughter is being considered as a method for vetting pork being sold in Peru, however carcass examination is not foolproof. Cysts not easily detected during inspection are bound to be passed over. The requirement for containment of pigs in a corral has been considered as well. However, this would force villagers to feed their pigs on their own, which they most likely cannot afford. The appealing aspect TAE_002of allowing the pigs to roam freely is that they are then capable of finding their own food. This, as previously mentioned, is a main cause of the continuation of Taeniasis’ life cycle, as this is when eggs are consumed by pigs. One final proposition for the treatment of this disease is mass, nonspecific treatment of humans, which would entail mass chemotherapy of all people in an endemic area using praziquantel and niclosamide. This has been done in other neglected tropical areas, and results were positive. Mass treatment is less costly as less engagement with patients in diagnosis and individual care is required, but it does nothing to prohibit the presence of Taenia eggs already in the environment. These tapeworm eggs can last for several years in soil, and may outlast the effect of the mass treatment performed. New people may move into the environment during that time, or children born after the time of the treatment may be vulnerable. Thus, the life cycle of the disease would resume after a short period of elimination. Another concern would be the possibility of giving praziquantel to a patient who is already suffering from Cysticercosis, thus heightening their neurologic disorder, causing more seizures.

The effort in Northern Peru is still a work in progress, but these options are being weighed, and a combination of these courses of action may lead to the eventual elimination of this disease. Elimination will improve the quality of life in this area, as well as make pork consumption safer. Thanks to the Bill and Melinda Gates Foundation, funding for the procedures being pursued has been easier to come by.

 

 

Source article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005116/#b6

Pictures acquired from:

http://itg.author-e.eu/Generated/pubx/173/helminthiasis/cestodes_-_tapeworms.htm

http://www.pet-informed-veterinary-advice-online.com/Taenia.html

http://www.trackingzebra.com/new-blog/2016/8/30/repurposing-drugs-to-fight-zika-putting-it-into-context

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