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Hymenolepis nana (Dwarf Tapeworm) Infection


Chelsea Marie

, PhD, University of Virginia;

William A. Petri, Jr

, MD, PhD, University of Virginia School of Medicine

Last review/revision Dec 2021 | Modified Sep 2022
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Hymenolepis nana, a tiny intestinal tapeworm Overview of Tapeworm Infections Tapeworms (cestodes) are flat, parasitic worms. The four main intestinal cestode pathogens of humans are Taenia saginata ( beef tapeworm) Taenia solium ( pork tapeworm) Hymenolepis... read more , is one of the most common human cestodes; the life cycle does not require an intermediate host. Infection is treated with praziquantel or niclosamide.

H. nana is only 15 to 40 mm long. It differs from other tapeworm because it requires only one host, but can also cycle through two. Its larvae migrate only within the gut wall, and its life span is relatively short (4 to 6 weeks).

H. nana is more frequent in populations, particularly children, living in conditions of poverty and poor hygiene, particularly when fleas are present.

H. nana has 3 modes of infection:

  • Indirect 2-host cycle: Rodents are the primary definitive hosts, and grain beetles, fleas, or other insects feed on contaminated rodent droppings as intermediate hosts; humans can become infected by ingesting parasitized insects.

  • Human-to-human oral-anal cycle: Eggs are passed from one human to another or recycle externally in a single host.

  • Internal autoinfection: Eggs hatch within the gut and initiate a 2nd generation without ever exiting the host. Autoinfection can result in large numbers of worms and symptoms.

Infections are often asymptomatic, but heavy infections may cause crampy abdominal pain, diarrhea, anorexia, pruritis ani, and nonspecific systemic symptoms. On occasion H. nana is misdiagnosed as pinworm infection Pinworm Infestation Enterobiasis is an intestinal infestation by the pinworm Enterobius vermicularis, usually in children, but adult members of their household and caregivers, institutionalized people, and... read more Pinworm Infestation .

Diagnosis is made by finding eggs in stool samples.

Treatment of Hymenolepis nana Infection

  • Praziquantel

  • Alternatively, nitazoxanide or, outside the US, niclosamide

The treatment of choice for H. nana infection is

  • Praziquantel 25 mg/kg orally once

Alternatives include nitazoxanide and niclosamide (not available in the US).

For nitazoxanide, dosage is

  • For patients > 11 years: 500 mg orally 2 times a day for 3 days

  • For children aged 4 to 11 years: 200 mg orally 2 times a day for 3 days

  • For children aged 1 to 4 years: 100 mg orally 2 times a day for 3 days

For niclosamide, dosage is

  • For adults: 2 g orally once/day for 7 days

  • For children > 34 kg: 1.5 g in a single dose on day 1, then 1 g once/day for 6 days

  • For children 11 to 34 kg: 1 g in a single dose on day 1, then 500 mg once/day for 6 days

A stool sample should be repeated one month after therapy is completed to verify cure.

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