Anesthesia & Analgesia:
LETTERS TO THE EDITOR: Letters & Announcements
Department of Anesthesiology
Lady Hardinge Medical College and Associated Hospitals
New Delhi, India
To the Editor:
A 20-yr-old patient with ASA physical status I underwent an uneventful lower segment cesarean section for cephalopelvic disproportion under subarachnoid block. While the dressing was being applied, the patient started complaining of nausea and vomited out a small volume of fluid. Following this, she felt a burning sensation in the throat. Her heart rate, arterial blood pressure, and oxygen saturation were 82 bpm, 124/76 mm Hg and 99%, respectively. Metoclopramide was administered slowly IV. The burning sensation continued and in addition, she now felt some fullness in the throat. She became restless and while being transferred on the trolley, she put her hand in the mouth and took out a curled up tape-like structure from her mouth. On closer examination, it was noted to be a 128-cm long tapeworm. She appeared comfortable after this but about 5 min after transfer to the recovery area, she vomited once again and pulled out another tapeworm (64 cm) from her throat. Her vitals through the two episodes remained stable. The burning sensation disappeared after she pulled out the second tapeworm. On questioning, she gave a history of eating pork once in a while over the last few years. She was referred to the attending physician who treated her with niclosamide. The postoperative period was uneventful and she was discharged on the 7th postoperative day.
Man is the final host in the life cycle of tapeworm that grows mainly in the upper jejunum. Infection in man occurs generally by eating raw or undercooked meat containing the cysticercus stage. In the stomach, proteolytic enzymes dissolve the capsule of the cyst and the parasite attaches itself to the intestinal mucosa. Infection can also be acquired by ingestion of mature eggs or egg-laden segments (proglottides) that are passed out with stools from time to time (1). Intestinal tapeworms are considered to be minimally pathogenic causing little or no symptoms, but they do utilize some of the food consumed by the host and some of the species are known to cause pernicious anemia. Clinical manifestations of tapeworm infestation are often mild and infections may remain unrecognized or inadequately treated for many years (2). However, the problems frequently occur when man develops cysticercosis.
We wish to create awareness that a tapeworm can pass out orally with vomit in the immediate postoperative period. As the terminal segments of the tape worm (proglottides) are laden with mature eggs, the possibility of the anesthetist contaminating his hands with eggs and thereby getting infected while handling such a patient cannot be ruled out. We suggest that an anesthetist wear gloves while dealing with a patient who is vomiting.
Vandana Chugh, MD
Baljit Singh, MD
1. Andreassen J. Intestinal tapeworms. In: Collier L, Balows A, Sussman M, eds. Topley & Wilson’s Microbioloy and microbial infections. Parasitology, Vol 5, 9th ed. London: Arnold, 1998: 521–37.
2. Wright EP, Jain S. Human infestation by Taenia saginata lasting over 20 years. Postgrad Med J 1984; 60: 495–6.