目的 通过观察和比较不同药物组合对带绦虫感染者的驱绦效果及不良反应,探讨在高度流行区开展群体性服药,控制带绦虫病流行的安全、有效的方法和途径. 方法 将四川省藏区雅江县查出的带绦虫病患者,在自愿服药的基础上随机分为3组,分别采用南瓜子-槟榔-硫酸镁,氯硝柳胺-硫酸镁和吡喹酮-硫酸镁驱虫,观察驱绦效果和可能发生的不良反应. 结果 南瓜子槟榔组、氯硝柳胺组、吡喹酮组治疗后5h内排出完整虫体的比率分别为77.14％(27/35),40.54％(15/37),47.37％(18/38),差异有统计学意义(x2=10.93,P＜0.01);而氯硝柳胺组与吡喹酮组间比较,差异无统计学意义(x2 =0.35,P＞0.05);药物不良反应发生率分别为48.57％、35.14％和39.47％,差异无统计学意义(x2 =1.10,P＞0.05).患者服药后出现的不良反应均不需做任何特殊处理即可缓解. 结论 在带绦虫病高度流行的藏区,采用南瓜子-槟榔-硫酸镁驱治绦虫,效果好且安全,可为人群接受,是一种值得推广应用的治疗带绦虫感染的方法.

Taeniasis, caused by Taenia species, is one of the common zoonoses in China, particularly in the western region of China. Up to now, not enough attention has been given in the high prevalence and high burden of the diseases. In order to study the endemic patterns and control strategies of taeniasis, a series of epidemiological investigations, molecular researches and pilot control activities have been conducted in recent years. This paper reviews the relevant publications in taeniasis research over the last 10 years.

SUMMARY Human cysticercosis, caused by accidental ingestion of eggs of Taenia solium , is one of the most pathogenic helminthiases and is listed among the 17 WHO Neglected Tropical Diseases. Controlling the life-cycle of T. solium between humans and pigs is essential for eradication of cysticercosis. One difficulty for the accurate detection and identification of T. solium species is the possible co-existence of two other human Taenia tapeworms ( T. saginata and T. asiatica , which do not cause cysticercosis in humans). Several key issues for taeniasis/cysticercosis (T/C) evidence-based epidemiology and control are reviewed: (1) advances in immunological and molecular tools for screening of human and animals hosts and identification of Taenia species, with a focus on real-time detection of taeniasis carriers and infected animals in field community screenings, and (2) spatial ecological approaches that have been used to detect geospatial patterns of case distributions and to monitor pig activity and behaviour. Most recent eco-epidemiological studies undertaken in Sichuan province, China, are introduced and reviewed.

Upper left: Yak herd crossing a river on the Tibetan plateau (altitude 4200m), Shiqu prefecture, Western Sichuan, July 2002.Lower left: Winter pastures in the Niniu valley (altitude 4200 m), Western Sichuan, May 2006.Central image: Echinococcoses, cysticercosis and taeniases represent a large disease burden in China and neighbouring countries.Coloured circles locate some of the areas where international and multidisciplinary research programmes on the transmission of both E. granulosus and E. multilocularis have been carried out during the last 20 years (see legend in Giraudoux et al. in this Special Issue of Parasitology).Upper right: Tibetan family resting after fi eld work, Niniu village, Western Sichuan, May 2006.Note the grandmother patting the young dog which is lying alongside a yak dung heap, almost certainly mixed with dog faeces, and the child thumb sucking, all behaviours which confer a high risk for the transmission of Echinococcus infection.Lower right: Dogs scavenging on a sheep carcass in the vicinity of Sary-Mogol village (altitude 3000 m), Alay valley, South Kyrgyztan, May 2012.

A 43-year-old Tibetan woman living in northwest Sichuan, China, confirmed to be a taeniasis carrier of Taenia solium was treated with pumpkin seeds combined with Areca nut extract in October 2009. All 20 tapeworms except one without scolex were expelled under good conditions. She was free of secondary cysticercosis within one year follow up. Although the first choice for treatment of taeniasis is still praziquantel, it may often cause serious side effect on asymptomatic cysticercosis cases to suddenly become symptomatic within a half day of the treatment. Therefore, the problems in treatment of taeniasis and/or cysticercosis in Asia are briefly overviewed, since other platyhelminthic diseases including schistosomiasis, opisthorchiasis etc. are more common and praziquantel is strongly recommended for mass treatment of these trematodiases with no idea on the co-infection with eggs of T. solium which cause asymptomatic cysticercosis.

SUMMARY Detection of taeniasis carriers of Taenia solium is essential for control of cysticercosis in humans and pigs. In the current study, we assessed the positive detection rate of a self-detection tool, stool microscopy with direct smear and coproPCR for taeniasis carriers in endemic Tibetan areas of northwest Sichuan. The self-detection tool through questioning about a history of proglottid expulsion within the previous one year showed an overall positive detection rate of more than 80% for Taenia saginata, T. solium and T. asiatica . The positive detection rate was similar for T. saginata and T. solium . In 132 taeniid tapeworm carriers, 68 (51·5%) were detected by microscopy and 92 (69·7%) were diagnosed by coproPCR. A combination of microscopy and coproPCR increased the positive detection rate to 77·3%. There remained 10 cases (7·6%) coproPCR negative but microscopy positive. Due to the high cost and complicated process, coproPCR is required for the identification of Taenia species only when necessary, though it had a significant higher positive detection rate than microscopy. Combined use of self-detection and stool microscopy are recommended in community-based mass screening for taeniases in this Tibetan area or in other situation-similar endemic regions.

Taeniasis refers to the infection with adult tapeworms of Taenia spp. in the upper small intestine of humans, which is also a cause of cysticercosis infection in either both humans and/or animals. Currently the most commonly applied anthelminthics for treatment of taeniasis are praziquantel and niclosamide. Praziquantel is very effective, but has the risk of induction of epileptic seizures or convulsions in carriers with asymptomatic concurrent neurocysticercosis. In contrast, niclosamide is safe and effective, but is not readily available in many endemic countries including China. In the current community-based study, we assessed the curative effect of either pumpkin seeds or areca nut extract alone in taeniasis, and also looked at synergistic effects of these two herb drugs on tapeworms. In the study group with the pumpkin seed/areca nut extract treatment, 91 (79.1%) of 115 suspected taeniasis cases (with a history of expulsion of proglottids within the previous one year) released whole tapeworms, four (3.5%) expelled incomplete strobila, and no tapeworms or proglottids were recovered in the remaining 20 cases. In these 115 persons, 45 were confirmed as taeniasis before treatment by microscopy and/or coproPCR. Forty (88.9%) of 45 confirmed cases eliminated intact worms following treatment. The mean time period for complete elimination of tapeworms in 91 taeniasis cases was 2h (range 20min to 8h 30min), and 89.0% (81) of 91 patients discharged intact worms within 3h after drug administration. In Control Group A with treatment of pumpkin seeds alone, 75.0% (9/12) of confirmed taeniasis cases expelled whole tapeworms, but the mean time period for complete elimination was about 14h 10min (range 3h 20min to 21h 20min), which was much longer than that (2h) for the study group, whereas in Control Group B treated with areca nut extract alone, only 63.6% (7/11) of taeniasis cases discharged whole tapeworms, and the mean time period was 6h 27min (range 1–22h). Mild side effects included nausea and dizziness in about 46.3% of patients with the pumpkin seeds/areca nut extract treatment, but all discomforts were transient and well tolerated. In conclusion, a synergistic effect of pumpkin seed and areca nut extract on Taenia spp. tapeworms was confirmed in the current study, primarily in producing an increased rate of effect on tapeworm expulsion (average time 2h for combination vs 6–21h for individual extracts). The pumpkin seed/areca combined treatment was indicated to be safe and highly effective (89%) for human taeniasis.

Objective To assess the efficacy of pumpkin seeds combining areca in taeniasis carriers.Methods During May 2007 to November 2009,questionnaire investigation was performed in 18 villages of 7 townships of Yajiang County.Volunteers with the history of discharge of tapeworm proglottids within previous two years were treated with pumpkin seeds combining areca.Parasite isolates were further exa mined using multiplex PCR for species identification.Results In total 112 of 175 subjects treated expelled tapeworms or proglottids 5 hours after treatment.In other words,the efficacy rate was 64.0%.Among the 112 cases,93(83.0%) discharged whole tapeworms with discovery of scolex.The common side-effects presented as dizziness and gastrointestinal discomfort,which disappeared after expulsion of worms.Conclusion Pumpkin seeds combining areca is a safe,effective treatment method for taeniasis carriers.

目的 对四川省藏区雅江县结核病控制效果进行分析,为促进结核病防治规划的实施提供依据.方法 按照<中国结核病防治规划实施工作指南>要求,收集2003-2006年的结核病相关报表及基础资料,进行统计分析.结果 结核病控制工作在雅江县实施4年,县疾控中心初诊患者就诊率为525.29/10万,痰菌阳检出率为18.37%,涂阳新登记率为66.5/10万,涂阳患者年均发现率为79.07%,结核病患者完成治疗率97.74%、治愈率93.29%.结论 该县结核病控制实施效果明显,达到高发现和高治愈率的目标.

目的 了解四川省雅江县呷拉乡藏族人群绦虫病/囊尾蚴病流行现状.方法 通过问卷、体检了解近一年内人群排绦虫史、癫痫发作史、皮下结节以及相关的其他临床表现.对自愿接受治疗的患者用吡喹酮驱除绦虫,用multiplex PCR对虫种进行鉴定.对1例高度怀疑为猪带绦虫患者的粪便标本采用粪-PCR进行检测.用囊液抗原检测血清囊尾蚴病特异性抗体,了解人群囊尾蚴感染水平.结果 11.96%(216/1 806)的村民近一年内有排绦虫史,1.05%(19/1 806)发现皮下结节,0.61%(11/1 806)有癫痫发作史.24份虫体标本PCR鉴定结果均为牛带绦虫,1份粪便标本粪-PCR结果为猪带绦虫.4.35%(4/92)人群血清囊尾蚴病抗体阳性.结论 牛带绦虫和猪带绦虫共同流行于雅江县呷拉乡,以牛带绦虫为优势虫种.人群囊尾蚴感染率为4.35%.

Objective To investigate the current status of taeniasis/cysticercosis in Yajiang County of Sichuan province.Method Traditional epidemiological methods was used to investigate taeniasis/cysticercosis infection in 7 Villages of Yajiang County.Result 59 patients with clinical symptoms(55 males and 4 females) were investigated.One female patient and 20 male patients were able to expel adult worms after taking pumpkin seeds,and 18 patients with subcutaneous knob.The infection rate of adults was 35.59%.The patients are principally young men.The people in this area like eating raw meal of cattle and pig.Conclusion Yajiang area is a severely endemic area of taeniasis/cysticercosis.