Megaloblastic Anemia + Weight loss 30kgs due to ?Fish Tapeworm

A 56 year old female presented to me with only one complaint of vomiting in night for last few weeks and significant weight loss in last one year She was being treated with Ferrous supplements at bedtime, which added to her problem She being infected with ?fish tapeworm is something which I doubt how, as she is a vegetarian History She adds that she had an episode of vomiting last year Feb 2020 where she passed out bunch of worms, which as per her were quite big and adult sized, its her wordings She even admits taking Albendazole 400mg after which she passed out worms last year Vitals Vitals are normal Investigations Stool for RM, HIV, ANA by IF, Iron Studies ESR, CRP - All awaited Non contrast CT didnt reveal anything Management I had started her Vit B12 supplements IV for first 5 days, then weekly, monthly and so on, Protera L in morning and Levazeo 25mg before dinner, folvite 5mg once weekly, limcee 500mg TDS I would like to know how to get rid of these worms? Frequency of albenadazole administration? Any other medicine? Praziquantel? Are these worms causing reflux/vomiting in night? Though after medications it has decreased.

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Indeed it is megaloblastic anaemia Parasitic infection is cause Associated vomiting are just a presenting symptom which can very from individual to individual so as diurnal variation Rx yes it is albendazole 400mg 1od for 5days may be repeated monthly after assessment I had an opportunity to treat such case and i choose to repeat fortnightly till the stools were egg free Vegetarian or nonvageterian all may be infested with contamination Suppliment vitb12 and vitd3

So repeat stool for RM on monthly basis sir?
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3 daily doses of Albendazole

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