INTESTINAL CESTODES HOSTS

Taenia saginata Beef tapeworm INTESTINAL CESTODES

• Definitive host
Taenia solium Pork tapeworm o Humans
Taenia saginata
Hymenolepis nana Dwarf tapeworm
Man → cow → man • Intermediate host
o Cattle
Hymenolepis diminuta Rat tapeworm
• Definitive host: taeniasis
Dipylidium caninum Double-pored dog tapeworm o Humans
Taenia solium • Intermediate host
Diphyllobothrium latum Fish or broad tapeworm Man → pig → man
Man → man o Pigs
EXTRAINTESTINAL CESTODES • Accidental intermediate: cysticercosis
o Humans
Hydatid tapeworm
Echinococcus granulosus
Cystic echinococcosis
• Definitive host
Echinococcus multilocularis Alveolar echinococcosis o Human strain: humans
Hymenolepis nana o Murine strain: rodents
Echinococcus vogeli Polycystic echinococcosis Man → man
• Intermediate host
Man → insect → man/rodent

Spirometra spp. - o Murine strain: fleas, beetles

Human strain: does not need IH
Murine strain: needs IH ▪ Tenebrio sp. (flour beetles)
• Accidental host
TRANSMISSION o Murine strain: humans
INTESTINAL CESTODES
Taenia saginata Ingestion of undercooked beef • Definitive host
o Rodents
Ingestion of measly pork (taeniasis) • Intermediate host
Taenia solium Hymenolepis diminuta
Contaminated food, water (cysticercosis) o Arthropods (adults, larvae)
Needs IH o Fleas, myriapods, cockroaches
Human: autoinfection
• Accidental host
Murine: ingestion of IH (fleas, beetle)
Hymenolepis nana o Humans
Direct hand to mouth transmission
Contaminated food, water (less frequent)
• Definitive host
Hymenolepis diminuta Ingestion of Tribolium (IH) o Dogs, cats, carnivores
• Intermediate host
Dipylidium caninum Ingestion of dog or cat flea (IH) o Dog flea (Ctenocephalides canis)
Dipylidium caninum o Cat flea (Ctenocephalides felis)
Diphyllobothrium latum Ingestion of raw, undercooked fish
o Human flea (Pulex irritans)
EXTRAINTESTINAL CESTODES o Dog louse (Trichodected canis)
Echinococcus spp. Ingestion of embryonated eggs (feces) • Accidental host
o Human (children)
Infected water (plerocercoid)
Spirometra spp.
Eating infected fish, frogs, snakes (2nd IH) • Definitive host
o Humans, piscivores
INFECTIVE STAGE o Birds, fish-eating mammals
INTESTINAL CESTODES Diphyllobothrium latum • Intermediate host: consume coracidia
Order Pseudophyllidea
Man → crustaceans → fish o Freshwater copepods, fishes
Taenia saginata Cysticercus bovis (in muscle) ▪ Cyclops spp.
▪ Diaptomus spp.
Cysticercus cellulosae (taeniasis)
Taenia solium • Paratenic host: predator fishes
Eggs (cysticercosis)
EXTRAINTESTINAL CESTODES
Hymenolepis nana Embryonated egg
• Definitive host
Hymenolepis diminuta Cysticercoid larvae o Dogs, canine
• Intermediate host
Dipylidium caninum Cysticercoid larvae
Echinococcus spp. o Goat, swine, cattle, horses, camel
Plerocercoid larvae in fish
Family Taeniidae, Order Cyclophyllidea o Rodents
Diphyllobothrium latum ▪ E. multilocularis, vogeli, oligarthus
Unembryonated eggs (feces)
• Accidental host
EXTRAINTESTINAL CESTODES o Humans
Echinococcus spp. Embryonated eggs
• Definitive host
Spirometra spp. Plerocercoid (in cold-blooded vertebrates) o Dogs, cats, carnivores
Plerocercoid : spargana Procercoid larvae (in copepods) o Humans cannot be definitive host
▪ Onlu 2nd intermediate or paratenic
DIAGNOSTIC STAGE • 1st intermediate host
INTESTINAL CESTODES Spirometra spp. o Copepods
Family Taeniidae, Order Cyclophyllidea ▪ Cyclops sp.
Taenia saginata
• 2nd intermediate host
Proglottids, eggs
Taenia solium o Frogs, snakes, chicken, lizards, bird,
monkey
Hymenolepis nana • Accidental host
Embryonated egg o Humans
Hymenolepis diminuta

Dipylidium caninum Proglottids HABITAT

INTESTINAL CESTODES
Diphyllobothrium latum Unembryonated eggs
Taenia saginata Small intestines
EXTRAINTESTINAL CESTODES
Echinococcus spp. Hydatid cysts Taenia solium Upper jejunum

Spirometra spp. Unembryonated eggs (in DH) Hymenolepis nana Ileum

Hymenolepis diminuta Small intestines

• Diphyllobothrium latym
Pseudophyllidean cestodes Dipylidium caninum Small intestines
• Sparganum mansoni
Bothria: false slits
• Sparganum proliferum Diphyllobothrium latum Small intestines
EXTRAINTESTINAL CESTODES
• Taenia saginata
• Taenia solium Small intestines (canines)
Cyclophyllidean cestodes Echinococcus spp.
• Hymenolepsis nana Various organs
Acetabula: cup-like, round suckers
• Hymenolepis diminuta
Eyes, muscle
• Dipyllidium caninum Spirometra spp.
Various organs
PATHOLOGY DIAGNOSIS
INTESTINAL CESTODES INTESTINAL CESTODES
• Pruritus ani • Microscope: India ink
Taenia saginata o Due to proglottid migration o Specimen: proglottid
Appears in underwear
• Intestinal taeniasis ONLY ▪ Seen in underwear
o CC: passage of proglottids o India ink for counting
• Obstruction of structures: Taenia saginata o Number: 15 – 20 branches
o Bile duct, pancreatic duct • Stool exam: uncommon
o Appendix • Concentration techniques
o FECT
• Intestinal AND tissue taeniasis • Perianal swab
o No obstruction of structures
• Microscope: India ink
• Cysticercosis: encystation
o Specimen: proglottid
o Locations: striated muscle, brain
o India ink for counting
▪ SC, eye, heart, lung, peritoneum
o Number: 7 – 13 branches
• Neurocysticercosis: calcification
• Taeniasis
o Most common manifestation
o Clinical diagnosis; history
▪ Convulsions
o ID: proglottids, eggs, scolex
o With scolex: brain, ventricles
▪ Mature: accessory ovarian lobe
Taenia solium o No scolex: basal cisternal spaces
• Neurocysticercosis
AUTOINFECTION • Types of neurocysticercosis
o SHx: endemic area, epileptic sz
o Parenchymal: focal neuro deficits
▪ No systemic symtoms
▪ Seizures if cysts are in cortex
o CSF: elevated protein, low glucose,
o Extraparenchymal
increased MN cells
▪ Subarachnoid
• CT, MRI: localize cysticerci
→ Racemous: base of brain
Taenia solium o Round low density
▪ Intraventricular
▪ Viable larva, no inflammation
→ 3rd or 4th ventricle
o Ring-like enhancement
→ Obstructive hydrocephalus
▪ Dead larva
▪ Spinal (rare) o Calcified area
• Ophthalmic cysticercosis ▪ Dead scolex
o Locations: retina, subretinal
• Ophthalmic cysticercosis
o Chorioretinitis, vasculitis
o Ophthalmoscopy
o Intraorbital pain, photopsia
• Muscular, SC cysticercosis
o Tissue biopsy
• Light infection: non-specific
• Serology
o Anorexia, pallor
o ELISA
o Urticaria, anal pruritus, irritability
o EIT
• Heavy infection
Hymenolepis nana o Western blot
o Profuse diarrhea, enteritis
AUTOINFECTION • Dot-ELISA: screening test
o Exaggerated disorders
o Extreme apathy
Hymenolepis nana • Stools: recovery of ova
o Epileptic seizures Cannot recover proglottids
o Enteritis • Light infection
Hymenolepis diminuta o Concentration techniques
Hymenolepis diminuta • Non-specific, or asymptomatic
Dipylidium caninum • Stool exam: proglottids
• Light infections: non-specific
• Direct fecal smear
o Slight intestinal discomfort
Dipylidium caninum • Laboratory
o Epigastric pain, diarrhea
Appears in underwear o Proglottids may be vomited
o Anal pruritus
• Acid ether concentration technique
o Allergic reactions, eosinophilia Diphyllobothrium latum
• Clinical diagnosis
• Systemic toxemia (by adult worm) o Residence, travel in endemic area
• Mechanical obstruction due to o Raw fish diet
entanglement o Pernicious anemia, abdominal pain
• Bothriocephalus pernicious anemia EXTRAINTESTINAL CESTODES
Diphyllobothrium latum
• Other manifestations
o Nervous disturbances • Radiography, ultrasonography
o Digestive disorders • Casoni test
o Mucosal irritation o Hypersensitivity test to hydatid Ag
Echinococcus spp.
• Serological tests: may be confirmatory
EXTRAINTESTINAL CESTODES
o Detection of IgG to hydatid cyst
• Human cystic echinococcosis: liver fluid-derived Ag B-subunit (Gold st.)
o Hepatomegaly, jaundice, right
epigastric pain • Recovery of plerocercoid from infected
o Development of unilocular cyst tissues
▪ Causes local immunosuppression o Spatulate scolex with
o Jacksonian epilepsy, increased ICP Spirometra spp. pseudosegmentation
Echinococcus spp. o Hematuria, hydatid material in urine • Stool exam: unembryonated eggs
• Secondary infection: pyogenic abscess • Experimental animal infection
• Rupture of hepatic cyst: o Species identification
o Intermittent jaundice, fever
o Eosinophilia
• Intrabiliary rupture of the cyst
o Most common complication

• Sparganosis: migrating tumor

o Larvae: eyes, SC and muscles of thorax,
thighs, inguinal region
• Inflammation + painful edema
o Elongating and contracting larvae
• Other manifestations
o Local indurations
o Periodic giant urticaria
Spirometra spp.
o Edema
o Erthema + chills
o Ocular infection
• Branching / proliferative spargana
o Spirometra proliferum
• Brain migration: weakness, headache
• Inner ear migration: vertigo, deafness
• SC migration: painless
TREATMENT
• Human strain: humans are chief source
INTESTINAL CESTODES o Natural host: humans
• Praziquantel (5 – 10) o Intermediate host: -
o Must have expulsion of the scolex o Avoid eating raw vegetable salads
Taenia saginata • If scolex is not observed after o Clean toilet seats
o Stool exam after 3 months Hymenolepis nana • Murine strain: var. fraterna
o If no eggs or proglottids, negative o Natural host: rats, mice
o Intermediate host: fleas, beetles
o Eradicate rats and mice
TAENIASIS
o Residual spraying of nests, burrows
• Praziquantel: do not delay • Poor sanitation, overcrowding
o Due to autoinfection
• Niclosamide • Rodent control
o Not in the PH • Eliminate insect IH
Hymenolepis diminuta
• Scolex expulsion is essential • Dispose human waste
• Treat human cases
CYSTICERCOSIS
• Periodic deworming of cats and dogs
• Neurocysticercosis Dipylidium caninum • Insecticide dusting for fleas
Taenia solium o Parenchymal lesions • Avoid children playing with infected pets
▪ Albendazole
▪ Praziquantel • Thorough cooking of freshwater fish
▪ Corticosteroids Diphyllobothrium latum • Freezing fish at -18oC kills plerocercoids
▪ CS + mannitol: for high ICP
• Proper treatment, sewage disposal
o Subarachnoid form
▪ Surgery EXTRAINTESTINAL CESTODES
▪ Albendazole
o Ventricular form: surgery • Minimize transmission
• Ocular cysticercosis o Do not allow dogs in slaughterhouses
o Surgery before benzimidazole • Regular testing and quarantine
Echinococcus spp.
o Treat dogs with praziquantel
• Health education
• Praziquantel • Vaccination of livestock
Hymenolepis nana • Niclosamide
• Paromomycin • Drink boiled or filtered watre
Spirometra spp. • Cook thoroughly IH, paratenic hosts
Hymenolepis diminuta • Praziquantel • Avoid frog flesh as poultice

• Praziquantel
• Niclosamide (4 tablets) ---
Dipylidium caninum CESTODES
• Paromomycin
• Quinacrine HCl • Only reproduction and tegument
• All eggs have hexacanth embryo, except one
• Praziquantel o Oncospheres: 3 pairs of hooklets
• Niclosamide
Diphyllobothrium latum • Paramomycin Body parts
• Quinacrine HCl • Scolex: head
o Four suckers
• Make sure scolex is recovered in feces
o Rostellum: one has bothria instead of rostellum
EXTRAINTESTINAL CESTODES • Neck
• Surgical resection • Proglottids: segments
o For the following o Chain of proglottids: strobila
▪ Large cysts (+10cm)
▪ Secondary infection Taenia saginata
▪ Extrahepatic cysts • Oncosphere actively penetrate cow intestinal wall
• Chemotherapy + benzimidazole o Go to circulation to migrate to striated muscles
o Fot the following o Forms cysticercus; contains the oncosphere
▪ Small cysts • Only one adult is present in an infection
▪ Uncomplicated cysts
Echinococcus spp. ▪ Negative serology Taenia solium
• PAIR technique • Cosmopolitan distribution
o Involves UTZ-guided percutaneous • Unique features vs. saginata
puncture o Accessory ovarian lobe
o Aspiration of fluid + injection of o No vaginal sphincter
protoscolicidal agent
▪ Ethanol + hypertonic saline Hymenolepis nana
o For the following • Smallest tapeworm infecting humans
▪ Single, multiple cysts in organs • Only tapeworm which can complete its entire cycle in single host
who cannot undergo surgery o No obligatory IH
• Man can harbor both adult and larva
• Surgical removal of larvae • Limited to children in warm climates
Spirometra spp.
• Praziquantel (?) • Proglottids: disintegrate upon passage
o Mature: 3 round testes + bilobed ovary
EPIDEMIOLOGY o Gravid: ovary and testes disappear
INTESTINAL CESTODES • Liberated embryos penetrate mucosal villi → cysticercoid larvae

• Adequate cooking of meat Hymenolepis diminuta

• Freeze meat -20oC for 10 days • Larger than nana
Taenia saginata
• Sanitary inspection of slaughter house • Sometimes, the entire worm is expelled
• Meat inspection
Dipylidium caninum
• Keep pigs, cattle in pens to avoid access to • Strobila: melon-shaped proglottids
human feces
• Freeze meat -20oC for 10 days Diphyllobothrium latum
o To kill cysticerci • Eggs embryonate in water, released immature
Taenia solium
• Proper sanitation • Coracidia hatch → procercoid (in crustaceans) → plerocercoid (in fish)
• Thorough cooking of meat • Adults attach t intestinal mucosa via bothria in scolex
• Inspection of slaughtered pigs, cattle
• Meat inspection : liver examination Echinococcus granulosus
• Eggs hatch in duodenum, release oncospheres
o Penetrate intestinal wall of IH → mesenteric venules → cysts
• Hydatid cyst: by central vesiculation
o Two layers
▪ Outer laminated hyaline layer
 ▪ Inner nucleated germinal layer
o Million protoscolices can be found within the cyst
▪ Can be found in brood capsules
• Hydatid sand: protoscolices + brood capsules lying free in cyst
• Echinococcus granulosus: unilocular hydatid cysts
• Echinococcus multilocularis: alveolar cysts

Spirometra spp.
• Unembryonated eggs shed in feces