Compiled by: EFREN II C.

DEOCADES, RMT

Module
10

Module
10
MTPC 124
CLINICAL
PARASITOLOGY
EFREN II C. DEOCADES, RMT

JMJ Marists Brothers

Notre Dame of Marbel University

NOTRE DAME OF MARBEL UNIVERSITY
College of Arts and Sciences Medical Technology Department
MEDICAL TECHNOLOGY DEPARTMENT
 Compiled by: EFREN II C. DEOCADES, RMT

MODULE X:

cestodes
`

Learning Outcomes

At the end of the session, the students must be able to:

1. thoroughly explain the pathogenesis, epidemiology, prevention and control, treatment,

and diagnosis of clinically-relevant cestodes;
2. exemplify mastery of the concept through passing the online assessment.

Introduction

In this module, we will discuss the group, Cestodes, which are also known as Tapeworms
because of their characteristic ribbonlike body. These are segmented worms with specialized
structure for attachment known as the scolex. These parasites can cause myriad of infections
ranging from intestinal infections and also extraintestinal infections involving tissues, liver, lungs, and
even the brain.

Activity/ Application

The students will be tasked to watch documentaries regarding Cestode cases.

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The Cestodes Scolex (pl. scolices)

− The anterior end of an adult tapeworm that
typically possesses cup-shaped suckers for
purpose of intestinal attachment
Intestinal Species Integument
1. Taenia saginata – Beef tapeworm − the outer covering or skin of the organism
2. Taenia solium – Pork tapeworm − part where food is absorbed
3. Hymenolepis diminuta – Rat tapeworm
4. Hymenolepis nana – Dwarf tapeworm
5. Dipylidium caninum – Dog/cat tapeworm
6. Dibothriocephalus latus (Diphyllobothrium latum)
– Broad fish tapeworm

Intestinal-Extraintestinal Species
1. Echinococcus granulosus – Dog/hydatid
Tapeworm
2. Taenia solium
3. Echinococcus multilocularis
4. Taenia multiceps
5. Spirometra mansonoides GENERAL NOTES
KEY DEFINITIONS Adults
− Possess anterior (head) region known as scolex
Cestodes − Numerous segments with reproductive
− Group of worms characterized by flat, segmented capabilities known as proglottids
adult worms that resemble tape measures
Eggs
Hermaphroditic − With two exceptions, consist of hexacanth embryo
− Self-fertilizing; both male and female sex organs − Ingestion of a single tapeworm egg allows life
are present in the same adult worm section called cycle to continue.
a proglottid
− Most life cycles require at least one intermediate
host for life cycle to continue.
Hexacanth embryo
− Motile, first larval stage characterized by the Laboratory Diagnosis
presence of six small hooks (hooklets) arranged in
− Primary specimen to recover intestinal tapeworms
pairs that are believed to pierce the intestinal wall
is stool for the presence of:
of the host
1. Eggs
2. Gravid proglottids (on occasion) that may be
partially degenerated
Proglottid
3. Scolex (rare)
− Individual segment of adult tapeworm that when
− Biopsy of tissue may recover the intestinal-
mature houses both male and female reproductive
extraintestinal tapeworm Echinococcus
organs that are able to mate and produce eggs
granulosus.
Rostellum
− Fleshy extension of select tapeworm scolices
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Habitat Small intestine Small intestine

1. Taenia spp. Final Host Man Man
Intermediate Host Cattle Pigs and Man
Taenia saginata Taenia solium Taenia asiatica
beef tapeworm pork tapeworm Taiwan Taenia Cysticercus
Infective Stage Cysticercus bovis cellulosae and
Third Taenia spp. Embryonated Egg
reported in Ingestion of measly
Ingestion of
Taiwan, Korea, MOT pork (infected pork)
uncooked/raw beef and embryonated egg
intestinal cestode Thailand and
capable of Indonesia − Human infection is initiated by consuming
more common
causing serious raw/undercooked beef (T. saginata) or pork
pathologic Cysticercus (T. solium) contaminated with cysticercus larva.
than T. solium
damage to the larvae − Adult worms emerge and attach to intestinal
human host; up (cysticercus
mucosa.
to 25 years viscerotropica)
is found in the − Self-reproduction in numerous eggs, some of
LIVER of various which may be passed into the feces.
intermediate host − T. solium: The organisms can grow to be 1.5 to 8
extraintestinal m long and produce more than 1000
live up to 25 form of the IH: pig, cattle, proglottids, each containing about 50,000 eggs.
years in the disease and can goats, wild boars − T. saginata: The worm can grow 4 to 12 m and
human intestine be much more and monkeys contain 1000 to 2000 segments and may produce
severe. 100,000 eggs
− Usually, only one adult tapeworm is present in
T. saginata infections.
− The adult seems to be irritated by alcohol, and
passage of proglottids sometimes results after a
drinking bout.
− Cows or pigs consume appropriate contaminated
eggs.
− Infective cysticercus larvae forms in animal tissue
and is then ready for next cycle to begin.

Epidemiology
− Infections correlate with areas of the world in
which the inhabitants do not practice sanitary
conditions and where beef or pork is eaten on a
routine basis.
Life Cycle Notes • T. saginata common in cosmopolitan areas
• T. solium found worldwide
T. saginata T. solium
Common Name Beef Tapeworm Pork Tapeworm Clinical Symptoms
Length Up to 25 meters Less than 7 meters − Asymptomatic
15-20; Dichotomous/ 7-13; Dendritic or − Taeniasis (beef or pork tapeworm infection)
Lateral Branches
Tree-like finger-like • Nondescript symptoms
Proglottid Taller than Wide Wider than tall
1. Diarrhea
2. Abdominal pain
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3. Change in appetite − Perianal opening using cellophane tape prep

4. Slight weight loss procedure has resulted in high egg recovery rate.
5. Dizziness − Uterine branches may be visualized by staining
6. Vomiting the proglottids with India ink.
7. Nausea
8. Moderate eosinophilia Neurocysticercosis
• Prognosis is usually good − Checking CSF Abnormalities (↑↑ protein, ↓↓
glucose, and ↑↑ mononuclear cells may be seen)
− CAT scan, MRI
− Serological Tests (serum and CSF ELISA and
EITB/ Western Blot- IgG and IgM)

Treatment
− In order to successfully treat the infection, total
eradication of the scolex (scolices) must occur.
− Praziquantel is treatment of choice in most cases.
Cysticercosis (T. solium) − Alternative treatments:
− (larval forms throughout the body) is the • Paramomycin
extraintestinal form of the disease and can be • Quinacrine hydrochloride
much more severe.
− The disease is life threatening if the organism Prevention and Control
invades the central nervous system. − Exercising proper sanitation practices
− One of the most serious manifestations is − Thorough cooking of beef and pork
neurocysticercosis (NCC), which is considered − Promptly treating infected persons
as one of the most serious zoonotic diseases
worldwide 2. Hymenolepis diminuta
Two Forms of NCC:
− rat tapeworm
1. Parenchymal
− larger than H. nana
− focal neurologic deficits are
encountered
2. Extraparenchymal
A. Subarachnoid Form
− may lead to an aggressive form of NCC
called racemous cysticercosis.
− proliferation of cysts in the base of the
brain
− poor prognosis
B. Spinal Form: Rare

Laboratory Diagnosis
− Specimen of choice is stool.
• Eggs and gravid proglottids
• Scolex only seen after treatment
• Since eggs identical, must recover gravid
proglottid or scolex to speciate

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Life Cycle Notes Laboratory Diagnosis

Diagnostic Stage: Egg − Eggs in stool
Infective Stage: Cysticercoid Larva − Proglottids typically not found in stool because
MOT: Ingestion of IH they disintegrate in human gut
Final Host: Rat − Scolices also rarely seen in stool
Intermediate Hosts: Rat Flea, Flour Beetle,
Cockroach Treatment
− Praziquantel
Egg Adult Worm − Alternative therapy that is not readily available in
the U.S. – niclosamide

Prevention and Control

− Administration of effective rodent control plan
− Protection of foodstuffs from insects and rat
droppings
− Inspection of food prior to consumption

3. Hymenolepis nana
− dwarf tapeworm
− Typically a parasite of rats − most common tapeworm
− Beetle or flea ingest contaminated rat droppings. − the only human tapeworm, which can complete its
− Development of cysticercoid larva occurs in insect entire life cycle in a single host
host.
− Consumption of contaminated insects that reside
in grains or cereal by a rat allows process to
continue.
− Rats host adult worms that ultimately produce
eggs many of which are excreted in feces
− Human infection is accidental via consumption of
contaminated grains or cereal and takes the place
of the rat in the life cycle.

Epidemiology
− Worldwide – anywhere that foodstuffs such as
grain or cereal are not protected from rats and
where insects are prevalent

Clinical Symptoms
− Asymptomatic Life Cycle Notes
− Hymenolepiasis: rat tapeworm disease Diagnostic Stage: Egg
• Diarrhea Infective Stage: Embryonated Egg (Direct),
• Nausea Cysticercoid Larva (Indirect)
• Abdominal pain MOT: Ingestion of Embryonated Egg/ Cysticercoid
• Anorexia Larvae
Final Host: Man (Children)
Reservoir Host: Mice/Rats
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Intermediate Hosts: None (Direct), Flea/Beetle Treatment

(Indirect) − Praziquantel
− Alternative niclosamide
Egg Adult Worm
Prevention and Control
− Proper personal hygiene and sanitation practices
− Controlling transport host populations
− Avoidance of contact with infected rodent feces

4. Dipylidium caninum
− Dog Tapeworm/ Double-pored Tapeworm
− Cucumber Tapeworm (proglottid: “cucumber
− Human infection initiated following ingestion of seed” appearance when they are wet, as well as
infective eggs. their resemblance to a dried grain of rice), Flea
− Adults form in intestinal mucosa. Tapeworm
− Eggs emerge following gravid proglottid − The only parasite with two sets of reproductive
disintegration. organs
− Resulting eggs may be passed out in the stool or − Common intestinal parasite of dogs and cats
initiate an autoreinfection.
− Eggs in outside environment mature to infective D. caninum
Cucumber Seeds
stage for new cycle to begin. proglottids
− No intermediate host is required.
− There are numerous transport hosts (including
rats).

Epidemiology
− Considered the most common tapeworm
recovered in the U.S. (especially in the southeast)
− Tropical and subtropical climates worldwide
− Persons residing in closed quarters
− Children attending preschool/daycare centers

Clinical Symptoms
− Asymptomatic
− Hymenolepiasis: dwarf tapeworm disease
• Gastrointestinal symptoms:
1. Abdominal pain
2. Anorexia
3. Diarrhea
4. Dizziness
5. Headache

Laboratory Diagnosis
− Eggs in stool samples

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Life Cycle Notes • Indigestion

Diagnostic Stage: Egg • Anal pruritis
Infective Stage: Cysticercoid Larva
MOT: Ingestion of Beetle Laboratory Diagnosis
Final Host: Dogs − Egg packets or gravid proglottids in stool samples
Accidental Host: Man − The presence of a single egg extremely rare
Intermediate Hosts: Flea (Ctenophalides canis,
dog flea; Ctenophalides felis, cat flea; Pulex Treatment
irritans, human flea) − Praziquantel – treatment of choice
− Alternates – niclosamide (if available) and
Egg Adult Worm paramycin

Prevention and Control

− Take pets (dogs/cats) to the vet on regular basis
• Deworm infected animals
• Periodic administration of prophylactic
medications
− Protect and treat flea-infected dogs/cats
− Teach children not to let dogs/cats lick them in or
near their mouths

5. Dibothriocephalus latus
− Primarily a parasite of dogs and cats (humans are − Formerly known as Diphyllobothrium latum
accidental hosts) − freshwater broad fish tapeworm
− Humans ingest contaminated fleas via the lick of − the largest human tapeworm
an infected dog/cat or hand-to-mouth − the only cestode to have an aquatic life cycle
contamination.
− Adult worms emerge that self-fertilize.
− Egg packets and gravid proglottids may be passed
into the stool.
− For cycle to continue, the eggs must be ingested
by a dog or cat flea.
− Humans take the place of a dog or cat in this cycle.

Epidemiology
− Worldwide
− Children appear to be at highest risk of contracting
D. caninum.

Clinical Symptoms
− Asymptomatic
− Dipylidiasis: dog/cat tapeworm Disease
• Appetite loss
• Diarrhea
• Abdominal discomfort
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Life Cycle Notes Epidemiology

Diagnostic Stage: Egg/ Scolex (indicates − Temperate regions worldwide (cool lakes are
complete/ successful treatment), no segment contaminated by sewage) including:
seen • Alaska
Infective Stage: Plerocercoid Larvae/Procercoid • Great Lakes
Larvae • Central and South America
MOT: Ingestion − Fish-eating animals may also become infected.
Final Host: Man
Reservoir Host: Fish, Dogs, Cats, Rats and other Clinical Symptoms
Fish-eating Mammals − Asymptomatic
1st IH: Copepods (cyclops) − Diphyllobothriasis: fish tapeworm infection
2nd IH: Fresh water fish • Digestive discomfort
Paratenic Host: Carnivorous Fish • Overall weakness
• Weight loss
Egg Adult Worm • Abdominal pain
• Vitamin B12 deficiency (Megaloblastic
Anemia → Pernicious Anemia)

Laboratory Diagnosis
− Specimen of choice – stool
• Eggs most commonly
• Less frequently than eggs, may see
proglottids
• On occasion, scolex present
• Note: The presence of proglottids and
− Relatively complex – requires two intermediate scolices in untreated patients is rare; better
hosts seen in treated patients; passage of scolex
− Human infection occurs when plerocercoid without proglottids indicates successful
(precursor larval stage) is ingested in treatment.
contaminated freshwater fish that are raw or
undercooked Treatment
− Scolex emerges in small intestine − Praziquantel
− Adult worm self-fertilizes. − Niclosamide (if available)
− Undeveloped eggs pass in stool.
− On contact with fresh water (2 weeks incubation), Prevention and Control
the eggs hatch, and free-swimming larvae emerge − Proper human fecal disposal
(coracidium-first larval stage). − Avoidance of eating raw/undercooked fish
− Larvae are ingested by the first intermediate host. − Thorough cooking of all fish before consumption
• Copepod (water flea)
− Larval stage known as procercoid occurs in 6. Echinococcus granulosus
copepod.
− Formerly known as Taenia granulosus
− Infected copepod ingested by second
intermediate host – freshwater fish. − Common Name: Hydatid Worm
− Once inside the fish, procercoid larvae develop − Shortest tapeworm (3 segments)
into plerocercoid larvae in the muscle tissue. − E. granulosus: cystic echinococcosis
− Now the larvae are ready to initiate a new cycle. − E. multilocularis: alveolar echinococcosis
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− E. vogeli and E. oligarthrus: polycystic − Larvae emerge and penetrate intestine; larvae
echinococcosis. migrate via bloodstream to tissue sites.
• Liver, lung
− Hydatid cyst develops.
− Cycle ceases.
− Typical intermediate host – sheep (or other
herbivores)
− In sheep, hydatid cyst forms in viscera after
ingestion of infected dog feces.
− Dogs (or wild canines) contract the parasite by
consuming infected sheep viscera.
− Adult worms form in dogs.
− Eggs get passed into the environment and can
initiate a new cycle.

Epidemiology
− Found in areas where sheep or other herbivores
are raised and are in close contact with dogs/wild
Life Cycle Notes
canines
Habitat: Small Intestine (Final Host); Connective
− Areas in U.S. where infections are known to have
Tissues (Man/Accidental Intermediate Host)
Diagnostic Stage: Egg occurred:
Infective Stage to Final Host: Hydatid Cyst • Alaska
Infective Stage to IH: Egg • West
• Southwest
Accidental IH: Man
MOT: Ingestion of Beetle
Final Host: Dogs/Canine/Foxes Clinical Symptoms
Intermediate Host: Sheep (Herbivores) − Echinococcus: hydatid cyst/hydatid
disease/hydatidosis
Cross-section of E. • Symptoms vary based on size and location
Adult Worm of hydatid cyst
granulosus cyst
• Liver: 70% of the cases, 85% of which is
located in the right lobe.
• Lungs: 20 to 30% of cases
• Other organ (brain and the orbit): 10% of
cases
• Typically, little if any discomfort for
approximately 1 year or more after ingesting
eggs
• Over time cyst enlarges
• Rupture of cyst may occur naturally or during
specimen collection that may result in.
1. Anaphylactic shock
− Humans are accidental hosts. 2. Eosinophilia
− Humans ingest eggs by contact with infected dog 3. Allergic reactions
feces. 4. Death

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• Lung involvement − Infective Stage: Cysticercoid Larva

1. Chest pain − MOT: Ingestion of IH
2. Coughing − Adult: Rice Grain Appearance
3. Shortness of breath
• Liver involvement
1. May result in obstructive jaundice
8. Taenia multiceps
• Other organ involvement − most common canid tapeworm that causes
1. Site-specific symptoms coenurosis in humans

Laboratory Diagnosis Coenurus cyst

− Hydatid cyst fluid − is a unilocular cyst that contains a transparent
• Examine for presence of scolices, daughter fluid, similar to cysticercus, although the worm has
cysts, brood capsules, or hydatid sand multiple scolices
• Note: If fluid escapes from the cyst during
specimen collection, infected patients may Coenurus (larval form)
experience anaphylaxis. − may cause destructive damage or death but is an
− Serologic tests extremely rare disease in humans.
− Radiography
− CT scan CT and MRI may be useful for detecting the cysts.
Microscopic identification can be used if the cyst has
− Ultrasound
been removed surgically.
Treatment
− Historical treatment of choice: surgical removal 9. Spirometra mansonoides
when possible − No scolex is present
− Advent of anti-parasitic medications now offers an − found worldwide
alternative when appropriate. − has bothria
• Mebendazole − Humans are accidental hosts
• Albendozole
• Praziquantel

Prevention and Control

− Adhering to appropriate personal hygiene
practices
− Discontinuing the practice of feeding canines
potentially infected sheep viscera
− Promptly treating infected canines and humans
− Educating individuals in high-risk transmission
areas

7. Raillietina garrisoni
− Common tapeworm of man
− Habitat: Small Intestine Sparganosis
− Final Host: Rats − is an infection caused by the plerocercoid larvae
− Accidental Host: Man of Spirometra
− IH: Flour Beetle
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References
Belizario Jr., V. Y., & de Leon, W. U. (Eds.). (2015). Medical Parasitology in the
Philippines (3rd ed.). University of the Philippines Press.

Tille, P. M. (2017). Bailey and Scott’s diagnostic microbiology (14th ed.). Elsevier Inc.

Zeibig, E. A. (2013). Clinical Parasitology: A Practical Approach (2nd ed.). Saunders Elsevier.

Assessment
An online, 50-item quiz will be given and will be accessed using the Learning
Management System.

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