CLINICAL PARASITOLOGY (Lecture)

Topic: CESTODES BSMT

CESTODES  Reproductive system consists of both

male and female which are both
present in each segment (monoecious)
(one house – male & female)

1. Intestinal

 Diphyllobothrium latum
 Dipylidium caninum
 Hymenolepis nana
 Hymenolepis diminuta
 Taenia saginata
 Taenia solium

2. Tissue

 Echinococcus granulosus
 Echinococcus multilocularis
 Spirometria mansonoides

GENERAL CHARACTERISTICS AND

GENERAL CHARACTERISTICS
CLASSIFICATION
 multicellular flatworms or “tapeworms
Adult “hermaphroditic” and can initiate a
 White and yellowish in color new life cycle with the ingestion of a
 Long, tape-like multi-segmented worms single egg
flattened dorsoventrally (flat and
ribbon like in appearance)
 Found in the small intestine of man
 No circulatory system and is usually
divided into segments or proglottids
 No digestive system
 Nervous system is confined primarily in
the scolex
 Excretory system consists of flame
cells, capillaries and collecting tubules

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Life Cycle

1. The Egg
The egg with a hexacanth embryo or
oncosphere
2. The Larval Stage
Three types of segments
Coracidium, Procercoid, Plerocercoid,
Cysticercoid, and Cysticercus larvae
3. Adult Stage

 Immature segment
o Present near the neck. The male
and female sex organs are still
immature and are not
differentiated
 Mature segment
Three parts/regions of adult tapeworm o Large segment. Male and
female sex organs are
•Scolex
differentiated
o Head o Each segment contains single,
o For attachment (holdfast organ) sometime two sets of male and
o Accessory structures present that will female genital organs
help in the attachment  Gravid segment
o 2 sucking grooves/sulci o Situated farthest away from the
o 4 cup-like suckers (in some scolex
species) o Uterus is completely filled up
o Rostellum with eggs
o Hooklets

• Neck

o Region of growth

• Strobila

 Chain of proglottids or segments

The Larval Stage

Larval stages

•Solid type

 Plerocercus/procercoid/procercus
o Present in the 1st IH
o Relatively globular with the
scolex invaginated into the
body

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

 Plerocercoid/sparganum larva B. Species which require invertebrate IH

o Present in the 2nd IH Dipylidium caninum
o Elongated with head free or Hymenolepis diminuta
invaginated only in the neck Raillietina garisoni
C. Species which may or may not require
• Cystic type IH
 Cysticercoid Hymenolepis nana
o Larva is provided with a slightly D. Species which may infect man in their
developed bladder anteriorly, larval stage
into which the head is Echinococcus granulosus
invaginated and with an Echinococcus multilocularis
elongated solid posterior Taenia solium
portion Spirometra mansoni

•Cysticercus (true bladder worm) Laboratory Diagnosis

 In this type of larva, head is invaginated  involves examining stool samples for
into the proximal portion of the bladder eggs or proglottids. `
 Simple, Coenurus,  Symptoms of cestode infections vary
Echinococcus/Hydatid but can include gastrointestinal
discomfort, diarrhea, abdominal pain,
nausea, weight loss, anemia, and organ
involvement.
 Some infections can lead to allergic
responses or anaphylactic shock

CLASS CESTOIDEA

• Order Pseudophillidea

 Scolex typically unarmed, with a dorsal

and ventral grooves (bothria)
 All representatives in man belong to Taenia saginata & Taenia solium
Superfamily Bothriocephaloidea • Cysticercus: survive for several years in the
• Order Cyclophillidea host

 Scolex with 4 suckers and usually a • Human intestine: cysticercus develops over 2
centrally placed apical rostellum, months into adult tapeworm
frequently armed with hooks
 All species found in man belong to
Superfamily Taeniodea

Medically important species of tapeworms

Order Pseudophillidea

 Diphyllobothrium latum

Order Cyclophillidea

A. Species which require vertebrate IH

Taenia solium
Taenia saginata

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Taenia saginata  The scolex is similar to that of T. solium

except for the absence of rostellum,
 Common name: Beef tapeworm.
spines or hooklets.
 Common associated disease and
 There are more segments in T. saginata
condition names: Taeniasis, beef
than in T. solium, there being 1,000 to
tapeworm infection
2,000 segments in T. saginata. The
 Recently, a third human tapeworm was
lateral uterine branches of the uterus in
shown to be distributed in the Asian-
the gravid segments number 15 or
Pacific region: Korea, Indonesia,
more.
Philippines, and Thailand.
 It is now generally referred to as the
Asian Taenia.

Taenia saginata

• Eggs:

 Each proglottid may contain about

 DNA studies showed that the Asian 80,000 eggs.
Taenia is closely related to T. saginata.  T. saginata eggs are indistinguishable
 The Asian Taenia infects cattle, goats, from T. solium eggs.
monkeys and wild boars, but pigs are • Larval Stage:
the dominant intermediate hosts.
 Habitat: Small intestine particularly the  Cysticercus bovis or the larval stage of
upper jejunum. They remain attached T. saginata is similar to cysticercus
to the intestinal mucosa with their cellulosae except that the scolex is
suckers unarmed.
 Cysticercus larvae may remain viable in
the tissue of cattle for about 8 months.

MORPHOLOGY Disease

Adult: •Taeniasis

 Whitish opaque in color  Majority of patients are asymptomatic.

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

 Those with high worm burden may  T. solium infection underdeveloped

complain of diarrhea, abdominal pain, communities with poor sanitation and
loss of appetite with result weight loss,  where people eat raw or undercooked
and body malaise. pork. Higher rates of illness have been
 The gravid proglottids may reach the seen in people in Latin America,
anus where egg laying may occur Eastern Europe, sub Saharan Africa,
resulting in itchiness in the anal region India, and Asia (CDC).
(pruritus ani).  Adult worms produce little damage in
the intestines

Reservoir, source and transmission of

infection
Disease
 Man is the only reservoir of infection
 Contamination of the environment by 1. Taeniasis– the disease produced by the adult
human feces is the most crucial in worm. Most cases are asymptomatic but in the
maintaining the infection in the presence of high worm burden, manifestations
community may be similar to beef tapeworm infection.
 Raw or undercooked beef containing
2. Cysticercosis– the result of larval encystation
Cysticercus bovis is the source of
in various tissues of the body. The most
infection for human Man acquires
common involvement is that of the skeletal
infection by:
muscles where patients may
 Eating raw or undercooked beef
harboring the cysticerci Cyticercosis of the brain (neurocysticercosis) is
 Tasting meat dishes during cooking the most feared and most severe involvement.

It may present with symptoms associated with

increased intracranial pressure such as seizures,
headache, and vomiting. Ocular cysticercosis
may lead to visual disturbances due to
development of inflammation of the uvea
(uveitis) and retina (retinitis).
Taenia solium \;lo
 Common name: Pork tapeworm.
 Common associated disease and
condition names: Taeniasis, pork
tapeworm infection.

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Morphological Differences Taenia solium Taenia saginata

Adult – Length 2-7 meters 5-10 meters

Adult - # of segments 800-1,000 1,000-2,000

Scolex – shape Globular Quadrte

Scolex - # of suckers 4 4

Scolex - Rostellum Present Absent

Scolex – Hooklets Present, double row of 20-25 Absent

Mature segment - Tubular uterus - 1 ovary with 2 large ovarian lobes

-1 ovary with 2 large ovarian - wider than long
lobes and 1 accessory
-wider than long

Gravid segment - 150-200 testicular follicle - 330-400 testicular follicle

-5-14 uterine branches -15-20 uterine branches
- Longer than broad - Longer than broad

Infective stage Cysticercus cellulosae Cysticercus bovis

Intermediate hosts Hogs, pigs Cattle cow

Eggs Spherical, non-operculated, mature with 3 Same as T. solium

pairs of hooklet and shell striation. Walnut
brown

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Laboratory Diagnosis

 Stool is the specimen of choice for the

recovery of Taenia eggs and gravid
proglottids.
 The scolex may be seen only after the
patient has been treated with anti-
parasitic medication.
 Furthermore, there is evidence to
suggest that specimens collected
around the perianal area using the
cellophane tape prep procedure result
in a very high recovery rate of Taenia
eggs.

Treatment

 The drug of choice for treatment of

intestinal infection is praziquantel.
 For cysticercosis, praziquantel may
also be effective but it is usually not
recommended for ocular and CNS
involvement.
 Alternative drugs: albendazole,
paromomycin, and quinacrine
hydrochloride.
 Surgical removal of the larvae may be
necessary. Anticonvulsants may be
given in cases of neurocysticercosis.

Prevention and Control

 Proper waste disposal and sanitation

practices as well as the adequate
cooking of beef or pork are the main
preventive measures for taeniasis.
 Freezing of beef meat for
approximately 10 days may kill the
encysted larvae.
 Prompt treatment of infected persons
help prevent spread of the disease.

Hymenolepis diminuta

 Common name: Rat tapeworm.

 Common associated disease and
condition names: Hymenolepiasis, rat
tapeworm disease*worldwide

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Laboratory Diagnosis

 recovery of the characteristic eggs in

stool specimens.
 proglottids are typically not found in
stool they disintegrate in the human
gut.
 Similarly, the scolex is rarely seen in
these samples.

Clinical Symptoms  H. nana does not require an obligatory

intermediate animal host. The eggs are
 Asymptomatic. directly infectious and humans get the
 Hymenolepiasis: Rat Tapeworm infection after the accidental ingestion
Disease. Persons infected with H. of the eggs of the parasite
diminuta usually present with mild
symptoms such as diarrhea, nausea, MOT: Fecal-oral, touching one’s mouth with
abdominal pains, and anorexia. contaminated fingers or through ingestion of
contaminated soil, Accidental ingestion of rice
The treatment of choice against H. diminuta or flour beetles containing the infective larvae.
 praziquantel.
 Niclosamide is an effective alternative
therapy; however, it is not yet readily
available in the United States.

Prevention and Control

 First, administering effective rodent

control thus preventing rats from
contaminating foodstuffs such as grains
and cereals.
 Second, protection of these foods from
both rat droppings and from Three phases in the Life Cycle of H. nana
intermediate host insects is critical to 1.Direct phase
prevent consumption of contaminated
food. Does not require intermediate host
only definitive host
Hymenolepis nana
2.Indirect phase
 Common name: Dwarf tapeworm.
 Common associated disease and Ex. H. nana var. fraternal Ova in beatles
condition names: Hymenolepiasis, and fleas which may serve as IH. Ova
dwarf tapeworm disease. becomes cysticercoid

3.Internal and external autoinfection

Internal – eggs hatch out in the lumen

of SI and liberate embryo which directly
invade the intestinal villi. Responsible in
the increase of worm load in the SI

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

External – person ingests one’s own

eggs by fecal-oral route due to bad
personal hygiene. Responsible for
persistence of infection in the host

Intermediate Hosts:

 Ctenocephalides canis
 Pulex irritans
 Xenopsylla cheopis
 Tenebrio molitor
 Tenebrio confusum

Pathogenesis And Pathology

 Development of cycticercoid larvae in

the intestine of man causes little or no
pathology
 In heavy infections, large number of
worms may cause:
o Mechanical irritation of the
intestine
o Various allergic manifestation Treatment :
such as anal and nasal pruritus
 Praziquantel is considered to be the
by releasing toxic metabolites
treatment of choice for infections with
Reservoir, source and transmission of infection H. nana

 Infected human are the chief source of Prevention and Control

infection
 Proper personal hygiene and sanitation
 Man is the main reservoir
practices are crucial to preventing the
 Hexacanth eggs are infective to human
spread of H. nana. Controlling transport
Transmission of infection in man occurs: host populations and avoidance of
contact with potentially infected rodent
1. Fecal-oral route feces are also prevention and control
2. Contamination of foods and water measures aimed at halting the spread of
3. Ingestion of foods contaminated with the parasite.
fleas
Dipylidium caninum
Diagnosis
 Common names: Dog or cat tapeworm,
 Stool examination reveals the pumpkin seed tapeworm.
characteristic eggs with its six hooklets  Common associated disease and
embryo and polar filaments condition names: Dipylidiasis, dog or cat
tapeworm disease.

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

children not to let pets lick them near

their mouths.

Diphyllobothrium latum

 Common name: Broad fish tapeworm.

 Common associated disease and
condition names: Diphyllobothriasis,
fish tapeworm infection, broad fish
tapeworm infection

Laboratory Diagnosis

 D. caninum diagnosis is based on the

recovery of the characteristic egg
packets or gravid proglottids in stool
samples. The presence of a single egg in
a stool sample may occur, but is
extremely rare.

Clinical symptoms:

 Usually asymptomatic, but heavy

infections can cause appetite loss,
diarrhea, abdominal discomfort,
indigestion, and anal pruritus.

Treatment:

 Praziquantel is the preferred drug, with

niclosamide and paromomycin as
alternatives.

Prevention and control

 Regular veterinary examinations,

deworming of infected pets, flea
prevention for pets, and teaching

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Clinical symptoms

 Most infected individuals are

asymptomatic. Symptoms may include
digestive discomfort, weakness, weight
loss, abdominal pain, and vitamin B12
deficiency.

Treatment

 Praziquantel and niclosamide are

effective drugs.

Prevention and control

 Proper human fecal disposal, avoiding

raw or undercooked fish, and thorough
cooking of all fish before consumption.

Echinococcus granulosus

 Common names: Dog tapeworm,

hydatid tapeworm.
 Common associated disease and
condition names: Echinococcosis,
hyatid cyst, hyatid disease, hyatidosis.

Morphology: Hyadatid cyst.

Laboratory diagnosis

 Examination of stool samples for eggs,

proglottids, or scolex.
 Life cycle: Requires two intermediate
hosts (copepods and freshwater fish) to
complete the cycle.

MOT: Ingestion of contaminated raw or

undercooked fish by humans initiates infection.

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Disease

 Echinococcosis, Hydatid Cyst Disease,

Hydatid Disease, Hydatidosis
 Most patients are asymptomatic during
the early stages of the disease.
 cysts enlarge, necrosis of the infected
tissues occur.
 liver: obstructive jaundice.
 lung involvement: with cough, chest
pain, and shortness of breath. Other
organs that may be infected include the
spleen, kidneys, heart, bone, and
central nervous system, including the
brain and eyes

TREATMENT

 Care should be exercised when doing

biopsy to prevent rupture of the cyst.
Treatment In cases when surgery is
possible, removal of the cyst has been
considered as the treatment of choice.
 Drugs that have been proven effective
include mebendazole, albendazole, and
praziquantel.

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CLINICAL PARASITOLOGY (Lecture)
Topic: CESTODES BSMT

Prevention and Control

 Improvement of personal hygiene

practices prevention of contamination
of food and water with dog feces
 avoidance of feeding pet dogs with
contaminated viscera,
 prompt treatment of infected canines
and humans are some measures to
prevent the spread of the parasite.
 Chemoprophylaxis should be given to
dogs in endemic areas.
 Health education

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