MEDICAL PARASITOLOGY

CESTODES (Tapeworms)

Cestodes (Greek kestos-girdle or ribbon) are multisegmented, dorsoventrally flattened tapelike

worms whose sizes vary from a few millimeters to several meters. The adult worms are found in
the small intestine of humans.

General Characteristics

Tapeworms can be classified into 2 orders Pseudophyllidea and Cyclophyllidea.

The adult worm consists of 3 parts:

1. Head (Scolex)

It is the organ of attachment to the intestinal mucosa of the definitive host. In parasites of the
order Cyclophyllidea, the scolex possesses 4 suckers. In some Cyclophyllidea like Taenia
solium, scolex has an apical protrusion called rostellum. The rostellum may or may not be armed
with hooks. In parasites of the order Pseudophyllidea, the scolex does not possess suckers but
possesses a pair of longitudinal grooves called bothria, by which it attaches to the intestine of the
host.

2. Neck

It is the part, immediately behind the head and is the region of growth from where the new
proglottids are being formed.

3. Proglottids (strobila)

The proglottids consist of immature followed by mature and gravid proglottids. Tapeworms are
hermaphrodites and every mature segment contains both male and female reproductive organs.
In the immature segments, the reproductive organs are not well developed. The gravid segments
have uterus filled with eggs. Tapeworms do not have a body cavity or alimentary canal.
Nutrients are absorbed via the cuticle. Rudimentary excretory and nervous systems are present.

The eggs of Cyclophyllidea and Pseudophyllidea are different from each other. In
Cyclophyllidea, the embryo inside the egg is called the oncosphere (hexacanth embryo). It is
spherical and has 3 pairs of hooklets. In Pseudophyllidea, the egg is operculated.

Clinical disease can be caused by the adult worm or the larval form. In general, adult worm
causes mild disease or are asymptomatic, while the larvae can produce serious illness and
complications, particularly when they lodge in the CNS or eyes.
PSEUDOPHYLLIDEAN TAPEWORMS

Diphyllobothrium latum (Fish tapeworm/Broad tapeworm)

Distribution

Its infection occurs in central and northern Europe, particularly in the Scandinavian countries. It
is also found in Siberia, Japan, North America and Central Africa. Dogs, cats and many wild
animals may be naturally infected.

Habitat

The adult worm is found in the small intestine, usually in the ileum, where it lies folded in
several loops with the scolex embedded in the mucosa.

Morphology

Adult measures up to 10 m or more. It is the largest tapeworm inhabiting the small intestine of
human. Scolex is spatulate or spoon shaped, about 2-3 mm long and 1 mm broad. It has 2 slitlike
longitudinal dorsoventral sucking grooves (bothria). Neck is thin and unsegmented. Strobila
consists of 3000-4000 proglottids. Proglottids are wider than they are long. The genital pores
open midventrally.

Egg is broadly ovoid, about 65μm by 45μm, with a thick, light brown shell. It has an operculum
at one end. It is passed in faeces and completes development in freshwater. The egg is not
infective to humans.

There are 3 stages of larval development:

1. First stage larva (coracidium)

2. Second stage larva (procercoid)

3. Third stage larva (plerocercoid)

Life Cycle

(1) Unembryonated eggs are passed in faeces of infected human. (2) Eggs embryonate in
water. (3) Coracidia hatch from eggs and are ingested by crustaceans. (4) Procercoid
larvae develop in body cavity of crustaceans. (5) The infected crustaceans are ingested by
small freshwater fish and the procercoid larvae develop into plerocercoid larvae. (6)
Predator fish eats the infected small fish. (7) Human acquires infection via ingesting raw
or undercooked infected fish containing plerocercoid larvae. (8) Adults develop in the
small intestine. (9) Proglottids release immature eggs which are passed in the faeces.
Pathogenesis and Clinical Features

The pathogenic effects of diphyllobothriasis depend on the mass of the worm, absorption of its
byproducts by the host and deprivation of the host's essential metabolic intermediates.

Infection may be asymptomatic, while some patients may present with intestinal obstruction.
Abdominal discomfort, diarrhoea, nausea, weakness, weight loss and anaemia are the usual
manifestations. The worm lives in the ileum where vitamin B12 absorption takes place. It
competes with the host for vitamin B12 and may cause vitamin B12 deficiency anaemia.

Diagnosis

1. Microscopic examination

Detection of operculated eggs or gravid proglottids in faeces. The arrangement of the uterus in
gravid proglottid at its center is frequently likened to a rosette.

2. Molecular diagnosis
PCR on clinical specimens

CYCLOPHYLLIDEAN TAPEWORMS

Taenia saginata and Taenia solium

Distribution

Taenia saginata and Taenia solium have a worldwide distribution.

Habitat

The adult worms of both T. saginata and T. solium live in the small intestine of human.

Morphology

Taenia saginata (Beef tapeworm)

The adult T. saginata is dorsoventrally flattened and segmented, measuring 5-10 m in length.
The scolex of T. saginata is about 1-2 mm in diameter, bearing 4 suckers for attachment. The
scolex has no rostellum or hooklets. The neck is long and narrow. The strobila consists of 1000-
2000 proglottids. They are hermaphrodites. The gravid segments are about 20mm long and 5mm
broad and each gravid segment has 15-30 lateral uterine branches. The gravid segments break
away and are expelled singly out through the host’s anus. The gravid segment can be seen
moving actively.

Eggs of T. solium and T. saginata are identical. They are brown and spherical, measuring 31-
43μm in diameter. The shell is radially striated. The embryo (oncosphere) has 6 hooklets.

Cysticercus bovis is the larva of T. saginata. The larva is the infective stage to humans. It is
ovoid, milkywhite opalescent fluidfilled vesicle measuring about 5mm × 10mm in diameter and
contains a single invaginated scolex (bladder worm).

The cysticerci are found in the muscles of infected cattle. They can be seen grossly as white dots
in the infected beef (measly beef). Cysticercus bovis infection is not reported in humans.

Taenia solium (Pork tapeworm)

The adult T. solium is dorsoventrally flattened and segmented, measuring 2-3 m in length. The
scolex of T. solium is about 1mm in diameter, bearing 4 suckers for attachment. The scolex has
rostellum and hooklets. The neck is short. The strobila consists of less than 1000 proglottids. The
gravid segments are about 12mm long and 6mm broad and each gravid segment has 7–13 lateral
uterine branches. They are hermaphrodites. The gravid segments are expelled in chains through
the host’s anus.
Cysticercus cellulosae is the larval form of T. solium and also the infective form of the parasite to
humans. It can develop in various organs of pig as well as in human. Its morphology is similar to
cysticercus bovis. The morphology of the invaginated scolex of cysticercus cellulosae is similar
to the adult scolex of Taenia solium.

Life Cycle of Taenia

(1) Eggs or gravid proglottids in faeces of infected humans are passed out. (2) Cattle (T.
saginata) and pigs (T. solium) become infected by ingesting vegetation contaminated by eggs or
gravid proglottids. (3) Oncospheres hatch, penetrate intestinal wall and circulate to muscles to
develop into cysticerci. (4) Humans acquire infection by ingesting raw or undercooked infected
meat containing the larvae. (5–6) Adults develop in the small intestine of human and scolex
attaches to the mucosa of the small intestine.

Lifecycle of Taenia

Pathogenesis and Clinical Features

Intestinal taeniasis can be caused by both T. saginata and T. solium. It is mostly asymptomatic.
In symptomatic infection, patient presents with vague abdominal discomfort, indigestion, nausea,
diarrhoea and weight loss. Cases of acute intestinal obstruction and acute appendicitis have been
reported.
Cysticercosis is caused by larval stage (cysticecus cellulosae) of T. solium.

Humans acquire infection after ingesting eggs of T. solium in contaminated food or water. Any
organ or tissue may be involved, the most common being subcutaneous tissues, brain and eye.
The cysticercus is surrounded by a fibrous capsule except in the eye and ventricles of the brain.
The degenerating larvae evoke a cellular reaction with infiltration of neutrophils, eosinophils,
lymphocytes and plasma cells. This is followed by fibrosis and death of the larva which
eventually calcify. The clinical features depend on the site affected. Subcutaneous nodules are
mostly asymptomatic. Muscular cysticercosis may cause acute myositis. Neurocysticercosis
(cysticercosis of the brain) is the most common and most serious form of cysticercosis. Majority
of adult onset epilepsy is due to neurocysticercosis. Headache is also a common manifestation of
neurocysticercosis. In ocular cysticercosis, patients may present with blurred vision or loss of
vision.

Diagnosis of Taeniasis

1. Microscopic examination

Detection of characteristic eggs, scolex or gravid proglottids of Taenia in faeces. Species

identification cannot be made from the eggs since the eggs of T. saginata and T. solium look
alike. Eggs can also be detected around the perianal region by cellophane swab technique.

2. Molecular diagnosis

PCR on faecal sample.