Introduction to Class Cestodes

The Tapeworms
Classifications of Helminths

 
Classification of cestodes
Intestinal cestodes

Tissue cestodes
 General introduction
• The adult tape worm has:

scolex/head with botheria/sucking grooves in

pseudophylldean (D latum) or suckers & rostellum as in
cyclophylldean (Taenia spp)

 neck is the region of growth from which proglottids

proliferate

 Proglottids / Strobila
Strobila : Chain of segments
Proglottids: segments ( immature/mature/gravid)
 Strobila…
• (a.) immature proglottids
– immature proglottids continue to grow from the neck area and push older
maturing proglottids downwards
– Do not contain fully developed internal structures

• (b.) mature proglottids

– Are larger and found near the middle of the chain
– each may contain one or two sets of both male & female reproductive
organs

• (c.) gravid proglottids

– terminal portion of the strobila that is usually filled with eggs
– eggs are enclosed in the uterus
– gravid proglottid of some specie may become detached in the intestine
and pass out in the feces; but some may be too small to be seen in gross
examination
– After leaving the host, the proglottids rupture and eggs are released
Strobila…
Body is divided into three main regions

a. Scolex (head)
b. Neck

c. Strobila made up
of proglottids
Neck
• Area where new
segments are created

• Give rise to
proglottids in strobila.
• Three main types of Scolex
Cyclophyllidae
A-Globular head with 4
Muscular Sucker

B- 4 Sucker +Rostellum
armed with hooks

Pseudohyllidea

Bothria-Shallow grooves
or pits
 Reproduction
• Sex:- Hermaphrodites
• Have well developed reproductive system.
• Reproduction
– Sexual-Oviporous
– Asexual-Sometimes multiplication with
in larval forms
 Egg: -
• Two types
– Operculated, immature when voided to the
external environment.

– Non-operculated ,fully embryonated when

voided to the external environment.
Operculated
Operculum
Non-operculated
 Larvae:
• Generally two types
1. Solid :
– eg. Procercoid, Plerocercoid, cysticercoid
2. Cystic ( true bladder) can be with:
– Single scolex
eg. Cysticercus;
– Many scolexes and/or with daughter cyst
eg. hydatid cyst, coenurus cyst, etc
 Larval stages

(T.
solium)

(Hymenolepis (E.
sp.) granulosu (D. latum) (D.
s) latum)
 Larval stages…

• Procercoid: spindle-shaped larva with a solid body with

posterior hooks; the first larval stage D. latum

• Plerocercoid: a 2nd larval stages of D. latum, a solid larva

possessing an adult scolex

• Cysticercoid: a larva consisting of an interior vesicle

containing the scolex, which is not invaginated,
(H.diminuta)
 Larval stages
• Cysticercus: a bladder enclosing a single scolex retracted &
invaginated, Taenia spp

• Strobilocercus: scolex not usually invaginated and

connected by a long, solid, segmented strobila to a small
bladder (Hydatigena taeniaeformis)

• Coenurus: of cysticercus type; groups of scoleces are

budded from wall of bladder (Taenia multiceps)

• Hydatid cyst: scoleces do not develop in walls of bladder

but within vesicles called ‘brood capsules’ (E. granulosus)
 Classification
• Less medically important:
1. Order Cyclophyllidea
– Order Cyclophyllidea
1. T. saginata,
• T. multiceps
2. T. solium,
• Dipylidium caninum
3. Hymenelopis sps • Echinococcus
multicuralis.
4. Echinococcus
– Order Pseudophyllidea
granulosus
• Spirometra species
2. Order Pseudophyllidea

1. Diphyllobothrium latum
 Larva of cyclophyllidean
Adult Larva Adult Larva
T. solium Cysticercus H. Diminuta --- Cysticercoid
cellulosa
D. Caninum---- Cysticercoid
T. Saginata Cysticercus bovis

H. nana Cysticercoid E. granulosus Hydatid cyst

D. latum Procercoid in
1st IH

Plerocercoid in
2nd IH
 Life cycle
• Complete in two host (exception H.nana)

• Haibtat:- Adult live in small intestine

• Human is:-
• The only/main DH for T. saginata, T. solium, H. nana
and D. latum

• IH for E. granulosus and E. multilcolaris

• DH & IH for H. nana and T. solium

1-Pseudohyllidea
Egg
Adult

} Definitive
Host

2-Cyclophyllidea

}
Operculated, Non-operculated
Intermediate
Coracidium Oncosphere Host

Solid larval
form Cystic larval form
procercoid larva
Cysticercus Cysticercoide, coenuruses, Hydatid Cysts
Plerocercoid larva
Hymenolepsis nana, Hdiminuta, Taenia saginata, T solium, Diphyllobothrium latum, Dipylidium craninum.
Note hexacanth embryos. Cysticercus larva in cow and pig; procercoid larva in copepod, plerocercoid
(sparganum) larva in fish; cysticercoid larva in insect.
Generalized lifecycle of intestinal nematodes
1. Taenia saginata (beef
tapeworm)
 Epidemiology

• Is prevalent in beef-breeding areas.

• Taenia spp are the most common cestode parasites of

humans.
• More than 60 million people are infected with T.
saginata world wide

• T. saginata common in developing countries where

hygiene is poor & the inhabitants have a tendency of
eating raw or insufficiently cooked meat.
Transmission & Life cycle
Transmission &…
 Transmission &…
• Eggs/gravid proglottids in feces passed into environment

• Embryonated egg/gravid proglottids ingested by cattle

• Oncosphere hatch, penetrate intestinal wall & circulate

to musculature in cattle

• Oncosphere develop into cysticerci in muscle of cattle &

get encysted

• Human acquire the infection by ingesting raw/ poorly

cooked cattle meat that contain C. bovis.
 Predilection site

• Adult worm is attached into small intestine of

human by its scolex
 Route of infection

Oral: by ingestion/ eating of raw or undercooked

beef/cattle meat containing an invaginated protoscolex.
 Clinical features

Though non specific symptoms include:

 Abdominal discomfort, indigestion, pain,
nausea, dizziness, headache, weight loss, increased
appetite, pruritis ani

 The proglottids crawling out the anus, particularly

during the night time may cause alarm/embarrassment
 Diagnosis

• Can be made by patients who feels the proglottids

crawling down the anus unexpectedly or notices them in
stool

• Gravid proglottids/ova can be found in feces

• Eggs of T saginata & T solium is indistinguishable

• Pressing gravid proglottid b/n two slides & counting the

# uterine branches (15-20 lateral branch in T saginata;
under 13 in T solium)
 Prevention

• Avoiding indiscriminate defecation

• Proper meat inspection

• Avoid eating raw/poorly cooked/under cooked beef

meat
2. Taenia solium/pork tapeworm
• Common name: Pork tapeworm

• DH: Human

• IH: Swine/pig & human

• Habitat of adult worm: SI of the DH

• Habitat of larva: Muscle of the IH

• Infective stage: Cysticercus cellulosae
• Diagnostic stage: Eggs/proglottids in feces

• Disease in human: Taeniasis & cysticercosis

• More dangerous than T. sagniata (why)?.

• Unlike T. saginata, it cause two types of disease in

human:

 Taeniasis Vs cysticercosis

• T. saginata (beef tapeworm) does not cause human

cysticercosis.
 Taeniasis

• Is caused by eating raw/poorly cooked pork meat that

contain larva known as C cellulosae
 Cysticercosis
• Is caused by ingestion of T solium eggs from the
definitive host (human), auto-infection. Human act as
IH in cysticercosis and as a DH in Taeniasis.

• Two ways to get

– Ingestion of T. solium eggs in contaminated food (feco-
oral)

– Autoinfection

• Eggs hatch before leaving D.H.

 Clinical features of cysticercosis

• Symptoms depend on where larvae develop and

number of larvae

Skeletal Muscle – little pathology

 Eye/ ocular cysticercosis – cause blindness
 Heart/ Cardiac cysticercosis – may cause heart
failure
 Brain/ neurocysticercosis – leading cause of epilepsy
 (1) Muscle/Subcutaneous type:

• The subcutaneous nodules are usually found in head,

limbs, neck, abdomen and back. They are movable and
painless
 Ocular cysticercosis
The cysticercus is usually found in the vitreous body or
subretina.
Visual disturbance often occurs. The died body of worm
may provokes local inflammation causing blindness.
 Neurocysticercosis
• The patients may manifest headache, nausea, vomiting,
epilepsy , paralysis, weakness in limbs, diplopia,
dizziness, mental disorder.

• Epilepsy is the most frequent symptoms of brain

cysticercosis.
 Diagnosis of cysticercosis

• Serology (ELISA).

• x-rays/ MRI scans may reveal the presence of lesions in

the brain.

• QualiCodeTM Cysticercosis Kit,

• Gravid proglottids/ova in feces in case of taeniasis

 Prevention
Proper disposal of human feces

Identification & treatment of infected individuals

Confinement of pigs

Pigs should be kept away from human excrement

Avoid undercooked pork

Avoid eating vegetation/fruits not properly washed
In butcher shops, grinding machines must be cleaned between
grinding pork.
Proper sanitation
 I. Morphology:
The biological differences between T. solium and T. saginata
______________________________________________________________________
Adult T. solium T. saginata
______________________________________________________________________
1. length 2-4 meters 4-8 meters
2. scolex 4 suckers and hooklets 4 suckers but no hooklets

3.Number of segment 700 to 1000 1000 to 2000

4. Mature proglottid 3 lobes of ovary 2 lobes of ovary
5. Gravid proglottid 7-13 uterine lateral 15-30 uterine lateral
branches on one side branches on one side
6. Number of gravid usually several segments usually single segment
proglottid detached

7. Mode of proglottids passively expelled actively migrate out of anus

passing out

8. Cysticercus scolex with hooklets no hooklets on scolex

found in man and pig only found in cattle

9. Disease caused in man Taeniasis & Cysticercosis Taeniasis

______________________________________________________________________
10. Egg: same
 Taenia multiceps (Multiceps multiceps)
3. Taenia multiceps
• Morphology
• Larva (coenurus): Characterized by unilocular cyst with multiple
scolices, hence, named as Multiceps
• Coenurosis is infection by the metacestode larval
stage (coenurus) of Taenia multiceps and T. serialis .

• Coenuri may be found in most tissue types, but those of T.

multiceps have a predilection for the CNS and eye; those of T.
serialis are usually found in subcutaneous tissue.

• Coenuri are thin-walled, whitish or gray, and spherical to

polycephalicin shape.

• A coenurus contains multiple protoscoleces, which

distinguishes
• The DHs for Taenia multiceps And T. serialis are members of
the family Canidae.
• Many canids can serve as DHs for T. multiceps , but only dogs
and foxes can serve as hosts forTserialis.
• Eggs and gravid proglottids are shed in feces into the
environment , where they are ingested by an intermediate host .

• Many animals may serve as intermediate hosts, including

rodents, rabbits, horses, cattle, sheep and goats.

• Eggs hatch in the intestine, and oncospheres are released that

circulate in blood until they lodge in suitable organs (including
skeletal muscle, eyes, brain and subcutaneous tissue).
• After about three months, oncospheres develop into coenuri.
• The DH becomes infected by ingesting the tissue of
an infected IH containing a coenurus .
• The adult cestodes reside in the SI of the DH .
• Humans become infected after the accidental ingestion of eggs
on fomites or in food and water contaminated with dog feces .
• Eggs hatch in the intestine, and oncospheres are released that
circulate in blood until they lodge in suitable organs and after
about three months develop into coenuri .
• Coenuri of T. multiceps are usually found in the eyes and
brain; those of T. serialis are usually found in subcutaneous
tissue
 Clinical Features:

• Coenuri in the skin or subcutaneous tissue usually present as

painless nodules.

• The lesions are often fluctuant and tender.

• Most subcutaneous nodules manifest on the trunk, sclera,

subconjuctiva, neck, shoulders, head and limbs.

• Coenuri in the neck may affect neck movement and

swallowing.
• Clinically, coenuri may mimic lymphomas, lipomas,
pseudotumors, or neurofibromas.
• Coenuri in the CNS may cause headache, fever and vomiting.
• Localizing neurologic symptoms may also develop, including
nerve palsies, jacksonian epilepsy, pachymeningitis, obstructive
or communicating hydrocephalus, and intracranial arteritis
with transient hemiparesis.
• Coenuri in the eye cause both intraocular and orbital infections,
and patients may present with varying degrees of visual
impairment.

• If not removed, coenuri in the eye may eventually blindness.

• Laboratory Diagnosis:
• Diagnosis is made by the observation of coenuri in
biopsy or autopsy specimens.

• Coenuriare usually readily distinguished from

cysticerci by the presence of multiple protoscoleces
• Treatment:

• Removal of the coenurus effectively treats intracranial

coenurosis in most cases.
• Therehave also been reports of successful removal
of coenuri from patients' eyes, resulting in arecovery of
sight.
• Coenuri are susceptible to praziquantel, but caution
should be used,especially in cases of intraocular
coenurosis.
4. Hymenolepis nana
 Introduction
• Common name: Dwarf tapeworm
• DH: Human and rodent
• IH: Insect/beetle larva?!
• Habitat of adult worm: SI of the human/rodent
• Infective stage for human:
i. eggs
ii. Cysticercoid larvae in IH
• Diagnostic stage: Eggs/proglottids in feces
• Disease: Hymenolepiasis
 Distribution/epidemiology

• Hymenolepis nana has a cosmopolitan distribution

and is thought to be the most common tapeworm
throughout the world.

• The infection is more frequently seen in children

although adults are also infected, causing
hymenolepiasis.
• H nana, the dwarf tapeworm, is the smallest
tapeworm to infect humans.

• 36 million are infected world wide

• Hymenolepiasis is also a disease of populations

living under conditions of poor hygeine & poverty.
Transmission & life cycle
Life Cycle
• Naturaldefinitive hosts, in addition to humans, are rodents like mice and rats
• In humans, gravid proglottids from adult worms rupture, releasing
onconsphere containing eggs into the host intestine to be eliminated with the
feces; eggs are infective upon release
• Upon being ingested by a
new host, the oncosphere,
freed in the small intestine
penetrates a villus
• There it sheds its 6
hooklets and in a few days
becomes a modified
cysticercoid larva known
as a cercocystis
Life Cycle cont.
• It erupts from the villus into the lumen of the small intestine, attaches
itself to the mucosal lining, and develops into the sexually mature adult
• In the case of rodents, an insect (flour beetle) may serve as an
intermediate host
• In this case, when the insect
host is ingested by a rodent
the cysticercoid attaches to
the intestinal wall and
develops to maturity
Autoinfection
• Autoinfection can exacerbate the condition by increasing the number
of worms

• Eggs released from gravid proglottids, instead of passing to the

exterior to infect new hosts, hatch in the small intestine and re-infect
the same host

• The freed oncosphere penetrates a villus and repeats the cycle

 Transmission & …
• The lifecycle of H. nana does not require an IH,
complete dev’t occurring within the villi of a
single host, resulting in a ‘direct’ life cycle.

• It can also utilize an insect as an IH.

• The eggs which are ingested by insects, such as fleas,

beetles or cockroaches hatch to form tailed cysticercoids

• If they are accidentally swallowed by a human they pass

down to the ileum and establish themselves.
Transmission & …
 Route of human infection

• By accidental ingestion infected IH

• By ingestion of water & food contaminated with mouse

feces & can also be transmitted from one child to
another by passing infective eggs on dirty hands

• By internal autoinfection

i.e. If egg remain in the intestine the eggs then release

the hexacanth embryo, which penetrates the intestinal
villus continuing the cycle
 Clinical features
• Infections due to H. nana may cause no symptoms even
with heavy worm burdens.

• However, symptoms of restlessness, irritability,

anorexia, abdominal pain & diarrhea have been
reported.

• Heavy worm burdens may be caused by auto-infection

which can be a problem in the immunocompromised.
 Diagnosis

• Diagnosis is based on recovery & identification of

the characteristic ova in a formol-ether concentrate
of feces.

• Adult worms & proglottids are rarely seen in stool

samples.
 Prevention

• Preventing fecal contamination of food & water in

institutions & crowded areas is of primary importance.

• General sanitation and rodent and insect control

(especially control of fleas & grain insects) are also
essential for prevention of H. nana infection.

• Proper personal hygeine

 Treatment

• Praziquantel: 25mg/kg

• Niclosamide
5. Hymenolepis diminuta
 Epidemiology

• H diminuta is a small tapeworm commonly found in rats

& mice.
• It has a world wide distribution in these hosts but is
infrequently found in humans, with only sporadic cases
being reported.
• Common name: rat tapeworm
• DH: Rodents (rat, mouse), accidentally human
• IH: Fleas, beetles
• Infective stage for human:
ii. Cysticercoid larvae in the IH
• Diagnostic stage: Eggs in feces
• Disease: Hymenolepiasis
• Larva form is called cysticercoid
 Predilection site

• Habitat of adult worm: SI of the human

 Route of infection

• Human infection occurs by the accidental ingestion

of an infected arthropod, which contains the
cysticercoids.
 Clinical features

• Generally there is no effect on the host

 Diagnosis

• Diagnosis is based on recovery and identification of

the characteristic ova in a formol-ether concentrate
of feces.

• Adult worms & proglottids are rarely seen in stool

samples.
 Prevention

• Cleaning of the environment: remove rats & fleas

from home.
6. Dipyllidium caninum
 Dipylidium caninum (Dog Tapeworm)
• World wide • Habitat:
Distribution • Adult: mucus membrane of
• Dogs or cats small intestine of carnivores
(humans rarely) as such as dog, cat, Man
the definitive host • Cysticercoid larvae: In the
• Fleas or lice are body cavity of insects
the intermediate • Egg: in the faeces of dog,
host. cat, man
 Dipylidium caninum
• Flea or louse ingests the
eggs in the perianal region of
the dog or cat.
• The dog or cat (or human) is
infected when they ingest a
flea or louse infected with the
metacestode state
(cysticercoid)

Dog flea
Dipyllidium caninum life cycle
Proglottids of Dipylidium
caninum compared to a
match stick.
These are often passed intact
in the feces of an infected
dog.
When the proglottids dry,
their appearance is similar to
grains of rice.
D. caninum
• Egg: 5-15 eggs in
capsule
• 40m in size and
yellowish brown in
color
Taenia sp.

H. dimunata
Diphyllobothrium
latum H. nana

Eggs
Dipylidium
caninum
Tissue cestodes
7. Echinococcosis/hydatid disease/hydatidosis
 Causative agent
Four spp are known to cause

2. E. multilocularis
----- causes alveolar echinococcosis,
3. E. vogeli causes
----- polycystic echinococcosis,
4. E. oligarthrus causes
------ polycystic echinococcosis.
 Transmission
• Indirect life cycle
– Definitive hosts ingest cysts in tissues of
intermediate hosts
– Cysts develop into tapeworms
– Gravid proglottids or eggs shed in feces by
definitive host
– Eggs ingested by intermediate hosts

Center for Food Security and

Public Health, Iowa State
 Echinococcus granulosus
• DH: Dogs

• IH: Human, cattle, sheep

• Habitat of adult worm: SI of the DH, Dogs

• Habitat of larva: Viscera (internal) organ of the IH

• Infective stage: eggs

• Diagnostic stage: Eggs in feces

• Disease: Cystic echinococcosis

 Epidemiology
• More frequently in rural, grazing areas of the world
where dogs ingest organs from infected animals.

• Echinococcosis or Hydatid disease in man is caused by

the larval stage of the dog tapeworm, E granulosus.

• The larvae in man develop into a unilocular cyst which

gives rise to unilocular hydatid disease.

• Characterized by having only one bladder or many

completely isolated bladders, each enclosed in its own
well-developed envelope.
 Transmission: E. granulosus

• Definitive hosts
– Canids
– Felids
– Hyaenids
• Intermediate hosts
– Herbivores
– Humans

Center for Food Security and

Public Health, Iowa State
Transmission & life cycle
Transmission & life cycle
Echinococcus granulosus:the dog tape worm

Adult E. granulosus adult worms live in the intestine of dogs

They produce eggs which are shed with the feces
Eggs are infective to herbivores (and humans)
 Route of infection

• Oral: People become infected when the tapeworm's eggs

are transferred to the mouth on contaminated food items.

i.e. If a dog has the tape-worm, eggs pass out of the animal
with faeces & the environment becomes contaminated.

The dog may roll in this area & the eggs may transfer to the
coat.
Usually, the eggs get onto a person's hands as they pat a dog.
Occasionally people may be exposed to eggs present in grass
contaminated with dog
Predilection site of hydatid cysts
 Disease in Humans: E. granulosus

• May be asymptomatic
• Usually one cyst present
• Cyst location
– 60 to 70% in liver
– 20 to 25% in lungs
• Symptoms dependent on cyst location

Center for Food Security and

Public Health, Iowa State
 Clinical ….

• The spectrum symptoms depends primarily on:

a) the organ(s) involved
b) the size of the cysts & their site within the affected
organ
c) the interaction between the expanding cysts & the
adjacent organ structures
d) the complications related to cyst rupture, spread of
protoscoleces

– Echinococcosis in humans is an infection which is

caused by a larval stage, the metacestode, of
Echinococcus species & may result in asymptomatic
infection to severe disease; it may even be fatal.
Clinical pictures

EE. granulosus s. l. cysts can remain asymptomatic for many years. They are
usually well tolerated until they cause pressure on surrounding tissues.
EThe symptoms resemble those of a slowly growing tumor.
EAlthough most people have only one cyst, multiple cysts can be found.
EApproximately 60-70% of E. granulosus cysts occur in the liver and 20-25%
in the lungs.
* The remaining cysts can be found almost anywhere in the body including the
bones, kidneys, spleen, muscles, CNS and behind the eye.
* Depending on the location, some cysts can become very large and may
contain up to several liters of fluid. Others in critical locations such as the
brain become symptomatic when they are still small.
 occurs when a cyst leaks
or ruptures; dissemination is seen mainly in the abdominal
cavity.
E Leakage of the cyst fluid can also cause allergic reactions
including shaking chills and/or fever, asthma, pruritus,
urticaria or life-threatening anaphylaxis.
E Other symptoms vary with the location(s) of the cysts. E.
granulosus cysts can also be asymptomatic throughout the
individual’s life, and may be incidental findings at surgery or
autopsy. Some cysts may die and not develop further.
 Hydatid cyst of E. multilocularis

Larvae form thin-walled cyst with

many chambers
Multilocular hydatid cyst
Hydatid…

• Thousands of protoscolices can fill

the hydatid (hydatide sand)

• Protoscolices are the infective

stage for dogs
• Hydatides usually grow slowly but
steadily (1-5 cm per year)

• They are usually well tolerated

until their size becomes a problem
or they rupture

• Cyst rupture or leakage can result

in allergic reactions and metastasis
Hydatid cyst of E. granulosus
• The cyst is lined by a multilayer parasite
tissue with the innermost layer being the
germinal layer

• This layer is a undifferentiated “stem cell”

layer that can spawn the formation of “brood
capsules” which are themselves lined by GL

• The daughter cysts (the encircled body)

"bud" into the center of the fluid-filled cyst.

• This is a very small portion of the cyst which

may become quite large.

• Each of the smaller bodies will develop into

diminutive tapeworms should this be eaten
by a definitive or final host such as a canine.
 Certain location of cysts

• Hepatic cysts

• Pulmonary cysts

• Cardiac cysts

• Cysts in other abdominal sites

 Diagnosis

• Hydatid cysts are usually found in MRI or X-rays.

• Serology
 Treatment

• Treatment options

• surgery

• PAIR

• Chemotherapy: benzimidazoles, Albendazole

 Prevention
• Washing hands after handling dogs of any description
and before eating or smoking.

• Don't allow dogs access to uncooked sheep, cattle offal

(including lungs, liver, kidneys and intestines).

• Restrain working dogs to prevent them from roaming &

getting access to dead animal carcasses

• Treat dogs regularly for tape-worms with tablets

containing praziquantel.
 Prevention in Humans

– Don’t feed livestock entrails to dogs

– Don’t allow dogs and cats to hunt
– Regularly test and/or treat animals allowed outside

Center for Food Security and

Public Health, Iowa State
 Prevention in Humans
• Minimize risk of egg ingestion
– Wash fruits and vegetables
– Wash hands frequently
– Avoid untreated water sources
– Do not handle wild carnivores
or their carcasses
– Thoroughly cook meat
before eating

Center for Food Security and

Public Health, Iowa State
 Prevention in Humans
• Wear personal protective equipment
• Regular surveillance
– Laboratory personnel
– Children exposed to feces of infected animals
• No vaccine

Center for Food Security and

Public Health, Iowa State
 Prevention in Animals
• Regular surveillance
• Treat infected animals (dogs)
– Praziquantel
– Multiple doses required
• Vaccination
– Recombinant

Center for Food Security and

Public Health, Iowa State
 E. multilocularis
• metastasizing
Transmission: E. multilocularis
• Definitive hosts
– Wild carnivores (e.g., fox)
– Domestic dogs and cats
• Intermediate hosts
– Small mammals (rodents)
– Domesticated mammals
– Humans

Center for Food Security and

Public Health, Iowa State
 Echinococcus multilocularis
• Common name: Fox tapeworm
• DH: Fox, dogs, cats
• IH: Rodents, small mammals & humans
• Habitat of adult worm: SI of the DH
• Habitat of larva: Viscera (internal) organ of the
IH
• Infective stage: Multilocular hydatid cyst
• Diagnostic stage: Eggs in feces
• Disease: Multilocular echinococcosis
Disease in Humans: E. multilocularis
• Cysts not enclosed within membrane as a
consequence:
* Invade surrounding tissues
* Disease is progressive and malignant
• May be asymptomatic
if cyst dies early in
development

Center for Food Security and

Public Health, Iowa State
• Hydatide grows like a sponge through entire liver

• Symptoms closely mimic cirrhosis or hepatocarcinoma

• Metastases can form in lung or brain

•
Prognosis is poor and depends on extend of organ
involvement
 Diagnosis
• Imaging techniques
– Ultrasound, radiology,
MRI, CT
• Serology
• Biopsy
• Detection of protoscolices
– Cyst fluid, sputum
• PCR
Center for Food Security and
Public Health, Iowa State
 Transmission
• E. vogeli • E. oligarthrus
– Definitive hosts – Definitive hosts
• Bush dogs • Wild felids
• Domestic dogs – Intermediate hosts
– Intermediate hosts • Rodents
• South American
rodents
(e.g., pacas)

Center for Food Security and

Public Health, Iowa State
 E. multilocularis cysts are very dangerous
1) as they are not enclosed within a membrane and
2) invade tissues by budding outward;
3) alveolar hydatidosis is progressive and malignant.

• As a result, cysts can spread to nearby organs and

metastasize to the brain, lungs, mediastinum and
other organs or tissues.
 Diphyllobothrium latum

Introduction
Epidemiology
Outline

Transmission & life cycle

Route of infection
Clinical pictures
Diagnosis
Prevention
 Introduction

• Diphyllobothrium latum, is the largest cestode found in

human intestine

• It is also known as fish tapeworm or human broad

tapeworm (proglottids are broader than longer,
latum means broader)
• Common name: Broad fish tapeworm
• DH: Fish-eating carnivores, including dogs, bears,
humans
• Two IHs are required
1st IH: Crustaceans, including copepods
 2nd IH: Fish
• Habitat of adult worm: SI of the human
• Infective stage for human: Plerocercoid larvae
• Diagnostic stage: Eggs/proglottids in feces
• Disease: Diphylobothriasis
Lifecycle stage: Egg----coracidium---procercoid-----
plerocercoid---adult
Has 3 larval stages
 Has 3 larval stages:
),
 Require 2 IHs to complete their lifecycle.
 D. latum (the fish or broad tapeworm), the
largest human tapeworm.
Other Diphyllobothrium species infecting
humans
D. pacificum,
D. cordatum,
D. ursi, and D. dendriticum,
 Epidemiology
• D. latum has a wide distribution, occurring
especially in populations known to eat uncooked or
partly cooked (i.e. smoked) fish.

• Are chiefly parasites of fish-eating mammals, birds

and fish.

• The life cycle of this tapeworm requires two

intermediate hosts.
Life cycle
Lifecycle
 Life cycle…

• A single worm shed 1,000,000 eggs/day

• Once in water they hatch out into small ciliates

coracidium which swim until ingested by
Copepods.

• In coracidium, 1st IH, the 1st larval stage are called

procercoids developed.
 Life cycle…

• When crustaceans/copepods are eaten by fish, the

procercoid larvae develops into plerocercoid larvae.

• It is this plerocercoid which develops in man when

they eat undercooked fish & they grow into adult
worms in the small intestine.

• The life cycle is completed when a human ingests

raw/under cooked infected fresh water fish
 Route of infection

• Oral: ingestion/eating of raw/under cooked

freshwater fish containing plerocercoid larva
 Clinical pictures
• The symptoms associated with D. latum infection may be
absent or minimal with eosinophilia.

• There may be occasional intestinal obstruction,

diarrhea, and abdominal pain.

• The most serious symptom is the onset of pernicious

anemia also called megaloblastic anaemia (low serum
B12).

• This is due to a vitamin B12 deficiency, caused by

excessive absorption of the vitamin by the adult worm
 Diagnosis

• The parasite should be suspected in a persons with

the history of eating raw or under cooked fish,

• By identification of proglottids & oval-shaped eggs

with a characteristics operculum
 Prevention

• This tapeworm infection can be avoided by not

eating/ingesting raw or undercooked fish in known
endemic areas

• Direct drainage of sewage into freshwater lakes

should avoided
 Summary
Organism Transmission Symptoms Diagnosis Treatment

Tenia saginata Cyst in beef Epigastric pain, vomiting, Proglottids or eggs in stool or Praziquantel
diarrhea perianal area

Tenia solium Cyst in pork Epigastric pain, vomiting, Proglottids or eggs in stool or Praziquantel
diarrhea perianal area

T. solium Cysticercosis Oro-fecal Muscle pain and weakness, Roentgenography, anti- Praziquantel
ocular and neurologic cysticercal antibody (EIA)
problems

D. latum Cyst in fish Abdominal pain, loss of weight, Proglottids or eggs in stool or Praziquantel
anorexia, malnutrition and perianal area
B12 deficiency problems

E. granulosus Oro-fecal Large cysts produce various Roentgenography, anti-hydatid Surgery, formalin injection and
symptoms depending on fluid antibody (EIA), drainage, Praziquantel
the location of the Casoni skin test
organism.

E. multiloculoris Oro-fecal As above As above Surgery, Albendazole

 Spirometra species
• Spirometra and Diphyllobothrium species other
than D. latum (that are not normal human
parasites) can accidentally infect human and
cause a disease called as sparganosis.
 What is Sparganosis?

• Ectopic infection by sparganum (plerocercoid) of non

human D latum spp (spirometra) i.e D. mansonoides
of cats
Most infections are due to copepods in drinking water or
ingestion of eggs accidentally.
Some are due to undercooked amphibians, reptiles, birds or mammals
 Sparganosis infection in human
• Human infection usually takes place in 3 ways
◙ By direct ingestion of infected copepods
◙ By ingestion of amphibian, reptiles, birds or
mammals (which in these spp serve as an IH instead
of fish) & the subsequent penetration of the released
plerocercoids
◙ By local application of flesh (e.g. frogs) as
poultices to wounds or to sore eyes where the larvae
migrate into the human tissue from the poultice
1. Procercoid penetrates
intestinal wall and migrates
into the subcutaneous
regions as the plerocercoid.
2. Plerocercoid
migrates to
subcutaneous
tissues and
undergoes no further
3. By a poultice, when
infected frog flesh is
applied into wound
Plerocercoid crawls
out of this host into
human.
 Summary
Organism Transmission Symptoms Diagnosis Treatment

Tenia saginata Cyst in beef Epigastric pain, vomiting, Proglottids or eggs in stool or Praziquantel
diarrhea perianal area

Tenia solium Cyst in pork Epigastric pain, vomiting, Proglottids or eggs in stool or Praziquantel
diarrhea perianal area

T. solium Cysticercosis Oro-fecal Muscle pain and weakness, Roentgenography, anti- Praziquantel
ocular and neurologic cysticercal antibody (EIA)
problems

D. latum Cyst in fish Abdominal pain, loss of weight, Proglottids or eggs in stool or Praziquantel
anorexia, malnutrition and perianal area
B12 deficiency problems

E. granulosus Oro-fecal Large cysts produce various Roentgenography, anti-hydatid Surgery, formalin injection and
symptoms depending on fluid antibody (EIA), drainage, Praziquantel
the location of the Casoni skin test
organism.

E. multiloculoris Oro-fecal As above As above Surgery, Albendazole