Trematodes (flat worm) , flukes

Dr. Nada AL- Bashier 1

Phylum Platyhelminthes
Bilaterally symmetrical
Compressed dorso-ventrally
They lack a circulatory
system
Some species are
hermaphroditic or monoecious
Some are diecious
Possess a bilaterally
symmetrical excretory system,
collecting tubules, and
capillaries which terminate in
“flame cells”.
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Two classes under Phylum Platyhelminthes
which are of medical importance:
a. Class Cestoidea

b. Class Trematoda

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 Cestoda (Tapeworms)

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Characters:-
•Cestodes are tape-like , or ribbon like shape .
•Flattened dorso-ventrally, with segmented
bodies.
•They possess head (scolex), followed by an
unsegmented germinative section (neck), and
a posterior chain of segments (proglottids ).
•The head carries four cup like suckers, or
bothria
they has rostellum which may be armed with
hooklets.
•The posterior chain strobila (body or trunk) ,
it consists of a number of segments (or
proglottids). The length of the tapeworm
varies based on the number of segments .

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•Proglottids bear the reproductive
organs(both male and female); there are
three types of proglottids
(1) Immature
(2) mature and
(3) gravid segments
•Has no body cavity , they do not possess
an alimentary system, so nutrients are
taken up through the absorptive
integument
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•They are hermaphrodites (monoecious)
•They are oviparous
•The life cycle of cestodes include one or two
intermediate hosts.
• Humans can also be infected by larval stages
of various tapeworm species (cysticerci,
metacestodes).
•These stages develop in body tissues and
generally cause much greater pathological
damage than the intestinal cestode (adult)
stages.

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Class : Cestodes
Order: Pseudophyllidea – scolex spatulate with bothria
Diphyllobothrium latum
Order: Cyclophyllidea- scolex globular with 4 cuplike suckers
A. Species which requires vertebrate intermediate hosts
1. Taenia solium
2. Taenia saginata
B. Species which require invertebrate intermediate hosts
1. Dipyllidium caninum
2. Hymenolepis diminuta
C. Species which may or may not require intermediate host
Hymenolepis nana
D. Species which may infect man in their larval stages
1. Echinococcus granulosus
2. Echinococcus multilocularis
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Diphyllobothrium latum :-

•Diphyllobothrium latum, is the largest

cestode found in human intestine
,reaching lengths up to 10 m or more
and consisting of a chain of 3,000 to
4,000 proglottids, each up to 2 cm wide.
•Common name: Fish tape worm /
Broad tape worm (proglottids are wide
more than long, latum means broader)
•Diphyllobothrium is a genus of tape
worm which can cause
Diphyllobothriasis in humans through
consumption of raw or undercooked
fish. 9 Dr. Nada AL- Bashier
•Its life cycle was described by
Rosen in 1917
•Few species other than D. latum
can rarely infect humans like D.
dendriticum, & D. pacificum

Habitat
The adult worm of D. latum resides in the
small intestine (jejunum and ileum) of
humans.

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 bothria
Morphology
Adult worm
•The adult worm is composed of three fairly distinct
morphological segments:
1. Scolex elliptical or spatula-like or almond in shape,
2. The neck, represents the growing end, from which the
proglottids arise.
3. The lower body (Strobila).
•Each side of the scolex has a slit-like sucking groove, one dorsal
and the other ventral (bothria ) for attachment to the intestine.
•The scolex lacks suckers and hooks, the scolex attaches to the
neck, or proliferative region.
•From the neck grow many proglottid (3,000-4,000) segments
which contain the reproductive organs of the worm.
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•In adults, segments divided into
•immature,
•mature and
• gravid segments which are wider than they
are long.
• In Pseudophyllid cestodes, the genital pores
open mid ventrally.
• Gravid segment: Uterus is filled with eggs
•Some terminal gravid segments become
shrunken and empty due to discharge of eggs
and break off from the body and passed in
the feces. (This is known as pseudo apolysis).
• Adults can shed up to a million operculated
eggs a day. operculated
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Host:

Infective form: Third stage (plerocercoid) larvae

Modes of transmission: Humans get infection by
ingestion of undercooked fresh water fish
containing third stage plerocercoid larva.
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 Immature eggs discharged from gravid
proglottids of the adult in the human
small intestine and passed in the feces
The egg hatches in fresh water to
produce a ciliated oncosphere
(coracidium)
Coracidia ingestion by
copepod

Coracidia develops into

procercoid larvae
Fresh water fish ingests
copepod
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 When infected Cyclops are ingested by
the freshwater fish the procercoid
larva penetrates the intestinal wall
They develop into plerocercoid
larvae (sparaganum)

Infective stage for humans, cat,

dog, or bear plecercoid larvae

Plecercoid larvae in musculature

of the fish

When human eat raw or

undercooked fish
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 Pleceroid larvae becomes immature
adults

Then mature adults

Reside in the small intestine as
tapeworms
Attached to the intestinal mucosa by
the bothria of their solex
Adults have more than 3000
proglottides
Produce immature eggs ( 1,000,000 eggs
per worm) Proglottids and eggs pass in
faeces

After 5-6 weeks after infection eggs

appear in faeces
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 Pathogenicity

Intestinal disturbances as
abdominal pains,
dyspepsia,
diarrhoea,constipation&
weight loss

Worms that attached in the Neurologic

Large duodenum or jejunum and manifestations
number of absorbing 80% or more of are common
worms may the host’s B12 intake lead due to sever
produce to sever vitamin B12 anemia
intestinal deficiency which lead to
obstruction pernicious macrocytic
(megaloblastic) anemia
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 Blood Examination
Eosinophilia mild to moderate
Evidence of megaloblastic anemia
Macrocytes (enlarged RBCs) are present.

characteristic
eggs
Diagnosis Stool
Examination
proglottid
segments

identify the nature of the

infection to the genus level
Molecular
PCR
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Treatment:-
Praziquantel is highly effective (drug of choice)
Niclosamide is given alternatively
Vitamin B12 should be given if B12 deficiency is
manifested.
Another interesting potential diagnostic tool and
treatment is the contrast medium, Gastrografin,
introduced into the duodenum, which allows both
visualization of the parasite, and has also been
shown to cause detachment and passing of the whole
worm.
Prevention and Control :-
Sanitary disposal of sewage
Proper cooking/ freezing of fish
Treat infected patients
Health education
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 (Tapeworms)
Taenia saginata,
Taenia solium

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Cestoda (Tapeworms)Taenia saginata , & Taenia solium
*Taeniasis is a small intestine infection of humans caused by
Taenia species.
*In T. saginata, the intermediate hosts are cattle. Human are
definitive host
*In the muscles of the cattle (intermediate hosts) cysticerci
develop and can be ingested by humans (final host ) who eat raw
beef.
*The cysticerci of T. solium develop in the muscles of pigs and
can be ingested by humans (final host) who eat raw pork meat

Taenia saginata
Taenia solium
small intestine

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Taenia saginata (Beef Tapeworm),
unarmed tapeworm
Causative agent:-
T. saginata causes taeniasis in human
Occurrence.:- This species occurs
worldwide the number of infected
humans is estimated to be between 40
and 60 million.
•The parasite T. saginata grows as
long as 10m and has a scolex with four
suckers
•No rostellum, No hooklets.

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The mature segment contains the male and the
female reproductive organs
Proglottids at the posterior end (gravid) of the
chain are longer than wide and each contains with
15–20 lateral branches tree-like branched uterus
containing eggs.
No. of Proglottids :1000-2000
•The eggs are released when a proglottid
separate from the tapeworm in the
intestinal lumen or when a segment
disintegrates outside the host.
•The eggs are small diameter (30–40 µm)
and round.
•The eggs are highly resistant and can
remain infective in a moist environment
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for weeks or months. 26
life Cycle of Taenia saginata
Host: Men act as the definitive and cattle serve as the
intermediate host.
Infective stage: Cysticercus bovis (larval stage) is the infective
stage to men while eggs are infective to cattle.
The Human Cycle
Mode of transmission: Man acquires the infection by ingestion of
undercooked beef containing encysted larval (beef measles) stage
cysticercus bovis).
Larva transforms to adult: The larva hatch out in small
intestine, the scolices evaginates and attaches to the intestinal
wall by suckers and gradually develop into the adult worms.
Adult worms become sexually mature in 14 weeks, fertilization
occurs (self or cross fertilization within the segments) and eggs
are formed & later released to the feces.
Eggs are infective to cattle.
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The Cattle Cycle
•Feces of humans infected with Taenia,
contaminate pasture or feed either directly or
via sewage.
•When the cattle ingest the eggs, the
hexacanth embryo (oncospheres) hatch in the
small intestine, migrate into the intestinal
wall, and are transported with the
bloodstream into the striated muscles and
heart of the cattle .
•In the striated muscle they develop in to the
infective metacestodes or cysticerci
(Cysticercus bovis) within three to four
months.
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•Each cysticercus is a pea-sized, fluid-filled cyst containing a
single invaginated scolex
•Humans are infected by ingesting raw or undercooked beef
(beef measles )containing cysticerci.

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Pathogenesis and clinical manifestations.
•T.saginata causes morphological changes in small
intestine like villus deformation, enterocyte
proliferation, cellular mucosal infiltration, and
functional disturbances.
•Eosinophilia may occur sometimes.
•The infection takes an asymptomatic course in about
25% of cases.
•Symptoms of infection include nausea, vomiting,
upper abdominal pains, diarrhea or constipation and
decreased appetite.

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 Antigen,
Antibody
detection Segments /
gravid
proglottids,
Stool
examination
to detect
Diagnosis
eggs

Molecular
method PCR

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 Treatment
Drug of choice is prazi-quantel ,
It is effective against adult tapeworm in a single
dose and kills cysticerci in high dose (50-100mg/kg)
Niclosamide

Prophylaxis
Sanitary disposal of human feces
Adequate meat inspection
Cooking beef or freezing at -20c for 24 hours
Stool examination of food handlers of endemic area

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Taenia solium (Pork Tapeworm)

Causative agent of T. solium taeniasis and

cysticercosis
T. solium (solium: from the Arabic word sosl:
chain) is 3–4 m long and is thus smaller than
T. saginata.
The scolex of T. solium has a rostellum
armed with two rows of hooks in addition to
the four suckers.
•Inside the gravid segments, the number of
lateral uterus branches is usually 7–13, i.e.,
less than in T. saginata (usually >15).

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 life Cycle of Taenia solium

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T. solium depends on the disease it causes.
When it causes intestinal taeniasis, the life cycle is exactly
similar to that of T. saginata except:
The intermediate host is pig (hence called as pork
tapeworm)
Men is the final host , harboring the adult worm
excrete the eggs in feces.
But when it causes cysticercosis, the life cycle is different
and given as below:
Host: Man acts as intermediate host.
Infective stage: Eggs of T. solium.
Mode of transmission: Firstly man acquire the infection
by:- (1) ingestion of contaminated food or water with eggs
of T. solium
(2) autoinfection. 35 Dr. Nada AL- Bashier
Further life cycle in men is similar to that in
pigs.
Oncosphere is released from the eggs,
penetrates the intestine and enters into the
portal circulation or mesenteric lymphatics
and reaches to various organs like
subcutaneous tissue, muscle, eye and brain
where it is transformed to the larval stage
cysticercus cellulosae
Full development to mature cysts takes 2–3 months of
time.
Cysticercus cellulosae: A mature cysticercus cellulosae
is 0.5–1.5 cm size, spherical (or slightly oval), yellowish
white, separated from the host tissue by a thin
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collagenous capsule. 36
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Clinical manifestations:-
•T. solium in the intestine causes
taeniasis with mild symptoms,
similar to infections with T. saginata.

Diagnosis, therapy, prevention, and control.

•The recommendations made for diagnosis and therapy
of T.saginata apply here as well.
•Infections with T. solium can be prevented by cooking
or deep-freezing the pork (–20 C for at least 24 hours).
•Control measures in endemic areas include mass
treatment of the population with prazi-quantel,
improvement of hygiene and slaughter animal
inspection.
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Cysticercosis:-
Clinical manifestation of the disease
depend upon the localization of the cyst.
Any organ or tissue may be involved,
the most common sites of infection are
central nervous system (CNS) ,
subcutaneous tissue, skeletal.
 It may also affect the eyes, brain,
and less often the heart, liver, lungs,
abdominal cavity, and spinal cord.

The cysticercus is surrounded by a fibrous

capsule except in the eye , and brain.
Subcutaneous cysticercosis: It is frequently
asymptomatic, but may manifest as clear
nodules
Muscular cysticercosis: Manifest as muscular
pain, weakness
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Ocular cysticercosis: Can involve eye lids,
conjunctiva.
 Common symptoms like proptosis, diplopia,
loss of vision and slow growing nodule with focal
inflammation
Neuro-cysticercosis (NCC). Neuro-cysticerosis
(cysticercosis of brain) is the most common and
most serious form of cysticercosis.
 About 70% of adult-onset epilepsy is due to
neuro-cysticercosis. Other clinical features of
neuro-cysticercosis are increased intracranial
tension, hydrocephalus, , meningoencephalitis, ,
behavioral disorders , aphasia, and visual
disturbances.

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