MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA

BS MEDICAL LABORATORY SCIENCE

CESTODES/CESTODA ▪ Gravid proglottids

Sources: PPT, Recorded Video Lectures, & Belizario, • Uterus have eggs.
Vicente Jr., & De Leon (2013/2015) - Parasitology o Apolysis – the shedding of segments.
LIFE CYCLE & MOT
INTRODUCTION TO • Most cestodes require 1 intermediate host.
CESTODES/CESTODA • MOT: Ingestion and autoinfection
Note:
GENERAL CHARACTERISTICS All cestodes are non-operculated, and
• Multicellular worms embryonated & require 1 intermediate host.
• Flat or ribbon-like appearance o Except: Diphyllobothrium latum
• Hermaphroditic • Autoinfection
o Self-fertilizing/fertilization → Gravid o Hymenolepis nana
proglottids o Taenia solium
• Lacks digestive system and internal means of • Spp. requires a vertebrate intermediate host
excretion but has a reproductive system. o Taenia solium (pig)
• Common names: Flatworms/tapeworms o Taenia saginata (cow/cattle)
MORPHOLOGY • Spp. requires an invertebrate intermediate host
3 forms o Hymenolepis diminuta (IH: beetle,
• Egg fleas)
o Hexacanth embryo (oncosphere) • Spp. may/may not require an intermediate host
o Motile o Hymenolepis nana (IH: rice beetle
o 1st larval stage Tenebrio)
▪ Hooklets in pairs (6 small • Spp. may infect man in the larval stage
hooks) o Echinococcus granulosus
• Pierce intestinal wall o Taenia solium
• Larval LAB DX
o Intermediate host required (life cycles) • Specimens:
• Adult o Stool
o Resemble ribbon ▪ Eggs
o 15-20 m ▪ Gravid proglottids
▪ Tegument (occasionally)
• Nutrient absorption & • Crushed between 2
waste secretion site. slides.
Adult Body ▪ Scolex (rare)
3 distinct parts: • Appears after treatment.
• Scolex (anterior end) o Biopsy
o Suckers (4 cup-shaped) ▪ E. granulosus
▪ Attachment to the intestinal o Serum/plasma
mucosa. ▪ Serologic tests: enzyme
o Rostellum (some spp.) (CROWN) immunoassay, immunoblot
▪ Fleshy extension w/ 1 or 2 rows ▪ Echinococcosis
of hooks. ▪ Cysticercosis
• Neck CESTODES CLASSIFICATION
o Region of growth
o Germinal cells • Cestodes belong to the phylum:
o Responsible for new segment Platyhelminthes
production. • 2 categories: intestinal & intestinal-
• Strobila (Immature → Mature → Gravid) extraintestinal
o Entire length of tapeworm except for TAENIA SAGINATA &
scolex & neck.
o Collection of proglottids/segments TAENIA SOLIUM
▪ Mature proglottids T. saginata
• Reproductive organ site. • Common name: Beef tapeworm

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 MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA
BS MEDICAL LABORATORY SCIENCE

• Common asso. disease & condition: Taeniasis,

Beef tapeworm infection
• T. solium
o Common name: Pork tapeworm
o Common asso. disease & condition:
Cysticercosis, Pork tapeworm
infection
EPIDEMIOLOGY
• Distribution: areas w/c inhabitants do not
practice beef/pork sanitary conditions.
• T. saginata: cosmopolitan areas Larva: scolex surrounded w/ bladder-like, a thin-walled
• T. solium: worldwide cyst filled w/ fluid.
MORPHOLOGY
Egg/Ova (Taenia spp.)

LIFE CYCLE
DH: Man
IH: Saginata (cattle); Solium (pig)

Adult
T. saginata & T. solium
Characteristics T. saginata T. Solium
Scolex
• Suckers 4 4
• Rostellum Absent Present
• Hooks Absent Present
Gravid
proglottids 1. Diagnostic Stage: Egg/Gravid proglottids in the
Appearance/shape Longer (17.5 Somewhat feces.
by 5.5 µ) square 2. Cattle/Pig ingested eggs/GP then became
Rectangular infected.
# of lateral 15-30 7-15 3. Oncosphere hatch & penetrates intestinal wall &
branches (uterus’ circulate to muscles.
sides) 4. Infective Stage: The oncosphere develops into
Cysticerci in the muscle. Ingested by humans
thru raw/undercooked infected meat.
5. Scolex of either saginata/solium attaches to the
intestine.
6. Adults stay inside the small intestine.

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 MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA
BS MEDICAL LABORATORY SCIENCE

LAB DX Taenia asiatica (Asian taenia)

• Stool
o Taenia eggs
o Gravid proglottids
o Scolex (after antiparasitic treatment)
• Perianal area
o Taenia eggs (cellophane tape prep:
high rate)
• India ink
o Injected in genital pores for an accurate
count of lateral branches of the uterus.
PATHOLOGY
• Most people are asymptomatic.
• TAENIASIS:
o Diarrhea, abdominal pain, appetite
changes, slight weight loss, vomiting,
nausea, & dizziness. EPIDEMIOLOGY
o Pruritus ani (perianal itching) • Taiwan, Korea, Thailand, & Indonesia.
o Intestinal obstruction • Closely related to T. saginata.
• CYSTICERCOSIS/CYSTICERCUS Additional Info
CELLULOSAE: (t. solium) • Cysticercus larvae: liver (Cysticercus
o Location: striated muscles & brain viscerotropica)
(common); sub tissues, eye, heart, lung, • IH:
& peritoneum. o Pigs
o Living cyst produce inflammation. o Cattle
o Manifestation: o Goats
NEUROCYSTICERCOSIS (NCC) o Wild boars
▪ Cysticerci (w/ scolex) found in o Monkeys
brain parenchyma/free floating MORPHOLOGY
in ventricles. Adult (T. asiatica)
▪ Seizures, headache, confusion,
ataxia, or death.
TREATMENT
• Most important treatment: the eradication of
scolex
• Praziquantel
o Effective against adult form
o Not advisable if ocular/CNS is involved
• Paramomycin
• Quinacrine hydrochloride (Atabrine)
PREVENTION AND CONTROL
3 important p & c: • Wart-like protuberances (external surface)
1. Exercising proper sanitation practices. • Scolex & prominent Rostellum (Present)
2. Thorough beef & pork cooking prior to • Hooklets (Absent)
consumption. • Gravid proglottids
3. Promptly treating infected persons. o 11-32 lateral branches (main uterus)
4. Freezing meat at -20°C (10 days) kills ▪ Misidentified as T.saginata
Cysticerci. • Mature proglottids
o Carries a vaginal sphincter.
HYMENOLEPIS DIMINUTA
• Common name: Rat tapeworm

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 MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA
BS MEDICAL LABORATORY SCIENCE

• Common asso. disease & condition:

Hymenolepiasis, Rat tapeworm disease
• “Fan-shaped; “Fried-egg” appearance
• Trapezoidal proglottids
EPIDEMIOLOGY
• Worldwide (poor areas w/ rat infestation)
o Common: Children
• Areas w/ foodstuffs of grain/cereal not protected
from rats & insects.
• Accidental ingestion of grain beetles infesting
dried grains/fruits, flour, & cereal.
• IH: Grain beetle, flea
• Nana & Diminuta has same proglottids.
MORPHOLOGY
Ova (Hymenolepis diminuta)
LIFE CYCLE

Adult (Hymenolepis diminuta)

Characteristics H. diminuta
1. Diagnostic Stage: Eggs in the feces.
Scolex 2. Arthropods (IH: grain beetles) ingested eggs
• Suckers 4 and became infected.
• Rostellum (small) Present 3. Oncosphere hatch & penetrates intestinal wall &
• Hooks Absent circulate to muscles.
Gravid proglottids 4. Infective Stage: The oncosphere develops into
Size Rectangular (1 mm Cysticerci in the insect’s muscle. Insects
by 2mm) ingested by humans/rodents.
Appearance/shape Saclike uterus filled 5. Scolex attaches to the intestine.
w/ eggs 6. Adults stay inside the small intestine.
7. Adults develop to mature gravid adults.
• Each Segment
o One pair of male & female repro organs. HYMENOLEPIS NANA
• Common name: Dwarf tapeworm
• Common asso. disease & condition:
Hymenolepiasis, Dwarf tapeworm disease
• IH: Transport hosts:
o Rice beetle/Tenebrio
o Fleas, beetles, rats/House mice
• Lancet-shaped

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 MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA
BS MEDICAL LABORATORY SCIENCE

MORPHOLOGY LIFE CYCLE

Ova (Hymenolepis nana)

1. Diagnostic/Infective Stage: Embryonated eggs

in the feces.
2. Eggs ingested by insects & cysticercoid
develop/proceed to #4.
3. Humans & rodents get infected after ingestion of
cysticercoid-infected arthropods.
4. Infective Stage: Embryonated egg ingested by
Adult (Hymenolepis diminuta)
humans from contaminated food, water/hands.
Characteristics H. nana 5. From # 4: Oncosphere hatches. From #3/4:
Scolex Rhomboid Cysticercoids develop in the intestinal villus.
• Suckers 4 6. Scolex attaches to the intestine.
• Rostellum (small) Present (short) 7. Adults in the small intestine (ileal portion).
• Hooks Present (one row) 8. Mature gravid adults release eggs thru genital
Gravid proglottids atrium/gravid proglottids disintegrate releasing
Size Rectangular (1 mm eggs passed on stools.
by 2mm) 9. Autoinfection (eggs stay in the intestine)
Appearance/shape Saclike uterus filled Infective stage: Eggs release hexacanth embryo
w/ eggs → penetrates intestinal villus then repeat cycle.
LAB DX
• Stool
o Eggs
o Proglottids (occasionally because they
disintegrate in the gut)
o Scolex (rare)
PATHOLOGY
• Asymptomatic (H. diminuta)
• Hymenolepiasis, Dwarf/Rat tapeworm disease
▪ Diarrhea
▪ Nausea
▪ Abdominal pains
▪ Anorexia
▪ Dizziness
▪ Headache
TREATMENT
• Praziquantel (treatment of choice)

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 MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA
BS MEDICAL LABORATORY SCIENCE

• Niclosamide (alt) • Neck Short & slender

DIPYLIDIUM CANINUM Gravid proglottids
• Common name: Dog/cat tapeworm; Pumpkin Size Pumpkin seed
seed tapeworm; Double-pored tapeworm Appearance/shape Full of eggs in enclosed
• Common asso. disease & condition: embryonic membrane
Dipylidiasis, Dog/cat tapeworm disease • Immature Broader than longer
• Very common intestinal tapeworm of dogs & (Squarish outline)
cats. • Mature Cucumber seeds/pumpkin
DH: Dogs/cats; IDH: Human seeds (relaxed water)
• IH: Bilateral genital pores
• Ctenocephalides canis-dog flea (Dog flea) • Doubled rep organs
• Ctenocephalides felis-cat flea (Cat flea) (each segment)
• Pulex irritans-human flea (Human flea) • Gravid Shaped: Vase-shaped
• Trichodectes canis (dog louse) Packets: 8-15 eggs
MORPHOLOGY Embryonic membrane: filled
Ova (Dipylidium caninum) w/ membranous egg capsules in
“mother packets”

• Spherical
• Thin-shelled (hyaline w/ hexacanth embryo)
• Brick-red tinge

LIFE CYCLE

Adult (Dipylidium caninum)

Characteristics
Scolex Rhomboid, small, globular
• Suckers 4 (deeply cupped)
• Rostellum • Present
(small) (refractile/protrusible
conical)
• Club-shaped
• 1-7 circlet/rows (rose-
1. Diagnostic: Gravid proglottids (Feces/Perianal
thorned shaped spines)
region) of human/animal.
• Hooks Absent

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 MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA
BS MEDICAL LABORATORY SCIENCE

2. DIAGNOSTIC: Proglottids disintegrate & MORPHOLOGY

release egg packets. OVA (Diphyllobothrium latum)
3. Flea larvae of IH ingests egg packets.
Oncospheres hatch into cysticercoids.
4. Flea larvae mature into adult fleas (continuously
harbor cysticercoid).
5. INFECTIVE: DH ingests fleas w/
cysticercoids. IDH (human) transmission:
ingestion of infected fleas from cats/dogs
6. Cysticercoid develops into an adult in the small
intestine & develops a scolex.
• Habitat:
• Small intestine
• Diagnostic stage:
• Proglottids; Egg packets
• Infective stage:
• Cysticercoid larvae
• Mode of Transmission:
• Ingestion of infected flea
LAB DX
ADULT (Diphyllobothrium latum)
• Stool
o Egg packets/gravid proglottids Characteristics
PATHOLOGY Scolex
• Dipylidiasis/Dog tapeworm infection • Suckers & shape 2 bothria/bothrium
1. Pruritus ani (perianal anal) (Almond/spatulate)
2. Epigastric pain Gravid proglottids
3. Diarrhea Shape Wider than long
PREVENTION & CONTROL
1. Dogs & cats examined by vet regularly Appearance of uterine & Central; rosette
(deworming). loc
2. Pets are treated & protected against flea Mature proglottids Male organs:
infestation regularly. Terminate in muscular
3. Children are taught not to let dogs/cats lick them cirrus in common
in/near their mouths. genital pore.
TREATMENT Female organs:
• Praziquantel, Niclosamide, Quinacrine, & Symmetrically bilobed
Epsiprantel. ovary.
Vagina extending from
DIPHYLLOBOTHRIUM common genital pore
LATUM in midventral line.
• Common name: Broad/Fish tapeworm
• Common asso. disease & condition:
Diphyllobothriasis, Fish tapeworm infection,
broad fish tapeworm infection
• 1st IH:
o Copepods
• 2nd IH:
o Freshwater fish
• LARGEST TAPEWORM TO MAN
• Found in places that consume raw fish.

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 MANILA ADVENTIST COLLEGE BSMLS-3: CESTODES/CESTODA
BS MEDICAL LABORATORY SCIENCE

• Common asso. disease & condition:

LIFE CYCLE Echinococcosis, hyatid cyst/disease,
hyatidosis.
EPIDEMIOLOGY
- Found in areas where sheep/herbivores raised
has close contacts w/ dogs/wild canines.
- Former: Taenia granulosus
- SHORTEST TAPEWORM
- DH: Dog
- IH: Sheep, Goats/Swine
- AH & Dead-end host: Human
MORPHOLOGY
OVA (Echinococcus granulosus) – same w/ taenia spp.
HYATID CYST (Echinococcus granulosus)

1. DIAGNOSTIC: Unembryonated eggs (feces)

2. Water: become embryonated
3. Coracidia: hatch from eggs & ingested by
crustaceans/copepods (cyclops) – 1st IH
4. Procercoid larvae [larval stage – 2nd] (body
cavity – crustaceans)
5. INFECTIVE: Infected crustacean ingested by
small freshwater fish. Procercoid larvae →
pleurocercoid larvae [ precursor larval stage –
1st] (small fish cavity) – 2nd IH
6. Predator fish (transport host) ingests small fish.
7. Human ingests raw infected fish
(small/predator).
8. Small intestine: adult development (scolex &
proglottids)
9. Gravid proglottids release
immature/unembryonated eggs.
LAB DX
• Stool
o Eggs
o Proglottids (occasionally because they
disintegrate in the gut)
o Scolex (rare)
PATHOLOGY
Diphyllobothriasis (Jewish housewife’s disease,
bothriocephalitis)
• Loss of vitamin B12
• Macrocytic anemia
TREATMENT - Unilocular; slow growing
- Drug of choice: Praziquantel - Round & cystic
- Other drugs: Niclosamide, Quinacrine, & HCl - Tumor-like space occupying structure.
o Cystic fluid
ECHINOCOCCUS
o Brood capsule: tapeworm scolices form
GRANULOSUS o Protoscolex: form new cysts
• Common name: Dog/hyatid tapeworm

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BS MEDICAL LABORATORY SCIENCE

▪
Hyatid sand: accumulation of - Hydatid cyst: liver, lung, brain, eye, kidney,
protoscolex that settle down at muscle, bone, heart
bottom of cyst. LAB DX
ADULT (Echinococcus granulosus) - BIOPSY (method of choice)
Characteristics o Hyatid cyst fluid
Scolex Rhomboid ▪ Presence of scolices, daughter
• Shape Pyriform cysts, brood caps/hyatid sand.
• Suckers 4 ▪ Careful method usage when
• Rostellum (small) Present collecting to avoid anaphylaxis
(fluid escapes from cyst)
• Hooks Present (30-36)
- SEROLOGIC TEST
Neck & Strobila
o ELISA
• Length Short o Indirect hemagglutination
• Segments 3 (immature, mature o Western blot
& gravid) - DETECTION OF HYATID CYSTS
Gravid proglottids o Radiography
o CT
Size Small o Ultrasound
Appearance/shape Loosely twisted coil PATHOLOGY
uterus - Echinococcosis: Hydatid Cyst, Hydatid
Disease, Hyatidosis
o Tissue necrosis w/ buildup of pressure.
o Death
o Anaphylactic shock, eosinophilia, &
allergic rxn/death (rapture cyst)
o Lung infection (cough, chest pain, &
shortness of breath)
o Liver (obstructive jaundice)
o Larval stage (hyatid cyst)
LIFE CYCLE ▪ Carry P blood group antigen
- Casseous hyatid cyst
o Unilocular cyst found in bone canal.
TREATMENT
- Treatment of choice
o Surgical removal of hyatid cyst on
operable sites.
- Surgical management
o Hibitane
o 95% ethanol
o 30% hypertonic saline
- PAIR Treatment
o Puncture
o Aspiration of 30 mL cyst fluid
o Injection of scolicidal agents
o Respiration
- Drugs (inoperable)
▪ Definitive host: Dogs, Jackals, wolves, canines o Mebendazole
▪ Intermediate host: sheep, goat, camel, horse, hogs, o Albendazole
human o Praziquantel
▪ Diagnostic stage: Hydatid cyst PREVENTION & CONTROL
▪ Infective stage: embryonated eggs - Appropriate personal hygiene practices.
▪ Habitat: - Discontinue feeding canines potentially
- Adult: Small intestine contaminated viscera.
- Treat infected canines & human.

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