CESTODES

PREPARED BY: LOUISE ANNE D. SANTOS, RMT

CLASSIFICATION OF CESTODES
SYSTEMIC CLASSIFICATION

PHYLUM CLASS ORDER FAMILY GENUS

Pseudophyllidea Diphyllobothriidae Diphyllobothrium

Spirometra

Platyhelminthes Cestoda Taeniidae Taenia

Echinococcus

Cyclophyllidea Hymenolepididae Hymenolepis

Dipylidiidae Dipylidium
 CLASSIFICATION OF CESTODES
Classification of Cestodes Based on the Form of Parasite Important to Man
TAPEWORMS: GENERAL CHARACTERISTICS
1. White, Yellowish in color/Creamy white in color
2. Adult is FLAT
3. Segmented
4. MONOECIOUS/ HERMAPHRODITIC
5. NO GASTROINTESTINAL TRACT / ALIMENTRACT TRACT
6. NO CIRCULATORY SYSTEM
7. Entry of Nutrients and Exit of waste: Integument Skin
8. With Well-developed REPRODUCTIVE Organs: Testes, Ovary, Uterus
9. Mode of Transmission: Oral Route
10. HABITAT: Small Intestine
TAPEWORMS: GENERAL CHARACTERISTICS

11. CESTODE BODY CONSIST OF:

a. SCOLEX
- Anterior Attachment Organ
- Spoon-like (Almond)
 Pseudophyllidean vs. Cyclophyllidean
Pseudophyllidean Cyclophyllidean
✔ Spatulate or Spoon shape ✔ Globular scolex
Scolex ✔ With 2 bothria (false suckers) ✔ 4 acetabula (true suckers)
✔ Ventral and dorsal suckers ✔ May have rostellum or hooks
TAPEWORMS: GENERAL CHARACTERISTICS
11. CESTODE BODY CONSIST OF:

b. NECK Place where immature proglottids grow

- Region of growth
- Point of proliferation for the next set of
segments
 TAPEWORMS: GENERAL CHARACTERISTICS
11. CESTODE BODY CONSIST OF:

c. PROGLOTTIDS

- Chain of Segments/ Strobila

- Stained with India Ink:

→ Immature: found to the neck

→ Mature: at the middle portion where

reproductive structures are found

→ Gravid: filled with eggs, presence of

egg in the uterus
TAPEWORMS: GENERAL CHARACTERISTICS
11. CESTODE BODY CONSIST OF:
OTHER STRUCTURES

d. UTERINE PORE Pseudophyllidea

-Found at the Medical Surface
-Found in Diphyllobothrium latum
-Where the Eggs exits

e. GENITAL PORE Cyclophyllidea

-Site at where Male and Female
Organs Meet
Where india ink inject
 Characteristics of Gravid Proglottids
(Process of Egg Release)
1. Apolytic all cyclophyllidea
• segments rupture to release the
eggs (Lysis)
• Detaches ruptures liberating
the eggs
2. Anapolytic All pseudophyllidea
• Eggs are released through a
uterine pore
 Characteristics of Gravid Proglottids
(Process of Egg Release)

3. Craspedote
• Overlapping of segments
• Characteristic of
Hymenolepis spp.
4. Acraspedote
• No overlapping
 Pseudophyllidean vs. Cyclophyllidean
Pseudophyllidean Cyclophyllidean

✔ With central genital/ uterine ✔ Lateral genital pore

pore ✔ No uterine pore
Gravid ✔ Uterus: Rosette like appearance ✔ Uterus: In different shapes/patterns
Segments ✔ Anapolytic ✔ Apolytic
TAPEWORMS: GENERAL CHARACTERISTICS
12. Eggs: All eggs are non-operculated and mature (embryonated) except for
Diphyllobothrium latum.

→ ONCOSPHERE: Protects the Embryo; contains hooklets

→ HEXACANTH EMBRYO: Embryo with 6 hooklets
→ Diphyllobothrium latum: Operculated and immature (unembryonated) with
abopercular thickening
—> No Oncosphere, No Hexacanth Embryo
 Pseudophyllidean vs. Cyclophyllidean
Pseudophyllidean Cyclophyllidean
✔ Always operculated, immature ✔ Always non-operculated, mature and
Eggs
embryonated
Embryo ✔ Called coracidium ✔ Hexacanth (thorn spike)/ Oncosphere
 TAPEWORMS: GENERAL CHARACTERISTICS
13. ADULT: found in the intestines of the definitive host
14. Larva: Encysted in the tissues of the intermediate host
 Pseudophyllidean vs. Cyclophyllidean

Pseudophyllidean Cyclophyllidean
✔ 2 ✔ 1
IH –requirement

✔ 2 larval forms (L1 = procercoid, L2 = ✔ Larval form

plerocercoid/ sparganum) ✔ Cysticercus
✔ Cysticercoid
Encysted Larvae
✔ Hydatid cyst
✔ Coenurus
✔ protoscolex
 IV. A. Life Cycle of Pseudophyllidea

Infective stage

Coracidium
Embryo
 B. Life Cycle of Taenia
Eggs
Infective stage
C. Life Cycle of Hymenolepis nana
C. Life Cycle of Hymenolepis diminuta
D. Life Cycle of Dipylidium caninum
E. Life Cycle of Raillietina garrison
F. Life Cycle of Echinococcus
 V. INTESTINAL CESTODES
• Diphyllobothrium latum
• Taenia solium
• Taenia saginata
• Hymenolepis nana
• Hymenolepis diminuta
• Dipylidium caninum
• Raillietina garrisoni
 NEW NAME:
Diphyllobothrium latum Dibothriocephalus latus
• COMMON NAME: Broad Fish Tapeworm / Russian Broad Tapeworm / Fish
Tapeworm / Broad Tapeworm
Reservoir host : cats, dogs, bears
• INTERMEDIATE HOST:
• Primary = Cyclops and Diaptomus (Freshwater Copepods)
• Secondary = Trout, Salmon, Pike, Perch, Whitefish and Turbot (Freshwater
fishes)
• PARATENIC HOST: Carnivorous Fish (Bigger Fishes)

• DEFINITIVE HOST: Human

• Larval Stages: Coracidium -> Procercoid -> Plerocercoid

• INFECTIVE STAGE: Plerocercoid or Sparganum

• DIAGNOSTIC STAGE: Presence of Egg or Scolex
• DIAGNOSTIC TECHNIQUE
• Stool Examination (Identification of eggs, scolex, proglottids)
Morphology of Eggs
✔ Yellowish-brown in
color
✔ 58-76 um by 40-51
um in size
✔ Has an
inconspicuous
operculum at one
end and an
abopercular knob operculum
at the other end
✔ Has a thick shell
✔ Can be confused
with P. westermani
abopercular
Morphology of Adults
• Broader than long
• Rosette shaped uterus
• Absence of rostellum and hooks
• has spatulate scolex
Scolex with suctorial DARK, Rosette-like, COILED uteri Broad proglottids with
groves craspedote (overhanging)
margins.
 Disease: Diphyllobothriasis

Pathogenesis and Symptoms Mistaken as: pernicious anemia

• Infection is usually limited to a single worm

• Large number of worms are rarely involved and cause
intestinal obstruction
• Infected individuals may show no signs of infection
• Nervous disturbances, digestive disorders, abdominal
discomfort, weight loss, weakness and anemia may be
experienced
Similar with vitamin B12 defiency
• D. latum infection results in hyperchromic, megaloblastic
anemia with thrombocytopenia and leukopenia
Diagnosis
• History of travel to endemic areas accompanied by a raw
fish diet and pernicious type anemia is suggestive
• Finding the characteristic operculated eggs or proglottids
in the stool through DFS or Kato technique
Treatment
• Praziquantel is the drug of choice
• Make sure that the scolex is expelled in feces
• Re-examine the stool after 3 months if scolex was not seen
Prevention and Control

• Proper human fecal disposal

• Avoidance of eating raw or undercooked fish
• Thorough cooking of fish before consumption
Taenia spp
Morphology of Eggs
✔ Yellowish brown
✔ Spherical or subspherical in
shape
✔ Consists of a thick covering
called embryophore which is striated
striated
✔ The embryo or the
oncosphere is enclosed
within the embryo
✔ Three pairs of hooklets can
be seen in the embro 30-45 um in size
✔ Eggs cannot be distinguished
if T. saginata or T. solium
DIAGNOSTIC TECHNIQUE
• Scotch tape technique
• Formalin-ether/ethyl acetate concentration technique
• Intravital staining (eg. India ink)

EPIDEMIOLOGY
• Very common in places where people eat raw or poorly cooked
beef/pork
• Poor sanitation and flooded pastures along rivers
• Raw sewage disposed disposed in the river
• Use of nightsoil
• Human feces are fed to cows/pigs
 PREVENTION
• Cysticercus bovis in cattle meat may be destroyed by:
• freezing (-10°C) for 5 days
• Heating above 57°C (thermal death point)
• Soaking in 25% salt solution for 5 days
• Cysticercus cellulosae in pig meat may be destroyed by:
• Freezing (-20°C) for 10 days
• Control source of infection
• Avoid soil contamination CRITERIA FOR THE CURE:
• Proper meat inspection a) recovery of the scolex

b) a negative stool examination

3 months after treatment
 Taenia solium
• COMMON NAME: Pork Tapeworm
• INTERMEDIATE HOST : Pig
• DEFINITIVE HOST: Man
• INFECTIVE STAGE: Cysticercus cellulosae
• severe than T. saginata
Morphology of Adults
• 2 to 4 meters in length
• 8, 000 to 10, 000
proglottids
• Scolex has 4 acetabula
but smaller and more
spherical than T.
saginata
• Scolex has a cushion
like rostellum with a
double crown of 25-30
T. solium Rostellum
large and small hooks (Electron Micrograph)
• Has immature, mature and gravid
proglottids Gravid Proglottid
(7 to 13 finger or dendritic
1. Mature: Scolex like branches )
- square in shape
- contain mature male and
female reproductive organs ( 3 large
lobes of ovaries and 100-200 follicular
tests )

2. Gravid:
- 7 to 13 lateral branches
- contains 30, 000 to 50, 000
ova
- undergo apolysis
Cysticercus cellulosae in Pig’s flesh

Heart Liver
Cysticercus cellulosae
Pathogenesis:
1. Taeniasis solium (Intestinal infection)
• mild non-specific abdominal complaints
Diagnosis:
• Identifying the characteristic proglottids, eggs, or scolex
Treatment:
• Drug of choices are praziquantel and niclosamide
Pathogenesis:
Neurocysticercosis: in brain
2. Cysticercosis
• The cysticerci are often multiple
and can develop in any organ.
• Most common: Striated muscle
in the brain
• Subcutaneous tissue, eye, heart,
lung and peritoneum may be
involved
• Cysts may survive up to 5 years
•Ophthalmic cysticercosis - EYE
Optalmic cystercosis: in eyes
Neurocysticercosis
• Most serious clinical manifestation
• Most serious zoonotic disease worldwide

NCC is divided into 2 general forms:

• Parenchymal
• Extraparenchymal
• Subarachnoid/Meningitic
• Intraventricular
• Spinal
Diagnosis of Neurocysticercosis:
• Patient coming from an endemic area with epileptic seizures without
associated systemic symptoms
• Presumptive evidence: presence of subcutaneous cysticerci concomitant
with neurologic symptoms
• Computed axial tomography scan and Nuclear magnetic resonance
imaging
• CSF abnormalities:
• Increased protein and mononuclear cells and decreased glucose
• Serologic tests: ELISA and EITB/Western blot

Treatment of Neurocysticercosis:
• Praziquantel
• Corticosteroids (prednisone or IM dexamethasone)
• Albendazole
 Taenia saginata
• COMMON NAME: Beef Tapeworm
• INTERMEDIATE HOST: Cow or Cattle
• DEFINITIVE HOST: Man
• INFECTIVE STAGE: Cysticercus bovis
 Morphology of Adults
• 4 to 10 meters in length
• 1, 000 to 4, 000 proglottids
• It can reach up to 25 meters
in length
• Has a cuboidal scolex and 4
prominent acetabula
(suckers)
• Scolex has no rostellum or
hooks
• Has immature, mature and gravid
proglottids Gravid Proglottid
(Central trunk with 15-20
1. Mature: tree like branches)
- square in shape Scolex
- contain mature male and
female reproductive organs ( 2 large
lobes of ovaries and a median club-
shaped uterus, 300-400 follicular tests
and a vaginal sphincter )

2. Gravid:
- longer than wide
-Genital pores
-15-20 lateral branches
-Uterus
Cysticercus bovis in Cattle Flesh
Pathogenesis and Symptoms
• Patients with taeniasis may experience non- specific symptoms,
such as epigastric pain, vague discomfort, hunger pangs, weakness,
weight loss, loss of appetite, and pruritus ani (perianal itching).
• T. saginata proglottids are actively motile and they have been
documented to cause obstruction in the bile and pancreatic ducts,
as well as the appendix.
• Usually involves single worm infection
• 6 – 28 worms in a single patient were reported

Treatment
• Praziquantel
WHICH IS WHICH?
GRAVID PROGLOTTID
SCOLEX
Taenia asiatica Third species of taenia

• The third Taenia species, has been reported in Taiwan, Korea, Thailand,
and Indonesia.
• The cysticercus larvae of Taenia asiatica were found in the liver of
variable intermediate hosts that include pigs, cattle, goats, wild boars,
and monkeys, hence the term cysticercus viscerotropica.
• The cysticercus has wart-like protuberances on the external surface and
contains an invaginated scolex armed with vestigial hooklets.
• The scolex is devoid of hooklets but there is a prominent rostellum.
• The gravid proglottids have posterior protuberance with 11 to 32 lateral
branches arising from the main uterus.
• Due to the number of uterine branches and the presence of vaginal
sphincter, Taenia asiatica may be misidentified as Taenia saginata.
 Hymenolepis nana
• COMMON NAME: Dwarf Tapeworm
• SMALLEST TAPEWORM OF MAN
• MOST COMMON CESTODE OF MAN
• TRUE HUMAN TAPEWORM
• INTERMEDIATE HOST:
• Indirect: Insect (Rice or Flour Beetle — Tenebrio spp)
• Direct: None
• DEFINITIVE HOST: Man
• INFECTIVE STAGE:
• Indirect: Cysticercoid
• Direct: Embryonated Eggs
Morphology of Eggs
✔ Spherical or subspherical
✔ Colorless or clay colored
✔ Oncosphere has a thin outer
membrane and a thick inner
membrane
✔ With conspicuous bipolar
thickenings
✔ 4- 8 hair like polar filaments
spread between inner and
outer membrane
✔ Non-operculated

✔ Eggs die immediately once

30-47um in diameter
passed out into the
environment
 Note the presence of hooks in the oncosphere
and polar filaments within the space between the
oncosphere and outer shell.
 Morphology of Adults
• Craspedote strobila
• 25 to 45 mm in length, 1 mm in
width
• Scolex is subglobular with 4 cup
shaped suckers
• Retractable rostellum armed with
a single row of 20-30 Y shaped
hooklets
1. Mature:
- three ovoid testes
and one ovary
Scolex
-genital pores Gravid Proglottid

2. Gravid:
- testes and ovary
disappear
- sac like uterus filled
with eggs
Cercocystis cyst in intestinal villus
 Hymenolepis diminuta
• COMMON NAME: Rat Tapeworm
• INTERMEDIATE HOST : Rat flea, Flour Beetle, Cockroach
• DEFINITIVE HOST: Rat, Rarely man
• INFECTIVE STAGE: Cysticercoid
Morphology of Eggs

✔ Oncosphere is
enclosed in an inner
membrane with
bipolar thickenings
✔ NO BIPOLAR
FILAMENTS
✔ Hooklets have a fan-
like arrangement
30-47um in diameter
Four of the hooks are visible
Morphology of Adults
• 60 cm in length
• Rudimentary unarmed
rostellum
• No hooks
• Club shaped scolex
• 4 small suckers
1. Mature: Scolex 2 suckers Gravid Proglottid
- broader than long
- genital pores are
unilateral
- 3 ovoid testes and
1 ovary in a straight
pattern

2. Gravid:
-sac like uterus filled
with eggs
Pathogenesis and Symptoms
H. nana H. diminuta
• Light worm burden is generally • In man, the highest number recorded is 19
asymptomatic. worms.
• Clinical manifestations include headache, • Clinical manifestations are minimal and
dizziness, anorexia, pruritus of nose and non-specific.
anus, diarrhea, vomiting, abdominal pain,
• The life span of H. diminuta in humans is
pallor, and weight loss.
short, which possibly explains why human
• Some infected children are restless, infections are usually light.
irritable, and exhibit sleep disturbances.
• Heavy infections may result in enteritis
due to necrosis and desquamation of the
intestinal epithelial cells.
 Diagnosis
• Finding of the characteristic eggs in the stool

Treatment
• Praziquantel and Nitazoxanide

Prevention and Control

• Treatment of infected persons
• Hygiene
• Food sanitation
• Rodent control
WHICH IS WHICH?
 Dipylidium caninum
• COMMON NAME: Dog or cat tapeworm, pumpkin seed tapeworm or
Double pored tapeworm
• INTERMEDIATE HOST: Ctenocephalides canis (dog flea), Ctenocephalides
felis (cat flea) and Pulex irritans (human flea)
• DEFINITIVE HOST: Dog, Rarely man
• INFECTIVE STAGE: Cysticercoid
Morphology of Eggs

✔ Egg packet each

containing 8-15 eggs
✔ Enclosed in a packet
✔ Spherical, thin-shelled
with a hexacanth
embryo
✔ Non-operculated

✔ Size range of each egg:

30-60 um in diameter
 Morphology of Adults
• Pale reddish in color measures
10 to 70 cm in length
• Scolex is small and globular
• 4 deeply cupped suckers
• Protrusible rostellum which is
armed with 1 to 7 rows of rose
thorn shaped hooklets
1. Mature: Gravid Proglottid
Scolex
- narrow
- 2 sets of male and
female reproductive organs
- bilateral genital pores

2. Gravid:
- have the size and
shape of a pumpkin seed
- filled with packets of
8 to 15 eggs enclosed in an
embryonic membrane
 Pathogenesis and Symptoms
• Infection is rarely heavy and symptoms are minimal.
• Slight intestinal discomfort, epigastric pain, diarrhea, anal pruritus, and allergic
reactions have been reported.
• While most patients are asymptomatic, moderate eosinophilia has been
reported.

Diagnosis
• Recovery of the characteristic gravid proglottids passed out singly or in chain.

Treatment
• Praziquantel
Prevention

• Periodic deworming of pet cats and dogs

• Insecticide dusting of dogs and cats are effective against
fleas
 Raillietina garrisoni
• NO COMMON NAME
• Common tapeworm of rats
• Habitat: Small intestine
• Final host: Rats
• Accidental host: Man
• Intermediate host: Tribolium confusum (Flour beetle)
• Infective stage: Cysticercoid
• MOT: Ingestion of beetle
Morphology of Eggs

✔ Enclosed in an egg
capsule with 1-4
spindle shaped eggs
Morphology of Adults
• 60 cm in length 1. Mature:
• Minute, subglobular scolex with 4 - bilobed ovary
acetabula - 36 to 50 ovoid testes
• Rostellum is armed with 2 alternating - genital pore
circular rows of 90-140 hammer-
shaped hooks 2. Gravid:
- 2 mm in length containing
200 to 400 egg capsules with 1 to 4
spindle shaped eggs
- apolysis
Pathogenesis
• Patients are usually asymptomatic

Diagnosis
• Finding the characteristic proglottids or ova in stools

Treatment
• Praziquantel

Prevention and control

• Elimination of rodents

• Proper storage of grain products

• Sanitary waste disposal