Acknowledgements

 Addis Ababa University

 Jimma University
 Hawassa University
 Haramaya University
 University of Gondar
 American Society for Clinical Pathology
 Center for Disease Control and Prevention
 Class Cestoidea

 The Tape Worms

 General characteristics
 Segmented long tape-like worms
 Vary from few mm to several meters
 Flattened dorsoventrally
 Has no body cavity/alimentary canal, circulatory
system & respiratory system
 Obtains its nutrient by absorption through body
surface.
Characterstics...
 Bilaterally symmetrical
 Hermaphrodities ( well developed reproductive
system.
 Sexual-Oviporous
 Excretory system: flame cells and collecting
tubules drain into ventral and dorsal longitudinal
excretory canals

4
 Morphology
 The body is divided in to three main body regions:
 Head (scolex) – attachment region
 Neck – growth region
 Strobila

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Morphology...
1. Scolex (head): carry organs of fixation.
 Two basic types of scolex:
 Acetabulum – suckers

 Bothria – slit – like grooves

 The scolex may carry rostellum.

 A rostellum with hooks = armed

 A rostellum without hooks = unarmed

2. Neck : actively dividing part forming the strobila

3. Strobila (segments or proglottids): entire chain of
proglotids. 6
Morphology…

Scolex (head)

Neck

Strobila made up of
proglottids
Proglotids

 Set of reproductive organs

 Includes male & female organs & genital pore
 Segments/ Body divisions
 Segments may have one or more proglottids
 More mature as gets farther from neck
 Size & shape of segment along with number of
proglottids & location of genital pore key to
identification of the tapeworms.
 The strobila has three portions:
a. Immature segements the anterior most
segments in which the reproductive organs
are not fully developed
b. Mature segments in which the organs are fully
developed and functioning, and
c. Gravid segments having a uterus full of eggs.
It has reduced or atrophied primary genital
organs. 9
Cestode scolex

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Cestode eggs
 Two type
 Operculated, immature when voided to the
external environment.
operculum
Eggs…
 Non-operculated ,fully embryonated when
voided to the external environment.
Cestode - Eggs

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 Man may be infected with the adult tapeworms or their
larval stages:
1. Human infection with adult cestodes (intestinal
cestodes):
a. D. Latum (Broad fish tapeworm)
b. T. Saginata (Beef tapeworm)
c. T. Solium (Pork tapeworm)
d. H. Nana (Dwarf tapeworm)
e. H. Diminuta
f. D. Caninum (Dog tapeworm)

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Cestodes…
1. Human infection with larval cestodes (extra -
intestinal cestodes):
a. Sparganosis
b. Cysticercosis
c. Hydatid disease
d. Coenurosis
 Taenia
Taenia species
species
Habitat
 Adult : in the small intesine of man
 Larvae: in muscular tissues of cattle, pigs
 Eggs: in faeces of man or in gravid segments
 Geographical Distribution:-
 T. saginata
 World wide distribution where cattle are raised
& beef is eaten raw or under cooked.
 Very common in Ethiopia
Geographic…
 T. solium
 Not widely distributed as T saginata.
 Common in all areas where raw or partially
cooked pork is eaten.
 Common throughout Mexico, South America
and southern Africa & southern Europe.
 Not reported from Ethiopia
 T. saginata T. solium
 Adult:  Adult
 Size: 4-10 m long (can
 Size: 2-3m
reach up to 20 m)
 Colour: pale blue
 Colour: ivory white
 Strobila: 800-1000
 Strobila : 1000-2000
Proglottides
proglottides
 Mature segment :0.5-
 Mature segment: 1-
1.5 cm
2cm long
Taenia saginata
Scolex (head):
 Quadrate, with 4suckers, no hooks, no rostellum
 Size-2mm across
Taenia solium
Scolex has
 Four suckers
 two rows of hooks on a prominent rostellum
 Size-1mm
Taenia species larvae

 Larval stage is cysticercus

 Invaginated scolex in fluid filled body
 Cysticercus bovis-
T saginata
 Cysticercus cellulosae
-T solium
Eggs
 Eggs are very round with very thick walls.
 Morphologically eggs of T.saginata & T. solium
are indistinguishable unless stained by AFB
Eggs..
 Size: 33-40 m
 Shape: Round
 Colour: Shell-dark yellowish-brown,
 Content: light yellowish gray.
 Shell: Thick, Smooth, brown, radially straited
(embryophore)
 Content: A round granular mass enclosed by a
fine membrane with six hooklets
 Transmission and lifecycle
 Transmission
 Humans become infected by ingesting raw or
undercooked meat infected with infective
cysticercus larvae:
 Beef- T.saginata*
 pork meat –T.solium
 T. solium can also be transmitted by :
 Ingesting ova in food or water
 Internal autoinfection
 Clinical manifestation
 T saginata
 Taeniasis.

 Usually asymptomatic but may cause dizziness,

abdominal pain, diarrhea, headache and nausea.
 Proglottids obvious in feces.
 Proglottids have a strong tendency to crawl from
the anus during the day when its host is active
Pruritis ani.
 Clinical….
 Taenia solium taeniasis
 Major symptoms are as a result of the adult
worm and its location.
 include abdominal pain, loss of appetite,
 Cysticercosis

 when infected by eggs

 larval cysts in lung, liver, eye and brain
resulting in blindness and neurological
disorders.
Laboratory diagnosis
 Detecting eggs in faeces.
 Macroscopic Identification of gravid
segments/proglotids in underclothing/beding/ in
faeces
 scolex recovered from clothing or passed in
faeces;
 T.saginata ova on perianal skin (cellotape slide)
 T.solium (cysticercosis): Finding calcified larvae in
histological or X-rays examination .
Treatment
 Praziquqntel in adults 2.5-10mg/kg given in a
single dose
 Albendazole: adults 6.6mg/kg or two doses each
of 200mg/day on 3consecutive days.(this drug
should not be used in children<2years old or
during pregnancy.
Prevention and control

 Avoid eating raw or or insufficiently cooked meat

 Inspecting meat for larvae
 Provide latrine for proper waste disposal
 Not using untreated human faeces as fertilizers
 Protection of cattle from grazing on faeces or
sewage polluted grass
 Treating infected persons & providing health
education
 T. Saginata T. Solium

Disease Taeniasis saginata Taeniasis solium

Distrubution Cosmopolitan Cosmopolitan (in pig meat eating

Adult

Size 4 – 6m 2 - 4m

Scolex 2mm in diameter 1mm in diameter

No rostellum or hooks Rostellum with double crown larg

Mature segment Testes more numerous (400) Testes fewer (200)

Ovary bilobed Ovary trilobed
Vaginal opening with sphinicter Vaginal opening without sphinicte

Gravid segment 20 x 7mm 12 x 6 mm

Uterus with 15 – 30 lateral branches 7 – 12 lateral branches
Segments detach singly Segments detach in groups of ab

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 T. Saginata T. Solium

Egg Similar (not infective to man) Similar (infective to man = cystice

Definitive host Man Man

Intermediate host Cattle (not man) Pig (and man)

Larval stage Cysticercus bovis Cysticercus cellulosae

(scolex without hooks) (scolex with hooks)
Human infection Ingestion of undercooked beef Ingestion of undercooked pork = T
= Taeniasis Ingestion of eggs = cysticercosis

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Hymenolepis nana (Dwarf Tape
worm)
 H.nana
 Disease: Hymenolepiasis nana
 Distribution: cosmopolitan (more common in children)
 Morphology:
1. Adult : the smallest tapeworm of man (1 – 3cm)
 Scolex: globular, 4 suckers, a retractile
rostellum with a single crown of hooks.
 Mature segments: broader than long
 Male genitals: 3 testes, one on the side of
the genital pore and two on the apical side
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Morphology….
 Female genitals: as in taenia.
 Genital pores are unilateral and
always open to one side
 Proglottids are wider than long with lateral
genital pore
 Gravid segment: broader than long occupied by
a sac-like uterus full of eggs
 H. Nana Eggs
 Oval & smaller than those of H. diminuta,
 Size being 40 to 60 µm by 30 to 50 µm.
 On the inner membrane are two poles, from which 4
to 8 polar filaments spread out between the two
membranes.
 The oncosphere has six hooks (seen as dark lines)
 Cysticercoid:
 A bladder like structure similar to cysticercus but the
head is withdrawn in upright position and not
invaginated
 It has a tail like appendage
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Geographical Distribution:-

 H.nana is widely distributed in countries with

warm climates than in cold climates and fairly
common in Ethiopia.
 Prevalent in school children in tropical and
subtropical climates.
Transmission and life cycle
 Mode of Transmisssion: -
 Ingestion of egg with contaminated food, drink
or finger.
 Autoinfection.

 Life Cycle:
 Has a direct life cycle with a human host serving
as both definitive and intermediate host.
 Clinical manifestations
 Majority of infections are asymptomatic and are
probably associated with low no. of parasites.
 Symptoms are vague abdominal discomfort,
nausea, vomiting, weight loss, diarrhea &
irritability in light infections.
 In heavy infections, ulcerations of the mucosa
lead to enteritis
 Some patients especially children suffer from
dizziness and there may be convulsion, attributed
to a neurotoxic product of the worms
Diagnosis
 Finding eggs in feces
 Size: 35-50m
 Shape: oval, almost round
 Shell: double; thin external membrane and internal
membrane often thicker at the poles.
 Thread like polar filaments coming from both poles
 Colour: colour less or very pale gray
 Content: Rounded mass (embryo) with six refractile
hooklets arranged in fan shaped.

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 Diagnosis…

 Sometimes adult
worms in the feces
Treatment

 Niclosamide (Yomesan): dose of 2gdaily for

5consequetive days
 Praziquantel at a dose of 25mg/kg
Prevention and control
 Personal cleanliness (to avoid autoinfection)
 Wash hands before eating & after defecation
 Sanitary disposal of feces in to latrines
 Avoiding eating uncooked food
 Health education
 Treatment of infected persons
 Rodent control
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Hymenolepis dimunata (Rat
tape worm
Morphology

 Disease: Hymenolepiasis
 Distribution: cosmopolitan, fairly common in
Ethiopia
 Morphology:
 Adult : 20 – 80cm
 Scolex with 4 suckers and retractile
rostellum without hooklets
 Strobila: 800 – 1000 segments
H.dimunata
 Slightly larger than H. nana but still very small.
 Scolex has very small rostellum with no hooks
 Proglottid same as H. nana but larger.
Eggs
 size 70 to 86 µm by 60 to 80 µm, with a striated outer
membrane and a thin inner membrane.
 Round or slightly oval,

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Eggs…
 Bigger than H. nana
 Oncosphere has

six hooks
 No polar filament
 Eggs not infective

when passed
 Yellowish brown

or bile pigmented
with double shell &
with out thread like polar filaments.
Life cycle of H.diminuta
 Eggs passed in the feces of the infected definitive
host (rodents, man) .
 Mature eggs are ingested by an intermediate host
(various arthropod adults or larvae)
 Oncospheres released from the eggs & penetrate the
intestinal wall of the host , develop into cysticercoid
larvae.
 The cysticercoid larvae persist through the
arthropod's morphogenesis to adulthood.
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Life cycle of H. diminuta
 Maturation of the parasites occurs within 20 days &
the adult worms can reach an average of 30 cm in
length .
 Eggs are released in the small intestine from gravid
proglottids that disintegrate after breaking off from the
adult worms.
 The eggs are expelled to the environment in the
mammalian host's feces .
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Life cycle of H. diminuta

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Transmission and pathogenesis
 Infection is acquired by the mammalian host after
ingestion of an intermediate host carrying the
cysticercoid larvae .
 After ingestion, the tissue of the infected arthropod is
digested releasing the cysticercoid larvae in the
stomach and small intestine.

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Transmission….

 Eversion of the scoleces occurs shortly after the

cysticercoid larvae are released
 Using the four suckers on the scolex, the
parasite attaches to the small intestine wall.
Pathogenesis
Similar to H.nana
 H. Nana H. Diminuta

Distrubution Cosmopolitan Cosmopolitan

Adult

Size 1 – 3 cm 30 – 60 cm

Scolex Rostellum with hooks Rostellum without hooks

Mature segment Similar but smaller (0.5 x 0.15 mm) Similar but bigger (4 x 0.8mm)

Gravid segment Testes and ovary close together in Two aporal testes and one poral t
the middle of the mature segment ovary in between

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 H. Nana H. Diminuta

Egg

Size 30 – 50  in diameter 60 – 70 in diameter

Shape Polar filament Absent

Color Transparent Yellowish

Content onchosphere Onchosphere
Definitive host Man (rat, mice) Rats, mice (rarely man)

Intermediate host Optional Obligatory (rat flea and other ins

and cockroaches)
Larval stage Cysticercoid Cysticercoid
(infective stage)
Human infection 1. Direct (ingestion of eggs, Ingestion of fleas and insects co
autoinfection) cysticercoid
2. Indirect (ingestion of fleas and
insects containing cysticercoid)

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 Diagnosis
 Finding eggs in the feces

Treatment
 Antitaenial drugs

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 Prevention and control

 Care to avoid ingesting ectoparasites of rodents

and other insects of flour and cereals
 Health education
 Rodent control

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