CESTODES

Generalities:
 Adult Worms appear as flat and ribbon like
o Excrete waste products via outer surface
called tegument
 No internal means of excretion
 All are monoecious
o Self fertilizing or hermaphroditic
 Causing autoretroinfection on
human ingestion of single egg (ex
Hymenolepsis nana)
 Development of a cyst in tssue occurs in the
intestinal-extraintestinal cestode species
Echinococcus granulosus
 No gastrointestinal tract
 Adult Worms inhabit the small intestine
 Eggs are non-operculated, embryonated, except for
Diphyllobothrium latum
o D. latum doesn’t consist of a hexacanth
embryo (also known as oncosphere)
 Motile 1st larva stage with the
presence of six small hooks called
hooklets arranged in pairs :
pierces the intestinal wall
Laboratory Diagnosis
 All intestinal tapeworm scolices have 4 cuplike
 Primary specimen: stool
cuckers except D. latum
o Presence of eggs or gravid
 No known circumstances is the larval form seen in
proglottids(diagnostic stage)
human specimens( it is seen in the intermediate
o Rarely, a scolex may be recovered following
host)
treatment
 SCOLEX – attachment organ, defined anterior end  Tissue biopsy : examnition of E. granulosus
o May possess a rostellum
Pathogenesis
 The rostellum can be armed or
unarmed  Asymptomatic
 One or two rows of hook  Vit. B12-induced macrocytic anemia with D. latum
are present infection
o Suckers  Liver and lung involvement with E. granulosus
 4 Cuplike Suckers or infection
 2 slit like grooves – “bothria”  Anaphylactic shock
 NECK – region of growth o Serious allergic reaction which produces a
 PROGLOTTID – tapeworm segments large amount if histamines and other
o IMMATURE chemical mediators that are fatal
o MATURE
Order Pseduophyllidea
 Equipped with both male and
female reproductive system
Diphyllobothrium latum
referred as strobila
 CN: Broad or Fish Tapeworm
o GRAVID/RIPE
 Final Host: Man
 Pregnant proglottid that consist of
 Reservoir Host: Dogs, cats, other fish eating
a uterus filled with eggs
mammals
 STROBILA – chain of proglottids
 Paratenic Host: Carnivorous Fish
 TWO ORDERS of TAPEWORMS
 Habitat: Small Intestine (Ileum)
1. Order Pseudophyllidea
2. Order Cyclophyllidea
 1st IH: Copepods
* False vs True tapeworms
 2nd IH: Freshwater Fish (salmon, trout, pike, ruff,
etc.)
 Infective Stage: Plerocercoid
 MOT: Ingestion of raw, undercooked, or pickled
freshwater fish
 8. Scolex attaches to intestines ; adult develop in small
intestine releases immature eggs via
proglottids( segment containing complete sexually
mature reproductive system)

Disease Manifestation
 Diphyllobothriasis – infection
o Asymptomatic in most persons
o Obstruction, diarrhea or anemia have been
reported
o Non specific abdominal symptoms
 Hyperchromic Megaloblastic Anemia with
Thrombocytopenia and Leukopenia
o Bothriocephalus anemia
o B12 deficiency
o Mistaken for Pernicious anemia
 Sparganosis
o Due to larval forms of D. latum and
Spirometra
o Human Sparaganosis
 Ingestion of infected Cyclops
 Ingestion of raw infected flesh of
amphibians and reptiles
 Eggs: o Sparganum can be recovered in different
o Not comprised of the typical hexacanth parts of the body. May cause local
embryo inflammation, eosinophilia
o Oblong in shape o Diagnosis: surgical removal worms
o Consists of a ciliated larval stage known as o Treatment: Surgery; PZQ
coracidium surrounded by a smooth yellow
to brown shell Epidemiology
o Lid structure: operculum (one end)  Occurs in the Northern Temperate Areas where raw,
o Terminal knob: Abopercular knob (opposite pickled or inadequately cooked fish are eaten
end)  Endemic Foci include Scandinavia,Finland, Japan,
Europe, Chile and North America
 Scolex
o 4 cuplike suckers  Finnish people: genetic predisposition to Pernicious
Anemia
o almond shaped with 2 long prominent
sucking grooves
Diagnosis
 Proglottids
 Demonstration of Eggs
o Wider than they are long
o FECT,
o Gravid proglottid
o Kato-Katz
 Centrally located uterine structure
o DFS
frequently assumes a rosette
 Demonstration of Proglottids
formation
 Travel History and Diet
Life cycle: o May suggest Diphyllobothriasis
1. Unembryonated egg in feces (Diagnostic stage)
2. embryonated in water Treatment
3. Coracidia hatch forom eggs and are ingested by  Drug of choice: Praziquantel
crustaceans  Niclosamide
4. Procercoid larva develops in body cavity of o Side effects may be seen
crustaceans
5. Infected crustacean ingested by small freshwater Prevention and control
fish; releasing procercoid larva from crustacean to  Cook fish well
develop to plerocercoid larva(infective stage) in the  Store fish properly
fish o -18c kills the plerocerocid larva
6. Small fish ingested by predator fish(Paratenic host)  Environmental sanitation
7. Human ingest undercooked or raw predator fish or  Health education
small fish with plerocercoid larva
Order Cyclophyllidea o May experience vague abdominal
Taeniasis discomfort, hunger pangs, chronic
1. Taenia solium indigestion
2. Taenia saginata  Cysticercosis
3. Taenia saginata asiatica o Accidental ingestion of T. solium eggs
1. Eggs or gravid proglottids in feces is
Taenia solium ingested
 Pork Tapeworm 2. Oncospheres hatch and penetrate
 FH: Humans intestinal wall and circulate to
 Habitat: Small Intestine musculature
 IH: Pigs, Humans 3. Cysticerci may develop in any
 Infective Stage organ(more common in subcutaneous
o Cysticercus cellulosae (Armed) tissue as well as in the brain and eyes)
o Egg  Food or Drink
 Transmission: consumption of contaminated o Autoinfection
undercooked pork (MEASLY PORK) or ingestion of o Deposition of oncosphere (larva) in
egg different parts of the body
o More serious
 Adult: o Lodging of the larva in vital organs and
o Globular Scolex (4 cup shaped suckers) striated muscles
o Armed Rostellum o NEUROCYSTICERCOSIS: most common
o Short neck parasitic disease of CNS
 Proglottids
o Wider than tall Epidemiology
o 7-15 lateral uterine branches o Eating habits relates to the prevalence of
 square in appearance the
o 898 segments o disease
 Eggs o Religious beliefs
o Indistinguishable with saginata  Muslim countries have low or none
o Surrounded by a yellow brown shell cases of Taeniasis solium and
present on select tapeworms known as cysticercosis
embyophore o Prevalence of Taeniasis solium relates to
o Spherical brown and striated the number of cases of cysticercosis
o Oncosphere with 6 hooklets (3 pairs) o Worldwide distribution
 Scolex  Areas where pork are consumed or
o 1-2mm in diameter Equipped with 4 raised
 Central and South America
suckers
(MEXICO), Africa, South East Asia,
o contains a fleshy rostellum and double
Eastern Europe, Micronesia
crown (row) of well-defined hooks
Taenia saginata
Life Cycle
 Beef Tapeworm
1. Eggs or gravid proglottids in feces passed into
 FH: Man
environment (Diagnostic stage)
2. Pig become infected by ingesting vegetation  Habitat: Small Intestine
contaminated by eggs or gravid proglottids  IH: Cattle
3. Oncospheres hatch, penetrate intenstinal wall and  INFECTIVE STAGE: Cysticercus bovis
circulate to musculature  MOT: Ingestion of raw or undercooked beef
4. Oncospheres develop into cysticerci (Infective Adult
stage) in muscle  Whitish opaque
5. Humans infected by ingesting undercooked or raw  Cuboidal
meat with cysticerci  4-10 meters in length up to 25 m
6. Scolex attaches to intestine, adults develop in small Gravid Proglottids
intestine  Longer than wide
 Tree-like uterine segments (15-30)
Disease Manifesttion o Typically rectangular averaging 17.5mm by
 Taeniasis solium 5.5 mm
o Usually asymptomatic  1048 segments
Eggs
  Indistinguishable from other Taenia spp. (same with o IMMUNOBLOT using purified Glycoproteins
T. solium) (Western Blot)
 Thick and Striated  Ab against cysticercercal antigens
Scolex (IgG and IgM)
 Same with T. solium but fleshy rostellum and double  CDC Recommendation
crown (row) are absent  ELISA
 MOLECULAR METHODS
Life Cycle:
1. Eggs or gravid proglottids in feces passed into Treatment:
environment (Diagnostic stage)  PZQ or Niclosamide
2. Cattle become infected by ingesting vegetation  Surgery for Cysticercosis
contaminated by eggs or gravid proglottids o PZQ and Albendazole
3. Oncospheres hatch, penetrate intenstinal wall and  Criteria for cure:
circulate to musculature o Recovery of Scolex or;
4. Oncospheres develop into cysticerci (Infective o Negative Stool Exam 3 months after
stage) in muscle treatment
5. Humans infected by ingesting undercooked or raw
meat with cysticerci Taenia saginata asiatica
6. Scolex attaches to intestine, adults develop in small  3rd species of Taenia
intestine
 Asian Tapeworm
 Hybrid tapeworm
Pathology and manifestation
 First reported in Taiwan
 Large size
 Quite difficult to differentiate from T. saginata
 By-products of the worm >> Systemic Intoxication
 Scolex is similar to T. solium
 Vague abdominal pains
 Sister species of T. saginata
 Obstruction
 Found in Taiwan, China, Korea, Indonesia,
 Usually asymptomatic
Philippines,
 Common in cattle raising countries
 Vietman and Thailand
 Cultural and religious beliefs can determine its
 Intermediate hosts are quite varied aside from pigs
prevalence
 Cysticerci usually found in the liver
o Hindus
 Do not cause cysticercosis
 NO human cysticercosis due to T. saginata
Treatment
Diagnosis of T. solium and T. saginata
 Drugs of Choice
 Eggs: Stool Exam (DFS, Kato-Katz, FECT)
o Praziquantel and Niclosamide
o Eggs are indistinguishable
 Cysticercosis
 Proglottids: Number of Uterine Branches
o Praziquantel + Corticosteroids +
o Double Slide Compression Technique
Albendazole
 Use of India Ink or Carmine to
o Avoid Niclosamide and Dichlorhen
Visualize
 Disintegration of the segments
 Scolex – after treatment/recovery
 Criteria for Cure
 Coproantigen Detection: ELISA
o Recovery of the Scolex
 Molecular Methods
o Negative stool exam 3 months after
treatment
Cysticercosis
o Surgery
Prevention and control
o Xray, CT-Scan or MRI
 Thorough cooking of meat
o Serology
o At -20c for 10 days kills the cysticerci
o At 65c
 Basis of suspecting NCC:
 Proper sanitary meat inspection
o Neurologic Disorders
 Proper waste disposal
o Neuroimaging
 Personal hygiene
o Travel history
 Case finding and chemotherapy
 GOLD STANDARD for DETECTION
 Health education
Dipylidium caninum  Habitat: Small Intestine
 Double Pored Tapeworm; Dog Tapeworm; Flea  IH: Ctenocephalides canis, Ctenocephalides felis
 Tapeworm; Cucumber Tapeworm  Infective Stage: Cysticercoid Larva
 Final Host: Dogs, Cats  MOT: Ingestion
 Accidental Host: Man
  Scolex
o Conical/ club shaped
o 4 suckers
o Retractable Armed Rostellum
 1-6 or 7 circlets of spines that
reside on the rostellum
 Eggs
o Consists of a typical 6-hooked oncosphere
o Membrane enclosed packers
 Each packet with 5-30 eggs
 Proglottids Egg-in egg packets
o Mature and Gravid proglottid
 Resemble pumpkin seeds in
shape
o Mature
 Contains 2 sets of both male and
female reproductive system
o Gravid
 Full of eggs enclosed in an
embryonic membrane

Life cycle Disease Manifestation

1. Gravid proglottids are passed intact in feces or
 Disease Manifestation
emerge in perianal region of either animal or host
 Usually asymptomatic
2. Egg packets containing embryhonated eggs are
 Abdominal pain, anal pruritus may occur
ingested by larval stage of flea
 Diagnosis: Look for the Egg packets or Proglottid
3. Oncospheres hatch from the eggs and penetrate
in Stool or Perianal Area
the intestinal wall of the larvae to form
o Anal pruritus caused by gravid
Cystericercoid larvae which develop in the body
cavity proglottids migrating out of the anus
4. As soon the the larva flea becomes adult, it  Epidemiology: Common among small children
harbours the infective cystericercoid (Infective  Treatment: Praziquantel
stage)
5. Host is infected (dogs/cats) by ingesting fleas with
cystericercoid Raillietina garrisoni
6. Human acquire infection by ingestion of infected  AKA Railletina madagascariensis
flea  “Madagascar Worm”
7. Scolex attaches to intestine and develops into  A Common Tapeworm of Rats
adult in small intestine  Final Host: Rats
8. Feces of man contains the proglottid containg egg  Accidental Host: Man
packets held together by an outer embryonic  Habitat: Small Intestine
membrane and later on releases the egg packets  Intermediate Host: Tribolium confusum
(Diagnostic stage)  Infective Stage: Cysticercoid Larva
 MOT: Ingestion
 SCOLEX:
o Subglobular
o Armed Rostellum

Proglottid:

Proglottids

Clinical Manifestations
  Usually Asymtpomatic
 Children are usually affected
 Proglottids are usually passed out
 Diagnosis: Stool Exam (Proglottids or Ova)
 Treatment: Praziquantel
Epidemiology
 Common Cestode of Rodents in the Philippines
 Infections usually occur due to ingestion of
 infested grains
 Children less than 3years old are affected
2. Embryonated egg in feces (infective stage)
- Infective stage for IH
3. Oncosphere hatches; penetrates intestinal wall
4. Hydatid cyst in liver, lungs, etc (Diagnostic stage)
5. Protoscolec from cyst
6. Scolex attaches to intestine
Proglottids:

Echinococcus species
1. E. granulosus
2. E. multilocularis
3. E. vogelli

Echinococcus granulosus
 Hydatid Worm Hydatid cyst
 Smallest Tapeworm of Dogs (3-6 mm)
 Final Host: Canines (Dogs)
 Habitat: Small Intestine
 Intermediate Host: Sheep , Goat, Swine, Cattle
 Horses, Camel, Humans*)
o Humans – accidental IH;
 Infective Stage : Hydatid Cyst
 MOT: Ingestion

 SCOLEX
o Pyriform Scolex
o Armed Rostellum
o 4 Suckers with 36 hooks
 typically found in definitice hosts
 Eggs
o Identical to Taenia eggs
 Hystatid cyst
o Found in human tissue
o Protectice coverings
 Cyst wall; multiple laminated
germinal tissue layers
o Basic cyst makeup
 Fluid filled bladder
o Structures that arise
 Daughter cysts
o Brood capsules
 Inner germinal layer
o Hydatid sand
 Other possible structure present
 Adult
o Consists of a scolex, small neck and 3
proglottids; one at each developmental
stages: immature, mature, gravid.

Life cycle:
 For the definitive host: Ingestion of cysts in organs
 For the IH: Ingestion of eggs in feces
1. Adult in small intestine
Clinical manifestation:
 Cystic Echinococcosis; Hydatid Cyst; Cysticercosis
of Visceral Organs
 Organs Affected: Liver and Lungs
 Signs and Symptoms
o Simple Cysts usually do not cause
symptoms
o Ruptured Cysts can lead to symptoms of
 Intermittent Jaundice and
Eosinophilia
 Brain Involvement
 Renal Involvemnt
 Anaphylaxis when fluid escapes
form hystatid cyst

Other Echinococcus species

 E. multilocularis
o FH: Foxes
o IH: Rodents (voles, lemmings, shrews,
mice)
o Causes Alveolar Echinococcosis
 E. vogeli
o FH: Bush Dogs and Dogs
o IH: Rodents

Epidemiology
 E. granulosus infections
o More common in sheep grazing countries
such as Australia, New Zealand, Middle
East, SouthAmerica
 E. multilocularis infection
o Subarctic Areas such as Alaska, Canada
 E. vogeli infection
o Central and South America

Diagnosis
 Hydatid cyst fluid biopsy
o For presence ofscolices, daughter cysts,
brood capsules or hydatid sand
o Proceed with care or may lead to
anaphylaxis
 X-ray
 Ultrasound, CT-Scan
 Surgery
 Serology:
o BFT, Casoni Intradermal Test, ELISA

Treatment
 Surgical Resection
 Albendazole
 PZQ
 PAIR