EXTRA-INTESTINAL CESTODES

PARASITOLOGY LEC – WEEK 8

Echinococcus spp. 1 Scolex TE Testes

§ FAMILY: Taeniidae 2 Immature Proglottid (short CS Cirrus Sac
§ ORDER: Cyclophyllidea segment next to the neck; (copulatory
§ Four species of public health importance no differentiation of organ) organ)
3 Mature Proglottid (globular OV Ovaries
Echinococcus granulosus Cystic echinococcosis features)

Echinococcus multilocularis Alveolar 4 Gravid Proglottid UT Uterus

echinococcosis R Rostellium (non retractable GP Genital pore
but w/hooks) (lateral)
Echinococcus vogeli Polycytic
echinococcosis S Acetabula/sucker
Echinococcus oligarthus

blue – rostellum
E. granulosus and multilocularis known to be infecting
human individuals red – 30-36 hooks

E. vogeli and E. oligarthus are less common because their black – acetabula
life cycle is sylvatic which means their lifespan spent
cycling between wild animals and vectors.
A cyclophyllidean cestode – requires intermediate host
for the embryonated eggs to mature into larva stage
Echinococcus granulosus
§ Intermediate Host: goats, horses, camels, sheep
§ Shortest tapeworm with only three (barn/farm animals)
segments § Final Host: DOG (K9)
§ Adult worm: 3-6mm in length (base § Accidental Host: Man (transport host)
on CDC, 2-7mm) § Larval stage: Hydatid cyst
§ Scolex: pyriform/pear-shaped § Mode of Infection:
o Has four cup-like sucker or o IH: Ingestion of embryonated eggs (in feces)
acetabula (distinctive feature o FH: Ingestion of cysts (organs)
under cyclophyllidean)
o Non retractable rostellum (muscular gland LIFE CYCLE: E.Granulosus
over the head)
o Armed: 30-36 hooks (base on CDC, 25-50
hooks)
§ Proglottids:
o 1 short immature
o 1 elongated mature (where reproductive
organ is differentiated; male reproductive
organ would appear)
o 1 terminal (longer than wide) gravid
proglottid (possesses the gravid uterus filled
with eggs)

§ Definitive host – where adult tapeworm can be

found (capable of producing embryonated egg)

1

§ Embryonated egg excreted in the fecal material of o Capable of infecting IH
definitive host which is directly infectious to § HYDATID CYST: larval stage
intermediate host (goat, sheep, horses, camels – are o 1-7cm in diameter
infected through ingestion of food/water o Has TWO layers:
contaminated with fecal material ) § OUTER: Laminated hyaline
§ Egg will penetrate the intestinal wall à will be layer
hatched and release the oncosphere or embryo à § INNER: Nucleated germinal layer
develop into hydatid cyst which can be seen in o Complete their development (invaginated à
various organ (commonly in liver and lungs) evaginated) inside the definitive host
§ Hydatid cyst can produce the protoscolex o May contain up to 2 MILLION protoscolices
(baby/juvenile scolex (with invagination) of E. (released when hydatid rupture; develop into
granulosus) scolex and this will produce adult tapeworm)
§ After it envaginate, scolex can now attach to the
intestine of definitive host à then 3 segments

will be formed
§ “How can the definitive host be infected if the
hydatid cyst is in the intermediate host?”
o K9 dog can ingest the larva by eating the
organs of intermediate host
§ Accidental host (MAN) can be infected when
food/water is contaminated with fecal material A Host tissue D Broad Capsule
that contain embryonated egg. (release the
§ Human can also acquire the egg from dog that protoscolices)

has parasitic infection. Dog fur can be
B Hyaline Layer E Protoscolices (w/
contaminated with fecal material containing hooklets already)
eggs which can be can be ingested if an
individual did not practice handwashing. C Germinal layer F Hooklets
(nucleated)
§ Ingested embryonated egg will penetrate the
intestinal wall à then oncosphere will be
released à develop into larval stage (which Hyadatid sand – free
located commonly in liver and lungs and other broad capsules and
sites such as bones, brain ) free scolices in cyst



PATHOGENESIS: Cystic echinococcosis
§ Common sites: LIVER, LUNG, BRAIN, ORBIT
o Spleen, kidneys, heart, bone, CNS
§ Cysts are called unilocular hydatid cyst
§ Generally causes inflammation, tissue necrosis,
atrophy, and organ impairment
§ EGGS: not distinguishable from Taenia ova § Triad: intermittent jaundice, fever, eosinophilia
o Hexacanth embryo (w/ 3 pairs of hooklets)
o Enclosed in brown radially striated wall
(thick)
There’s. Primary infection and Second infection
(happened when hydatid cyst rupture à protosclolices
will spread and can penetrate other extra-intestinal site)

DIAGNOSIS
(Usually, accidental finding when there’s irritation and
pain in tissues)
§ Exploratory cyst puncture
Commonly used but very risky when the cyst
accidentally rupture which may lead to secondary
infection
§ Imaging: XRAY or Ultrasonography
§ Serological tests
Highly sensitive and specific but there’s chance of
releasing false positive result specially if there’s other
helminths present in the body.
§ Immunologic Test: PREVENTION
o Indirect Hemagglutination § Strict personal hygiene (before & after eating, going
o Indirect Fluorescent Antibody to the bathroom)
o Enzyme Immunoassay § Regular testing, quarantine and treatment of dogs
o Immunoblot Assay (confirm the positive (use of Praziquantel)
result from enzyme immunoassay) § Regular deworming of dogs
TREATMENT

§ Surgical resection Echinococcus multilocularis

Preferred method for larger cyst measuring >10 § Second most common cause of alveolar
diameter and located in the liver and other hepatic echinococcosis
site; very risky § FAMILY: Taenniidae
§ Chemotherapy § ORDER: Cyclophyllidea
For <7mm & diameter cyst – considered as § Intermediate host: Rodents
uncomplicated cyst § Final Host: Fox and other canines
§ PAIR – Percutaneous Aspiration, Injection, Re- § Same MOI with E.granulosus
Aspiration (for patient who cannot undergo surgery § Larval Stage: Alveolar hydatid cyst
and for the presence of multiple cyst) § Pathogenesis: Alveolar echinococcosis
o Ultrasound-guided percutaneous puncture o Common Sites: liver, lung, CNS
o Aspiration of cystic fluid (inside hydatid cyst)
o Injection of protoscolicidal agent (95%
ethanol, hypertonic saline) – to kill
protoscolices
o Re-aspiration (to get the fluid that harbors
the dead protoscolices)
§ Albendazole or Mebendazol
for inoperable patient who cannot also be subjected
to chemotherapy; use for minimum of 3 months
period

Recommended: both use of PAIR and Albendazole/

Mebendazole
Life cycle – same with E.granulosus
§ Definitive host (fox) – has the adult tapeworm (will
release embryonated egg)
§ Egg ingested by intermediate host (rodents)
àoncosphere hatches and will penetrate intestinal
wall à develop into hydatid alveolar cyst à harbor
protoscolices
§ Definitive host will be infected when they eat the
rodents (protoscolices will develop into scolex inside
DH and will attach to intestinal wall à develop into
adult tapeworm)
§ Accidental host (MAN) (ingestion of egg à penetrate
intestinal wall à release oncosphereà development
of alveolar hydatid cyst in the liver and other organs) § Definitive host excrete unembryonated egg
(operculated) in their fecal material à embryonate
in water à release of ciliated embryo
Alveolar hydatid cyst – larval stage (E. multilocularis – (coracidium/coracidia) à ingested by primary host
multilocular; multiple sacs) (crustaceans – cylops) à procercoid larva develop in
Black arrow – protoscolices the body cavity of cyclops
§ Crustaceans eaten by secondary intermediate host
(procercoid larva release then develop into
plerocercoid larva)
o L1 – coracidium
o L2 – procercoid
o L3 – plerocercoid (infective stage; also called
sparganum/spargana)
§ second intermediate host eaten by definitive host or
accidental host (MAN)

Spirometra mansoni
§ Gravid proglottid: Spiral uterus
§ Eggs: operculated (smaller than D. latum ova)




Spirometra spp.
§ ORDER: Pseudophyllidea (life cycle same with D.
latum) U Uterus

§ Intermediate host: UP Uterine pore
o Primary: cyclops
VP Vaginal pore
o Second: Fish, reptiles, amphibians, MAN

(accidental, paratenic or intermediate host) GP Genital pore
§ Definitive Host: Dogs and cats
§ Species involved in human infection § Mode of Infection;
o Spirometra mansoni o Ingestion of cyclops with procercoid larvae
o Spirometra erinacei by drinking contaminated water
o Spirometra ranarum
 o Ingestion of plerocercoid (spargana) by
eating second IH (ex. frogs, toads, snakes) or
by eating paratenic host (ex. Pigs)
o Cutaneous penetration of plerocercoid by
application of infected flesh on sores (sites:
eyes, vagina, skin)
§ Pathogenesis: Sparganosis
o Painful edema – “migrating tumor”
(plerocercoid)
o Edema
o Erythema
o Chills, fever
o Marked Eosinophilia
§ Diagnosis:
o Recovery of larvae from infected tissues
o Opaque, glistening white (bothria – slit
mouth)
o Measures 3.5 cm in length

§ Treatment:
o Surgical removal
o Praziquantel (not yet proven to be effective
in human; given to definitive host such as
dog & cat)
§ Prevention:
o Drinking of boiled or filtered water
o Cooking paratenic/IH host thoroughly
o Avoiding practice of applying flesh frogs to
inflamed areas