INTESTINAL CESTODES

PARASITOLOGY LEC – WEEK 7

GENERAL CHARACTERISTICS When proglottid becomes gravid or possesses uterus

filled with eggs, some of the organs decrease in size
• Phylum: Platyhelminthes or may disappear
• Common name: TAPEWORM
• Long, flat, ribbon-like, tape-like
worm
• Dorso-ventrally flattened (the
upper and the lower body
surface of the worm is flat)
• Resides in the small intestine of their host
Definitive/ final host: humans
• Has three primary regions:
CLASSIFICATION OF CESTODES
o Scolex (head) – serves as the organ of
attachment to the intestinal wall A. Pseudophyllidean
o Neck – origin of growth, regenerative region for - False or slit-like groves (bothria)
the proglottids
o Proglottids (strobila) – compose of segments

B. Cyclophyllidean
- Cup-like and round suckers (acetabula)

• Sexes are not separate HERMAPHRODITISM

✗ Body cavity (acoelomates) fluid-filled cavity
between the body and the surface is not present
✗ Alimentary canal (no digestive tract) tapeworm
gets its nutrients form the hosts stomach contents or Most distinct differentiation: scolex
stomach nutrients and it is absorbed through its body
Pseudophyllidean VS Cyclophyllidean
surface
✓ Excretory system Pseudophyllidean Cyclophyllidean
✓ Nervous system Scolex 2 slit-like grooves 4 cup-like
• Absorbs nutrients directly suckers
from its body surface Uterus No branching Branching
• Contains hooks that may be Uterine pore Present Absent
arranged in one or two rows Common Ventral midline Lateral
genital pore
situated on the head (Scolex)
Eggs Operculated Not operculated
• Types of Proglottid:
Adult worm in Diphyllobotrium Taenia saginata
o Immature – male and
the intestine latum Taenia solium
female organs are not Hymenolepis
differentiated nana
*can be seen near the Hymenolepis
scolex diminuta
o Mature – reproductive Dipylidum
organs have become differentiated caninum
Male organs appear first Larval stages Plerocercoid Cysticercoid
o Gravid – uteri are filled with eggs in man
 Cysticercosis (via Computed Acial Tomography
fecal/ oral route) (CT Scan)
Magnetic Resonance Imaging
(MRI)

Mode of infection:

• Ingestion of Cysticercus cellulosae from

undercooked/raw pork ––“measly pork”)
Operculated eggs (lid-like covers) give rise to ciliated • Ingestion of eggs
larva, while non operculated eggs can only progress to
larval stage in the presence of an intermediate host Treatment: Praziquantel *, Albendazole **

• Taenia saginata (beef tapeworm) *Drug of choice in Taeniasis

• Taenia solium (pork tapeworm) **Given together with Praziquantel for
• Hymenolepis nana (dwarf tapeworm) Cysticercosis
• Hymenolepis diminuta (rat tapeworm) Life cycle
• Dipylidum caninum (dog tapeworm)

^Lay non operculated eggs which needs an intermediate

host before it develops into the larval stage or
cysticercoid

TAENIA SOLIUM
Common name: Pork tapeworm

Tip from Prof Pangan: There’s letter “O” in pork and

solium has letter o

Morphology

• Length: 2-4 meters in length

• Scolex:
o 4 cup-like suckers
o With rostellum armed with double row of
hooklets (aka armed tapeworm of men)
• Neck: short, 5-10mm long
• Proglottids: 800-1000 segments Taeniasis
• Common genital pore: Marginal - Pig (intermediate host) is needed to develop this kind
• Gravid uterus: Median stem with 7-13 lateral of disease
uterine branches
The definitive host will excrete through its feces the eggs
Intermediate host: Pig and man or gravid proglottid
Definitive/ Final host: Man The eggs will be ingested by the pigs
Pathogenesis Diagnosis The embryonated eggs will hatch and release
Intestinal infection Recovery of eggs or proglottids oncospheres (embryo)
(Taeniasis) in stool (DFS, Concentration
technique, Perianal swab)
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Oncospheres will penetrate the intestinal wall and Diagnosis:
circulate to the musculature and will develop to
• DFS
cysticercoid stage or the larval stage, Cysticercus
cellulosae • Concentration Technique
• Perianal swabs
If the human eats an uncooked meat, he will ingest the
cysticercoid and the cysticercoid will attach to the Treatment: Praziquantel (5-10 mg per kg of individual
intestinal wall and then develop to an adult tapeworm given at a single dose)

Cysticercosis Pathogenesis

- Tissue infection • Taeniasis

- Direct ingestion of the eggs and proglottid via fecal • Mild irritation at point of attachment
and oral route • Epigastric pain
• Hunger fangs
• Weakness
TAENIA SAGINATA • Pruritis
Common name: Beef Tapeworm • Intestinal obstruction
• Bile, pancreatic ducts, pancreas obstruction
Another corny tip (her words, not mine) from Prof.
Pangan: Baka (cow) may letter A, saginata may A rin

Morphology lateral branches more than 12

• Length: 4-10 m in length

• Scolex Cuboidal head, does not possess
o Cuboidal in shape with 4 cup-like rostellum and hooks
o Without hooks or rostellum (aka unarmed
tapeworm of men)
• Proglottids: 1000-4000 segments cysticercoid in meat
• Common genital pore: marginal
o Vagina is provided with sphincter muscle
• Gravid uterus: Median club shaped with 15-20 Life cycle
lateral branches

Beef tapeworm can grow up to 25 meters and can

live 25 years in the stomach (upper jejunum) area

Gravid uterus is filled with eggs and can lay up to

97,000-124,000 per day (549 million eggs per year)

Intermediate host: Cattle, cow, buffalo

Definitive/ Final host: Man

Humans cannot develop cysticercosis with taenia

saginata, and can only have taeniasis

Mode of infection: Ingestion of Cysticercus bovis (from

undercooked or raw beef)

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Definitive host will excrete eggs or the gravid proglottids o Concentration Technique
through its fecal material o Perianal swabs
o MRI
Eggs and proglottids may contaminate the food of the
o CT scan
cattle, cow, buffalo and be ingested
• Drug of choice: Praziquantel (for Taeniasis)
Embryonated ova will hatch and release oncosphere that • Criteria for cure
will penetrate the intestinal walls of the cow, buffalo, o Recovery of the scolex
cattle and may circulate to the musculature o Negative stool exam (3 months post
treatment
If ingested, Cysticercus bovis will penetrate human’s
• Prevention: Cook meats thoroughly and proper
intestinal wall then develop to adult tapeworm
handwashing

TAENIA OVA
DIPYLIDIUM CANINUM
Eggs are very similar
Order: Cyclophyllidea
Tania solium Taenia saginata
Common name: Dog tapeworm / Double pored
tapeworm

- Common intestinal parasite

of dogs/ cats
Characteristics 30-45 microns in diameter
- Presence of bilateral genital
Thick striated embryophore
pores in each segment
(covering of the embryo)
Contains embryo and 6 hooklets Morphology
(hexacanth)
Length 2-5 meters 4-10 meters • Adult: 10-70 cm in length
Scolex Armed with Large, quadrate, • Scolex: small, globular, with 4
rostellum; with unarmed deeply cupped suckers with
hooklets retractile rostellum
No. of <1000 (30,000- 1000-4000 • Rostellum: 1-7 rows
proglottids 50,000 ova) (97,000-124,000 of rose thorn shaped
ova) hooklets
Expulsions Expelled Singly, and may
• Proglottids: thin,
passively (5-6 crawl out
narrow
segments) towards anal
sphincter o With 2 sets of
Uterus Thin and with 7- Dichotomous reproductive
10 lateral Thin & highly organs
branches branched 15-20 • Gravid Proglottids
Absence of lateral branches (packet)
vaginal and Presence of o Pumpkin size/shape
dendritic vaginal sphincter o Contains 8-15 eggs enclosed
sphincter in embryonic membrane
Testis 100-200 follicles 300-400 follicles • Ova
o Spherical
Prevention and Control
o Thin walled
• Diagnosis o With hexacanth embryo
o DFS
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 Passed out in feces along with proglottids o Epigastric pain
o Diarrhea
Intermediate host: Arthropods (Fleas)
o Pruritus
• Ctenocephalides canis (dog flea) o Allergic reactions
• Ctenocephalides felis (cat flea) Diagnosis: Examination of Proglottids (DFS)
• Pulex irritans (human flea)
• Trichoedectes canis (dog lice) Treatment: Praziquantel

Definitive/ Final Host: Dogs, cats, man Prevention:

Mode of Infection: Ingestion of infected fleas • Deworming

(cysticercoid larvae) • Use of insecticide
• Health Education
Life cycle

HYMENOLEPIS NANA
Common name: Dwarf Tapeworm

- Smallest tapeworm
infecting man
- It does not require an
obligatory IH
- Man can harbor both
adult and larval stages of
parasite

This type of tapeworm is the exemption to the general

rule that helminths do not multiply inside the body of a
definitive host. This type of tapeworm completes its life
Gravid proglottid are excreted through the fecal material
cycle in a single host. It can mature in the body of the
of the infected definitive host (cat, dog or man)
definitive host (man)
Egg packets containing embryonated eggs are ingested
Morphology
by larval stage of flea
• Adult: 25-45 mm in length,
Oncospheres hatch from the eggs and penetrate the
resides in the ileum
intestinal wall of the larvae flea. cysticercoid larvae
• Scolex:
develop in the body cavity
o Subglobular
Infected larval stage will then develop into adult flea. o 4 suckers
adult flea now harbors the infective cysticercoid o armed with single row
20-30 hooklets (rostella/ Y/ tuning fork
It will then be ingested by their definitive host (cat, dog,
shape-like hooklets)
human) and attach to the intestinal wall (small intestine)
• Neck: long and slender
then develop into an adult dog tapeworm
• Proglottids: 175-220
More common in children o Width: 0.8-1.0 mm
Length: 0.15-0.30 mm
Pathogenesis: Dipylidiasis
Characterized as broader than longer
• Symptoms: o 3 testes, 1 ovary **
o Intestinal discomfort o Transverse uterus
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 Immature, mature, gravid proglottid Mode of infection

• DIRECT – ingestion of eggs that hatches in the

duodenum
• INDIRECT – ingestion of infected arthropod
(serves as IH)
o Tenebrio sp.- rice and flour beetles
• Short life span of 2 weeks
• Autoinfection is also possible
• Ova
o Size: 30-47um Pathogenesis
o Spherical or subspherical
o Colorless or clay colored • Can be
o With 2 distinct membrane asymptomatic
Outer membrane (thin) • Headache
Inner membrane (thick, filled with yolk • Dizziness
granules and possesses polar thickenings) • Anorexia
Thickenings are from 4-8 hair-like polar • Pruritus of
filaments nose/anus
o Oncosphere (hexacanth embryo) has pairs of • Diarrhea
hooklets • Vomiting
• Abdominal pain
Definitive hosts: Rats or humans
• Pallor
Life cycle • Weight loss
• Sleep disturbance
• Enteritis
• Convulsions

*if numerous amounts of worms are found in the

system, the symptoms are enteritis and convulsions

Diagnosis:

• DFS
• Concentration technique

Treatment: Praziquantel***, Nitazoxanide

***Uses higher dosage than usual, because of the

Definitive hosts can excrete the embryonated eggs resistance of cysticercoids in intestinal tissue (25mg/kg)
through their feces
***Treatment is also repeated after 2 weeks (for possible
Embryonated eggs will then be ingested by arthropods autoinfection)
(usually rice or fly beetles) and develop to larval stage
(cysticercoid) then penetrate to the intestinal wall and Prevention and Control
body cavity of the insects • Improving environmental sanitation and
Then the insects can be ingested by humans and can personal
develop into adult tapeworm • hygiene
• Control of rodents
*Autoinfection can occur if eggs remain in the intestine. • Proper storage of food
The eggs then release the hexacanth embryo, which
penetrates the intestinal villus continuing the cycle
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HYMENOLEPIS DIMINUTA • Proper storage of food

Common name: Rat Tapeworm

- Requires intermediate host DIPHYLLOBOTHRIUM LATUM

- Causes accidental human infection (hymenolepiasis)
Common name: Fish Tapeworm, Broad Tapeworm
Gravid proglottids of this worm disintegrate and
releases eggs into the fecal material of the definitive Morphology
host
• Adult: 3-10 meters in length
The eggs when ingested by the wide range of adult
and larval insects like flea, beetles and cockroaches • Scolex: 2-3 mm in length, 1 mm in diameter
they develop into an infective cysticercoid larva then o Has two bothria (slit-like grooves)
the embryonated egg will then hatch and the
oncosphere will be released and develop into a
cysticercoid larva and the in the intestinal wall

Morphology o Spoon or spatula shaped

• Adult: 60cm in length o Unarmed (no hooklets)
• Scolex: unarmed rostellum, • Neck: long, unsegmented
with 4 suckers
• Proglottids: broader than
long (800-1000)
o Length: 0.75 mm
o Width: 3.5 mm • Proglottids: 4,000 proglottids
• 3 ovoid testes, 1 ovary ** o Mature: W: 10-12 mm, L: 2-4 mm
• Genital pores are unilateral o Can approximately release 1 million eggs
• Ova daily
o Circular, 60-80um in diameter The terminal end
o With hooklets tends to shrink and
o With bipolar thickening becomes empty as
o No polar filaments the eggs are being
Bluish color in the inner membrane expelled from the
proglottids
Diagnosis:
• Uterus: Rosette-like,
• DFS centrally located
• Concentration technique o Dark central markings (because of the
concentration of the organs at the center of
Treatment: Praziquantel***, Nitazoxanide the proglottid and more likely because of the
***Uses higher dosage than usual, because of the uterus)
resistance of cysticercoids in intestinal tissue (25mg/kg)

***Treatment is also repeated after 2 weeks

Prevention and Control

• Ova
• Improving environmental sanitation and
personal
• hygiene
• Control of rodents
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 o Oval in shape
o Yellowish brown
o Thick shell
o Has an operculum (lid-like
opening) and knob like
thickening
o Not yet infective to man
(because it needs to develop
to the plerocercoid or the infectious larval
stage)
Intermediate host
• 1st: Copepods (Genera: Cyclops, Diaptomus)
When the ova are released to the water it will
then develop to a coracidium or ciliated embryo
then later on develop into a procercoid larvae (3
hooklets) then develop into plerocercoids
(infective stage)
• 2nd: Fish
Procercoid larvae are ingested by fishes then
fishes are eaten by humans
Definitive Host: Man, fish eating mammals/birds
Mode of Infection: Ingestion of raw/imperfectly cooked
fish infected with plerocercoids
Life cycle
Definitive host will excrete the unembryonated through
its fecal material
The unembryonated eggs will then contaminate the
water source and become embryonated eggs in the
water and hatch to give rise to coracidia
Coracidia are ingested by the copepods and develop into
procercoid larva in the body cavity of copepods
Copepods will be ingested by larger creatures (like fish)
then the procercoid larva will be released from the
crustacean and develop into plerocercoid larva in the
body cavity of the 2nd intermediate host (fish)
Then the fish can be eaten by humans or by a bigger fish
and will now be considered as the paratenic host
(meaning, the plerocercoid larva will invade its tissue and
live their until definitive host eats it)
Pathogenesis: Diphyllobothriasis
Limited to one worm only but in other reports, there are
cases of mechanical obstruction (large number of D.
latum adult worms)
• Nervous disturbances (due to the absorbed
toxins or the byproducts of the degenerating
proglottids or mucosal irritation)
• Digestive disorders
• Abdominal discomfort
• Weight loss
• Anemia*: hyperchromic, megaloblastic anemia
*BOARD EXAM MUST KNOW!
What type of worm results to hyperchromic,
megaloblastic anemia? Answer is D. Latum
Adult worm travels to the jejunum and competes
with the host for Vitamin B12 (that’s why it is
often misdiagnosed as Pernicious anemia or Vit.
B12 deficiency
How to know if it is pernicious anemia or D.
Latum infection?
Gastric juice examination
• Absence of free HCl acid – pernicious anemia
• Abundance of free HCl acid – D. latum
Diagnosis
• DFS
• Kato technique
• Gastric juice examination (free HCl acid)
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 Intermediate host: Tribolium confusum (flour and rice
beetles)

Definitive host: Rats

Accidental host: Man (if accidentally ingested the beetle

with larva)

Mode of Infection: Ingestion of beetle infected with

cysticercoid larva

Life cycle

D.latum usually resides in the intestinal wall but if there

are numerous numbers of adult worms, it can invade the
musculature

Treatment: Praziquantel

Criteria for cure

• Recovery scolex (major criteria)

Scolex should be removed to prevent the
regeneration of proglottids
• Negative stool exam (3 months post-treatment)

Definitive host excrete the proglottid containing egg

capsules through its feces
RAILLIETINA GARRISONI
Egg capsules will then release the eggs and be ingested
Family: Davaineidae
by the intermediate host (arthropods)
A R. garrisoni species was found in the Filipino adult back
Eggs will develop to cysticercoid and be ingested by rats
in 1911, found by Garrison and it is called Raillietina
or accidentally ingested by humans
madagascariensis
Larva will reside to the intestinal wall and becomes adult
- Common tapeworm in rats
tapeworm
- Raillietina madagascariensis (identical with R.
garrisoni) Ova of R. garrisoni and proglottid
Morphology

Adult: 60 cm in length

Scolex: subglobular, 4 acetabula

Armed rostellum: 90-140 hammer-

shaped hooklets • Ova encloses Hexacanth embryo
• Cysticercoid larva in 2 weeks
Proglottids: 200-400 egg capsules
• Adult tapeworm in 8 weeks
• 35-50 ovoid testes • 1 capsule can have 1-4 embryonated eggs
• Bilobed ovary

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Pathogenesis: Mostly asymptomatic

• Presence of white motile proglottids in stool

Diagnosis

• DFS
• Recovery of proglottids

Treatment: Praziquantel

Prevention and Control

• Rodent control
• Proper storage of food esp. grains
• Sanitation and hygiene

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