CREATED BY : MICHAELA ARROFO

MICROBIOLOGY & PARASITOLOGY ○ In some species, the scolex has a fleshy

:CESTODES extension called a rostellum to which hooks may

be attached.

1. What are Cestodes?

General Properties of Cestodes

● The neck serves as the region of growth and connects the

head to the body of the worm.

● the worm grows by adding new proglottids from the neck

● Cestodes are classified under the sub- ● The oldest proglottids are found at the most distal part of
● kingdom Metazoa, phylum Platyhelminthes. the body of the parasite.
● considered as primitive worms ;
● no digestive system nor a nervous system;
● They absorb nutrients and eliminate waste
products through their outer surface called the
tegument.
● commonly known as tapeworms

TAPEWORM TEGUMENT

● The body is divided into multiple segments (hence, the

name tapeworm) called proglottids.

○ A series of proglottids is called strobila (plural

strobili).

The tegument is the host-parasite interface, and

metabolically active body covering performing all the vital CESTODES: TAPEWORMS
activities such as protection, absorption and secretion.

Morphological Features

● parasites are flat and consist of three distinct

regions – the

Reproductive Organs

● the head contains an organ of attachment called the

scolex, which may consist of either

hooks, suckers, or sucking grooves.

 ● All cestodes are hermaphroditic (self-fertilizing)
with each proglottid containing both male and
female reproductive organs
○ each proglottid, therefore, is capable of
laying eggs (now called a pregnant
proglottid or gravid segment).
INTESTINAL CESTODES-TAENIA SAGINATA
(BEEF TAPEWORM)
Important Properties and Life Cycle
● The intermediate host is cattle where the eggs
enter the blood vessels within the cattle’s
intestines.

CESTODES - REPRODUCTION

Life Cycle
A typical cestode life cycle is divided into three stages –
egg, larva and adult worm.

● Infection in humans is usually acquired through

ingestion of the undercooked or raw flesh of the
● for the majority of cestodes, the egg contains an embryo
intermediate host containing the infective larvae.
called the oncosphere, which represents the first larval or
○ after ingestion, the ingested larvae are
transformed into adult worms in the motile stage.
intestines of the infected host.
○ The adult worm then undergoes ● It is equipped with small hooks (hooklets) that

self-impregnation with the gravid eventually enable the parasite to pierce the wall of the

segment rupturing to release the eggs in intestines.

the intestines.
● The eggs are excreted in the feces of infected hosts and
○ the eggs are then passed out to the
are transmitted to the intermediate hosts (cattle, pig, or
external environment during defecation
fish).

Eggs released in the environment can survive for several

weeks to months; can be ingested by intermediate host

In the context of our discussion, Cysticerci develop in:
A) The human intestine
B) The human liver
C) The intermediate host of the tapeworm
D) The bloodstream
Epidemiology and Pathogenesis
- Taenia saginata infection is common in the areas of the
world
where beef is routinely eaten, especially undercooked.
- Endemic in Eastern Europe, Russia, Eastern Africa, and
Latin America (Centers for Disease Control and
Prevention).
- The adult worms do not produce significant damage in
the small intestines.
Disease : Taeniasis
- Majority of patients are asymptomatic.
- Those with a high worm burden may complain of
diarrhea, abdominal pain, loss of appetite with resultant
weight loss, and body malaise.
- The gravid proglottids may reach the anus where
egg-laying may occur resulting in itchiness in the anal
region (pruritus ani).
Laboratory Diagnosis
- Examination of fecal specimen from infected patients is
the procedure of choice.
- Eggs or gravid proglottids may be recovered from the
stool although eggs are less often found than the
proglottids.
Treatment
- The drug of choice against the adult worm is
praziquantel.
Prevention and Control
- Proper waste disposal and sanitation practices as well as
the
adequate cooking of beef are the main preventive measures
for taeniasis.
- Freezing of beef meat for approximately 10 days may kill
the encysted larvae.
- Prompt treatment of infected persons help prevent
spread of the disease
Intestinal Cestodes: Taenia solium (Pork
Tapeworm)
Important Properties and Life Cycle
❏ Infection with the pork tapeworm is acquired through
ingestion of improperly cooked or raw pork meat which
contains the infective larvae called cysticercus cellulosae.
❏ Unlike the beef tapeworm, Taenia solium infection can
also occur following the ingestion of food or water
contaminated with human feces that contain the eggs of
the parasite.
❏ Therefore, unlike the beef tapeworm, Taenia solium has
two infective stages – eggs and larvae.
❏ Autoinfection may also occur.
❏ Pigs serve as the intermediate host while humans serve
as both intermediate and definitive hosts.
❏ There are two scenarios that can occur depending on
which infective stage
entered the human host.
❏ In cases where infection is acquired through ingestion of
undercooked or raw pork meat, the infective stage is the
larval form which transforms into adult worm in the
intestines of infected individuals. In this instance, humans
serve as the definitive hosts.
❏ On the other hand, ingested worm eggs hatch in the
small intestines, burrow through the wall of the intestines
into a blood vessel, and disseminate to various organs. In
this instance, humans serve as intermediate hosts.
Epidemiology and Pathogenesis
➔ T. solium infection is more prevalent is underdeveloped
communities with poor sanitation and where people eat
raw or undercooked pork.
➔ Higher rates of illness : Latin America, Eastern Europe,
sub-Saharan Africa, India, and Asia (Centers for Disease
Control and Prevention).
❏ Adult worms produce little damage in the intestines.
❏ Encysted larvae may produce damage in the tissues
where they disseminate.
❏ for instance, in the brain, they may manifest as
space-occupying lesions.
❏ although the larvae may encyst in various
tissues of the body, they evoke little inflammatory
response.
❏ however, when the encysted larvae die, they
may release substances that may induce an allergic
reaction in the host which may potentially be fatal
due to the development of anaphylactic shock.
Disease : Taeniasis
1. Taeniasis – the disease produced by the adult worm.
Most cases are asymptomatic but in the presence of high
worm burden, manifestations may be similar to beef
tapeworm infection.
Disease : Cysticercosis
2. Cysticercosis – the result of larval encystation in various
tissues of the
body. The most common involvement is that of the skeletal
muscles where
patients may complain of muscle pain.
● Neurocysticercosis : or cysticercosis of the brain, is the
most feared
and most severe involvement.
○ symptoms associated with increased intracranial
pressure such as seizures, headache, and vomiting.
○ Ocular cysticercosis may lead to visual
disturbance due to development of inflammation
of the uvea (uveitis) and retina (retinitis).
Laboratory Diagnosis
● Microscopic examination of stool specimen from
infected persons is the diagnostic procedure of choice in
patients with taeniasis.
● Demonstration of ova or proglottids may help establish
the diagnosis. The demonstration of the typical
morphology of the scolex can differentiate pork tapeworm
from beef tapeworm.
● For cysticercosis, diagnostic procedure depends on
demonstration of the cyst in tissue, through biopsy or CT
scan.
Treatment Intestinal Cestodes:Diphyllobothrium latum
- Drug of choice is praziquantel.
(Broad Fish Tapeworm)
● the longest of the tapeworms, the fish
- For cysticercosis, praziquantel may also be effective but
it is usually not recommended for ocular and CNS tapeworm can reach a length of about 13 meters.
involvement.
● its eggs consist of ciliated larvae
- Alternative drugs include albendazole, paromomycin,
called coracidia (s. coracidium).
and quinacrine hydrochloride.

● One end of the egg is occupied

- Anticonvulsants may be given in cases of
neurocysticercosis. by a lid structure called an operculum.

- Surgical removal of the larvae may be necessary.

- Drug of choice is praziquantel.

Prevention and Control

● Important preventive measures for pork tapeworm
infection are the same as of that for beef tapeworm

and include :

○ proper waste disposal and sanitary measures

○ thorough cooking of pork meat ; and

● its scolex contains a pair of long sucking grooves.
○ the prompt treatment of infected persons to
● the gravid segments contain a uterine
prevent the spread of the parasite.

structure that is centrally located and

assumes a rosette formation.

Comparison between T.saginata and T.solium

▪The eggs of Taenia saginata are usually indistinguishable

from the eggs of the pork tapeworm Taenia solium.

▪Both species may be differentiated by the appearance of

their scolices and the structures of their proglottids.

▪the scolex of Taenia solium contains a rostellum while ❏ Human infection with D. latum is through ingestion of

that of Taenia saginata do not.
▪Both species may be differentiated by the appearance of
their scolices and the structures of their proglottids.
improperly cooked or raw fish containing the plerocercoid
(infective stage), the precursor larval stage.
❏ After ingestion, the plerocercoid attaches to the
intestinal mucosa and matures into the adult worm.

❏ The adult worm self-fertilizes and the eggs are passed

out with the stool.

❏ If the eggs come to contact with fresh water, the

coracidium hatches and is ingested by the first
intermediate host, a tiny crustacean called a copepod
(Cyclops sp).

- After ingestion, the coracidium develops into the larval

stage called theprocercoid.
- The copepod is then eaten by a freshwater fish (second
intermediate host)where the procercoid develops into the
plerocercoid.
- Definitive hosts for the parasites are humans and other
fish-eating mammals such as dogs, cats, bears and seals.
Epidemiology and Pathogenesis
● D. latum infection occurs in countries where raw
freshwater fish is consumed.
● Little damage is produced in the small intestines of the
human hosts.
● In some individuals, the parasite may compete with the
host for
vitamin B12, leading to a deficiency of this vitamin.
Disease : Diphyllobothriasis
❏ Asymptomatic disease – the most common
presentation among most individuals infected with the
parasite.
❏ Diphyllobothriasis – may manifest with symptoms of
gastrointestinal involvement, which may include diarrhea
and
abdominal discomfort.
❏ when the adult worm attaches itself to the
jejunum and ileum, the patient may develop
deficiency of vitamin B12, leading to anemia
similar to pernicious anemia and is characterized
as megaloblastic anemia resulting from lack of
malnutrition of red blood cells.
Laboratory Diagnosis
● Diagnosis is based on finding of the characteristic eggs
and / or the proglottids (less frequent) in a stool
Specimen.
Treatment
🞂 The drug of choice for the treatment of
diphyllobothriasis is praziquantel.
🞂 An alternative drug is niclosamide.
Prevention and Control
● Preventive measures include :
○ proper sanitary procedures
○ thorough cooking of fish prior to consumption
and ;
○ the prompt treatment of infected individuals to
prevent spread of the parasite.
● Freezing of the fish for 24-48 hours at -18 degree celsius
can kill all larvae.
Intestinal Cestodes:Hymenolepis nana (Dwarf
Tapeworm)
Important Properties and Life Cycle
● H. nana is different from the other tapeworms because it
does not require an obligatory intermediate animal host.
● The eggs are directly infectious and humans get the
infection after the accidental ingestion of the eggs of the
parasite.
● This may occur after ingestion of fecally-contaminated
food or water.
● One may also acquire the eggs by touching one’s mouth
with contaminated fingers or through ingestion of
contaminated soil.
• Accidental ingestion of rice or flour
beetles containing the infective larvae and that may have
gotten into food is another way by which the infection may
be acquired.

• Rodents serve as additional source

of infection.

Disease : Hymenolepiasis

❏ Most patients are asymptomatic. In cases of high worm

burden, patients may complain of nausea, weakness, loss
of appetite,

diarrhea, and abdominal pain.

🞂 Once the eggs (infective stage) gain entrance into the ❏ In young children with heavy infection, anal itchiness
human host after ingestion of contaminated food and (pruritus ani) may occur leading to headaches due to
water, the eggs transform into cysticercoid larvae. difficulty sleeping.

🞂 The larvae mature into adult worms capable of ❏ It can be confused with a pinworm infection.
self-reproduction. Eggs are released after disintegration of
❏ Autoinfection may lead to hyperinfection syndrome
the gravid segments.
which can result in secondary bacterial infection and
🞂 There are two pathways for the eggs – the eggs may be spread of the worms to other tissues of the body.
passed to the outside environment through feces or some
of the eggs may remain inside the human host.
Laboratory Diagnosis
🞂 Those that remain inside the human host hatch into
● Diagnosis is established by finding the characteristic
larvae and mature into adult worms, thereby starting a
eggs in stool specimens
new cycle within the human host.

🞂 This type of re-infection is called autoinfection.

.Treatment
🞂 Praziquantel is the drug of choice. Niclosamide can be
Epidemiology and Pathogenesis an alternative drug.
• The dwarf tapeworm is the most common tapeworm
recovered in the United States.
Prevention and Control
• It has a worldwide distribution and is also found in East
● Important preventive measures include proper hygiene
Asia and the Philippines.
andwaste disposal, control of transport host population,

• It is common in areas with inadequate sanitation and and rodent control.

hygiene. Children and persons living in crowded areas are

● Proper storage of grains and flour must be observed to
at risk of developing infection.
prevent infestation with flour and grain beetles.

• The parasite produces little damage in the small

● Prompt treatment of infected individuals must be
intestines.
instituted to prevent the spread of the parasite.
Extraintestinal Cestode:Echinococcus
granulosus (Dog Tapeworm or Hydatid
Tapeworm

Important Properties and Life Cycle

- Infection with E. granulosus is primarily a zoonotic type
of infection.

- Dogs are the most important definitive hosts while sheep

are usually the intermediate hosts.

- Humans are considered as accidental and dead-end

hosts.

- The eggs of E. granulosus are identical to those of Taenia Disease : Echinococcosis, Hydatid Cyst
spp. and are thus not diagnostic. Disease, Hydatid Disease, Hydatidosis
- The diagnostic stage of the parasite is its larval form, 🞂 Most patients are asymptomatic during the early stages

which is encased in a cyst wall and is called the hydatid of the disease.

cyst.
🞂 However, as the cysts enlarge, necrosis of the infected

🞂 Infection is acquired after ingestion of eggs (infective
stage) from food and water contamination by dog feces or
through with contaminated dog feces.
tissues occur. Involvement of the liver may result in
obstructive jaundice.
🞂 Patients with lung involvement may manifest with
cough, chest pain, and shortness of breath.

🞂 Eggs transform into larvae in the intestines, penetrate 🞂 Other organs that may be infected include the spleen,
the kidneys, heart, bone and central nervous system, including

intestines, and migrate through the bloodstream to the brain and eyes (Center for Disease Control and
Prevention).
different tissues in the body, particularly the liver and the

🞂 Cyst rupture may lead to anaphylactic shock leading to

lungs.
death of the patient
🞂 The hydatid cyst (pathogenic stage) then develops in the

infected tissues.

🞂 Dogs acquire the parasite by eating the visceral organs of

the intermediate host.

🞂 E. granulosus infection is common in Africa, Europe,

Asia, the Middle East, Central and South America, and in
rare cases, North America (Center for Disease Control and
Prevention).
A. Hydatid cyst in the liver
🞂 The embryo develops into large, fluid-filled hydatid
cysts, which act as space-occupying lesions. B. Hydatid cyst seen in the pulmonic tissue

🞂 In addition, the cyst fluid contains antigens that can C. Hydatid cyst removed in the Brain
sensitize the host.

🞂 Rupture of the cysts, either spontaneously or during

trauma or surgical removal, may lead to the release of
these antigens leading to anaphylaxis and widespread
dissemination of the parasite.
Laboratory Diagnosis
🞂 Several ways include :

(1) examination of biopsy specimen ;

(2) serologic tests (e.g. ELISA or indirect

hemagglutination test) ; and

(3) radiography to demonstrate the hydatid cysts (e.g. CT

scan or ultrasound.

🞂 Care should be exercised when doing biopsy to prevent

rupture of the cyst.

Treatment
🞂 Surgery : removal of cyst has been considered as the
treatment of choice.

🞂 Medical management : if cyst is located in inaccessible

areas, drugs proven effective include mebendazole,
albendazole, and praziquantel.

Prevention and Control

🞂 Improvement of personal hygiene practices, prevention
of contamination of food and water with dog feces,
avoidance of feeding pet dogs with contaminated viscera,
and the prompt treatment of infected canines and humans
are some measures to prevent the spread of the parasite.

🞂 Chemoprophylaxis should be given to dogs in endemic

areas.

🞂 Health education is essential