Parasites infecting Gastro-Intestinal Tract

by
Dr. Shaimaa Helmy
Ass. Professor of Medical parasitology
Acting Head of parasitology Department
Faculty of Medicine
Helwan University
 Parasites of Small Intestine

Cystoda of Small Intestine:

Trematoda of Small Intestine: • Diphylobothrium latum
• Heterophyes heterophyes • Taenia saginata
• Taenia solium
• Hymenolepis nana
• Hymenolepis diminuta
• Dipylidium caninum

Nematoda of Small Intestine: Protozoa of Small Intestine:

• Ascaris lumbricoides • Giardia lamblia
• Ancylostoma duodenale • Cryptosporidium
• Strongyloides stercolaris • Isospora belli
• Capillaria philippinensis • Cyclospora cayetanensis
• Trichostrongylus colubriformis
 Objectives

By the end of this lecture, you will be able to:

• Recognize Taenia saginata and Taenia solium regarding their:
➢ Geographical distribution
➢ Life cycle
➢ Mode of infection
➢ Pathogenesis
➢ Clinical picture
➢ Diagnosis
➢ Treatment
➢ Prevention and control
• Define cysticercosis and identify its pathogenesis, clinical picture,
diagnosis and treatment.
Taenia species causes taeniasis
 Taenia saginata & Taenia solium

Geographical Distribution: Worldwide

Taenia saginata Taenia solium

Beef Tape Worm & Bald Tape Worm Pork Tape Worm
Especially in cattle Especially in pig
raising countries raising countries
4 -10 m long
2 - 4 m long
 The life cycle of Taenia saginata & T. solium

Mode of Infection
Ingestion of raw or undercooked:
❑ beef containing Cysticercus bovis
in Taenia saginata infection

❑ Pork containing Cysticercus

cellulosae in Taenia solium
Definitive host infection

Intermediate hosts

Habitat
 Larval stage of Taenia (Infective stage)

Oval cyst
Invaginated scolex

Taenia saginata larva Taenia solium larva

Cysticercus bovis Cysticercus cellulosae
Pathogenesis and Clinical Picture of Taeniasis

❑ Intestinal disturbances.
❑ Neurological manifestations.
❑ Intestinal obstruction.
❑ Loss of weight.
❑ Migrating segments In T. saginata infection only cause:
- Appendicitis
- Cholangitis
- Pass out of anus
Causes worry & anexiety
➢ In T. solium infection only
Cysticercosis may occur
 Diagnosis of Taeniasis
1- Stool Examination: Detection of eggs and segments in stool.
Size 30-40 µ
Shape Spherical with radially striated shell
Color Yellowish Brown
Content Hexa-canth onchosphere

2- Perianal swab for detection of eggs.

How to differentiate between egg of T. saginata & T. solium?
By Ziehl-Neelsen stain
Stained eggs Taenia saginata eggs
Unstained eggs Taenia solium eggs
3- Detection of motile segments under clothes or on bed in T. saginata:
4- Saline Purge to expel the segments.
 Treatment of Taeniasis
Praziquantel
Followed by saline purge 1-2 hours later to guard against
cysticercosis
Caused by eggs released from disintegrated T. solium worm

Prevention and Control

✓ Sanitary disposal of human excreta.
✓ Proper cooking of beef or pork.
✓ Proper inspection of slaughtered cattle or pigs.
✓ Health Education.
 Cysticercosis
Definition: Invasion of human tissues by cysticercus cellulosae, the larval
stage of T.solium.

cysticercus cellulosae
(Diagnostic stage)

Human
(Intermediate Host)

Egg
(Infective stage)
 Mode of Infection of Cysticercosis

• Ingestion of T. solium eggs in contaminated food or drink.

(Heteroinfection)
• Hand to mouth infection in a patient having adult worms in his intestine.
(External autoinfection)
• In a patient having adult worms in his intestine, some detached segments
ascend by anti-peristaltic movements to the stomach then descend again
to the intestine where eggs hatch and cause cysticercosis.

(Internal autoinfection)
 Pathogenesis of Cysticercosis

Common sites: brain, subcutaneous tissue, eye, heart.

Cysticercous cellulosae produces:
inflammatory reactions
ending in fibrosis & calcification.

Clinical Picture

➢ Patient suffers from muscle pain, fever.

➢ Subcutaneous cysts are easily palpable.
➢ Eye cysts lead to visual disturbances.
➢ Cysts affecting nerves cause neurological disorders.
 Diagnosis of Cysticercosis

Clinically: History of intestinal infection with T.solium

Biopsy: taken from a nodule in the skin or muscles

Laboratory Diagnosis
(1) Blood examination: Eosinophilia
(2) Serological tests: Ag & Ab detection
• Enzyme-linked immunosorbent assay
• indirect haemagglutination test
(3) Intradermal test:
 Diagnosis of Cysticercosis
Radiological Diagnosis

(1) X-ray
Rice grain calcifications

(2) MRI

(3) CT
 Treatment of Cysticercosis

1- Surgical removal

2- Praziquantel

3- Steroids
To relieve the intense local inflammatory reactions to
antigenic material of dead larvae