PARASITE AND THEIR COMMON NAMES
NEMATODES
Intestinal Roundworms
Ascaris lumbricoides
Enterobius vermicularis
Trichuris trichiura
Strongyloides stercoralis
Capillaria philippinensis
Ancylostoma duodenale
Necator americanus
Ancylostoma braziliense
Ancylostoma caninum
Toxocara cati
Toxocara canis
Tissue Roundworms
Trichinella spiralis
Dracunculus medinensis
Angiostrongylus cantonensis
Wuchereria bancrofti
Brugia malayi
Loa-loa
Onchocerca volvulus
TREMATODES/FLUKES
Blood Flukes
Schistosoma japonicum
Schistosoma haematobium
Schistosoma mansoni
Liver Fluke
Fasciola hepatica
Chlonorchis sinensis
Opistorchis felineus
Intestinal Fluke
Fasciolopsis buski
Echinostoma ilocanum
Heterophyes heterophyes
Lung Fluke
Paragonimus westermanni
CESTODES
Taenia saginata
Taenia solium
Diphyllobothrium latum
Hymenolepis nana
Hymenolepis diminuta
Echinococcus granulosus
Dipylidium caninum
QUEEN JANE M. BACON
- Large/ Giant Intestinal Roundworm
- Pinworm/Seatworm
- Whipworm/Japanese Lantern Egg
- Threadworm/Chinese Lantern Egg
- Pudoc worm/ Mystery Worm
- Old World Hookwrom
- New World Hookworm
- Cat Hookworm
- Dog Hookworm
- Cat Roundworm
- Dog Roundworm
- Great Imitator/ Muscle Worm
- Guinea worm/ Medina Worm/ Fiery Serpent of Israelites
- Rat Lungworm
- Bancroft’s filaria
- Malayan filaria
- African Eyeworm
- blinding filaria
- Oriental Blood Fluke
- Bladder Fluke/Vesical Blood Fluke
- Manson’s Blood Fluke/ Swamp Fever/ Bilharzia
- Sheep Liver Fluke
- Chinese Liver Fluke
- Cat Liver Fluke
- Giant Intestinal Fluke
- Garrison’s Fluke
- Von Siebold’s Fluke/ Smallest Fluke of Man
- Oriental Lung Fluke
- Beef Tapeworm
- Pork Tapeworm
- Broad Fish Tapeworm
- Dwarf Tapeworm
- Rat Tapeworm
- Hydatid Worm/ Hydatid Cyst/ Dog Tapeworm
- Double-pored Dog Tapeworm
UIC-MT/MLS PARASITOLOGY 2021
QUEEN JANE M. BACON UIC-MT/MLS PARASITOLOGY 2021
CESTODES
- also known as “flatworms” or “tapeworms” because of their long, segmented, ribbon
like bodies, that appear FLAT in a cross section

- scolex, strobila, proglottids, rostellum

- HERMAPHRODITIC contains male and female reproductive organs.
- most have cup like sucking discs;
- TREATMENT OF CHOICE : PRAZIQUANTEL

POINTS TO REMEMBER:
 GRAVID PROGLOTTIDS have fully developed reproductive organs with a uterus
FILLED WITH EGGS.
 APOLYSIS is defined as the detachment of the gravid segment from the scolex
 STROBILIZATION creating proglottids, made right in to the neck area under the
scolex, pushing other proglottid in to the strobila.

Taenia saginata (beef tapeworm)

- LONGER (5-10 m or longer)

Taenia solium (pork tapeworm)

- SHORTER (3-5 m)

 SOLIUM is common in poorer communities where humans live in close contact

with pigs (oncosphere in muscle)
 EGGS of the two spp CANNOT be differentiated
 INDIA INK stain used to visualize proglottids
 If diff is required, examination of gravid proglottid is done.

Taenia saginata Taenia solium

(cysticercus bovis) (cysticercus cellulosae)
OTHER NAME Beef tapeworm Pork Tapeworm
SIZE 5-10 m or longer 3-5 m
SCOLEX With 4 suckers ; NO With 4 suckers ; 2 ROWS
HOOKS OF HOOKS

With central crown of

hooks
PROGLOTTIDS 15-30 lateral uterine 5-10 lateral uterine
branches branches

Hymenolepis nana Hymenolepis dimunita

(cysticercoid larvae) (cysticercoid larvae)
OTHER NAME Dwarf tapeworm Rat tapeworm
EGGS BIPOLAR THICKENINGS With BIPOLAR
with 4-8 hairlike POLAR THICKENINGS, without
FILAMENTS POLAR FILAMENTS,

HOOKLETS have FAN

LIKE arrangement
SCOLEX ARMED RETRACTABLE UNARMED ROSTELLUM
ROSTELLUM; 20-30 Y
SHAPED HOOKLETS
Dibothriocephalus latus (broad fish tapeworm)

- previously known as: Diphyllobothrium latum

- the LONGEST TAPEWORM to infect human
- INFECTIVE STAGE: PLEROCERCOID LARVAE
- SPARGANOSIS: if man is infected with plerocercoid larvae
- has a DARK ROSETTE LIKE, coiled uterus
- SCOLEX : rounded SPATULA or ALMOND
- causes MEGALOBLASTIC ANEMIA
- freezing - 18C kills all PLEROCERCOIDS.

Dipylidium caninum

- a very COMMON intestinal parasite of DOGS and CATS

- “double-pored tapeworm” has a narrow BILATERAL GENITAL PORES
- PROGLOTTID: “ pumpkin seed” shape
-EGGS contained in polygonal sacs (8-15 eggs in a capsule)

Echinococcus spp.

- the SMALLEST TAPEWORM of man (3-6 mm)

- agent of HYDATID CYST disease
- DEFINITIVE HOST : dog or wild canine
- DIAGNOSIS : Casoni intradermal test
 MORPHOLOGY
TAENIA SAGINATA
- beef tapeworm
- cosmopolitan indistribution
- Definitive host: Human and never as intermediate
host.
- Human cysticercosis does not occur
INFECTIVE STAGE: CYSTICERCUS BOVIS
( 2months)
DIAGNOSTIC STAGE: EGGS OR GRAVID
PROGLOTTIS
MODE OF TRANSMISSION: INGESTION OF
RAW OR UNDERCOOKED BEEF
INTERMEDIATE HOST: CATTLE
Definitive host: Human
MORPHOLOGY
ADULT WORM
- upper jejunum (25 years)
- it derives nourishment from intestinal contents.
- 4 to 10 m in length (25 m reports)
SCOLEX
-cuboidal
- 1-2mm in diameter
- has 4 prominent acetabula
- devoid of hooks or a rostellum ( attached to the
scolex is a short neck from which a chain of
immature, mature, and gravid proglottids develop.
MATURE PROGLOTTIDS
- square in shape
- contain mature male and female reproductive
organs.
- there are 2 large lobes of ovaries and a median
club shaped uterus.
- Follicular testes numbering 300 to 400 scattered
in proglottid.
VAGINA OF T. SAGINATA HAS A SPHINCTER.
GRAVID PROGLOTTIDS
- longer that they are wide (16-20mm by 5-7mm)
most distal from the neck.
- uterus is distended with over (15-20 lateral
branches.
(the genital pores of proglottids are irregularly
alternate.
- contains 97000 - 124000 thousand ova.
- annually 594000000 million ova pass out via
feces or bowel
OVA
- spherical or subspherical in shape
- measures 30 to 45 um in diameter.
- original thin outer membrane surrounding the egg
is rarely retained after pits.
- Inside the eggshell is oncosphere or embryo
provided with three pairs of hooklets.
- by apolysis of gravid segments, eggs are
released and they remain viable in soil for weeks.
TAENIA SOLIUM
- pork tapeworm of man
- has a cosmpolitan distribution.
- Human serve both as a definitive and an
intermediate host.
- therefore, both intestinal and tissue infections
occur in man.
INFECTIVE STAGE: EMBRYONATED EGG
INGESTED BY HUMAN HOST
DIAGNOSTIC STAGE: EGGS OR GRAVID
PROGLOTTIS
MODE OF TRANSMISSION: INGESTION OF
RAW OR UNDERCOOKED INFECTED MEAT
INTERMEDIATE HOST: PIGS
DEFINITIVE HOST : HUMAN
ADULT WORM:
- upper small intestines
- it derives nourishment from intestinal contents of
the host.
- shorter that T. saginata and has less number of
proglottids.
- 2-4 m in length
- 8000 to 10000 proglottids.
SCOLEX
- has 4 acetabula but smaller (1mm)
- more spherical
- cushion-like rostellum with a double crown of 25-
30 large and small hooks which are absent in T.
saginata.
- The general morphology of the proglottids
resembles that of T. saginata. The difference lies in
the presence of an accessory ovarian
lobe, the absence of a vaginal sphincter,
-and the smaller number of follicular testes (100-
200) in the mature proglottid of T. solium
GRAVID PROGLOTTID
- contains 7-13 lateral branches
- proglottids of T. solium are relatively less active
than T. saginata
- approximately 30000 to 50000 (30 to 50 thousand)
ova
- it undergo apolysis to eventually release eggs
OVA / EGGS
- measure 30 to 45 um
- thick brown striated embryophore surrounding a
hexacanth embryo.
TAENIA ASIATICA
- third Taenia species reported in Taiwan, Korea,
Thailand and Indonesia.
- believed to be closely related to Taenia saginata
- cysticercus of larvae found in the liver of variable
intermediate hosts : pigs, cattle, goats, wild boars,
and monkeys.
CYSTICERCUS
- wart like protuberances on the external surface
and contains invaginated scolex armed with
vestigial hooklets.
ADULT WORM
- 4-8 m with 300-1000 segments.
- similar to T. saginata, the scolex is devoid of
hooklets but there is a prominent rostellum.
GRAVID PROGLOTTIDS
- posterior protuberance with 11-32 lateral
branches arising from the main uterus.
MATURE PROGLOTTIDS
- found to carry a vaginal sphincter.
(due to the e number of uterine branches and the
presence of vaginal sphincter, Taenia asiatica may
be misidentified as Taenia saginata
Japanese scientists collaborative a work that
gravid segments from 6 patients, identified earlier
as Taenia saginata were subjected to genetic
studies and the mitochondrial RNA of five out of the
six samples were found compatible with Taenia
asiatica.
- In the Philippines, T. saginata infection is more
common than T. solium infection.
- Surveys of animal intermediate hosts however
showed that pigs are infected more than cows or
cattle.
- Many of the identified cases were adult males
who came from the Northern Luzon provinces,
where eating raw or undercooked meat while
drinking alcohol is a delicacy.
- Neurocysticercosis has been reported in local
literature. There has
been one report of ocular cysticercosis.
HYMENOLEPIS NANA
- dwarf tapeworm
- is a cyclophyllidean tapeworm and is the smallest
tapeworm infecting humans.
- found worldwide, mainly children
- the parasite is the only human tapeworm which
can complete its entire life cycle in a single host,
indicating that it does not require an obligatory
intermediate host.
- Man can harbor both the adult and the larval
stages of the parasite.
The life cycle has a dual pathway: a direct
and an indirect development
INFECTIVE STAGE : EMBRYONATED EGGS
DIAGNOSTIC STAGE: EMBRYONATED EGGS IN
FECES
MODE OF TRANSMISSION: INGESTION OF
CONTAMINATED WATER, FOOD AND HAND
INTERMEDIATE HOST DIRECT: NONE
INTERMEDIATE HOST INDIRECT: ARTHROPOD
DEFINITIVE HOST : HUMAN
MORPHOLOGY
ADULT WORM
STROBILA
- measuring from 25-45 mm in length and 1 mm in
width
- reside in ileum
SCOLEX
- subglobular with 4 cup-shaped suckers.
- there is a retractable rostellum armed with a
single row of 20-30 Yshaped hooklets
- the neck is long and slender.
- anterior proglottids are short and the posterior
ones are broader than long.
- No more than 175 to 220 segments compose the
entire length of the strobila.
PROGLOTTIDS
- measures 0.15-0.3mm in length and 0.8-1.0mm in
width.
- genital pores are found along the same side of
the segments.
MATURE PROGLOTTIDS
- contain 3 ovoid testes and 1 ovary in a more or
less straight pattern across the segment.
- When segments become gravid, the testes and
the ovary disappear while the uterus hollows out
and
becomes filled with eggs.
- Gravid segments are separated from the strobila
and disintegrate as they pass out of the intestines,
releasing eggs in the stool.
OVA OR EGGS
- spherical or subspherical
- colorless or clay colored
- measuring 30-47 um in diameter.
ONCOSPHERE
- has a thin outer membrane and a thick inner
membrane with conspicuous bipolar thickenings
- arise four to eight hair-like polar
filaments embedded in the inner membrane.
- EGGS DIE IMMEDIATELY ONCE PASSED OUT
INTO THE ENVIRONMENT.
HYMENOLEPIS DIMUNITA
- cosmopolitan parasite primarily of rats.
- rat tapeworm
- Accidental human infections do occur resulting in
hymenolepiasis.
- Aside from morphological differences with H.
nana, H. diminuta differs in that it requires an
intermediate host.
INFECTIVE STAGE: CYSTICERCOID LARVAE
DIAGNOSTIC STAGE: EGGS PASSED IN FECES
MODE OF TRANSMISSION: INGESTION OF
EGGS
INTERMEDIATE HOST: BEETLES
DEFINITIVE HOST : RODENTS (RATS)
ADULT TAPEWORM
- larger than H. nana.
- measures about 60cm in length
SCOLEX
- differs from H. nana by having a rudimentary
unarmed rostellum.

MATURE PROGLOTTIDS
- broader than they are long
- 3 ovoid testes and 1 ovary in a more or less
straight pattern across the segment.
PROGLOTTIDS
- larger and may reach 0.75 mm in length and 3.5
mm in width.
- the genital pores are unilateral.
- each gravid proglottid contains a sac-like uterus
filled with eggs.
OVA / EGGS
- circular
- about 60-80 um in diameter
- bile stained.
ONCOSPHERE
- enclosed in an inner membrane, which has
bipolar thickenings but
lacks the bipolar filaments.
- The hooklets usually have a fan-like arrangement
GRAVID PROGLOTTIDS
- separate from the main body of the worm,
disintegrate and release eggs into the feces.
DIPYLIDIUM CANINUM
- double pored (Dog) Tapeworm
- a very common intestinal parasite of dogs and
cats worldwide.
- especially in dog populations where
ectoparasitism is high.
. Dipylidiasis in humans is accidental and is
observed to be more common in children than in
adults.
INFECTIVE STAGE: CYSTICERCOID LARVAE
DIAGNOSTIC STAGE: Egg packets and
proglottids
MODE OF TRANSMISSION: INGESTION OF
INFECTED FLEA
INTERMEDIATE HOST: DOG FLEA, CAT FLEA
DEFINITIVE HOST : DOGS AND CATS
ADULT WORM
- pale reddish
- measures 10-70 cm in length.
SCOLEX
- small and globular with 4 deeply cupped suckers
and a protrusible rostellum, which is armed with 1-7
rows of rose thorn shaped hooklets.
PROGLOTTIDS
- narrow with 2 sets of male and female
reproductive organs and bilateral genital pores.
GRAVID PROGLOTTIDS
- size and shape of a pumpkin seed and are filled
with capsules or packets of about 8-15 eggs
enclosed an embryonic membrane.
-When the gravid segments are detached, they
either migrate out of the anus or are passed out
with the feces. The ova are released by contraction
of the proglottid or by its disintegration outside the
host.
- Eggs are spherical, thin-shelled with a hexacanth
embryo.
DIPHYLLOBOTRIUM LATUM
- broad fish tapeworm
- belongs to the Order Pseudophyllidea.
- one of the 13 species of Diphyllobothrium that
infects human.
- Diphyllobothriasis refers to the intestinal infection
with the adult worm.
INFECTIVE STAGE: PLEROCERCOID LARVAE
DIAGNOSTIC STAGE:UNEMBRYONATED EGGS
MODE OF TRANSMISSION: INGESTION OF
UNCOOKED FRESHWATER FISH
INTERMEDIATE HOST: FRESHWATER FISH
DEFINITIVE HOST : HUMANS
ADULT WORM
- measures 3-10 m in length and may have 4000
proglottids.
SCOLEX
- spatulate and measures 2-3 mm in length by 1
mm in diameter.
- has 2 bothria or sucking grooves located dorsally
and ventrally.
- The neck is long and attenuated, and is followed
by immature proglottids. The terminal fourfifths of
the worm is composed of mature and gravid
proglottids.
MATURE PROGLOTTID
- has a longer width than its length.
- measures 2-4 mm in length by 10-12mm in width
and contains 1 set of reproductive organs.
- testes are located in the dorsolateral part of the
proglottid.
- vas deferens converge to form a vas deferens
and this enlarges into a seminal vesicle and
terminated in a muscular cirrus found at the
midventral common genital pore.
The dark, rosette-like, coiled uterus located in the
middle of the gravid proglottid extends from the
ootype and opens through a uterine pore in the
midventral line behind the common genital pore. A
symmetrical bilobed ovary is present at the
posterior third of the proglottid immediately above
the Mehlis’ gland. From the common genital pore,
the vagina extends up to join the oviduct and the
vitelline duct. Unlike in Taeniidae, the proglottids of
D.
latum disintegrate only when the segment has
completed its reproductive function.
OVA / EGGS
-With distention of the uterus, the uterine pore is
relaxed and unembryonated ova are discharged
from the proglottid.
- Approximately 1000000 ova may be released
daily.
-The ova are usually yellowish brown, with a
moderately thick shell and an inconspicuous
operculum.
- Opposite the operculum is a small
knob-like thickening. The mean size of the eggs is
66 by 44 μm, with a range of 58-76 μm in length
and 40-51 μm in width.

Echinococcus spp.
ECHINOCOCCUS GRANULOSUS

- hydatid worm / hydatid cyst / dog tapeworm

- Human echinococcosis is regarded as an
emerging /re emerging zoonotic disease.
- The disease is caused by the larval stage of
Echinococcus spp., which is acquired when the
eggs of this parasite are ingested.

INFECTIVE STAGE: EMBRYONATED EGGS

DIAGNOSTIC STAGE: HYDATID CYST
MODE OF TRANSMISSION: HAND TO MOUTH
CONTAMINATION
INTERMEDIATE HOST: SHEEP, CATTLE,
HORSES, PIGS, GOATS AND CAMELS
ACCIDENTAL INTERMEDIATE HOST: HUMANS
DEFINITIVE HOST : DOGS OR OTHER WILD
CANINES

Echinococcus spp. belong to the Family Taeniidae,

Order Cyclophyllidea.

There are 6 species of Echinococcus include, and

4 of them are of public health importance.
a. Echinococcus granulosus - causes cystic
echinococcosis.
b. Echinococcus multilocularis – causes alveolar
echinococcosis.
c. Echinococcus vogeli and;
d. Echinococcus oligarthus – both causespolycystic
echinococcosis

Note: E. multilocularis, E. vogeli and E. oligarthus

are less common due to their life cycles being
sylvatic.

ADULT WORM
- inhabits the small intestines of canines.
- measures 3-6 mm in length and

SCOLEX
- pyriform
- short neck and 3 proglottids ( one immature,
mature and gravid)
- typically taeniid and has 4 acetabula
- armed with 30-36 hooks.

GRAVID PROGLOTTID
- usually the widest and the longest proglottid

UTERUS IS MIDLINE
- with lateral evaginations, and is filled with eggs
which resemble those of other taeniid worms.

EGGS MAY BE RELEASED INSIDE OR OUTSIDE

THE HOST.
 PATHOGENESIS AND CLINICAL
MANIFESTATIONS
TAENIA SAGINATA
- the most common chief complaint is the passage
of proglottids or segments in the stool.
- causes mild irritation at the site of attachment.
- Patients with taeniasis may experience
nonspecific symptoms, such as epigastric pain,
vague discomfort, hunger pangs, weakness, weight
loss, loss of appetite, and pruritus ani (perianal
itching)
- Rarely, entangled proglottids result in intestinal
obstruction.
- proglottids are actively motile
and they have been documented to cause
obstruction in the bile and pancreatic ducts, as well
as the appendix.
- actively motile proglottids in the perianal area and
in the undergarments may result in anxiety and
distress.
TAENIA SOLIUM
- INTESTINAL INFECTION
results in mild non-specific abdominal
complaints.
CYSTICERCOSIS
cysticerci are often multiple and can
develop in any organ or tissue.
- located in striated muscle and in the brain, but
the subcutaneous tissues, eye, heart, lung, and
peritoneum may be involved.
- living cyst may produce inflammation.
- Cysts may survive up to 5 years
- if death, parasite will be calcified.
NCC
- One of the most serious manifestations is
neurocysticercosis (NCC), which is considered as
one of the most serious zoonotic diseases
worldwide.
- divided into two general forms:
1. Parenchymal
2. Extraparenchymal
which, in turn, is further divided into subarachnoid
or meningitic, intraventricular, and spinal. Clinical
manifestations and corresponding management
depend on the form of NCC present in the patient.
( Focal neurologic deficits are usually encountered
in parenchymal NCC. They would depend on the
location of the cysts. Focal or generalized seizures
are observed when cysts are located in the cortex.
The subarachnoid form may lead to an aggressive
form of NCC called racemous cysticercosis. In this
form,
there is a proliferation of cysts in the base of the
brain. This form has a poor prognosis. In the
intraventricular form, cysts are usually present in
the third or fourth ventricle and often lead to
obstructive hydrocephalus. The spinal form is rare.
The death of the larva leads to inflammation of the
affected region.
CLINICAL MANIFESTATIONS
Calcification is the end result of the cellular reaction.
Convulsions are the most common manifestations
of cerebral cysticercosis.
Visual and motor deficits, headache, and vomiting
may occur.
Cerebrospinal fluid (CSF) tap results may show an
increased opening pressure, elevated
protein,decreased glucose, and increased
mononuclear cells
In the eyes, cysticerci are often retinal or subretinal
in location. They may float freely in the vitreous or
aqueous humors. Vision is usually affected due to
chorioretinitis and vasculitis. Detachment of the
retina has also been reported. The patient may
complain of intraorbital pain, photopsia, and
blurring or loss of vision.
HYMENOLEPIS NANA
- Symptoms are generally produced because of
the patients immunological response to the
parasite.
-Light worm burden is generally asymptomatic.
-Clinical manifestations include headache,
dizziness, anorexia, pruritus of nose and anus,
diarrhea, vomiting, abdominal pain, pallor, and
weight loss.
- Some infected children are restless, irritable, and
exhibit sleep disturbances
- Rarely, convulsions occur.
- Heavy infections may result in enteritis due to
necrosis and desquamation of the intestinal
epithelial cells.
HYMENOLEPIS DIMUNITA
- The worm burden in rodents is relatively low. In
man, the highest number recorded is 19 worms.
- Clinical manifestations are minimal and non-
specific. The life span of H. diminuta in humans is
short, which possibly explains why human
infections are usually light.
DIPYLIDIUM CANINUM
- Infection is rarely heavy and symptoms are
minimal. Slight intestinal discomfort, epigastric pain,
diarrhea, anal pruritus, and allergic reactions have
been reported. While most patients are
asymptomatic, moderate eosinophilia has been
reported.
DIPHYLLOBOTRIUM LATUM
Infections are usually limited to one worm
❑ Often results in
o Hyperchromic, megaloblastic anemia with
thrombocytopenia and leukopenia
❑ Anemia seen in diphyllopbothriasis is similar to CLINICAL MANIFESTATIONS
Vitamin B12 deficiency anemia and could be
mistaken for pernicious anemia

- Worms located high up in the jejunum compete

effectively with the host for the Vitamin B12 in the
diet. If worms are pushed further down the
intestines, with treatment, anemia is relieved.

NOTE: Vitamin B12 content of D. latum is 50 times

higher than that of T. saginata

ECHINOCOCCUS GRANULOSUS
- Pathology of human cystic echinococcosis is
caused by the developing larval cyst in the tissues
of the intermediate host.

- The most common and most important site of

involvement is the liver, which is seen in 70% of the
cases, 85% of which is located in the right lobe.

- The lungs are involved in 20 to 30% of cases,

while other organ involvement, such as the brain
and the orbit, make up 10% of cases.

- Cysts are less commonly seen in the spleen,

kidneys, heart, bone, and central nervous system.

- cysts of E. granulosus are called unilocular

hydatid cysts, while those of E. multilocularis are
considered alveolar cysts.

- E. granulosus leads to down-regulation of

inflammatory cytokines, resulting in local
immunosuppression. This may be the mechanism
by which the parasite is able to escape host cell-
mediated response. Mass effect brought about by
the enlarging cyst results in organ impairment as
the neighboring tissues undergo atrophy and tissue
necrosis.

- Involvement of the brain

may cause increased intracranial pressure and
Jacksonian epilepsy
 DIAGNOSIS AND TREATMENT
TAENIA SAGINATA
- Specific diagnosis rest on:
o Identification of proglottids, eggs and scolex
First Specimens: Gravid Proglottids, either single or
in chains
o Examined against light allowing one to have
rough count of the lateral branches from the main
uterus
India Ink: injection in the genital pore help one
make an accurate count of lateral branches of the
uterus
NOTE: Stool can be examined but eggs rarely pass
out in
Stools
o FECT to demonstrate the eggs
Perianal Swab: useful as eggs are left in the
perianal skin
TREATMENT:
Praziquantel, 5-10 mg/kg, single dose for both
adults and children
NOTE: it is not necessary to recover the scolex
unless species-specific diagnosis is needed
1. Recovery of the scolex
2. Negative stool examination 3 months after
treatment
TAENIA SOLIUM
NCC may be suspected when patients live in
epileptic seizure endemic areas without systemic
symptoms.
Presumptive evidence of NCC: subcutaneous
cysticerci contaminant with neurologic symptoms
Computed axial tomography (CAT) and Magnetic
resonance imaging (MRI) – useful for localizing
cysticerci and evaluating the pathology before and
after treatment
CAT Scan patterns:
1. Round low-density area without surrounding
enhancement after administration of contrast dye
➢ Shows a viable larva with no
inflammation
2. Ring-like enhancement after injection of contrast
dye
A. Dead larva
3. Small calcified area within a cystic space
➢ Dead scolex
Ophthalmoscopy – diagnosis of ophthalmic
cysticercosis, but may induce movement and/or
evagination of the scolex
Tissue biopsy – recovers muscular and
subcutaneous cysticerci
Serologic Tests
DIAGNOSIS AND TREATMENT
- Serum and CSF ELISA
- Electro-immuno transfer blot (EITB)
- Western blot: specific for IgG and IgM
anticysticercal antibodies
o These tests have a sensitivity of 75-100% using
partially purified glycoprotein antigen
- Dot-ELISA: screening test for cysticercosis
TREATMENT
Taeniasis
o Praziquantel
o Niclosamide
Because of the theoretical possibility of
autoinfection and subsequent cysticercosis,
treatment should not be delayed.
Cysticercosis
➢ Management of NCC depends on the form
present
➢ Parenchymal cystic lesion:
o Praziquantel. 50-75 mg/kg divided into 3 doses
for 30 days
o Corticosteroids (either prednisone 80 mg or IM
dexamethasone 10 mg) 4 hours after the last dose
➢ Subarachnoid and Ventricular forms, as well as
symptomatic cysts outside the CNS: surgical
removal of the cyst
➢ Ocular cysticercosis should be treated surgically
before praziquantel or albendazoles
HYMENOLEPIS NANA
Specific diagnosis: demonstration of the
characteristics of eggs in the patient’s stool
Light infections: Concentration of the stool
specimens on alternate days
NOTE: Generally, proglottids are not recovered as
they undergo degeneration prior to passage with
stools
DRUG OF CHOICE: Praziquantel
❑ 25mg/kg single dose
❑ Causes vacuolization and disruption of the
tegument in the neck region
❑ Dose is higher than Taeniasis, because of the
relative resistant cysticercoids in the intestinal
tissue
Treatment is considered successful if stools are
negative for H. nana eggs at one month
posttreatment.
ALTERNATIVE: Nitazoxanide, 500 mg orally for 3
days
NOTE: Suggestion shows that parasitic conditions
should be treated first before any
immunosuppressive therapy be given.
 HYMENOLEPIS DIMUNITA
➢ Identification of eggs
➢ H. diminuta eggs are distinguished by their
circular shape, larger size, and lack of bipolar
filaments
➢ Morphology of the scolex may be used as an aid
in diagnosis
❑ Praziquantel, 25 mg/kg single dose
DIPYLIDIUM CANINUM
➢ Established upon the recovery pf the
characteristic gravid proglottids passed out either
singly or in chains as they may pass out
involuntarily
➢ Stool examinations - Proglottids should be
pressed or flattened between two glass slides for
examination
- Stool examination for the presence of the egg
capsules is not recommended, since the gravid
proglottids do not disintegrate in the intestines but
in the environment.
NOTE: Egg capsules are rarely recovered from the
stool
❑ Praziquantel, 5-10 mg/kg single dose
DIPHYLLOBOTRIUM LATUM
- Residence in or travel to an endemic area,
a raw-fish diet, and a pernicious type of anemia
may be suggestive of diphyllobothriasis.
- Sometimes, proglottids may be vomited.
Since eggs are usually numerous, direct fecal
smears usually suffice. The Kato technique is
also useful in demonstrating eggs
- To differentiate anemia due to diphyllobothriasis
from pernicious anemia, examination of the gastric
juice for the presence of free hydrochloric acid is
useful. Pernicious anemia is associated with
achlorhydria.
- The drug of choice is praziquantel as 5 to
10 mg/kg single dose.
The criterion for cure is recovery of the scolex in
feces after treatment.
If the scolex is not recovered, a repeat stool
examination is done after 3 months to be certain
that the patient is no longer infected.
ECHINOCOCCUS GRANULOSUS
- Radiographic findings and /or ultrasonography
-Serologic tests
o Indirect hemagglutination (IHA)
o Indirect fluorescent antibody (IFA)
o Enzyme immunoassays (EIA)
NOTE: Serology may have a relatively high
sensitivity if the cysts are located in the liver.
DIAGNOSIS AND TREATMENT
Other locations may decrease the reliability of
adjunctive diagnostic test.
GOLD STANDARD: Detection of IgG antibodies to
hydatid cyst fluid-derived native or recombinant
antigen B subunit, through ELISA or immunoblot
Type CL
Unilocular cystic lesion(s) with uniform anechoic
content without pathognomonic signs
Type CE1 Unilocular cysts with uniform anechoic
content and with pathognomonic signs that include
visible cyst wall and ‘snow flake sign’
Type CE2 Multivesicular, multiseptated cysts
Type CE3 Anechoic content with detachment of
laminated membrane from the cyst wall visible as
floating membrane or as ‘water-lily sign’
Type CE4 Heterogeneous hypoechoic or
hyperechoic degenerative contents, no daughter
cysts present
Type CE5 Cysts characterized by thick calcified
wall which is arch-shaped, producing a cone-
shaped shadow, the degree of calcification may
vary from partial to complete
TREATMENT:
Preferred treatment: Surgical resection for
echinococcosis presenting with a large liver cyst,
secondary infection, or cysts in extrahepatic sites
Chemotherapy with benzimidazole compounds:
small, isolated cysts, uncomplicated cysts, and
patients with negative serology
Albendazole, Mebendazole: Effective for a
minimum of three months
Percutaneous aspiration, injection, reaspiration
(PAIR): Indicated for patients with single or multiple
cysts in the liver, abdominal cavity, spleen, kidney,
bones, who cannot undergo surgery
a. Ultrasound-guided percutaneous
puncture
b. Aspiration of substantial amounts of
cystic fluid
c. Injection of a protoscolicidal agent for at
least 15 minutes
d. Reaspiration
*PAIR with albendazole/mebendazole – have
greater efficacy and lower rates of morbidity,
mortality, and disease recurrence
 PREVENTION

TAENIA
- Thorough cooking of meat (primary measure)
❑ Freezing at -20C for 10 days kills
❑ Sanitary inspection
❑ Meat inspection

HYMENOLEPIS SPP
Direct Cycle: Requires a single host
❑ Personal hygiene
❑ Environmental sanitation
❑ Rodent control
❑ Proper storage of food

➢ Rodent control
➢ Elimination the insect intermediate host
➢ Protection of food
➢ Sanitary disposal of human waste
➢ Treatment of human case

DIPYLIDIUM
❑ Periodic deworming of pet cats and dogs
❑ Insecticide dusting of dogs and cats

DIPHYLLOBOTHRIUM LATUM
❑ Cook freshwater fish thoroughly
❑ Freezing for 24-48 hours at -18C kills all
plerocercoids
❑ Proper disposal of sewage and marketing of fish
ECHINOCOCCUS

❑ Achieved by reducing the infected populations

and by minimizing opportunities for transmission
❑ Regular testing and quarantine
❑ Treatment of dogs with praziquantel in endemic
areas
❑ Dogs should not be allowed in slaughterhouses,
and refuse from these facilities should be sterilized
or properly disposed of
❑ Health education
❑ Vaccination of livestock
❑ Development of more sensitive diagnostic
techniques for definitive and human hosts
Trematodes
Food-borne Parasites
Trematodes
- Intestinal Fluke
- Lung Fluke
- Liver Fluke

Intestinal Fluke
- Fasciolopsis buski
- Heterophyes heterophyes
- Echinostoma ilocanum
Lung Fluke -Paragonimus westermani
Liver Fluke - Fasciola hepatica & Clonorchis sinensis

General Characteristics: TREMATODES

1.) commonly known as FLUKES ( "trematos": pierced with holes):
2.) Leaf-like, unsegmented and flattened dorsoventrally:
3.) with suckers as organs of ATTACHMENTS
-oral sucker (surrounding the mouth)
-ventral sucker (found in the body surface)
4.) ALL requires 2 Intermediate Hosts (IH) EXCEPT Schistosoma spp.
Ist IH of All Trematodes: Snails
2nd IH of Trematodes: Fish, Water vegetations, crabs

General Characteristics: TREMATODES

1. ALL Trematodes are hermaphroditic EXCEPT Schistosoma spp.
2.ALL Trematodes are operculated EXCEPT Schistosoma spp.
3. ALL have metacercaria as infective,stage EXCEPT Schistosoma spp.
4. ALL are transmitted via INGESTION except Schistosoma spp.
5. ALL are ORGAN-dwellino EXCEPT Schistosoma spp.

PARAMETER OTHER FLUKES SCHISTOSOMES

Location Organ- dwelling Blood-dwelling
IH 2 1
Infective stage Metacercariae cercariae
Shape Flat Cylindrical
Sexes Hermaphroditic dioecious
Egg Operculated Non-operculated
Transmission Ingestion Skin penetration

1.Miracidium
- free swimming ciliated embryo/first larval stage.
-swimming at rate of about 2mm per second.
-needs to find a fit molluscan host rapidly since they can only survive for a few hours.
2.Sporocyst -2nd stage saclike larva
3.Rediae
- 3rd stage larva
-elongated and blunt at the posterior.
4.Cercariae
- 4th larval stage/infective stage of Schistosoma spp to humans
-attracted to amino acid ARGININE of the human skin:
-Requires only half an hour or less to penetrate the epidermis;
5.Metacercariae - infective stage of OTHER Trematodes to humans.

Life Cycle of Trematodes:

1.) Adult worm lays eggs that leave the definitive host (man) thru feces/sputum:
2.) Eggs develop into "ciliated larvae." known as MIRACIDIUM:
3.) Miracidium penetrates the snail (1st IH) and develops into SPOROCYST:
4.) Sporocyst develops into REDIAE;
5.) Rediae develops into CECARIAE;
G.) Cercariae leaves snail and encysts into METACERCARIAE:
7.) Humans consume food with Metacercariae and mature Into ADULTS.

BLOOD FLUKES
-Dioecious separate adult male and female
-males are short and robust
-females longer and slender
-Cylindrical body of adult worm not leaf-like;
-Skin Penetration is the Mode of Transmission:
-Intermediate Hast is only one: SNAILS!
-Schistosoma japonicum
-Schistosoma mansoni
-Schistosoma haemtobium

Schistosoma japonicum "Oriental Blood Fluke"

- IS: Cercariae (larva with "forked tail")
-MOI: Skin penetration IH: Oncomelania hupensis quadrasi
-Secretions attract the miracidium:
-Once the snail is penetrated, miracidum looses its ciliated surface
-Cercariae looses its tail upon skin penetration (SCHISTOSOMULE)
- " LARGEST blood fluke"
- ovoid, round or pear-shaped
- Pale yellow in color
- inconspicuous LATERAL KNOB
- Only MATURE EGGS hatch in water (2-4 hours):
- A water temperature between 25-31 C is ideal:
-an active MIRACIDIUM is released after hatching;
Schistosoma japonicum
PATHOGENESIS
Schistosomiasis 3 phases:
1. Migratory Phase
- time from penetration to maturation and egg production:
- symptomless but may produce dermatitis (Swimmers' itch) DERMATITIS with
PRURITIS and localized reaction due to skin penetration of cercariae:
2. Acute Phase
- sometimes called as "Katayama fever" (from Katayama region of Japan, a former
endemic area):
- occurs when Schistosomes begin to produce eggs about 4 to 10 weeks after initial
infection:
-syndrome is a systemic hypersensitivity reaction against the migrating schistosomula
with fever, respiratory symptoms, abdominal pain, myalgias, fatigability and etc.:
3. Chronic Phase
- commonly asymptomatic or with mild abdominal pain, mild or chronic bloody diarrhea
and I ethargy:
-pain in urination and presence of blood in the urine;
- periportal cirrhosis splenomegaly. Ascites

Circumoval precipitin test (COPT)

• The circumoval precipitin test (COPT) is based on patient serum precipitation with
lyophilized eggs or purified live eggs identified under microscope.
• This method is useful for the diagnosis of S. mansoni and S. japonicum.
• One drop, about 0.025 ml, of the suspension containing living larvae, eggs or 6-8
specimens of immature adults is put into the well of a slide, and 3 drops, about 0.075 ml,
of serum is added.
-A cover slip is placed over the well. The slide is incubated at 34 DC. After 24 hr, the slide
is examined by microscope for the appearance of
precipitates attached to the worms or eggs.

Schistosoma mansani " Mansonian Fluke"

-'Smallest blood fluke"
-LATERAL SPINE
-IH: Biomphalaria spp.
-lives in veins adjacent to the LARGE INTESTINES;
• Causes Bloody Diarrhea
• Causes Rectal Schistosomiasis

Schistosoma haematobium " Bladder Fluke"

• TERMINAL SPINE
• causes Bilharziasis
• IH: Bulinus spp.
• URINE: Hematuria
• Blood clots & Mucus may obstruct ureter and bladder:
• toxic irritation of eggs may lead to bladder carcinoma
 Summary Table of Differences
Schistosoma Schistosoma Schistosoma
japonicum mansoni haematobium
Common Name Oriental Blood Manson’s Blood Visceral Blood
Fluke (largest) Fluke (smallest) Fluke
Disease Katayama Disease Bilharziasis Schistosomal
Association Oriental Katayama Disease Hematuria
Schistosomiasis
Habitat in Man Superior Venules of the Vesical and Pelvic
Mesenteric Veins lower intestine Venous Complexes
Specimen for STOOL URINE
Diagnosis
Geographical Japan, China, Africa, South Africa, West Asia,
Distribution Thailand, America, Carribean South Europe
Philippines Islands
Distinguishing -55-85 um by 40-60 -112-182 um by 40- -110-170 um by 38-
featres of the EGG um 75 um 70 um
-Lateral Knob -Lateral Spine -Terminal Spine
-oval to spherical -Elliptical -Elliptical
Intermediate Host Oncomelania spp. Biomphalaria spp. Bulinus spp.
(snail spp)

Summary Table of General Characteristics:

Organ-dwelling Trematodes

SPECIES COMMON HABITAT INFECTIVE # OF HOST

NAME STAGE AND REQUIRED
MODE OF
TRANSMISSION
Pragonimus Oriental Lung Lung Fluke 1 Definitive
westermani Fluke Host
Fasciolopsis Giant Intestinal 2 Intermediate
buski Intestinal Fluke Hosts
Fluke Total = 3
Echinostoma Garission’s Hosts
ilocanum Fluke METACERCARIAE
Heterphyes Von Siebold’s (INGESTION)
heterophyes Fluke
-Fasciola -Sheep Liver Liver/ Hepatic
hepatica Fluke Fluke
-Fasciola -Tropical Liver
gigantica Fluke

Clonorchis Chinese Liver

sinensis Fluke
Paragonimus westermani "Oriental Lung Fluke"
• A perfect example of a zoonosis: Paragonimiasis
• Eggs are passed with sputum or swallowed and passed in feces
• IS: metacercariae
• DS: unembryonated egg
• Causes Endemic hemoptysis
- mimics symptoms of patients with PTB
• Treatment: Praziquantel
-SPUTUM: rusty-brown
1st /IH: Antemelania asperata
2nd/ IH: Sundathelphusa philippina

Paragonimus westermani adult fluke

-7.5 mmm long and 4 mm to E mm in width:
- very thick and reddish-brown and resembles color and shape of a coffee bean;
-Testes are LOBATED located at the same level:
-Uterus is tightly coiled into a rosette (uterine rosette'')
-Rounded anteriorly and tapered posteriorly;

Paragonimus westermani
- Immature egg embryonates in water:
- A "MIRACIDIUM" develops within 2 to 7 weeks
- Eggs are 80 um to 11& um by 48 to 60 um:
- oval, yellowish-brown and thick-shelled
- With praminent yet flattened operculum
- Immature egg embryonates in water:
- A "MIRACIDIUM" develops within 2 to 7 weeks
- Eggs are 80 um to 118 um by 48 to 60 um:
- oval, yellowish-brown and thick-shelled;
- With prominent yet flattened operculum
- Has thickened abopercular portion
- Resembles "Chinese vase"

INTESTINAL FLUKES
Fasciolopsis buski
Echinostoma sop.
Heterophyids

NICE TO KNOW FACTS

1. Crabs marinated in brine, vinegar or wine can only coaqulate the protein in the muscles
but cannot kill the metacercariae;
2.) Some ethnic groups use the juice
strained from the crushed crabs for medicinal use:
3.) Paragonimus killecati commonly found in North America closely resembles P.
westermani
Fasciolopsis buski
Adult
- 20 mm to 75 mm by 20 mm: elongated and oval:
- NO Cephalic cone or' "shoulders:"
- 2 coral-like BRANCHED testes
located in posterior half of the body:
-Tegument containes spines/scales;
-Unbranched cecum (unlike Fasciolid)

Echinostoma spp
(a.k.a Euparyphium ilocanum)
-"Garrison's Fluke"
1st IH: Gyraulus convexiusculus
2nd IH: Pila luzonica (kuhol)
**Only trematode with SNAIL as Ist and 2nd IH:
Egg
• Operculated
• Straw-colored
• With GERMBALL inside
- With characteristic circumoral collar" of peg-like spines;
- E. ilocanum possesses 4l to 59 spines;
- First isolated in Manila in 1907 from the stool of a prisoner;
- 2 testes deeply bilobed, arranged IN TANDEM in the 3rd quarter of the body;
- Tegument with scales/spines:

Heterophyids
Minute intestinal fluke
Heterophyes heteraphyes
Metagonimus yokogawai
Haplorchis taichui
Haplarchis yokogawai

Heterophyes heterophyes
-"Von Siebold's Fluke"
-"smallest trematode of man"
Egg
• Brownish vellow
• Prominent opercular shoulders
• Contains fully developed miracidium
• Embryonated egg- DS
• Infection can be acquired from eating uncooked fish with metacercariae
Adults
• 1.0 mm to 1.7 mm long and 0.3 mm to 0.4 mm in width:
• entire body is covered with SLENDER SCALES;
• TWO OVAL TESTES lie side by side near the posterior end;
Equipped with 3rd sucker: Genital
Sucker/"Gonotyl
• lives in the SMALL INTESTINES:

LIVER FLUKES
Fasciola hepatica/gigantica,
Clonorchis sinensis
Opistorchis felineus

Fasciola spp.
-Fasciala hepatica - Temperate liver fluke
-Fasciola gigantica - Tropical liver fluke
-Must important parasite of SHEEP and CATTLES
-Causes Sheep "Liver Rot"
-(flukes feed on the liver cells and blood)
-Fluke releases "Proline" a chemical substance that triggers bile duct collagen deposition
-But there are few human cases reported in the Philippines

Fasciola hepatica
-cephalic cone, 2 shoulders, converging margins,smaller in size
Fasciola gigantica
-Less prominent shoulders, parallel margins, larger in size

Clonorchis sinensis
"Chinese or Oriental Liver Fluke"
-" Spindlaid Fluke"
•Operculated egg with a light bulb shape:
• Has small knob
• ONLY Trematode without spines/ scales in its
• tegument for the Adult stage:

Manner of Reporting
• Fasciolopsis buski, Fasciola, Echinostoma:
FASCIOLID EGG

• Heterophyes, Clonorchis, Opistorchis:

HETEROPHYID EGG
Parasitology Taenia spp.
MATURE Square in shape
PROGLOTTIDS Contain mature male and female
reproductive organs
➢ Flatworms/tapeworms
2 large lobes of ovaries and a median club-
➢ Long, ribbon-like bodies that appear in a cross
shaped uterus
section
300-400 follicular testes
➢ Hermaphroditic – contains male and female
Vagina: Contains sphincter
reproductive organs
GRAVID 16-20mm by 5-7 mm
➢ Lacks mouth and digestive system; they eliminate PROGLOTTIDS Longer than they are wide
wastes and absorbs nutrients through their outer
97,000-124,000 ova; 594,000,000
body surface called tegument
annually
Important parts
Scolex Head NOTE: The scolex is devoid of hooks or rostellum.
Strobila Entire body consisting of proglottids
Proglottid Segments or portions comprising the
strobila o Spherical or subspherical
1. Immature – after the neck o 30-45 um
2. Mature o Brownish
3. Gravid – end most; most distal;
contains fully developed organs
with uterus filled with eggs
Thick embryophore that appears striated due to
rostellum Contains hooks or crowns numerous pits
Contains oncosphere or embryo with three pairs of
Treatment: Praziquantel
hooklets
➢ Effective when scolex is recovered in stool
sample

*Apolysis – detachment of gravid segment from the

scolex
*Oncosphere / hexacanth embryo – embryo visible in the
tapeworm eggs

Taenia saginata
➢ Beef tapeworm
➢ Cosmopolitan in distribution
➢ Definitive hosts: MAN
➢ Inhabits the upper ileum
➢ Can live up to 25 years

NOTE: Human cysticercosis due to this species does not

occur

1. Gravid proglottids undergo APOLYSIS and are

either passed out with the feces or they actively crawl out
the bowel to the external environment
2. Eggs are released and they remain viable in the
soil for weeks
3. T. saginata eggs are ingested by cattle, and the
oncosphere is released
4-10 m; some reach 25 m 4. They actively penetrate the intestinal mucosa,
enters a venule, and is carried to other parts of the body
1000-4000 proglottids
SCOLEX 5. It typically enters a muscle fiber and develops
1-2 mm
into an infective stage called Cysticercus bovis in 2
4 prominent acetabula
months
Cuboidal

TADENA 91
Parasitology Taenia spp.

6. Encysted larva is ingested from raw or

improperly cooked beef
7. Larva is digested out of the meat and the scolex
evaginates to attach to the mucosa of the small intestines
where they mature in 12 weeks
NOTE: Usually one adult tapeworm is present in T.
saginata infections. Adult worms are irritated by alcohol.
Taenia solium
➢ Pork tapeworm
➢ Definitive and Intermediate host: Man
➢ Both intestinal and tissue infections occur in man
➢ Inhabits the upper small intestines

o Shorter than T. saginata and has lesser number of

Most common chief of complaint: Passage of proglottids proglottids
or segments in the stool
➢ Causes mild irritation in the site of attachment
➢ Nonspecific symptoms
o Epigastric pain, vague discomfort, hunger
pangs, weakness, weight loss, loss of
appetite, pruritus ani

Rarely: Intestinal obstruction

Motility of proglottids in the perianal area and in the

undergarments may result in anxiety and distress.

NOTE: T. saginata proglottids are actively motile and have

been documented to cause obstruction in the bile and 2-4 m
pancreatic ducts, as well as the appendix. 8000-10000 proglottids
4 acetabula; more spherical than beef tapeworm
SCOLEX Carries cushion-like rostellum with double
crown of 25-30 large and small hooks
Specific diagnosis rest on:
PROGLOTTIDS Presence of an accessory ovarian love
o Identification of proglottids, eggs and scolex
Absence of vaginal sphincter
Small number of follicular testes (100-
First Specimens: Gravid Proglottids, either single or in
200)
chains
GRAVID 30,000-50,000 ova
o Examined against light allowing one to have rough
PROGLOTTIDS
count of the lateral branches from the main uterus

India Ink: injection in the genital pore help one make an

accurate count of lateral branches of the uterus o Indistinguishable from T.
saginata
NOTE: Stool can be examined but eggs rarely pass out in o 30-45 um
stools
o FECT to demonstrate the eggs

Perianal Swab: useful as eggs are left in the perianal skin Thick brown striated embryophore surrounding a
hexacanth embryo

Praziquantel, 5-10 mg/kg, single dose for both adults and
children
NOTE: it is not necessary to recover the scolex unless
species-specific diagnosis is needed
NOTE: Both T. saginata and T. solium are not
differentiated in terms of morphology; both are
reported as Taenia spp., Taenia egg.

1. Recovery of the scolex

2. Negative stool examination 3 months after
treatment

TADENA 92
Parasitology Taenia spp.

❑ Intestinal infection
o Mild nonspecific abdominal complaints

1. Cysticercosis
o Cysticerci often located in striated muscle, brain,
subcutaneous tissue, eye, heart, lung, and
peritoneum
o Living cyst may produce inflammation; living up
to 5 years
▪ Upon death, cystic fluid increases triggering
tissue response leading to calcification of
parasite

NOTE: Symptomatology depends on the number, size and

location of the lesion

➢ One of the most serious zoonotic diseases

worldwide
➢ Most serious manifestation
➢ General form: Parenchymal and
Extraparenchymal
o Subdivided into subarachnoid,
meningitic, intraventricular, spinal

1. Eggs are ingested by hogs and the oncosphere

are released in the intestines ➢ Focal Neurologic deficits
2. Oncosphere penetrates the intestinal mucosa to ➢ Depend on location of cyst
typically encyst in muscles as Cysticercus cullosae ➢ Cortex: focal or generalized seizures
3. Upon ingestion of improperly cooked infected
meat, the larva is liberated and the scolex attaches to the Subarachnoid ❑ Aggressive form of NCC
intestinal mucosa; form ❑ Racemous cyctiscercosis
4. Maturity is attained approximately 12 weeks ❑ Proliferation of cysts in the base
from ingestion of the brain
Intraventricular ❑ Cysts usually present in the 3rd or
NOTE: Cysticercus is commonly found in muscles, tongue, form 4th ventricle
heart, diaphragm, liver, spleen, and mesentery. ❑ Often leads to obstructive
hydrocephalus
Infected meat is often called “measly pork”. Spinal form Rare

Mature cysticercus Calcification – end-result of the cellular reaction

- Oval, translucent, and has an opaque
invaginated scolex with four suckers and a circlet of hooks Inflammation – caused by death of the larva
- Full size: 5 mm; attained in 10 weeks
Convulsions – most common manifestation of cerebral
When T. solium eggs are ingested, oncosphere hatches in cysticercosis
the duodenum and spreads to different organs through
the bloodstream, resulting to human cysticercosis. CSF tap results may show:
❑ Increases opening pressure
MOT: Fecal-oral route by ingesting T. solium eggs from ❑ Elevated protein
contaminated food or drink ❑ Decreased glucose
❑ Increased mononuclear cells
Autoinfection may occur due to poor hygiene practice. ❑ Half of the cases may present CSF eosinophilia
without peripheral blood eosinophilia

TADENA 93
Parasitology Taenia spp.

In the eyes: o Corticosteroids (either prednisone 80 mg or IM

➢ Cysticerci are often retinal or subretinal dexamethasone 10 mg) 4 hours after the last
➢ Vision is usually affected due to chorioretinitis dose
and vasculitis ➢ Subarachnoid and Ventricular forms, as well as
➢ Complains of intraorbital pain, photopsia, symptomatic cysts outside the CNS: surgical removal
blurring, loss of vision of the cyst
➢ Ocular cysticercosis should be treated surgically
before praziquantel or albendazoles
NCC may be suspected when patients live in epileptic
seizure endemic areas without systemic symptoms.
➢ Infections are highly related to the habit of eating raw
Presumptive evidence of NCC: subcutaneous cysticerci or improperly cooked meat
contaminant with neurologic symptoms ➢ Maintenance of the life cycle in nature is dependent
on the level of environmental sanitation practiced in
Computed axial tomography (CAT) and Magnetic the area
resonance imaging (MRI) – useful for localizing cysticerci
and evaluating the pathology before and after treatment
❑ Thorough cooking of meat (primary measure)
CAT Scan patterns:
❑ Freezing at -20C for 10 days kills
1. Round low-density area without surrounding
❑ Sanitary inspection
enhancement after administration of contrast dye
❑ Meat inspection
➢ Shows a viable larva with no inflammation
2. Ring-like enhancement after injection of contrast dye
A. Dead larva T. saginata T. solium
3. Small calcified area within a cystic space ➢ 15-20 lateral ➢ 7-13 lateral branches
➢ Dead scolex branches ➢ Found in Slavic
➢ Found in Ethiopia, countries, Latin
Ophthalmoscopy – diagnosis of ophthalmic cysticercosis, East Africa, Japan, America, Southeast
but may induce movement and/or evagination of the Europe, Australia, Asia, China, India
scolex Canada, USA ➢ Shorter
➢ Longer ➢ 3-5 m
Tissue biopsy – recovers muscular and subcutaneous ➢ 5-10 m ➢ Scolex: with 4 suckers
cysticerci ➢ Scolex: with 4 suckers and 2 rows of hooks
and no hooks ➢ CYSTICERCUS
Serologic Tests ➢ CYSTICERCUS BOVIS CELLULOSAE
- Serum and CSF ELISA ➢ More pathogenic due
- Electro-immuno transfer blot (EITB) to NCC
- Western blot: specific for IgG and IgM
anticysticercal antibodies
o These tests have a sensitivity of 75-100%
using partially purified glycoprotein antigen
- Dot-ELISA: screening test for cysticercosis

Taeniasis
o Praziquantel
o Niclosamide

Because of the theoretical possibility of autoinfection and

subsequent cysticercosis, treatment should not be
delayed.

Cysticercosis
➢ Management of NCC depends on the form present
➢ Parenchymal cystic lesion:
o Praziquantel. 50-75 mg/kg divided into 3 doses
for 30 days

TADENA 94
Parasitology
Hymenolepis nana
➢ Dwarf tapeworm
➢ Cyclophyllidean tapeworm
➢ Smallest tapeworm infecting humans
➢ Found worldwide, mainly among children
➢ Only human tapeworm, which can complete its entire
life cycle in a single host
➢ Does not require an obligatory intermediate host
➢ Man can harbor both the adult and the larval stages
of the parasite
25-45 mm by 1mm
Reside in the ileum
With delicate strobila
SCOLEX Subglobular, with four cup-shaped
suckers
Rostellum Retractable, armed with a single row
of 20-30 Y-shaped hooklets
Strobila No more than 175-220 segments
PROGLOTTIDS 0.15-0.3 mm in length, 0.8-10 mm in
width
Genital pores are found along the
same side of the segments
Mature proglottids contain three
ovoid testes and one ovary in a more
or less straight pattern across the
segment
o Spherical or subspherical
o 30-47 um
o Colorless / clay-colored
Oncosphere:
❑ Thin, outer membrane
❑ Thick, inner membrane with conspicuous bipolar
thickenings
o Arises 4-8 hair-like polar filaments
embedded in the inner membrane
NOTE: Eggs die immediately once passed out into the
environment.
Hymenolepis spp.
Mode Transmission: Ingestion of Contaminated Water,
Food and Hand
Definitive Host: Human (Direct, Indirect)
Intermediate Host: (Direct) None
Intermediate Host: (Indirect) Arthropod (Tribolium spp.),
Rodents
1. Embryonated Egg ingested by Human (Direct),
Arthropods and Rodents (Indirect)
2. Embryonated Egg will go to Small Intestine
(Duodenum, Ileum)
3. It will hatch in Small Intestine and will hatch into the
Small Intestine (duodenum, Ileum)
4. Cysticercoids will invade the Intestinal lining and will
develop into the Intestinal Villi (for 4-5 days)
5. Adult Cysticercoids will release the Embryonated Egg
6. Then Autoinfection will occur and H. nana will
continue his life cycle.
7. Then the egg will be passed out to the feces and the
2nd Development (Indirect Cycle) will enter
Symptoms are usually produced as a result of
immunological response to the parasite
Light worm burden
❑ Generally asymptomatic
❑ Headache, dizziness, anorexia, pruritus of nose and
anus, diarrhea, vomiting, abdominal pain, pallor,
weight loss
Heavy infections
❑ Result to enteritis due to necrosis and desquamation
of the intestinal epithelial cells
NOTE: With time, regulatory immunity may limit or
eventually clear H. nana population.
TADENA 95
Parasitology Hymenolepis spp.

Hymenolepis diminuta
Specific diagnosis: demonstration of the characteristics of ➢ Rat tapeworm
eggs in the patient’s stool ➢ Parasite primarily of rats
➢ Accidental human infections do occur resulting in
Light infections: Concentration of the stool specimens on hymenolepiasis
alternate days ➢ Requires an intermediate host

NOTE: Generally, proglottids are not recovered as they

undergo degeneration prior to passage with stools

Larger than H. nana

DRUG OF CHOICE: Praziquantel
❑ 25mg/kg single dose 60 cm
❑ Causes vacuolization and disruption of the tegument
in the neck region
❑ Dose is higher than Taeniasis, because of the relative
resistant cysticercoids in the intestinal tissue Rostellum Rudimentary unarmed
rostellum
Treatment is considered successful if stools are negative
Mature proglottids Broader than long
for H. nana eggs at one month posttreatment.
Gravid proglottids Contain a sac-like uterus filled
with eggs
ALTERNATIVE: Nitazoxanide, 500 mg orally for 3 days
PROGLOTTIDS 0.75 mm in length and 3.5 mm in
NOTE: Suggestion shows that parasitic conditions should width
be treated first before any immunosuppressive therapy be Genital pores: Unilateral
given

o Circular
o 60-80 um
➢ Found in areas with warm climate like Southern USA,
o Bile-stained
Latin America, the Mediterranean, East Asia,
Philippines
➢ Estimated 20 million are infected Oncosphere:
➢ Transmission: (generally occurs) in poor sanitated ❑ Enclosed in an inner membrane, which has bipolar
areas, overcrowded areas, and where poor personal thickenings but lacks bipolar filaments
hygiene is practiced ❑ Hooklets usually have a fan-like arrangement

NOTE: Direct contact plays an important role because the

eggs cannot survive long outside the host

Hymenolepiasis is a familial and institutional infection.

Dwarf tapeworm may also be found among mice and less

among rats (H. nana var. fraternal). Infected mice and
rats may be potential sources of infections to humans.

Direct Cycle: Requires a single host

❑ Personal hygiene
❑ Environmental sanitation
❑ Rodent control
❑ Proper storage of food

TADENA 96
Parasitology Hymenolepis spp.

1. The egg passes into the external environment

2. Eggs are ingested by Tribolium spp, the eggs
penetrate into the insects haemocoel where
hexacanth larva hatched and develops into
cysticercoid larvae (infective stage).
3. Humans or rats eats the infected insect.
4. Digestive enzymes in the stomach cause excystation
and transformation of cysticercoids to adult worm.
5. Tapeworms reside into the small intestine and mature
sexually in 2-3 weeks.

➢ Worm burden is relatively low

➢ Highest number recorded: 19 worms
❑ Clinical manifestations: minimal and nonspecific
NOTE: Lifespan of the rat tapeworm in humans is short,
hence, human infections are usually light

➢ Identification of eggs
➢ H. diminuta eggs are distinguished by their circular
shape, larger size, and lack of bipolar filaments
➢ Morphology of the scolex may be used as an aid in
diagnosis

❑ Praziquantel, 25 mg/kg single dose

➢ Occurs worldwide but common among children

➢ Common in poor communities with rat infestation
➢ Possibly occurs by ingestion of grain beetles infesting
dried grains, dried fruits, flour, and cereals
➢ 8% prevalence rate in the Philippines

➢ Rodent control
➢ Elimination the insect intermediate host
➢ Protection of food
➢ Sanitary disposal of human waste
➢ Treatment of human case

H. nana H. diminuta
➢ Bipolar thickening ➢ Bipolar thickenings
with 4-8 hair-like W/O polar filaments
polar filaments ➢ Unarmed rostellum
➢ Armed, retractable
rostellum
INFECTIVE: Cysticercoid larvae

TADENA 97
Parasitology
Dipylidium caninum
➢ Double-pored tapeworm
➢ Intestinal parasite of dogs and cats
➢ Found worldwide, especially in dog populations where
ectoparasitism is high
➢ Dipylidiasis in humans accidental; common in
children
Pale, reddish
10-70 cm in length
scolex Small and globularwith four
deeply cupped suckers and a
protrusible rostellum
rostellum Armed with 1-7 rows of rose
thorn-shaped hooklets
Gravid proglottids Pumpkin seed shape and size
containing packets with 8-15
eggs enclosed in an embryonic
membrane
PROGLOTTIDS Narrow with two sets of male
and female reproductive organs
and bilateral genital pores
o Spherical
o Thin-shelled with a
hexacanth embryo
❑ Released by contraction of the proglottid or by its
disintegration outside the host
Dipylidium caninum
Definitive Host: Dogs and Cats
Intermediate Hosts:
o Ctenocephalides canis (dog flea)
o Ctenocephalides felis (cat flea)
o Pulex irritans (human flea)
o Trichodectes canis (dog louse)
Infective Stage: Cysticercoid larvae
Diagnostic Stage: Egg packets and proglottids
1. Gravid proglottids are passed intact in the feces or
emerge from the perianal region of the host.
2. In the environment, the proglottids disintegrate and
release egg packets, which are also occasionally
found free in the feces.
3. The intermediate host (most often larval stages of the
dog or cat flea Ctenocephalides spp.) ingests egg
packets, and the oncosphere within is released into
the larval flea’s intestine. The oncosphere penetrates
the intestinal wall, invades the insect’s hemocoel
(body cavity), and develops into a cysticercoid.
4. The cysticercoid remains in the flea as it matures from
a larva into an adult.
5. The vertebrate host becomes infected by ingesting the
adult flea containing the cysticercoid.
6. In the small intestine of the vertebrate host, the
cysticercoid develops into the adult tapeworm after
about one month. The adult tapeworms (measuring
up to 60 cm in length and 3 mm in width) reside in the
small intestine of the host, where they each attach by
their scolex .
7. Gravid, double-pored proglottids detach from the
strobila (body) and are shed in the feces.
8. Humans also acquire infection by ingesting the
cysticercoid contaminated flea. Children are most
frequently infected, possibly due to close contact with
flea-infested pets
❑ Infection is rarely heavy; symptoms are minimal
❑ Slight intestinal discomfort, epigastric pain, diarrhea,
anal pruritus, allergic reactions
❑ Most are asymptomatic; moderate eosinophilia
reports
➢ Established upon the recovery pf the characteristic
gravid proglottids passed out either singly or in
chains as they may pass out involuntarily
➢ Stool examinations
NOTE: Egg capsules are rarely recovered from the stool
❑ Praziquantel, 5-10 mg/kg single dose
TADENA 98
Parasitology Dipylidium caninum

➢ Human infection is rare

➢ Reported in European countries, USA, Argentina,
Rhodesia, China, Philippines
➢ Transmission: Hand-to-mouth contamination,
accidentally swallowing arthropod hosts when
hugging and kissing the animal

NOTE: Adults are not commonly infected possible because

of age tolerance against the parasite

❑ Periodic deworming of pet cats and dogs

❑ Insecticide dusting of dogs and cats

TADENA 99
Parasitology Diphyllobothrium latum

Diphyllobothrium latum
➢ Broad fish tapeworm
➢ Order Pseudophyllidea
➢ One of the 13 species of Diphyllobothrium that infects
human
➢ Diphyllobothriasis – intestinal infection with the adult
worm
➢ NEW NAME: Dibothriocephalus latus
➢ Requires two intermediate hosts: copepods, fish

Yellowish-gray

3-10 m in length

4,000 proglottids
1st IH: Freshwater Copepods (Cyclops, Diaptomus)
scolex No rostellum nor
2nd IH: Carnivorous Fish (may also act as paratenic or
hooklets
transport host)
Spatulate / spoon-
Infective Stage: Plerocercoid Larva or Sparganum
shhaped
o 20 mm; appears glistening, opaque, white
2-3 mm in length by 1
and unsegmented
mm in diameter
Two bothria (sucking
1) The ova complete their development in water and
grooves) located
release the free-swimming coracidium, a ciliated
dorsally and ventrally
embryo
Neck is longer than
2) Freshwater copepods will ingest the coracidium and
thehead
develop into the procercoid larva measuring 550 um,
mature proglottids 2-4 mm by 10-12 mm retaining three hooklets in the cercomer (caudal
One set of reproductive attachment organ)
organs 3) The copepod is ingested by a fish and the larva
Gravid PROGLOTTIDS Uterus: dark, rosette- develops into the plerocercoid larva in the muscles
like, coiled and viscera
Symmetrical bilobed 4) Fish with infective plerocercoid larva is ingested raw
ovary above the by definitive hosts like man, dog, cat, and other
Merhli’s gland mammals, reaching maturity after 3 months

NOTE: The proglottids of D. latum disintegrate only when

the segment has completed its reproductive function.
o Oblong, egg-shaped
o Yellowish-brown
(bile-stained)
o 66 by 44 um
❑ Infections are usually limited to one worm
❑ Often results in
o Hyperchromic, megaloblastic anemia with
thrombocytopenia and leukopenia
❑ Anemia seen in diphyllopbothriasis is similar to
Vitamin B12 deficiency anemia and could be mistaken
for pernicious anemia

NOTE: Vitamin B12 content of D. latum is 50 times higher

than that of T. saginata
OPERCULUM: inconspicuous at one end
TERMINAL KNOB: small button-like on the other end
❑ Finding the characteristics of operculated eggs
❑ DFS
❑ Kato Technique
❑ Examination of gastric juices:

TADENA 100
Parasitology Diphyllobothrium latum
o HCl for diphyllobothriasis
o Achlorydia for pernicious anemia

DRUG OF CHOICE: Praziquantel

o 5-10 mg/kg single dose

NOTE: IF scolex is not recovered, a repeat stool

examination is done after three months to be certain that
the patient is no longer infected.

➢ Human infection is dependent on the presence of

human or animal definitive hosts, or the presence of
suitable intermediate hosts, dietary habits, and
amount of pollution of fresh waters
➢ Contributes to transmission: preference of eating raw
fish and lack of sanitary toilet facilities
➢ Man is responsible for the propagation of the
infection in endemic areas
➢ Prevalent in temperate regions where the population
has a habit of eating raw or improperly cooked fish
➢ Baltic countries, Switzerland, Romania, Danube
Basin, Russia, Turkistan, Israel, Northern Manchuria,
Japan, Chile, Argentina, North America, China
➢ Philippines: 7 human infections recorded

❑ Cook freshwater fish thoroughly

❑ Freezing for 24-48 hours at -18C kills all plerocercoids
❑ Proper disposal of sewage and marketing of fish

TADENA 101
Parasitology Echinococcus spp.
➢ Contains brood
Echinococcus spp capsule, protoscolex,
➢ Dog tapeworm / Hydatid tapeworm and daughter cyst
➢ Human echinococcosis – emerging/reemerging NOTE: Protoscolices and brood capsules that lie free in
zoonotic disease; caused by the larval stage of the cyst are referred to as hydatid sand
Echinococcus spp., which is acquired when the eggs
of this parasite are ingested
➢ Family Taeniidae, Order Cyclophyllidea
➢ 4/6 species are of public health importance
➢ E. granulosus – cystic echinococcosis
➢ E. multilocularis – alveolar echinococcosis
➢ E. vogeli, E. oligarthrus – polycystic echinococcosis
NOTE: The latter three are less common because their life
cycles are sylvatic
➢ EXTRAINTESTINAL CESTODE

Inhabits the small

intestine of canines

3-6 mm in length
scolex Pyriform, with a short ❏ Infective stage: Embryonated egg
neck and three ❏ Diagnostic stage: Hydatid Cyst
proglottids ❏ Definitive host: Dogs or other wild canines
Typically Taeniid, and ❏ Intermediate host: Sheep, cattle, horses, pigs, goats,
has 4 acetabula and camels
Armed with 30-36
❏ Accidental intermediate host: Humans
hooks
Gravid PROGLOTTIDS Widest and longest
1) Eggs are swallowed by suitable intermediate hosts
Uterus: midline, with
such as goats, horses, camels and sheep; man may
lateral evaginations
also accidentally ingest the eggs
filled with eggs that
2) The eggs hatch in the duodenum and release
resemble those of other
oncospheres that penetrate the intestinal wall of the
taeniid worms IH
3) The oncospheres migrate into the mesenteric venules
NOTE: the eggs of Echinococcus spp. are not differentiated that lead them to various organs and tissues where
with Taenia eggs. they eventually lodge and develop into cysts
4) Development is completed when cysts in tissues are
ingested by carnivores or omnivores
o Ovoid 5) Once inside the DH, the protoscolices evaginate and
o Brown attach to the intestinal wall where they develop into
o Identical and adult
indistinguishable 6) They reside in the small bowel of the host where thy
from Taenia spp. start to release eggs that are then passed out in the
eggs stool

➢ 1-7 cm in diameter ➢ Pathology of human cystic echinococcosis is caused

➢ Formed through by the developing larval cyst in the tissue of the IH
central vesiculation ➢ LIVER: Most common and most important site of
➢ Has an outer involvement (70% of all cases)
laminated hyaline o Lungs (20-30% of cases)
layer, and inner o Brain, and the orbit (remaining 10%)
nucleated germinal ➢ Cysts are less commonly seen in spleen, kidneys,
layer heart, bone and CNS

TADENA 102
Parasitology
➢ E. granulosus: unilocular hydatid cyst
➢ E. multilocularis: alveolar cyst
E. granulosus infection
❑ Leads to down-regulation of inflammatory cytokines,
resulting in local immunosuppression, a possible
mechanism in which the parasite is able to escape the
host cell-mediated response
❑ Mass effect brought about by the enlarging cyst
results in organ impairment as the neighboring
tissues undergo atrophy and necrosis
NOTE: Echinococcus cysts are slow-growing which
explains that one can harbor the parasite at an early age
but will experience extraintestinal infection in adulthood.
THE PRESENCE OF THE CYST IS ONLY AN INCIDENTAL
FINDING IN ROUTINE RADIOGRAPHIC EXAMINATION.
HEPATIC CYSTS – found in the inferior right lobe
presenting hepatic enlargement, right epigastric pain or
jaundice
o Rupture of this cyst into the biliary duct
produces a characteristic triad of finding:
▪ Intermittent jaundice
▪ Fever
▪ Eosinophilia
ABDOMINAL CYSTS – may cause discomfort when the
cysts are large enough
Cysts may rupture from:
o Coughing
o Muscle strain
o Trauma
o Aspiration
o Operation procedures
❑ The protoscolices, brood capsules, and daughter
cysts may metastasize and reach other tissues to
develop secondary cysts after 2-8 years
INTRATHORACIC CYSTS – located in the superior lobe of
the liver and rupture in the thoracic region
PERIBRONCHIAL CYST – may discharge into a bronchus
and result in sudden coughing accompanied by allergic
reactions
Intracranial pressure, Jacksonian epilepsy – involvement
of the brain
Hematuria, kidney dysfunction, hydatid material in urine
– renal involvement
NOTE: Secondary cysts and infected cysts result in higher
mortality rates
Serious Anaphylaxis – primary cyst ruptures due to large
amount of hydatid material entering the bloodstream
Echinococcus spp.
Multiple cysts – multiple organ failure (20-40 % of
infected individuals)
MOST COMMON COMPLICATION: Intrabiliary rupture of
the cysts, followed by suppuration
❑ Radiographic findings
❑ Ultrasonography
❑ Serologic tests
o Indirect hemagglutination (IHA)
o Indirect fluorescent antibody (IFA)
o Enzyme immunoassays (EIA)
NOTE: Serology may have a relatively high sensitivity if
the cysts are located in the liver. Other locations may
decrease the reliability of adjunctive diagnostic test.
GOLD STANDARD: Detection of IgG antibodies to hydatid
cyst fluid-derived native or recombinant antigen B
subunit, through ELISA or immunoblot
Preferred treatment: Surgical resection for echinococcosis
presenting with a large liver cyst, secondary infection, or
cysts in extrahepatic sites
Chemotherapy with benzimidazole compounds: small,
isolated cysts, uncomplicated cysts, and patients with
negative serology
Albendazole, Mebendazole: Effective for a minimum of
three months
Percutaneous aspiration, injection, reaspiration (PAIR):
Indicated for patients with single or multiple cysts in the
liver, abdominal cavity, spleen, kidney, bones, who cannot
undergo surgery
a. Ultrasound-guided percutaneous puncture
b. Aspiration of substantial amounts of cystic
fluid
c. Injection of a protoscolicidal agent for at
least 15 minutes
d. Reaspiration
*PAIR with albendazole/mebendazole – have greater
efficacy and lower rates of morbidity, mortality, and
disease recurrence
➢ Cystic echinococcosis: most common presentation of
echinococcal infection
➢ 2-3 million cases; 0.3-0.5 million have human
alveolar echinococcosis
➢ Most prevalent in temperate zones such as South
America, Mediterranean, southern and central parts
TADENA 103
Parasitology Echinococcus spp.
of Russia, Central Asia, China, Australia, and parts of
Africa

❑ Achieved by reducing the infected populations and by

minimizing opportunities for transmission
❑ Regular testing and quarantine
❑ Treatment of dogs with praziquantel in endemic areas
❑ Dogs should not be allowed in slaughterhouses, and
refuse from these facilities should be sterilized or
properly disposed of
❑ Health education
❑ Vaccination of livestock
❑ Development of more sensitive diagnostic techniques
for definitive and human hosts

TADENA 104
Parasitology Fasciolopsis buski
➢ Intestinal ceca: unbranched and reach up to the
posterior end
➢ Two testes: Dendritic, arranged in tandem in the
posterior half
❑ Flukes
➢ Branched ovary: lies in the midline
❑ Equipped with:
➢ Fine vitelline follicles: situated throughout the
o Oral sucker
lateral margin of the body
o Acetabulum (ventral sucker)
o Genital sucker / gonotyl (observed in
heterophyids)
❑ All are hermaphroditic o Large, operculated,
❑ All requires two intermediate hosts in their life cycle unembryonated
❑ INFECTIVE STAGE (for all trematodes): o Indistinguishable from
o Metacercariae (encysted larva), developed eggs of F. hepatica and F.
in the second intermediate host gigantica
o NOTE: The infective stage of schistosomes is o 130-140 um by 80-85 um
the cercariae
❑ First IH: Always a snail
❑ Second IH: fish, crustacean, another snail, freshwater
plants
❑ Generally grouped together based on habitat
o Adult schistosomes: mesenteric veins
o Adult Paragonimus: lung parenchyma
o Fashiola, Clonorchis, Opistorchis: liver and
bile passages
o Fasciolopsis, Echinostoma, heterophyids:
intestines
❑ Mature eggs contain miracidium (embryo)
o Schistosoma, Clonorchis, Opistorchis, and
heterophyids
❑ Immature eggs
o Paragonimus, Fasciola, Fasciolopsis,
Echinostoma
o NOTE: The miracidium of immature eggs
develops in an aquatic environment

Fasciolopsis buski I. Immature eggs are released together with feces

➢ Fasciolid digenetic trematode
➢ Largest intestinal fluke of humans and pigs
➢ MOT: ingestion of encysted metacercariae from
aquatic plants
o Occurs when plant itself is eaten, or when the
hull/skin of the fruits of these plants is peeled
off between the teeth
➢ Oval
➢ 20-75 mm in length, 8-20 mm in width
➢ DO NOT HAVE CEPHALIC CONE
into the water
II. The egg, which embryonates in water, gives rise
to miracidium in 3-7 weeks
III. The miracidium seeks out and infects the first IH:
a snail belonging to Segmentina or Hippeutis
IV. Inside the snail, the miracidium transforms into a
sporocyst, which subsequently produces mother
rediae, daughter rediae, and cercariae
V. Cercariae leave the daughter rediae and
undergo further development in the snail tissues
VI. 7 weeks after infection, cercariae emerge from
the snail into water
VII. Cercariae attach themselves and encyst as
metacercariae on the sufeaces of seed pods,
bulbs, stems, or roots or various aquatic plants
(serving as the second IH)
a. Trapa bicornis (water caltrop)
b. Eliocharis tuberosa (water chestnut)
c. Ipomea obscura (morning glory or
kangkong)
d. Nymphaea lotus (lotus)

TADENA 105
Parasitology Fasciolopsis buski
NOTE: Pigs and humans are the important definitive hosts

➢ Pathological changes:
o Traumatic
o Obstructive
o Toxic
➢ Inflammation and ulceration at the site of
attachment, resulting to increase mucus secretion
and minimal bleeding
➢ Gland abscesses occasionally formed in the mucosa
➢ Heavy infections: worms may cause intestinal
obstruction
➢ Intoxication: result from absorption of worm
metabolites by the host
➢ Generalize toxic and allergic symptoms
o Edema of the face, abdominal wall and lower
limbs
➢ Profound intoxication: death of the host

❑ Detection of parasite eggs in the stool

o F. buski eggs resemble Fasciola eggs under
the microscope

❑ Praziquantel, three doses of 25 mg/kg over 1 day

o Side effects:
▪ Epigastric pain
▪ Dizziness
▪ Drowsiness

❑ Endemic in Southeast Asia, China, Korea, India

❑ No locally acquired fasciolopsiasis in humans or pigs
has been reported in the Philippines

❑ Soaking of aquatic plans in water should be avoided

❑ Time between harvest and consumption could be
prolonged
❑ Washing of the plants to remove metacercariae
❑ Boiling plants to kill the parasite
❑ Protection of swamps or ponds from pollution by
untreated human or pig excreta

TADENA 106
Parasitology Fasciola spp.
❑ Accidental Host: Humans
Fasciola hepatica ❑ First intermediate host: Snails
➢ Sheep liver fluke o Genus Lymnea
➢ Temperate liver fluke o L. trunculata
➢ Causative agent of fascioliasis (also F. gigantica), o L. philippinensis
sheep liver rot o L. swinhoel
o Genus Radix
o R. japonicum
o R. pervia
o R. rubiginosa
❑ Second intermediate host: Water Cress
➢ Large, leaf-shaped o Ipomea obscura (kangkong)
➢ Brown to gray o Nasturtium officinale (watercress)
➢ 18-51 mm in length, 4- ❑ Infective form: Encysted metacercariae on aquatic
13 mm in width plants
➢ Has oval and ventral
suckers of equal size NOTE: F. hepatica first IH are amphibious living in mud,
➢ Cephalic cone: while F. gigantica first IH are aquatic snails living in slow-
anterior end is a moving bodies of water.
distinct conical
projection 1. Adult worm lives in the biliary passage of sheep or
o Shoulder – man. Eggs are laid in the biliary passages through the
marked sphincter of Oddi and are shed in feces.
widening at 2. The embryo matures in water in about 10 days and
the base of the miracidium escapes. It penetrates the tissues first
the cone intermediate host, snails of the genus Lymnaea
➢ Has a highly branched 3. In snail, miracidium progresses through the
intestinal ceca sporocyst and the first and second generation redia
stages to become the cercariae in about 1–2 months.
4. The cercariae escape into the water and encyst on
o Large aquatic vegetation or blades of grass to become
o Light brown metacercariae, which can survive for long periods.
o Ovoid with operculum 5. Sheep, cattle, or humans eating watercress or other
o 140-180 by 80-100 um water vegetation containing the metacercaria
become infected.
6. The metacercariae excyst in the duodenum of the
definitive host and pierce the gut wall to enter the
peritoneal cavity.
7. They penetrate the Glisson’s capsule, traverse the
liver parenchyma, and reach the biliary passages,
where they mature into the adult worms in about 3–4
months

NOTE: Metacercariae survive longer at a temperature

below 20 C; higher temp will destroy them.

ACUTE STAGE
- Invasive phase of human fascioliasis
- Corresponds to migration of the juvenile parasite
from intestine to liver
- Traumatic and necrotic lesions: produces when
the parasites burrow through the liver
parenchyma
- Asymptomatic with dyspepsia, fever, right upper
quadrant pain

NOTE: Triad of diagnostic significance – high fever,

❑ Definitive host: Sheep, Cattle and other herbivores hepatomegaly, marked eosinophilia

TADENA 107
Parasitology
CHRONIC/LATENTSTAGE
- Corresponds to the period when the parasite has
already reached the bile ducts
- Worms cause obstruction and inflammation in
the biliary epithelium which subsequently causes
fibrosis
➢ Extent of damage and symptoms depend on the
intensity of infection and duration of disease
➢ Light infection may be asymptomatic, however
because of its size, they may also cause symptoms of
biliary obstruction and cholangitis
➢ Heavy infections: atrophy of the liver parenchyma
and concomitant periductal cirrhosis
➢ Fever, chills and RUP pain radiating to the scapula
➢ Jaundice, tender liver, anemia may develop as
disease progresses
➢ Associated lithiasis of the bile ducts or gallbladder is
common as eggs or dead fragments of the parasite
form nuclei for calculi
➢ Rare complication: acute pancreatitis
➢ Halzuon suffocation: a pharyngeal form of fascioliasis
which is common in Middle East due to ingestion of
raw sheep and goat livers
o Flukes surviving mastication causes
hemorrhagic nasopharyngitis and
dysphagia (Lebanon: halzoun; Sudan:
marrara)
➢ Worms lodge in the pharyngeal mucosa, soft palate,
pharynx, larynx, nasal fossa and Eustachian tube
leading to symptoms like dyspnea, dysphagia,
deafness, asphyxiation
➢ Liver Rot: migration to the liver parenchyma tends to
produce massive tissue destruction; occurs in sheep
Stool Microscopy
▪ Clinical diagnosis is difficult: enlarged liver and
eosinophilia is suggestive.
▪ Recovery of eggs in feces or from duodenal or
biliary tract drainage
➢ Identification of eggs in stool, duodenal contents or
bile, or the recovery of adult worms during surgical
exploration
➢ SPURIOUS / FALSE FASCIOLIASIS: ingestion of poorly
cooked liver from infected animals
➢ ELISA
➢ Western blot
➢ Radiological examinations
❑ Sonography – useful method in the detection of
biliary lesions
❑ Computer tomography
o Multiple confluent
o Hypodense nodules
o Tunnel-like branching hypodense tracts
➢ Hepatic sonography
Fasciola spp.
➢ Endoscopic retrograde cholangiopancreatography
(ERCP) – useful in diagnosing fascioliasis in the biliary
phase
❑ Dichlorphenol (Bithionol): 30 to 50 mg/kg on
alternative days for 10 to 15 days
❑ Dehydroemetine dihydrochloride: 1mg/kg/day for 10
days
❑ Rafoxanide: uncouples oxidative phosphorylation in
adults
❑ Triclabendazole: current drug of choice binds with
worm tubulin; microtubules
❑ Peroxidic compounds (semisynthetic artemisinins,
synthetic trioxolanes): trematocidal activities
❑ Artesunate, artemether: cured chronic F. hepatica
infection in rats
➢ F. gigantica dominantly affects cattle and water
buffaloes in the Philippines
➢ Human fascioliasis is typically sporadic
➢ MOT: Eating raw water-grown vegetables harboring
Fasciola metacercariae
❑ Thorough washing or cooking of vegetables
❑ Boiling of water
❑ Elimination of the snail intermediate host through the
application of copper sulfate
❑ Killing the reservoir host by chemotherapy
❑ Vaccination with defined Fasciola antigens
- Fatty acid binding protein (FABP) termed Fh12
- Glutathione-S-transferase (GST)
- Cathepsin L (CatL)
- Proteinase
- Hemoglobin
❑ F. hepatica cathepsin B2 (FhCB2): vaccine for
fascioliasis, highly immunogenic, leading to reduced
liver damage
Fasciola gigantica
➢ Giant liver fluke
➢ Distributed in Africa and Asia
➢ species that is longer and more slender than Fasciola
hepatica
➢ A parasite of herbivores mainly camels, cattle and
water buffalo
➢ Very similar in morphology, biology, pathology,
diagnosis, and treatment with F. hepatica
➢ Greater length – 25-75 mm by 3-12 mm
➢ Longer and more numerous branches of ovary
➢ Short and less prominent cephalic cone
➢ Large ventral sucker
➢ More anterior position of the reproductive organs
➢ Larger eggs (140-180 by 63-90 um)
o Ovoidal, operculated
o Yellowish to brown
➢ More branching intestinal ceca
TADENA 108
Parasitology
Paragonimus westermani
➢ Oriental lung fluke
➢ Causative agent of paragonimiasis, infection of
humans and other mammals
➢ 40 known species of Paragonimus; P. westermani
causes 90% of infection
➢ Major species causing paragonimiasis in the
Philippines
o Other species: P. siamensis
➢ Reddish-brown
➢ 7-12 mm in length, 4-6
mm in width, 3.5-5 mm
thick
➢ Resembles a coffee
bean
➢ Rounded anteriorly,
tapered posteriorly
➢ Tegument: covered
with single-spaced
spines
➢ Two testes: deeply
lobed
➢ Ovary: has 6 long
unbranched lobes
o The vitellaria
are branched
extensively
❑ Covered with spines ❑ Round
❑ Ellipsoidal body ❑ 381-457 um
❑ Small tail
❑ Stylet: present at the
dorsal side of the oral
sucker
o Oval
o Yellowish-brown
o Thick-shelled
o 80-118 um by 48-60 um
o Unembryonated at
oviposition
Paragonimus westermani
1. Eggs coughed up and spit out or passed in feces
2. The eggs become embryonated and miracidia hatch
and seek the 1st intermediate host= a snail, and
penetrate its soft tissues
*Miracidia was release by the egg.
3. Miracidia hatch and penetrate snail
*Miracidia mature into cercariae in 3-5 months.
4. Sporocysts,
4a) rediae,
4b) with the latter giving rise to many cercariae,
4c.) Which emerge from the snail
The cercariae invade the second
intermediate host, a crustacean such as a
crab or crayfish, where they encyst and
become metacercariae- infective stage
Mnemonic: M iracidia, S porocysts, R ediae,
C ercariae
*Cercariae develops within 2 months.
5. Human infection with P. westermani occurs by eating
inadequately cooked or pickled crab or crayfish that
harbor metacercariae of the parasite.
6. The metacercariae excyst in the duodenum,
7. Penetrate through the intestinal wall into the
peritoneal cavity, then through the abdominal wall
and diaphragm into the lungs, where they become
encapsulated and develop into adults.
8. The worms can also reach other organs and tissues,
such as the brain and striated muscles, respectively.
However, when this takes place completion of the life
cycles is not achieved, because the eggs laid cannot
exit these sites. Infections may persist for 20 years in
humans.
Habitat: lungs, cystic cavities, near bronchi
The pair or group then migrates into the lung parenchyma
to develop into adults in about 5-6 weeks, where they
mate and lay eggs.
TADENA 109
Parasitology Paragonimus westermani

Paragonimiasis: Pulmonary Distomiasis
❑ Heavy intensity infection of the parasite
❑ Chronic cough and hemoptysis
❑ Pulmonary discomfort-cough, fever, chest pain
and increased production of blood-tinged
sputum
❑ Chronic bronchitis, eosinophilia
➢ These symptoms often mimic those seen in persons
infected with tuberculosis.
Serious: Chronic bronchiectasis & Cerebral
paragonimiasis (fatal organ)
Severe: parenchymal & pleural damage
*Clinical symptoms are less severe after 5 to 6 years.
➢ Occur in several areas in Asia, Africa, India, and
South America.
➢ Estimated that 20.7 million are infected with
Paragonimus westermani
➢ Endemic in China, Korea, Japan, Philippines and
Taiwan
➢ Causes 90% of paragonimiasis in Asia
❑ Avoid eating undercooked crayfish and crabs
❑ Safe food preparation
❑ Do not spit or avoid spitting out
❑ Health education and promotion
❑ Cook crustaceans to at least 145°F (63°C)

MICROSCOPY: Most basic and most readily available

diagnostic tool

Specimen: Sputum and Stool

❑ Serologic test
o Detection in sputum (37-88%), Sputum
concentration w/ 3% sodium hydroxide
(repeat 3 times, on different days)

❑ Tissue Biopsy
o performed to look for eggs in tissue samples

❑ Chest radiographs

❑ Complement fixation (CF) test

❑ Immunoblotting (IB) and ELISA- more sensitive and
specific
❑ Loop-mediated isothermal amplification (LAMP) -
simple, rapid, & cost-effective

Diagnosis is based on microscopic demonstration of eggs

in stool or sputum, but these are not present until 2 to 3
months after infection.

Detection of antibodies to Paragonimus westermani has

helped physicians differentiate paragonimiasis from
tuberculosis.

For cerebral paragonimiasis: Computer Tomography (CT)

scan or Magnetic Resonance Imaging (MRI)

❑ Praziquantel (25 mg, 3 x day)

❑ Triclabendazole
❑ Bithionol- alternative drug

TADENA 110
Parasitology Hetrophyes heterophyes

Heterophyes heterophyes
➢ Heterophyid fluke or Von Siebold’s fluke
➢ Small parasitic fluke infecting humans through
ingestion of raw or undercooked fish contaminated
with metacercaria
➢ Indistinguishable with other Heterophyid flukes
o Metagonimus yokogawai
o Haplorchis taichui
o Haplorchis yokogawai
➢ First IH: Snails
o Brackish water snails: H. taichui
o Melania juncea, Thiara riquetti: Procerovum
calderoni
➢ Second IH: Fish
➢ Definitive host: Humans and other fish-eating
mammals
➢ Inhabits the small intestine
➢ 28 known species of fish harboring metacercariae of
1. Adults release embryonated eggs each with fully-
21 heterophyid species
developed miracidium, and eggs are passed in the
host’s feces
2. After ingestion by a suitable snail(first intermediate
host) the eggs will hatch and release miracidia which
will penetrate the snail/s intestine.
➢ Elongated, 3. Genera Cerithidia and Pironella are important snail
oval/pyriform hosts in Asia and Middle East.
➢ Less than 2 mm in 4. The miracidia will undergo three larval stages
length a. Sporocyst
➢ Tegument: fine b. Rediae
scale-like spines c. Cercariae
➢ Gonotyl may be 5. Many cercariae are produced from the rediae. The
present cercariae are released from the snail.
➢ Ovary: globular or 6. And encyst as metacercariae in the tissues of a
slightly lobed suitable fresh/ brackish water fish (2nd intermediate
host)
7. The definitive host becomes infected by ingesting
undercooked or salted fish containing the
o Light brown
metacercariae.
o Ovoid, operculated
8. After ingestion, the metacercariae excyst and will
o 20-30 by 15-17 um
attach to the mucosa of the small intestine.
o Fully symmetrical
9. It will become mature into adult worm.
miracidium is present
o DOES NOT HAVE AN
NOTE: Other fish eating mammals can be infected as well
ABOPERCULAR
like Cats, Dog, and birds.
PROTRUBERANCE

❑ Usual inflammation at the site of attachments

❑ Excessive mucus production
❑ Sloughing off of the superficial layers
❑ MOST COMMON CLINICAL MANIFESTATION: peptic
ulcer disease (PUD) or acid peptic disease (APD)
❑ Colicky abdominal pain
❑ Mucoid diarrhea
❑ Eggs lodged in the spinal cords may result in motor
and sensory losses
❑ Lympho-vascular system as route of entry of eggs to
tissues
❑ Granuloma formation

TADENA 111
Parasitology Hetrophyes heterophyes
❑ Heterophyid myocarditis
❑ Intracerebral hemorrhage

❑ Detection of eggs in the stool using modified Kato

thick methods
❑ PCR: sensitive diagnostic tool for low-intensity
infection

NOTE: Heterophyid eggs have also been referred to as

Opisthorchid-like eggs where the liver fluke is endemic

DRUG OF CHOICE: Praziquantel, 25 mg/kg per dose, three

doses in 1 day

➢ Worldwide distribution
➢ Prevalent in Africa, Egypt, Philippines, Japan,
Taiwan, Korea, China, Israel
➢ Reservoir hosts: dogs, cats, birds
➢ Intestinal heterophyidiasis: emerging public health
concern in the Philippines

❑ Avoiding ingestion of raw or improperly cooked fish

❑ Capacity building for laboratory staff
❑ Surveillance in other regions where raw fish (kinilaw)
is eaten

TADENA 112
Parasitology
Clonorchis sinensis
➢ Chinese or oriental liver fluke
➢ Small digenetic trematode belonging to family
Opisthorchiiade
o Opisthorchis felineus
o Opisthorchis viverrini
➢ Parasites of the bile duct and gallbladder of humans
and fish-eating mammals
➢ Acquired by eating raw or undercooked fish, crabs,
or crayfish
➢ The only species in this genus involved in human
infection
➢ Leaf-like
➢ Transparent
tegument
➢ 10-25 mm long, 3-5
mm wide
o Yellowish-brown
o Ovoid
o 26-30 by 15-17
um
o Convex
operculum
o Small
protruberance at
the abopercular
end
o Asymmetrical
miracidium
NOTE: The eggs of the three species are difficult to
differentiate.
Clonorchis sinensis
1. Eggs release miracidia, it goes through several
developmental stages (sporocysts rediae, and
cercariae)
2. The cercariae are released from the snail and, after a
short period of free-swimming time in water, they
come in contact and penetrate the flesh of freshwater
fish, where they encyst as Metacercariae
3. Infection of humans occurs by ingestion of
undercooked, salted, pickled, or smoked freshwater
fish
4. After ingestion, the Metacercariae excyst in the
duodenum
5. And ascend the biliary tract through the ampulla of
Vater
6. Maturation takes approximately one month. The
adult flukes (measuring 10 to 25 mm by 3 to 5 mm)
reside in small and medium sized biliary ducts.
PHASES OF INFECTION
1) Desquamation of epithelial cells
2) Hyperplasia and desquamation of epithelial cells
3) Hyperplasia, desquamation of epithelial cells,
adenomatous tissue formation
4) Marked proliferation of the periductal connective
tissue with scattered abortive acini of epithelial cells,
and fibrosis of the wall of the biliary duct
Light infections (<100 flukes) – asymptomatic; few
nonspecific clinicals signs such as diarrhea and
abdominal pain
Moderate infections (101-1000 flukes) – may cause fever,
diarrhea, loss of appetite, rash, edema, night blindness,
swollen abdomen, enlargement of the liver
Heavy worm burden (up to 25,000 flukes) – acute pain in
the right upper quadrant
Chronic stage: liver malfunction
More severe late complications: calculi, acute
suppurative cholangitis, recurrent pyogenic cholangitis,
cholecystitis, hepatitis, pancreatitis
Most significant sequelae: hepatocellular carcinoma,
cholangiocarinoma
NOTE: C. sinensis is classified by International Agency for
Research on Cancer (IARC) as a probable carcinogen
❑ Detection of the parasite egg in the stool
❑ Cholangiography
- Saccular dilations of the intrahepatic bile ducts
- Rapid ductal tapering toward the periphery
(arrowhead sign)
TADENA 113
Parasitology Clonorchis sinensis
❑ ELISA
❑ Enzyme immunoassay (EIA)
❑ Coproovoscopy
- EIA and Coproovoscopy are used to define the
spread of the clonorchiasis in Russia
❑ PCR
- Single, one-step multiplex PCR, targeting
mitochondrial DNA, permits the detection and
discrimination of Clonorchis sinensis and
Opisthorchis viverrini in different life-stage
forms, from fish IH and from infected persons

❑ Praziquantel
❑ Albendazole: clearing various intestinal helminthiasis
simultaneously, with very low toxicity, excellent
tolerance, and relatively low cost

NOTE: A study showed that the combination of

praziquantel-albendazole is more effective

❑ Aspen bark
❑ Artemisinins and synthetic peroxides
❑ Tribendimidine

➢ MOT: consumption of raw, undercooked, salted,

dried, or pickled freshwater fish that harbors
encysted metacercaria
➢ 35 million infected; 601 million at risk
➢ Endemic in China, Korea, Japan, Vietnam

MAIN STRATEGIES
❑ Stool examination and treatment of positive cases
with praziquantel in order to eliminate human host
reservoir
❑ Health education for the promotion of cooked fish
consumption in order to prevent infection
❑ Proper waste disposal in order to interrupt
transmission

➢ Making the fish IH safe for consumption

- Irradiating fish at a dose of 0.15 kGy could
control the infectivity of C. sinensis
metacercariae

NOTE: Freezing or storing of infected freshwater fish in

heavy salt may not be effective

TADENA 114
Parasitology Clonorchis sinensis

TADENA 115