CLINICAL PARASITOLOGY

CESTODES ( LEC & LAB)

1st SEM, 2021
CESTODES (Flukes) Diphyllobothrium latum
General Characteristics: Disease Diphyllobothriasis; fish
● Flat, ribbon-like, chalk-white tapeworm infection; broad
● Hermaphrodite tapeworm infection
● Do not possess circulatory system
● Do not possess digestive tract Site in host small intestines
● Acquire food by means of osmosis
● Voracious appetite Portal of entry mouth
● Excretory system governed by flame cells
● Nervous system governed by ganglia Definitive host human, dogs, cats

TAPEWORM STRUCTURE 1st IH crustaceans (Cyclops or

Diaptomus)

2nd IH freshwater fish (carp, salmon)

Infective stage plerocercoid larvae

Sources of plerocercoid in freshwater fish

infection

Lab. Diagnosis eggs in stool

GROUPS
● Pseudophyllidean (aka FAKE TAPEWORM)
Scolex Almond shape/ spoon/
spatula shape with sucking
grooves

Proglottids Anapolytic (they contain Eggs of D. latum: oval or ellipsoidal, with at one end
uterine pore: secrete eggs) an operculum that can be inconspicuous. At the
opposite (abopercular) end is a small knob that can be
Gravid Proglottids All reproductive organs are barely discernible.
intact (MOST MATURE)

Egg/Ova Ovoidal shape; OPERCULATED

Intermediate Host 2

● Cyclophyllidean (aka TRUE TAPEWORM)

Scolex Quadrate shape; possess 4 D. latum scolex(LEFT) and gravid proglottids (RIGHT)
cup like suckers

Proglottids Apolytic (no uterine pore)

Gravid Proglottids Only uterus

Egg/Ova Spherical in shape; NON

OPERCULATED Proglottids of D. latum: broader than it is long; size 2
to 4 mm long by 10 to 12 mm wide; uterus coiled in
Intermediate Host 1 rosette appearance; genital pore at the center of the
proglottid.
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 CLINICAL PARASITOLOGY
CESTODES ( LEC & LAB)
1st SEM, 2021
Clinical Manifestations Taenia Saginata
● Diphyllobothriasis can be a long-lasting
Disease Solitario Disease
infection (decades).
● Most infections are asymptomatic. Common Name Beef tapeworm
● Manifestations may include abdominal
discomfort, diarrhea, vomiting, and weight Habitat duodenum
loss.
● Vitamin B12 deficiency with pernicious Infective Stage Cysticercus bovis larva
anemia may occur.
● Massive infections may result in intestinal Diagnostic Ova in stool, gravid segment
obstruction. Stage

Diagnostic Findings MOT oral fecal route

● Microscopic examination of stool
Final Host man
Treatment Intermediate Cow, cattle or carabao
● Praziquantel: is the drug of choice. Host
Alternatively, Niclosamide can also be used to
treat diphyllobothriasis.
LIFE CYCLE
Sparganum mansoni
Disease Sparganosis

Accidental Host man

Final Host Frogs, snakes

1st IH Cyclops

2nd IH freshwater fish

Habitat Skin, subcutaneous tissue,

Muscle

Infective Stage Procercoid/ Plerocercoid larva

Diagnostic Plerocercoid larva

Stage

MOT ingestion of cyclops

Clinical Manifestations
● Localized inflammation
● Cerebral/Ocular sparganosis
● Nodule formation in vital organs
● Toxemia

Diagnosis Taeniid eggs: rounded or subspherical, diameter 31 to

● Muscle/ tissue biopsy 43 µm, with a thick radially striated brown shell. Inside
● X-ray, CT Scan, MRI each shell is an embryonated oncosphere with 6
hooks (hexacanth embryo)

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 CLINICAL PARASITOLOGY
CESTODES ( LEC & LAB)
1st SEM, 2021

Taenia egg: Note the thick, "striated" shell and several

of the larval hooks; approximate size = 40 µm.

T. solium: scolex (LEFT) gravid proglottid (RIGHT)

T. Saginata gravid proglottid: has 15 to 30 main

uterine branches on each side of central stem;
proglottids are much longer than wide
Symptoms and Pathology
Scoleces of Taenia saginata and Taenia solium: Scolex
● Patient exhibit voracious appetite
of T. saginata has 4 suckers and no hooks. T. solium
● Vague abdominal pain
has 4 suckers in addition to a double row of hooks.
● Peptic ulcer like symptoms
● Intestinal obstruction
Symptoms and Pathology
● Intoxication
● Patient exhibit voracious appetite
● Anal pruritus
● Vague abdominal pain
● Obstruction of bile duct
● Muscle pain and atrophy
Diagnosis
● Hysteria
● Ova in stool
● Blurring and loss of vision
● Gravid segment using Rapid Slide Test
● Tachycardia
● Scotch Tape swab
CYSTICERCOSIS
Taenia Solium
● Degree of infection and severity depends on:
Disease pork tapeworm infection ○ Organ invaded
○ Number of cysticercoid larva
Site of Host small intestines ● Cysticercoid larva can cause necrosis and
fibrosis
Portal of Entry mouth ● There could be 4-7 adult T. solium in one
patient
Definitive Host human

Intermediate Host pig Diagnosis

● Ova in stool
Infective Stage Cysticercus cellulosae ● Gravid segment using Rapid Slide Test
● Radiological examination
Sources of Infection cysts in pork; autoinfection ● Muscle biopsy
● ELISA
Lab. Diagnosis segments and eggs in stool;
Scotch tape swab

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 CLINICAL PARASITOLOGY
CESTODES ( LEC & LAB)
1st SEM, 2021
Infective Stage cysticercus larva
Hymenolepis nana
Common Name Dwarf tapeworm Sources of Infection cysts from insects
Smallest tapeworm of man
Lab. Diagnosis eggs in stool
Habitat upper ileum

Infective Stage Embryonated ova, cysticercoid

larva

Diagnostic Stage Ova in stool

MOT Ingestion of ova or larva Egg of Hymenolepis diminuta: round or slightly oval,
size 70 - 86 µm X 60 - 80 µm, with a striated outer
Final Host man, rats membrane and a thin inner membrane. The space
between the membranes is smooth or faintly granular.
Intermediate Fleas (Ctenocephalides sp.) or The oncosphere has six hooks.
Host Flour beetles (Tenebrio sp.)

2 LIFE CYCLE
● Indirect
○ Infective stage is cysticercoid larva
○ Involvement of Intermediate host
● Direct Mature proglottids of Hymenolepis diminuta
○ Infective stage is ova Causal Agents
○ No involvement of Intermediate host ● Hymenolepiasis is caused by two cestodes
Symptoms and Pathology (tapeworm) species, Hymenolepis nana (the
● Asymptomatic in light infection dwarf tapeworm,) and Hymenolepis diminuta
● Diarrhea (rat tapeworm). Hymenolepis diminuta is a
● Eosinophilia cestode of rodents infrequently seen in
● Headache/ Dizziness humans and frequently found in rodents.
● Patient exhibit voracious appetite Geographic Distribution
● Hymenolepis nana is the most common cause
Diagnosis of all cestode infections, and is encountered
● Ova in stool worldwide. In temperate areas its incidence is
higher in children and institutionalized groups.
Treatment Hymenolepis diminuta, while less frequent,
● Praziquantel has been reported from various areas of the
world.
Hymenolepis diminuta Life Cycle
Disease Hymenolepiasis;
rat tapeworm infection

Site of Host small intestines

Portal of Entry mouth

Definitive Host human, mice and rats

Intermediate Host insects (rat and mouse flea,

the flour moth and flour
beetle)

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 CLINICAL PARASITOLOGY
CESTODES ( LEC & LAB)
1st SEM, 2021
Clinical Features
● Hymenolepis nana and H. diminuta infections
are most often asymptomatic. Heavy
infections with H. nana can cause weakness,
headaches, anorexia, abdominal pain, and
diarrhea.
Diagnostic Findings Adult tapeworm of Dipylidium caninum. The scolex of
● Microscopic examination of stool the worm is very narrow and the proglottids, as they
mature, get larger.
Treatment
● Praziquantel: drug of choice Life Cycle
Dipylidium caninum
Disease Dipylidiasis
dog tapeworm infection

Site of Host small intestines

Portal of Entry mouth

Definitive Host dog & cat (or humans)

Intermediate Host larval flea

Infective Stage cysticercoid larva

Sources of Infection flea and louse

Lab. Diagnosis eggs in stool or egg packets Clinical Features

in stool, proglottid
Egg packets of Dipylidium caninum: Proglottids of
Dipylidium caninum contain characteristic egg packets
that are round to ovoid and contain 5 to 15
(sometimes more) eggs each.
● Most infections with Dipylidium caninum are
asymptomatic. Pets may exhibit behavior to
relieve anal pruritis (such as scraping anal
region across grass or carpeting). Mild
gastrointestinal disturbances may occur. The
most striking feature in animals and children
consists of the passage of proglottids. These
can be found in the perianal region, in the
feces, on diapers, and occasionally on floor
covering and furniture. The proglottids are
motile when freshly passed and may be
mistaken for maggots or fly larvae.
Diagnostic Findings
● Microscopic examination

Treatment
● Treatment for both animals and humans is
Proglottids of D. caninum: barrel-shaped proglottids simple and very effective. Praziquantel is
(average mature size 12 mm × 3 mm) have two genital given either orally or by injection (pets only).
pores, one in the middle of each lateral margin.
Proglottids may be passed singly or in chains, and
occasionally may be seen dangling from the anus.
Proglottids are much longer than broad.

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 CLINICAL PARASITOLOGY
CESTODES ( LEC & LAB)
1st SEM, 2021
Echinococcus granulosus ADDED NOTES:
Disease Echinococcosis, Differences between CESTODES, TREMATODES &
hydatid disease NEMATODES
Shortest of all tapeworms Cestodes Trematodes Nematodes

Habitat small intestine of dogs Shape Tape like Leaf like Elongated,
segmented unsegmented cylindrical,
Intermediate Host Sheep,goat, cat unsegmented

Infective Stage to Hydatid cyst Sexes Sexes NOT Sexes NOT Sexes are
dogs separate separate separate
Monoecious Monoecious Diecious
Infective Stage to ova Hermaphrod Schistosoma
ite
man
Head end Suckers, Suckers, No No suckers, no
Diagnostic Stage Hydatid cyst containing often with hooks hooks, well
hydatid sand hooks developed

Alimentary Absent Present, Present,

canal incomplete, no complete, anus
anus present

Body cavity Absent Absent Present

Classification of Cestodes Infecting Man

● Pseudophyllidean cestodes: possessing false
slit like grooves (bothria)
○ Adult worms in intestine:
Symptoms and Pathology
■ Diphyllobothrium latum (fish
● Enlarged abdomen
worm)
● Pressure on the organ leads to organ
○ Larval stages (Plerocercoid) in man:
malfunction Osseous cyst if found in bound
■ Sparganum mansoni
● Anaphylactic shock
■ Sparganum proliferum
Differences between Pseudophyllidean VS.
Diagnosis
Cyclophyllidean Cestodes
● Radiological examination
● Hydatid drill Pseudophyllidean Cyclophyllidean
● Exploratory puncture
● Casoni’s test Head Bears 2 slit like Bears 4 cup like
● Serological tests (IHA, IFA, EIA) grooves suckers

Uterus No branching, Branching may or

Treatment rosette shaped may not be
● Surgical removal of the cyst Type of cyst: convoluted tubule present
Unilocular, Osseus, Alveolar
● PAIR Treatment (Hibitane, 95% EtOH) Uterine pore Present Absent

Common Ventral, in the Lateral

genital pore midline

Eggs Operculated giving Not operculated,

rise to ciliated larvae do not give rise to
ciliated larvae

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 CLINICAL PARASITOLOGY
CESTODES ( LEC & LAB)
1st SEM, 2021

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