Tapeworms of man

Multicellular with flat or ribbon-like appearance

Life cycle includes:
Egg
Has hexacanth embryo/ oncosphere
One or more larval stages
Adult worm
Absorbs nutrients and excretes wastes through tegument
Characterized by scolex, neck region and proglottids
(strobila)
All are hermaphroditic
One of earliest parasites of man
Biblical times.
Audry (1700) first reported T.
saginata
Goeze (1782) distinguished T.
saginata and T. solium
Leuckart (1863) tested proglottids
of T. saginata in calves to develop
cysticerci in calfs muscles

(Beef tapeworm)
Taeniasis, beef tapeworm
infection
Cosmopolitan
Humans are only
definitive hosts,
never intermediate
hosts
Human cysticercosis
does not occur

(Pork tapeworm)
Taeniasis, pork tapeworm
infection
Cosmopolitan
Humans may serve as
both definitive and
intermediate hosts
Human cysticercosis
may occur



Morphology - Egg
Indistinguishable between two species
Spherical or subspherical in shape
Size range: 28-40 m by 18-30 m

Three pairs
Yellow-brown
with radial
striations


Morphology - Scolex
Both measure 1-2 mm in diameter
Both has four suckers

Lacks distinct structures
Larger and less
spherical suckers
Has fleshy/cushion-
like rostellum
Double crown (row)
of well-defined hooks

Morphology Mature Proglottids
Longer than T. solium
Ave: 1048 proglottids
Typically rectangular (17.5 5.5 mm)
15-30 uterine branches on each side
of the uterus
Has two large ovarian lobes
Has vaginal sphincter
300-400 follicular testes


Morphology Mature Proglottids
Shorter
Ave: 898 proglottids
Somewhat square(17.5 5.5 mm)
7-15 uterine branches on each side
of the uterus
Has accessory ovarian lobe
No vaginal sphincter
100-200 follicular testes



Morphology Gravid Proglottid
Undergo apolysis to release eggs
Contains 97,000
124,000 ova

Approx. 30,000-
50,000 ova
Relatively less active
than T. saginata


Morphology Adults
Inhabits upper jejunum
May live for up to 25
years
4-10 m in length
(1,000-4,000 proglottids)
Inhabits upper small
intestine
2-4 m in length
(800-1,200 proglottids)

(Pathogenesis and Clinical Symptoms)
Mainly causes intestinal infection
Mild irritation, epigastric pain, vague discomfort
Hunger pangs
Weakness, weight loss, loss of appeite
Perianal itching
Intestinal, bile and pancreatic duct, appendix
obstruction

(Pathogenesis and Clinical Symptoms)
Intestinal Infection
Has mild non-specific abdominal complaints
Obstruction of the bile, pancreatic duct and appendix
is unlikely


(Pathogenesis and Clinical Symptoms)
Cysticercosis
Occurs in striated muscles, brain, subcutaneous tissues, eye,
heart, lung and peritoneum
Inflammation due to living cysts
Cysts can survive up to 5 years
Death leads to:
Cystic fluid increases
Pronounced tissue response
Parasite calcification
Symptomatology - dependent on number, size and location
of lesion




(Pathogenesis and Clinical Symptoms)
Cysticercosis
Neurocystercosis one of
the most serious zoonotic disease
worldwide
Cysticerci with scolex brain
parenchyma or floating freely in
ventricles
Without scolex located in
basal cisternal spaces


(Pathogenesis and Clinical Symptoms)
Neurocysticercosis
Classified as parenchymal (focal neurologic deficits) or
extraparenchymal (focal or generalized seizures)
Extraparenchymal can be subclassified as:
Subarachnoid or meningitic (racemous cysticercosis)
Intraventricular (obstructive hydrocephalus)
Spinal rare


(Pathogenesis and Clinical Symptoms)
Neurocysticercosis
Death of larva leads to inflammation of affected region
Convulsions are most common manifestation
Visual and motor deficits, headache and vomiting may
occur
CSF increased opening pressure, elevated protein,
decreased glucose ad increase in mononuclear cells

(Pathogenesis and Clinical Symptoms)
Cysticercosis
In the eyes retinal or subretinal in
location
May float freely in vitreous and
aqueous humors
Vision is affected
Chorioretinitis
Vasculitis
Retinal detachment
Intraorbital pain, photopsia, blurring
or loss of vision
(Diagnosis)
Stool specimen of choice
Recovery of eggs and gravid
proglottids (passed out in feces or
undergarments)
Scolex can be recovered (when in
treatment)
Gravid proglottids pressed in
between two glass slides and
examined against the light
Injection of India ink through
genital pore for lateral branch
count

(Diagnosis cont'd)
FECT
Perianal swabs - eggs are left
in perianal skin as gravid
segments squeeze out of the
anal opening
Speciation is made by scolex
or proglottid examination
Neurocysticercosis epileptic
seizures without associated
systemic symptoms but living
in an endemic area

(Diagnosis cont'd)
CSF abnormalities elevated protein, reduced glucose,
increased mononuclear cells
CAT scans, MRI imaging for cysticerci localization
Opthalmic cysticercosis - visualization using
ophthalmoscopy
Muscular/subcutaneous cysticercosis - palpation and
tissue biopsy for histopathologic processing
Serum and CSF ELISA and electro-immuno transfer blot
or Western blot for specific IgG and IgM anticysticercal
antibodies


Intestinal
Praziquantel (5-10 mg/kg
as a single dose) for
adults and children
Cure is indicated by:
Scolex recovery
Negative stool exam 3 mos.
After treatment
Praziquantel and
niclosamide (unavailable
locally)



Cysticercosis
Praziquantel (50-75
mg/kg divided into three
doses for 30 days)
Albendazole (400 mg
twice daily for 8-30 days)
High dose corticosteroid
therapy and mannitol
Surgical removal

Highly related to the habit of
eating raw or improperly
cooked meet
Abstinence from eating beef
or pork provides prevention
T. asiatica reported in
Taiwan
T. saginata > T. solium in
prevalence in PH (Northern
Luzon)
Thorough cooking of
meat
Freezing at -20C for
10 days kills cysticerci
Sanitary inspection of
all slaughtered pigs,
cows, and cattle.
Proper disposal of
animal excreta
Prompt treating of
infected individuals