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Cestodes
Cestodes
Cestodes
Phylum Platyhelminthes
Class Cestodes (tapeworms)
Subclass Cestoda
Order Pseudophyllidea scolex spatulate
with bothria
1. Diplyllobothrium latum
Order Cyclophyllidea scolex globular with
4 cup-like suckers
Order Cylophyllidea
A. Species which require vertebrate intermediate host
1. Taenia solium
2. Taenia saginata
B. Species which require intervertebrate intermediate
hosts
1. Dipylidium caninum
2. Hymennolepis diminuta
C. Species which may or may not require intermediate
host
1. Hymenolepis nana
D. Species which infect man in their larval stage
1. Echinococcus Multilocularis
2. Echinococcus granulosus
3. Taenia solium
General characteristics
Majority are long, segmented, and tape-like are called
tapeworms
Dorso-ventrally flattened
Size varies from a few mm to several meters
Adult worms found in the intestinal canal of man and
animal
head or scolex is provides with suckers and sometimes
with hooks that serve as organs of attachment
There are 3 regions in an adult worm:
Head: scolex
Neck
Strobilia (body and trunk)
General characteristics
Uterus
Uterine pore
Common genital
Pseudophyllidea
n
Spoon-shaped
with slit-like
sucking grooves
called bothria
No branching,
Convoluted
uterine tubes
assume the form
of rosettes
Present
Ventral; in the
Cyclophyllidean
Bears 4 cup-like
suckers
Branching
May or May not be
present
Absent
Lateral
Example
Strobila
Larval stage
Pseudophylli
dea
False
tapeworm
D. latum
Cyclophyllid
ea
True
tapeworm
All except D.
latum
Apolytic (shed
segments)
Anapolytic
(dont shed
segments)
1st coracidium 1st cysticercus
2nd procercoid 2nd
3rd
cysticercoid
rd
Order Pseudophyllidea
Characteristics
Large worms consists of a long chain of segments
head has two slit-like sucking grooves called Bothria instead of
suckers
Uterine glands scattered in the parenchyma, composed of many
acini
Genital pores on the ventral surface of the segment, not marginal
Uterus opens to the exterior through which eggs come out
Order Pseudophyllidea
Characteristics
Eggs are operculated and can
develop only in water; immature wh
en oviposited and oncoshere gives ris
e to ciliated embryo
Larval development proceeds into
two intermediate hosts:
Diphyllobothrium latum
Mode of infection
Infection
Diphyllobothriasis
Diphyllobothrium latum
Nec
k
Bothrium
Bothrium
Scolex spoon-shaped or
spatulate
Scolex bear 2 slit-like grooves
called bothria (1 on dorsal surf
ace the other on ventral)
Scolex has no rosetellum and
no hooklets
Neck thin and unsegmented,
much longer than the head,
followed by immature proglott
ids, mature and gravid proglot
tid
Scolex spatulate
Diphyllobothrium latum
Adult worm yellowish
grey in color
Dark central markings in
the strobia the egg-filled
uterus
Measure 3 to 10 meters in
length
Life-span 5 to 15 years
Encysts in fish muscle
Larvae develop on
intestinal wall
Diphyllobothrium
latum
A mature segment is filled with male
and female reproductive organs
Terminal segments shrink and
becomes empty as eggs are
constantly discharged
Dried up segments break off from
the body in chains, passed out in th
e hosts feces
Uterus at the center of the segment
appears in the form of a rosette
Diphyllobothrium latum
Oval, light brown, thick shell
Bile stained
Contains abundant granules
and unsegmented ovum
Inconspicuous operculum at
one end, small knob at the
other end
Does not float in saturated
solutions of common salt
A single egg gives rise to a
single larva
Eggs unembryonated when
passed in feces
Not infective to man
Kno
b
Diphyllobothrium latum
Larvae
o Passed first in water and then in the respective
intermediate hosts
3 stages
First stage larva
Coracidium
Ciliated oncoshere develop from egg in water
Procercoid
Spindle-like solid body with cephalic invagination
Found inside the cyclops (the first intermediate host)
Plercocercoid
Heads is invaginated in the neck
Found in the freshwater fish, the second intermediate host
Life Cycle
Diagnosis
Definitive diagnosis finding the
characteristic operculated eggs or on occasio
n, proglottids in stool, may be vomited.
DFS usually suffice due to a number of eggs.
TO differentiate anemia due to
diphyllobothriasis from pernicious anemia, ex
amination of gastric juice for the presence of
free HCL pernicious anemia is associated wit
h ACHLORHYDRIA
Treatment
Praziquantel 5 to 10 mg/kg single dose
If the scolex is not recovered, a repeat stool exam
is done after 3 months to be certain for no longer
infection.
Prevention and control
Order Cyclophyllidea
Characteristics
INTESTINAL CESTODES
Mature proglottids
almost square,
contain mature
male and female
Gravid proglottids
are longer than T.
solium
Taenia saginata
Taenia saginata
Diagnosis
Identify characteristics eggs, proglottids or scolex
Usual specimen gravid proglottids (lateral
branches 15-20)
Concentration techniques for eggs (eggs rarely
passed out in stool)
Perianal swabs
Treatment
Praziquantel 5-10 mg/kg single dose
Criteria for cure
Recovery scolex
Negative stool examination 3 months after
treatment
Cysticercus
Intestinal cestodes
Common name
Intermediate host
Scolex
Length
#of uterine
branches
# of proglottids
Gravid proglottid
Eggs
Larva
Infective stage
Taenia saginata
Beef tapeworm
Cattle
No rostellum
<25m
15 or more
Taenia solium
Pork tapeworm
Pig
Armed rostellum
<7m
13 or less
1000 to 2000
<1000
Tree-like
Finger(dichomotous)
like(dendritic)
Spherical and striated, inside is an
embryo or oncosphere with 6 hooklets
Cycticercus bovis Cysticercus
cellulosae
Cysticercus bovis Cysticercus
T. Solium
eggs
Characteristic
intermediate
host
Taenia
Saginata
cattle, reindeer
Taenia solium
pig, wild boar
Site of Development
Muscle, viscera
No hooks
Hooks
Scolex: cysticercus
No rostellum
Proglottis:uterine
branches
Passing of proglottids
23 (14 - 32) *
8 (7 -11) *
Single,
spontaneous
2 lobes
In groups, passively
Present
Absent
Ovary
Vagina:sphincter
muscle
3 lobes
Calcified cysts
of Cysticercus
bovis in muscle
tissue.
(Cysticercus
bovis, larval for
Numerous cysticerci
(Cysticercus cellulosae,
larval form of Taenia
solium)
Each cyst contains a
single inverted scolex
Taenia solium
Pork tapeworm
Armed tapeworm of
man
Taeniasis is common
among those eating
raw or insufficiently c
ooked (measly pork)
Uncommon among
non-pork eaters
T. Solium
scolex
T. solium
Taenia solium
Scolex globular in
outline with 4
circular suckers
Scolex has a
rostellum armed with
double row of
alternating large and
small hooklets
Rostellar hooklets
shaped like daggers
or Arabian poniards
Taenia solium
800-900 proglottids
Common genital pore marginal and
thick lipped
Vaginal opening not guarded by a
muscular sphincter
Gravid segments expelled passively in
chains of 5-6 at a time and not singly
Gravid proglottids contains approx.
30,000 to 50,000 eggs
Taenia solium
Ova
Same as those of
Taenia saginata
Infective to man as
well as pigs
Thick brown striated
embryophore
surrounding a
hexacanth embryo
Taenia solium
Final host: Man
Intermediate host: Pig
Mode of infection: eating measly
pork containing Cysticercus cellulosa
e
Diagnosis: stool examination for
proglottids/ eggs
Taenia solium
Pathogenesis
Mild, non-specific abdominal complaints
Proglottids are not as motile as T. saginata, so
organ obstruction is less likely.
Cysticercosis
Multiple
Develop in any organ or tissue
Neurocysticercosis (most serious zoonotic
disease)
Chorioretinitis
Vasculitis
Taenia solium
Diagnosis
Intestinal
Identifying the characteristic proglottids, eggs or scolex
Cysticercosis
Computed Axial Tomography
Magnetic Resonance Imaging
Treatment
Praziquantel 5-10 mg/kg single dose for children and
adults
Noclosamide not available locally
Criteria for cure
Recovery of scolex
Negative stool exam 3 months after treatment
Cysticercus
cellulosae, T
solium
Life cycle
EXTRAINTESTINAL
CESTODES
Echinococcus sp.
Echinococcus granulosus
Echinococcus multilocularis
Cause alveolar ecinococcosis
Echinococcus granulosus
Definitive host
Dog and other canines
Intermediate host
Goats, horses, cattle,
camels and sheep
Larval stage: hydatid cyst
Numerous (1M)
protoscolices may be found
within the cyst
Cyst has outer laminated
layer and inner nucleated
germinal layer
Protoscolices and
broad capsules lie
free in the cyst,
referred to as
hydatid sand
Echinococcus
granulosus
Adult worms are small (3-6
mm in length)
It is composed of a
Armed Scolex
Short Neck
Strobia
3 proglottids (occasionally
4)
Immature
Mature
Gravid
Echinococcus granulosus
Scolex bears 4 suckers and protrusible
rostellum with 2 circular rows of hooks
Resemble Taenia ova
Hexacanth embryo with 3 pairs of hooks
Infective to:
Man
Cattle
Sheep and other herbivorous animals
Echinococcus granulosus
Larva
Life cycle
Echinococcus granulosus
Diagnosis
Antigen detection
Diagnosis
1. Roentgenogram
2. Exploratory cyst puncture
3. Immunologic tests (intradermal, precipitin,
complement fixation, hemagglutination, and ben
tonite flocculation latex slide agglutination and fl
uorescent antibody tests)
. Positive cases will have to undergo a gel
diffusion assay that would demonstrate the echi
nococcal Arc 5 for confirmation.
Echinococcus granulosus
Treatment
Sparganosis
Refers to the larval infection with the
plerocercoid larvae also known as
spargana of pseudophyllidean
tapeowrms falling under the Genus S
pirometra.
Common in man: Spirometra
mansoni
Spirometra erinacei
Spirometra ranarum
Hymenolopis species
Genus derived from the membranous character of the
egg shell hymen
3 testes in each mature segment
Uterus sac-like and transverse
Eggs posses two membranes outer membrane is thin and
transparent
Larval stage is called cysticercoid
Small bladder containing the invaginated head proximally
and a solid, elongated portion as a caudal appendage
There are 2 species:
Hymenolopis nana
Hymenolopis diminuta
Hymenolepis
Hymenolepis nana
Hymenolepis
diminuta
Common name
Dwarf tapeworm
(smallest
tapeworm)
Rat tapeworm
Scolex
Armed rostellum
Unarmed rostellum
eggs
With 4 to 8 polar
filaments
Without filaments
Infective stage
Eggs (direct)
Cysticercoid larvae
(indirect)
Cysticercoid larvae
Intermediate host
Fleas
(Ctenocephalides
canis, Xenopsylla
cheopis, Pulex
iritans)
Flour beetles
Insects
H. Diminuta cysticercoid
larva
The larvae used to infect rats
should have longer tails to
insure they are mature
enough to be infectious to
rats.
Hymenolepis diminuta
Rat tapeworm
Common parasite of rats and mice
Accidental human infection
Differ from Hymenolepis nana in morphology and
life cycle because it requires an intermediate host
2 host
Larval stage: cysticercoid is passed in fleas
Adult stage: in rats and mice and accidentally in
humans especially children who accidentally
ingest infected fleas
Hymenolepis diminuta
Adult
Larger than Hymenolepis nana
Measures 60 cm in length
Scolex
Unarmed rostellum
4 suckers lacking hooklets
Hymenolepis diminuta
Ova
Larger than H.
nana
Outer shell
yellowish in color
Inner
embryophore 2
knob-like
thickenings
No polar filaments
Hymenolepis
diminuta
Cysticercoid of Hymenolepis diminuta
Like a cysticercus but this larva has no
bladder but has a tail instead
The dark body within the spherical
portion is the scolex
The longer the tail, the more mature
the cysticercoid
This stage found inside an insect as
the mealworm
H. diminuta
Pathogenesis
Hymenolepiasis
Worm burden in rodents relatively
low
In man, highest worm burden is 19
Clinical manifestations minimal and
non-specific
Life cycle
Hymenolepis nana
Common name: Dwarf tapeworm
Smallest tapeworm infecting man
Found worldwide
Mainly among children
Only human tapeworm that can complete its
life cycle in a single host
Man can harbor both the adult and larval
stages of the parasite
Exception to the general rule that
Hymenolepis nana
Adult
Found in the ileum
Delicate strobia
Short life span,
about 2 weeks
Up to 200
proglottids
Transverse uterus
3 testes
Hymenolepis nana
Scolex
Subglobular
4 suckers
Provided with a short retractile rostellum
armed with a single row of 20-30
hooklets
Rostellar hooklets are shaped like tuning
forks
Cysticercoid larva of H.
nana
Hymenolepis
nana
Ova
Sphereical or oval
Floats in saturated solution of common salt
2 distinct membranes
Hymenolepis nana
Mode of transmission is thru
Direct
Host ingests eggs that hatches in the
duodenum
Indirect pathway
Accidental ingestion of infected
arthropod intermediate host like rice and
flour beetles in which cysticercoid larvae
are released and develop into adult wor
ms in the small intestine of the host
Life cycle
Dipylidium caninum
Double Pored Dog tapeworm
Presence of bilateral genital pores in each segment
(di:2; pylis: gate): 2 entrance
Common intestinal parasite of dogs
Scolex
Small and globular
4 deeply cupped elliptical suckers
Protrusible/ retractile rostellum
Rostellum has 1-7 rows of rose thorn shaped
hooklets
Dipylidium caninum
Strobia
200 proglottids
Narrow
Mature proglottids
2 sets of male and
female reproductive
organs
Bilateral genital pores
Dipylidium caninum
Gravid proglottids
Have size and shape of
pumpkin seeds
Filled with capsules or
packets of 8-15 eggs
enclosed in an embryo
nic membrane
D. caninum
Ova
Passed out in the feces
along with the proglottids
Released by contraction of
proglottids or disintegration
outside the host
Spherical
Thin shelled
With a hexacanth embryo
Dipylidium caninum
Intermediate host
Ctenocephalides canis: dog flea
Ctenocephalides felis: cat flea
Pulex irritans: human flea
Trichoedectes canis: dog flea
Dipylidium caninum
Pathogenesis
Dipylidiasis
Rarely multiple
Symptoms are minimal
Slight intestinal discomfort
Epigastric pain
Diarrhea
Anal pruritus
Allergic reactions
Life cycle