1.

Cestodes- flatworms
2. Trematodes-
– intestinal flukes
– liver flukes
– lung flukes
– blood flukes
3. Nematodes-
Cestodes:
Tinea saginata
Diphylllobotrium latum
Hymenolepis nana
Echinococcus multilocularis
 dwarf tapeworm
because it is the smallest
tapeworm
infecting humans
ADULT TAPE WORM
Found in the ileum.
It has a delicate strobila or the body measuring from 25 to 45 mm in
length and 1 mm in width.

SCOLEX- sub globular with 4 cup shaped suckers.

RETRACTABLE ROSTELLUM- armed with a single row of 20 to 30 Y-

shaped hooklets.

PROGLOTTIDS- 8. 15 to 0.3 mm in length and 8 to 1.0 mm in width:

Anterior proglottids- short
Posterior proglottids- broader than long.

STROBILA- more than 175 to 220 segments.

EGGS- spherical or sub spherical

Hymenolepis nana, adult, stained whole mount; approximate
length = 35 mm. The tapeworm's body (strobila) consists of
proglottids in various stages of development.
Hymenolepis nana egg. The egg measures approximately 45 µm in
diameter. It can be differentiated from the egg of H. diminuta by the
presence of "polar filaments" in the area between the outside "shell" and
the internal larva
Symptoms are primarily produced because of the patients immunological
response to the presence to the presence of parasite. Light worm burden is
generally asymptomatic.

SYMPTOMS include:
Nausea
Dizziness
Anorexia
Pruritus of the nose and anus
Diarrhea
Pallor
Abdominal pain

Some children are:

Restless
Irritable
Sleep disturbance
Heavy infections may result
In enteritis due to necrosis and desquamation of the intestinal epithelial cells.
 Made by demonstration of the
characteristic egg in the patient’s stools.
Praziquantel drug is given as 25
mg/kg single dose. It causes
vacuolization and disruption of the
tegument of the neck region. It is
usually repeated after 2 wks to cover for
these worms emerging from the
remaining viable cystercoide.
Have a personal hygiene and
environment sanitation.
infected areas should be thoroughly
treated.
Rodent control must be observed.
Food must be properly stored and
protected from possible infestation with
grain beetles.
pork tapeworm
Adult worm- inhibits the upper small intestines.
Derives its nourishment from intestinal contents of the
host.
Shorter than T.saginata and less number of proglottids
Measures 2-4m in length
May have 800-1000 proglottids
Scolex- has four acetabula, but is smaller (1mm) and
more spherical than beef tapeworm.
Gravid Proglottid- has 7-15 lateral branches of t.
saginata. Contains 30,000-50,000 ova. All undergoes
apolysis to eventually release its eggs which remain
viable for weeks.
Eggs- indistinguishable from that of T. saginata.
Oncosphore-penetratesthe intestinal mucosa to
typically encyst in muscles as cysticercus cellulosae
Cysticercus-maybe found in all tissues. Commonly
infected areas are the muscle, tongue, spleen and
dysentery.
 Intestinal infection results in non-specific abdominal complaints .
Proglottids are not active.
Cysticercosis- often multiple and can develop in any organ
-most common located in striated muscles and
in the brain
-living cysts may produce inflammation and
may
survive up to 5 years

Neurocysticercosis (NCC)- most serious manifestation which is

considered as one of the most serious zoonotic disease worldwide

Two general forms:

1)Parenchymal
2)Extraparenchymal
-subarachnoid or meningitic- may lead to an
aggressive form called racemous cysticercosis

-intraventricular-cysts are usually presentin the third

or fourth ventricle and often lead to obstructive hydrocephalus
 Intestinal- identifying the charcteristics of the proglottids, eggs or the scolex
as described for T. saginata

Cysticercosis- neurocysticercosis may be suspectedin a patient with epileptic

seizures without associated systemic symptoms but living in an endemic
area. If a patient has a subcutaneous cysticerci concominant with neurologic
symptoms. CSF abnormalities such as an elevated protein, reduced glucose
and increased mononuclear cells may be seen.

Computed Axial Tomography (CAT) scans and nuclear manetic resonance

imaging MRI are useful for localizing cysticerci and evaluating the pathology
before and after treatment.
Three main 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- dead larva
3)small calcified area within a cystic space-dead scolex

Serologic test include serum and CSF ELISA and electro-immuno transfer blot
EITB or western blot for specific IgG and IgM anticysticercal antibodies
Intestinal-
Praziquantel is the drug of choice.
– 5-10 mg per kg, single dose for both adults and children

Cysticercosis
Praziquantel 50-75 mg per kg divided into three doses
for 30 days or albendazole at 400mg twice daily for 8-30
days
Steroids are then given either 80mg of prednisolone or
10mg of IM dexamethasone four hours after the last
dose
Thorough cooking of meat

Freezing at -20 degrees C for 10 days

kills the cysticerci

Sanitary inspection of all slaughtered

pigs, cows, and cattles should be done
Beef tapeworm
 Adult tapeworm inhibits the upper jejunum and may live up to 25
years
 Derives its nourishment from intestinal contents
 Adults measure 4-10 m in length and may have 1000-4000 proglottids
 Cuboidal scolex measures 1-2 mm in diameter
 Has four prominent acetabula
 Its vagina has a sphincter
 Gravid proglottids-longer than they are wide, contains 97,000-124,000
ova. Annually, a worm may pass out 594,000,000 ova.
 Gravid proglottids undergo apolysis and are either passed out with
the feces or actively crawl out of the bowel to the external
environment
 Upon ingestion of T.saginata eggs by cattle, the oncosphere is
released.
 The oncosphere actively penetrates the intestinal mucosa and enters
the venule from which it is carried to other parts of the body.
 Cyticercus- milky white, about 1mm in diameter, has a single scolex
 Most common complain of patients is the passage of proglottids
or segments in the stool
 Mild irritation at the site of attachment
 May experience non specific symptoms as epigastric pain,
vague discomfort, hunger pangs, weakness, weight loss, loss of
appetite, and pruritis angi(vaginal itching)
 Rarely tangled proglottids may result in intestinal obstruction
 T. saginata progottids are actively motile, causes obstruction in
the bile and pancreatic ducts as weell as appendix
 Sight of actively motile proglottids in the perianal area and in the
undergarments may result in anxiety and distress
 First specimen brought by patients are the gravid
proglottids, either single or in chains. They are
passed out of the feces and may be recovered in the
patient’s garments

 Examination of the stool can be done for the

presence of eggs, but eggs are irregularly passed out
with the stools

 Perianal swabs may also be useful because eggs are

left in the perianal skin as the gravid segments
squeeze out of the anal opening
• Praziquantel is the drug of choice
-given at a dose of 5-10 mg per kg as a
single dose for both adults and children

Criteria for cure:

1)Recovery of the scolex
2)A negative stool examination three months
after
The adult tapeworm measures from 3
to 10 m in length and may have 4,ooo
proglottids. It is the longest
tapeworm in humans.
 The scolex is spatulate and
measures 2-3mm in diameter.
 It has two bothria or sucking
grooves which are located dorsally
and ventrally.
  The mature
proglottid contains
one set of
reproductive system.
The testes are
located in the
dorsolateral part of
the proglottid.
The coiled uterus located in the middle of
the gravid proglottid.
A symmetrical bilobed ovary is present at
the posterior third of the proglottid
 With the distention of the uterus, the
uterine pore is relaxed and unembryonated
ova are discharged from the proglottis

Approximately 1,000,000 ova may be

released daily. The mean size of the eggs is
66 by 44 µm.
1. Eggs are released from the gravid proglottids and pass
out in the feces.
2. The egg hatches in water releasing a ciliated, free-
swimming coracidium.
3. A copepod ingests the coracidium and it develops into a
procercoid in the body cavity.
4. When a fish ingests the infected copepod, the
procercoid will migrate to the muscles or viscera and
develop to the pleurocercoid stage.
5. If the second intermediate host is eaten by another
fish the pleurocercoid will migrate to the muscles or
viscera of the new (paratenic) host.
6. When the host containing the pleurocercoid is ingested
by a definitive host the worm attaches to the small
intestine wall and begins to develop proglottids. The
prepatent period is 3 to 4 weeks.
 Diphyllobothriasis refers to the intestinal
infection caused by the infestation of D.
latum. Infections are usually limited to one
worm, although there have been reports of
mechanical obstruction due to a large number
of worms.
 SIGNS & SYMPTOMS:
 Diphyllobothriasis can last for decades if
untreated. Most infections are asymptomatic .
 Nervous disturbance, digestive disorders,
abdominal comfort, weight loss, weakness,
diarrhea, vomiting and anemia
 Migration of proglottids can cause cholecystitis or
cholangitis.
 D. latum infection results in hyperchromic,
megaloblastic anemia with thrombocytopenia and
leukopenia.
• Microscopic identification of eggs in the
stool is the basis of specific diagnosis
since eggs are usually numerous.

• Examination of proglottids passed in the

stool is also of diagnostic value.
Sometimes proglottids may also be
vomited.
 The drug of choice is Praziquantel as to 5 –
10mg/kg single dose. Alternatively,
Niclosamide can also be used to detach the
worms so they can be passed with feces.
The criterion for cure is the recovery of the
scolex in the feces after treatment.
 The preference for eating raw fish dishes and the lack
of sanitary toilet facilities contribute to the
transmission of the parasite.
D. latum is prevalent in the temperate zones where
members of the population are avid fish-eaters.
Diphyllobothriasis occurs in areas where lakes and rivers
coexist with human consumption of raw or undercooked
freshwater fish. Such areas are found in the Northern
Hemisphere (Europe, newly independent states of the
former Soviet Union (NIS), North America, Asia), and
in Uganda and Chile.
Seven human infections have been documented in the
Philippines.
 The best way for humans to avoid infection is not
to eat undercooked fish. All freshwater fishes
should be thoroughly cooked and freezed from 24-
48 hours at a temperature of -18°C kills all
plerocecroids. Also, because human feces is an
important mechanism for spreading eggs, proper
disposal of sewage and marketing of fish can cut
down on infection of fish and thus of humans.
•The adult worm inhibits the small intestines of animal. It means
3-6 mm in length and processes a pyriform scolex, a short neck
and three proglottids : one immature, one mature and one
gravid. Scolex is armed with 30-60 books. The gravid is the
widest and longest proglottid. The uterus is midline and filled
with eggs.
•The eggs are swallowed by suitable intermediate hosts. The
larval stage is collect hyatid cysts which formed through central
vesiculation and gradually enlarge once inside the definitive
host, the prostoscolices, attach to the intestinal wall and
develop into adults.
•The hyatid cysts usually measure 1-7 cm in diameter. The broad
capsule life in the cysts, there are reffered to as hyatid sard.
•Inflammation reaction is found
•May lead to local immunosuppresion
•Hepatic cysts are mostly found
•Causes discomfort when the cysts are large enough
•May rapture from coughing, muscle strain, trauma, aspiration,
and operative procedures
•May develop on secondary cysts after 2-8 years
•Intermittent jaundice, fever, and eosinophilia
•Coughing accompanied by allergic symptoms
•Increase intracranial pressure and Jacksonian epilepsy
•Hematuria, kidney dysfunction and hyatid material in urine
•Lead to pyoenic abscess formation
•May result in higher mortality rates
•Radiographic findings and ultasonography combined with
history of residence in an endemic area is one important
diagnosis. Positive serologic test are the use of indirect
hematoglutination (HIA), indirect fluorescent antibody (IFA) test,
and enzyme immunoaesap (EIA). Positive cases will have
diseases since some cysts carriers have undetectable antibody.
•Newest diagnostic methods detect echinococcus antigens
rather than antibodies a recent study by Wang et al. in 2002
made use of rapid dot ELISA to detect specific antigens of E>
granulosus in cysts tested strongly positive while non-parasitic
liver systs of human origin were all negative