CESTODES

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 are found in the intestinal canal of man and animals head or scolex is provided with suckers and sometimes with hooks that serve as organs of attachment There are 3 regions in an adult worm:
Head: scolex Neck Strobila (body or trunk)
Consist of a series of segment called proglottids

General Characteristics
Sexes are not separate Body cavity is absent Alimentary canal is entirely absent Excretory and nervous systems are present Reproductive system is present and complete in each segment
According to maturity of reproductive organs, three types of segments of the strobila can be recognized from the fron backwards
Immature: male and female organs are not differentiated Mature: male and female organs have become differentiated (male organs appear first) Gravid: uteri are filled with eggs (other organs are atrophied or have disappeared)

Classification of Cestodes Infecting Man

I. Pseudophyllidean cestodes
Possess false or slit-like grooves called bothria Adult worms in Intestine
Diphyllobothrium latum: Fish Tapeworm

Larval stages: Plerocercoid in Man

Sparganum mansoni Sparganum proliferum

Classification of Cestodes Infecting Man

II. Cyclophyllidean cestodes
Possess cup-like and round suckers called acetabula Adult Worms in the Intestine
Taenia saginata Taenia solium Hymenolepis nana Hymenolepis diminuta Dipylidium caninum

Classification of Cestodes Infecting Man

According to Habitat II. Cyclophyllidean cestodes
Possess cup-like and round suckers called acetabula Larval Stages in Man
Hydatid cyst of Echinococcus granulosus and Echinococcus multilocularis Cysticercus cellulosa of Taenia solium Coenurus cerebralis of Multiceps multiceps Coenurus glomeratus of Multiceps glomeratus

Differences Between a Pseudophyllidean and a Cyclophyllidean Cestode

Pseudophyllidean Cyclophyllidean

Head or scolex uterus

Bears 2 slit-like grooves No branching Convoluted uterine tubes assume the form of rosettes present Ventral; in the midline Operculated; gives rise to ciliated larvae

Bears 4cup-like suckers Branching May or may not be present absent lateral Not operculated; do not give rise to ciliated larvae

Uterine pore Common genital pore eggs

Order Pseudophyllidea Characteristics

Large worms consisting of a long chain of segments head has two slit-like sucking grooves called bothria instead of suckers Uterine glands are widely scattered in the parenchyma and is composed of many acini Genital pores are on the ventral surface of the segment and are not marginal Uterus opens to the exterior through which eggs come out Eggs are operculated and can develop only in water; immature when oviposited and oncosphere gives rise to ciliated embryo Larval development proceeds in two intermediate hosts: First larval stage is called procercoid Second larval stage is called plerocercoid

Diphyllobothrium latum
Common Name:
Fish Tapeworm Broad Tapeworm

Morphology
Adult worm is yellowish grey in color Dark central markings in the strobila are due to the egg-filled uterus Measures 3 to 10 meters in length Life-span is for a period of 5 to 15 years

http://www.revistaaquatic.com/aquatic/html/art1401/fig11.gif 3-01-08

Diphyllobothrium latum
Scolex is spoon-shaped or spatulate Scolex bears 2 slit-like grooves called bothria (1 on the dorsal surface and 1 on the ventral surface) Scolex has no rostellum and no hooklets Neck is thin and unsegmented and is much longer than the head

Diphyllobothrium latum
Morphology
3,000 to 4,000 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 and are passed out in the hosts feces Uterus at the center of the segment appears in the form of a rosette

Diphyllobothrium latum

http://pathmicro.med.sc.edu/parasitology/dip1.jpg 3-01-08

Diphyllobothrium latum
Ova
Passed out in the hosts feces in large numbers Oval Bile stained Contains abundant granules and unsegmented ovum Inconspicuous operculum at one end and a small knob at the other end Does not float in saturated solutions of common salt A single egg gives rise to a single larva Not infective to man

http://workforce.cup.edu/Buckelew/images/Diphyllobothrium%20latum%20egg.jpg 3-01-08

Diphyllobothrium latum
larva
Passed first in water and then in the respective intermediate hosts 3 stage
First stage larva Coracidium Ciliated oncosphere that develops from egg in water Second stage larva Procercoid Spindle-like solid body with cephalic invagination Found inside the cyclops (the first intermediate host) Third stage larva Plerocercoid Head is invaginated in the neck Found in the fresh water fish, the second intermediate host

Diphyllobothrium latum

Diphyllobothrium latum

Diphyllobothrium latum
Final Host Man, dog, cat Small intestine 1st I.H. Cyclops or Diaptomus 2nd I.H. Fresh water fish, pike, trout, salmon, perch Mode of Infection Ingestion of imperfectly cooked infected fish or roe containing plerocercoid larvae Infection Diphyllobothriasis G.I. disturbances and anemia Diagnosis Microscopic examination of feces for the characteristic operculated eggs

Order Cyclophyllidea Characteristics

Large or small worms consisting of chains of segments Scolex is quadrate with four cup-like round suckers An apical rostellum with hooklets may be present Vitelline glands concentrated in a single mass Common genital pore is marginal (on lateral side of segment) No uterine opening for the exit of eggs from the gravid uterus Eggs only escape from the rupture or disintegration of ripe segments Eggs are not operculated and can develop only in the intermediate host, fully embryonated Oncosphere is never a ciliated embryo Larval development proceeds in one intermediate host

Taenia saginata
Beef Tapeworm Unarmed Tapeworm of Man Adult worms are white and semi-transparent Measures about 5-10 meters or sometimes up to 24 meters Live up to 10 years or more

Taenia saginata
1,000 to 2,000 proglottids Common genital pore is marginally situated Vagina is provided with a sphincter muscle Gravid proglottid consists of a uterus and a central longitudinal stem with 15 30 branches on each side Highly branched proglottids Gravid proglottid contains 97,000 to 124,000 ova Gravid segments are expelled singly and force their way through the anal sphincter Free gravid proglottid crawls out of the anal orifice and oviposits on the perianal skin

Taenia saginata

Taenia saginata
Ova
Liberated by rupture of ripe proglottids No uterine opening Spherical Thin, outer transparent shell Inner embryophore is brown, thick walled and radially striated Has an oncosphere with 3 pairs of hooklets Does not float in saturated salt solutions Eggs are resistant and remain viable for 8 weeks Infective only to cattle

Taenia saginata
Final Host: Man Intermediate Host: cattle, cow buffalo Mode of Infection; eating beef containing Cysticercus bovis Pathogenesis
Taeniasis Passage of proglottids in stool Mild irritation at site of attachment Epigastric pain Hunger fangs Weakness Weight loss Loss of appetite Pruritis Obstruction in intestine but also in bile and pancreatic ducts and appendix because proglottids are actively motile

Taenia saginata
Diagnosis Identifying characteristic eggs, proglottids or scolex Usual specimen is gravid proglottids ( lateral branches 15-20) Concentration techniques for eggs (eggs rarely passed out in stool) Perianal swabs Treatment Praziquantel 5-10mg/kg single dose Criteria for cure Recovery of the scolex Negative stool examination 3 months after treatment

Taenia solium
Pork Tape worm Armed Tapeworm of Man Taeniasis is common among those eating raw or insufficiently cooked measly pork Uncommon among non-pork eaters

Taenia solium
Scolex is globular in outline with 4 circular suckers Scolex has a rostellum armed with a double row of alternating large and small hooklets Rostellar hooklets are shaped like daggers or Arabian poniards

Taenia solium

Taenia solium

Taenia solium
Adult worms measure 2-3 meters
Adult worms live up to 25 years

Taenia solium
800-900 proglottids Common genital pore is marginal and thick lipped Vaginal opening is not guarded by a muscular sphincter Gravid segments are 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 cellulosae 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 Niclosamide not available locally

Criteria for cure:

Recovery of scolex Negative stool exam 3 months after treatment

Comparison Between T. saginata and T. solium

Taenia saginata Taenia solium
length Head or scolex Number of proglottids Expulsion 5-10 meters Large, quadrate, no rostellum and hooks 1,000 to 2,000 Expelled singly and may be forced through the anal sphincter Highly branched with 1530 lateral branches on each side; thin; dichotomous 300-400 follicles 2-5 meters Armed; with rostellum; with hooklets Below 1000 Explelled passively in chains of 5 or 6 Lateral branches 5-10 on each side, thin, dendritic and vaginal sphincter is absent 150-200 follicles

uterus

testes

Echinococcus granulosus
Taenia echinococcus Dog Tapeworm Hydatid Worm Man harbors the larval form and not the adult worms which however is found in the intestine of dogs and canines

Echinococcus granulosus
Adult worms are small (3-6 mm in length) It is composed of a
Scolex Neck Strobila

3 segments (occassionally 4)
Immature Mature Gravid

Echinococcus granulosus
Scolex bears 4 suckers and a protrusible rostellum with 2 circular rows of hooks.

Echinococcus granulosus
Ova
Ovoid in shape Resemble Taenia ova Hexacanth embryo with 3 pairs of hooks

Infective to:
Man Cattle Sheep and other herbivorous animals

Echinococcus granulosus
Larva
Found within the hydatid cyst developing inside the intermediate host Represents the structure of the scolex of the future adult worm Young larva are transformed into a hollow bladder (hydatis , drop of water) Brood capsules develop within the cysts and may contain thousands of scolices On entering the final host, the scolex armed with a rostellum and 4 suckers become adult worms

Echinococcus granulosus

Echinococcus granulosus

Echinococcus granulosus
Definitive Host
Dog Wolf Fox Jackal

Intermediate Host
Sheep Pig Cattle Horse Goat

Echinococcus granulosus
Definitive Host
Dog Wolf Fox Jackal

Intermediate Host
Sheep Pig Cattle Horse Goat

Echinococcus granulosus
Pathogenesis Echinococcosis
Pathology is caused by the developing larval cyst in the intermediate host Most common site of involvement is the liver Echinococcus granulosus cyst: Unilocular hydatid cyst Echinococcus multilocularis: alveolar cyst Some may be asymptomatic for years Rupture of cyst in the lungs may present coughing accompanied by allergic reactions

Echinococcus granulosus

Echinococcus granulosus

Encysted scolices of Echinococcus granulosus in lung "hydatid sand"

Echinococcus granulosus

Encysted scolices of Echinococcus granulosus in lung "hydatid sand"

Echinococcus granulosus

Encysted scolices of Echinococcus granulosus in lung "hydatid sand"

Echinococcus granulosus
Diagnosis
Radiographic findings Immunodiagnosis Antibody detection
IHA IFA EIA

Antigen detection

Echinococcus granulosus
Treatment
Surgical resection: not 100% effective Solicidal agent
Hibitane 95% ethanol Hypertonic 30% Normal Saline Solution

PAIR technique for inoperable cyst

Puncture, Aspiration, Injection, Reaspiration Intervention Albendazole

Hymenolepis species
Genus is derived from the membranous character of the egg shell hymen 3 testes in each mature segment Uterus is sac-like and transverse Eggs possess two membranes outer membrane is thin and transparent larval stage is called cysticercoid Small bladder containing the invaginated head proximally and a solid, elongted portion as a caudal appendage There are 2 species;
Hymenolepis nana Hymenolepis diminuta

Hymenolepis nana
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 Helminths do not multiply inside the body of the definitive host

Hymenolepis nana
Adult Found in the ileum Delicate strobila 25 mm to 45 mm Worms may be presenr in large numbers from 1,000 to 8,000 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

Hymenolepis nana
Ova
Spherical or oval
Floats in saturated solutions of common salt

2 distinct membranes
Outer membrane is thin transparent and colorless Inner embryophore that encloses an oncosphere with 3 pairs of lancet shaped hooklets Intermembranous space is filled with yolk granules and 4-8 polar filaments emating from little knobs at either end of the embryophore

Hymenolepis nana

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 arve are released nd develop into adult worms in the small intestine of the host

Hymenolepis nana
Pathogenesis
Symptoms are produced due to patients immunological response to the parasite Asymptomatic for light worm burden Headache Dizziness Anorexia Pruritus of the nose and anus Abdominal pain Pallor Desquamation of intestinal epithelial cell or as serious as necrosis may occur

Regulatory immunity will eventually limit the infection

Hymenolepis nana
Diagnosis
Demonstration of characteristic ova in the stool Proglottids are not recovered because they undergo degeneration prior to passage

Treatment Praziquantel
25mg/kg single dose Drug dosage is higher than that of taeniasis because of resistant cysticercoids in intestinal tissue

Hymenolepis nana
Epidemiology
Countries with warm temperature Southern USA Latin America Mediterranean East Asia Philippines

Hymenolepis diminuta
Rat tapeworm Common parasite of rats and mice Accidental human infections Differs from Hymenolepis nana in morphology and life cycle because it requires an intermediate host 2 Hosts
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

Hymenolepis diminuta
Scolex Unarmed rostellum 4 suckers

Hymenolepis diminuta

Hymenolepis diminuta
Proglottid
8,00 1,000
Mature proglottids of Hymenolepis diminuta from the laboratory rat. The three spherical bodies are testes which surround the ovaries, ootype and vitelline glands. The genital pores are on the left margin

Hymenolepis diminuta
Ova
Larger than H. nana Outer shell is yellowish in color Inner embryohore has 2 knob-like thickenings No polar filaments

Hymenolepis diminuta
cysticercoid of Hymenolepis diminuta. The suffix indicates it is like a cysticercus but this larva has no bladder but instead has a tail. The dark body within the spherical portion is the scolex. The longer the tail, the more mature the cysticercoid. This stage is found inside an insect such as the mealworm,

Hymenolepis diminuta

Hymenolepis diminuta
Pathogenesis Hymenolepiasis Worm burden in rodents is relatively low In man, highest worm burden is 19 Clinical manifestations are minimal and non-specific

Hymenolepis diminuta
Treatment Praziquantel 25mg/kg body weight single dose Epidemiology World wide Common among children due to ingestion of infected grain beetles, dried fruits, flour and cereals Prevalence of H. diminuta in Philippine rats is about 8%

Dipylidium caninum
Double Pored Dog Tapeworm Presence of bilateral genital pores in each segment (di: 2; pylis: gate): 2 entrances Common intestinal parasite of dogs

Dipylidium caninum

Adult
10-70 cm in length Pale reddish

Dipylidium caninum
Scolex
Small and globular 4 deeply cupped elliptical suckers Protrusible/retra ctile rostellum Rostellum has 17 rows of rose thorn shaped hooklets

Dipylidium caninum

Dipylidium caninum

Strobila
200 proglottids narrow

Dipylidium caninum
Mature proglottids
2 sets of male and female reproductive organs Bilatera genital pores

Dipylidium caninum
Gravid proglottids
Have size and shape of pumpkin seeds Filled with capsules or packets of 8-15 eggs enclosed n an embryonic membrane

Dipylidium caninum

Proglottids

Dipylidium caninum

Dipylidium 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 hosts 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

Dipylidium caninum
Treatment Praziquantel 5-10 mg/kg body weight single dose Epidemiology USA Rhodesia Argentina China Philippines

Dipylidium caninum