Micro/Para (Dra.

Bunyi)

Cestodes

30 January 2008

Cestode Infections  Vagina has a sphincter

 Intestinal cestodes  Gravid proglottids
 Taenia saginata  Proglottids are
 T. solium longer than
 Hymenolepis nana they are wide
 H. diminuta  Uterus is
 Dypillidum caninum distended with
 D. latum ova and has 15 to 20 lateral branches
 Extraintestinal cestodes  Genital pores of proglottids are
 Echinococcus sp. irregularly shaped
 Ova
 Spirometra
Taenia saginata  Spherical or
subspherical in
 Known as the beef tapeworm
shape
 Humans serve only as definitive host (Not a
intermediate host)  In color, with a
thick embryophore
 Human cysticercosis Does Not occur
which appears
T. saginata: Morphology
striated because of
numerous pits
 Inside the eggshell is the oncosphere
or embryo 30-45 µm in diameter
Taenia saginata: Life cycle

 Adult worm

 Inhabits upper jejunum

 May live up to 25 years
 Measure 4-10m in length (25m)
 1,000-4,000
proglottids
 SCOLEX: cuboidal – 1-2
mm in diameter
 4 acetabula
 Devoid of hooks or
rostellum
 Mature proglottids  Gravid proglottids undergo apolysis 
 Contain mature passed out/crawls out  eggs are released
male and female  Cysticercus bovis: infective stage; ovoidal,
reproductive milky white, 10mm diameter, single scolex
organs invaginated into a fluid-filled bladder
 2 large varies  Only 1 adult tapeworm is present in T.
and a median saginata infections
clubbed uterus T. solium
 Follicular testes  Known as the pork tapeworm of man
300-400  Man serve as both a definitive host and an
intermediate host
Cams, shar, joy 1 of 10
 Micro/PARA – Cestodes by Dra. Bunyi Page 2 of 10

 Both intestinal and tissue infections occur in symptoms

man  Cysticercosis
T. solium: Morphology
 Adult worm
 Inhabits the upper small intestines
 Shorter than T. saginata
 Less number of proglottids
 Adults measure 2-4m in length
 800-1,000 proglottids
T. solium: diagnosis
 SCOLEX: smaller,
more spherical  Symptoms
 4 acetabula  History
 Cushion-like  …(naharangan po kasi ng pictures dun sa
rostellum binigay na hand-out kaya di mabasa. Kung
with a sino po nakakopya pa-share na lang po.
double Thanks!)
crown of 25-  …
30 large  Gravid proglottids and/or eggs in the stool
and small hooks  Cysticercosis diagnosis
 Mature proglottids  Radiographic
 Presence of localization of
accessory cysticercal
ovarian lobe lesions in tissues
 Absence of  Neurocysticercosis
vaginal  CT Scan findings:
sphincter 1. Round low-
 Smaller number of follicular testes density area
100-200 without
 Gravid proglottids surrounding
 Contains 7-15 uterine enhancement after administration
lateral branches of contrast dye (viable larva
without inflammation)
 Also undergo
2. Ring-like enhancement after
apolysis but not very
injection of contrast dye (dead
motile
larva)
 Ova
3. Small calcified area within a cystic
 Indistinguishing from space (dead scolex)
T. saginata Treatment: Taeniasis
T. solium: Life cycle
 Praziquantel: 5-10mg/kg as single dose for
****Same as T. saginata. Pls check above life
both adults and children
cycle******
 scolex expulsion is essential
Taenia solium: Pathology and Clinical  criteria for cure:
Manifestations
 recovery of the scolex
 Disease caused
 a negative stool examination 3
 Ingestion of eggs  cysticercosis months after treatment
 Ingestion of cysticercus  taeniasis Treatment: Cysticercosis
 Taeniasis symptoms  Neurocyticercosis
Site Symptoms Pathogenesis  Praziquantel: 50-75 mg/kg divided
Gastrointestinal Abdominal Physical into 3 doses for 30 days or
discomfort, presence of the
epigastric pain, worm
 Albendazole: 400mg 2x a day for 8-
30 days
vomiting
Other organs Cyst formation Physical mass  Steroids
(cysticercosis) in brain, eye, and  Surgical removal
lungs, and liver inflammation  Ocular cysticercosis
may cause  Surgical removal
related Epidemiology
Micro/PARA – Cestodes by Dra. Bunyi Page 3 of 10

 Related to the habit of eating raw or  Inner membrane with two polar
improperly cooked meat thickenings each provided with 4-8
 T. solium: Slavic countries, Latin America, threadlike filaments extending into
Southeast Asia, China and India the space between the two shells
 T. saginata: Etiopia and East Africa, Japan,  Hexacanth embryo with 6 hooklets
SEA, Europe, Australia, Canada, US enclosed by 2 membranes
 Philippines: prevalence of taeniasis – 0.56%; H. nana: Life cycle
Northern Luzon
Taeniasis: Prevention
 Adequate cooking of meat
 Freezing meat below 100C

Hymenolepis nana
 Common name: dwarf tapeworm
 Disease caused: Hymenolepiasis nana; dwarf
tapeworm infection
H. nana: Geographic distribution
 Primarily limited in human beings to children
in warm climates
 Prevalent throughout India, parts of the
USSR, countries bordering the
Mediterranean, all countries of Latin
America, Hawaii and some of the islands of
South and Southwest Pacific
 Common tapeworm in Southeastern US
H. nana: Morphology
H. nana: Epidemiology
 Adult worm  Human strain
 Only human tapeworm that does not
require an intermediate host to
complete its life cycle

 Length: 25-40mm
 Number of proglottid: 200
 SCOLEX
1. Small and globular
2. Bears a short retractile rostellum with
a single ring of 20-30 minute hooklets
3. Provided with 4 cup-shaped suckers
 Neck – long and slender
 Immature proglottid – undifferentiated
 Mature proglottid
1. Trapezoidal about 4x as broad as long
2. Has a single genital pore on its left
side towards the anterior border
3. Has 3 round testes and a bilobed
ovary
 Ripe or gravid proglottid – contains the
sacculate uterus filled
with eggs
 Ova
 Grayish hyaline,
nearly spherical
 20-40µm in
diameter
 Two thin membranous shells

Micro/PARA – Cestodes by Dra. Bunyi
 Man is the natural final
host
 Infective stage is the
embryonated ova
transmitted to man
through the agency of
foods and drinks
particularly raw leafy
vegetables usually eaten
as raw salad
 It is more common in children and in
institutionalized group
 Humanity is the chief source of
infection
 Murine strain, H. nana var. fraternal
 Final hosts are rats and mice
 Man is an accidental final host
 Intermediate hosts are fleas and
beetles
 Infection of definitive hosts results
from the ingestion of intermediate
hosts harboring the 4cysticercoid
larva
H. nana: Mode of Transmission
 Direct hand to mouth
 Less frequently, by contaminated food or
water
 Possibly, by indirect intermediate hosts
H. nana: Symptomatology
 Infection with a few H. nana may produce no
symptoms
 It may be responsible for:
1. Diarrhea
2. Anorexia
3. Vomiting
4. Insomnia
5. Loss of appetite and weight
6. Irritability
7. Pruritus of the anus and nose
8. Urticaria
9. Choreiform symptoms
 Heavy infection is invariably pathogenic
1. Moderate to profuse diarrheic stools
2. Abdominal pain
3. Anorexia and exaggerated disorders
4. Extreme apathy
5. Epileptiform seizures
H. nana: Laboratory Diagnosis
 Recovery of the characteristic ova in the
stools
 Light cases with the aid of acid ether
concentration technique
H. nana: Treatment
 Praziquantel – 25 mg/kg in single dose
 Niclosamide – 2 g each day for 5-7 days
 Children – half of the adult dose
Page 4 of 10
 Paromomycin – 45 mg/kg daily,
given in 4 doses at hour intervals
for a period of 5 days
H. nana: Prevention
 Human strain
a. Avoid ingestion of eggs by not eating
raw vegetables or salad
b. Personal hygiene
c. Cleanliness of toilet seats
 Murine strain
a. Eradicate the rats and mice around
the house
b. Residual spraying of their nests and
burrows with insecticides
c. Protection of cooked foods from
arthropods
Hymenolepis diminuta
 Common name: Rat tapeworm
 Disease caused: Hymenolepiasis diminuta;
rat tapeworm infection
H. diminuta: Geographic distribution
 Cosmopolitan parasite of rats, mice, and
other rodents
 Has been reported from human hosts
usually from children in India, Indonesia,
USSR, Japan, Philippines, S. Europe, Latin
America from Argentina to Mexico and
Cuba and from several parts of the US
H. diminuta: Morphology
 Adult worm
 Length: 10-60cm by 3-
5mm
 Number of proglottids:
800-1,000
 SCOLEX
 Knob-like; club-shaped
 Provided with a
rudimentary apical
unarmed rostellum or a deep apical
suctorial pocket without rostral
hooklets
 Provided with four relatively small
cup-shaped suckers
 Neck – short and stout
 Immature proglottid –
undifferentiated
 Mature proglottid
 0.8 by
2.5mm
 Same as H.
nana only the segments are larger
 Ripe or gravid proglottid – sacculate uterus
with egg masses
 Ova
 Hyaline with straw-colored hue
Micro/PARA – Cestodes by Dra. Bunyi Page 5 of 10

 Broadly ovoid or  Residual spraying of their nests and burrows

subspherical with insecticides
 58 by 86µm  Protection of cooked foods from arthropods
 2 egg membranes, Dipylidium caninum
outer and inner  Common name: Double-pores dog tapeworm
 Inner membrane  Disease caused: Dipylidiasis; dog tapeworm
with 2 polar infection
thickenings but with the absence of D. caninum: Geographic Distribution
filaments  A common tapeworm of the dog and cat
 Considerable space between outer throughout the world; also reported from
and inner wild cats and foxes
 Hexacanth embryo enclosed by 2  Human infection is rare but reported from
membranes European, China, and the Phils.
H. diminuta: Life cycle  In the Phils., survey of dogs – prevalence of
5.19% - 36%; dog and cat fleas – 2.4%
Dipylidium caninum: Morphology
 Adult worm
 Pale reddish
adult worm
measuring 15-
70cm in length
 Strobila – a
chain of
melon-shaped
proglottids
 Number of proglottids – 60-175
 SCOLEX
 Rhomboidal
 Retractile
conical
rostellum
armed with 30-
H. diminuta: Epidemiology 150 rose
 Man is only an accidental final host thorn-shaped
 Rats and other murines are the natural final hooklets
hosts arranged in transverse rows
 Principal intermediate hosts are the larval  4 prominent oval suckers
rat, mouse fleas and adult mealworm beetle  Neck – short and slender
 Other intermediate hosts – fleas, myriapods,  Immature proglottid
cockroaches, beetles, lepidopterans  Broader than long when very young
 Infective stage to the final host is the
 Square as they become older
cysticercoids larva in the arthropod host
 Mature proglottid
 Humans are infected accidentally by food or
hands contaminated with infected insects  Vase-
shaped,
H. diminuta: Symptomatology
melon
 H. diminuta usually produces no symptoms
seed-
 Indigestion and abdominal pain are the shaped or pumpkin seed-shaped
presenting complaints in infants
 Double sets of reproductive organs
H. diminuta: Lab Diagnosis
 Genital atrium on each side of the
 Recovery of the characteristic ova in the
segment
stools
 Gravid proglottid
H. diminuta: Treatment
 Vase-shaped, melon seed-shaped or
 Same as H. nana pumpkin seed-shaped
H. diminuta: Prevention
 Filled with polygonal shaped uterine
 Eradicate the rats and mice around the egg pockets or egg capsules
house containing 8 to 15 eggs
Micro/PARA – Cestodes by Dra. Bunyi
 Ova
Spherical
Thick
albuminous
covering
 Hexacanth
embryo with 3 pairs of lancet-shaped
hooklets
D. caninum: Life cycle
D. caninum: Epidemiology
 Definitive hosts are dogs, cats and wild
carnivore
 Man especially children are only accidental
final hosts
 Intermediate hosts are larval fleas of the
dog, cat and human being and the dog louse
o Dog flea – Ctenocephalides canis
o Cat flea – C. felis
o Human flea – Pulex irritans
o Dog louse – Trichodectes canis
 Ingestion of the infected fleas cause
infection of the final host
 Infants and young children are usually
infected because of their close contact with
their pet cats
D. caninum: Symptomatology
 Light infections – asymptomatic
 May cause:
1. Slight intestinal discomfort
2. Epigastric pain
3. Diarrhea
4. Anal pruritus
5. Allergic reactions
D. caninum: Diagnosis
Page 6 of 10
 Clinical – difficult since symptoms are non-
specific
 Laboratory
 Based upon the demonstration of:
1. A single or chain of melon-
shaped proglottids
2. Egg pockets or egg capsules
3. Embryonated ova
4. Ripe or gravid proglottid
D. caninum: Treatment
 Praziquantel – 10mg/kg in a single dose
 Niclosamide – 4 tablets (2g) chewed
thoroughly in a single dose after a light meal
 Paromomycin – 1g every 4 hours for 4 doses
 Quinacrine hydrochloride – 0.8g given over
a half hour interval
D. caninum: Prevention
 Periodic deworming of pet cats and dogs is
recommended
 Insecticide dusting of dogs and cats are
effective against fleas
 The potential danger of playing with pets
must be included in the health education of
children
 Small children should not be allowed to
fondle dogs and cats infected with fleas and
lice
Diphyllobothrium latum
 Common name: Broad or fish tapeworm
 Disease caused: Diphyllobothriasis; fish
tapeworm infection; broad tapeworm
infection
D. latum: Geographic Distribution
 Prevalent in regions of the temperate zones
where freshwater fish form an integral part
of the diet
 Common in N. Europe, N. America,
Manchuria and Japan and S. America
 Has been reported in man once from the
Phils.
D. latum: Morphology
 Adult worm
 Ivory or grayish
yellow
 Length – 3-10m
 Number of
proglottids –
3,000
 SCOLEX

Spatulate,
almond-
shaped
 2-3mm
by 1 mm
Micro/PARA – Cestodes by Dra. Bunyi Page 7 of 10

 N rostellum nor hooklets  Infective stage to man and other hosts –

 2 deep dorsoventral suctorial grooves plerocercoid larva in the 2nd intermediate
called bothria host
 Neck – unsegmented, several times the  Usual vehicle for transmission – raw, partially
length of the scolex cooked or frozen fish eaten raw
 Mature proglottid D. latum: Diagnosis
 Broader than 1. Clinical
long  Tapeworm appetite, abdominal pain
 Contains and anemia particularly in people
both male living in endemic areas
and female 2. Laboratory
reproductive  Demonstration of the characteristic
organs egg I the stool using acid ether
 Characteristic morphologic concentration technique
feature – dark rosette-like coiled D. latum: Treatment
uterus at the center 1. Niclosamide – 4 tablers (2g) chewed
 Ripe or gravid proglottid – same as mature thoroughly I a single dose after a light meal
proglottid 2. Paromomycin – 1g every 4 hrs for 4 doses
 Ova 3. Praziquantel – 10mg per kg in a single dose
 Yellowish 4. Quinacrine HCl – 0.8g given over a half hour
brown interval
 Measures 55- D. latum: Prevention
76µm by 41-  Thorough cooking of all fresh water fish and
56µm used for human consumption
 Inconspicuous  Freezing of fish for 48 hrs at a temperature
operculum at one end of -10oC
 Small knob-like thickening at the  Tasting of raw freash water fish while being
other end prepared for the table should not be
practiced
 Contains plenty of yolk cells  Proper treatment and disposal of sewage
 Immature when oviposited Sparganosis
D. latum: Life cycle
A. NONBRANCHING SPARGANA
 Spargana or plerocercoid larva of several
species of Spirometra (Diphyllobothrium)
mansonoides – found also in humans
Geographic Distribution
 Found in East and SE Asia, Japan, Indochina
and to a lesser extent North and South
America
Morphology
 Elongated, ivory white
ribbonlike larvae
 Has an antero-posterior
polarity
 Pseudosucker
 Elongated like a small
tapeworm
 No scolex and no defined
proglottids
D. latum: Epidemiology Life cycle
 The final hosts are man and other  Similar to D. latum
piscivorous mammals such as dog, cat,
leopard, foxes, mink, pig, bears
 1st intermediate hosts – copepods of the
Genus Diaptomus and Genus Cyclops
 2nd IH – freshwater fish like pike, trout,
salmon, whitefish, turbot and carp in the
Phils.
Micro/PARA – Cestodes by Dra. Bunyi
Epidemiology
 The final hosts are dogs and cats
 The first intermediate hosts are the
copepods of the Genus Cyclops
 The 2nd IH are the frogs, lizards, snakes, birds
and monkeys
 Man is an accidental IH
 The infective stages are:
 Porcercoid larva in the Cyclops
 Plerocercoid larva (spargana) in the
tissues of cold blooded vertebrates
 Human infection results from:
 Ingestion of Cyclops infected with
procercoid larva
 Ingestion of raw flesh of cold blooded
animals harboring thespargana
 Local application of the flesh of cold
blooded vartebrates harboring the
spargana
Pathogenesis and Symptomatology
 Found in any part of the body especially:
 Eyes
 Subcutaneous and muscular tissues
of the thorax
 Abdomen
 Thighs
 Inguinal region
 Thoracic vertebra
 Elongating and contracting larvae within a
slimy matrix cause an inflammatory and
painful edema of the surrounding tissue
 Degenerated larvae cause intense local
inflammation and necrosis but no fibrous
tissue formation
 Infected persons may show:
 Local indurations
 Periodic giant urticaria
 Edema
 Erythema accompanied by chills,
fever and high eosinophilia
Page 8 of 10
 Ocular infection – painful edematous
conjunctivitis with lacrimation and
ptosis
Diagnosis
 By finding the larvae in the lesion
Treatment
 Surgical removal of the larval plerocercoid
Prevention
 Only potable water should be drank
 Raw water from streams should be avoided
as this may contain infected Cyclops
 Use of cold blooded vertebrates as poultices
should be avoided
 Cold blooded vertebrates when eaten should
be in a cooked state
Sparganosis
B. BRANCHING SPARGANA
 Budding larval tapeworm – Spirometra
proliferum
Geographic Distribution
 Reported in Japan and US
Morphology
 LARVA – irregular, lateral, supernumerary
processes that may bud off as new spargan
in the tissues
Life cycle
 unknown
Diagnosis
 Finding the larvae in the chylons nodular
lesions
Echinococcus
 Disease caused by the larval stage which is
acquired when eggs are ingested
 E. granulosus – causes hydatid cysts
 E. multilocularis – alveolar echinococcosis
 Dogs and other canines are the most
common definitive hosts
E. granulosus (hydatid): Geographic
Distribution
E. granulosus (hydatid): Morphology
 ADULT WORM
 3-6mm length
 Possess pyriform, scolex, short neck
and 3 proglottids (immature, mature,
and gravid)
 Hydatid cyst – usually measures 1-7cm in
diameter
 Consists of protoscolices
 Micro/PARA – Cestodes by Dra. Bunyi
 The cysts (2-30cm) are constituted by
an external acellular cuticle and an
inner cellular “ germinal” layer (10-
25µ) that produces the brood
capsules containing 6-12
protoscolices or single protoscolices
(Germinal layer with a protoscolex)
 “Hydatid sand” – free protoscolices in
the cyst
 Fluid aspirated from a hydatid cyst
will show multiple protoscolices (size
approx. 100µm), each of which has
typical hooklets
 The protoscolices are normally
invaginated (left), and evaginate
(middle, then right) when put in
saline
E. granulosus: Life cycle
E. granulosus: Pathogenesis and
Symptomatology
 Pathology caused by developing larval cyst
in the intermediate host
 LIVER: most common and most important
site of involvement (70%); 85% located in
the right lobe
Site Percentage of
cases
Abdomen
Liver 75% Abdominal
pain, hepatic
mass, bile duct
obstruction
Lung 22% Chest pain,
cough,
hemptysis
Page 9 of 10
CNS
* guys, di ko na mabasa yung nakalagay ulit kaya
sensya na at incomplete to..dont know where they
got this pero may i-aadd na lang ako from the net
na siguro would describe whats supposed to be
here.
 The symptoms, comparable to those of a
slowly growing tumor, depend upon the
location of the cyst. Large abdominal
cysts produce increasing discomfort.
Liver cysts cause obstructive jaundice.
Peribronchial cysts may produce
pulmonary abscesses. Brain cysts
produce intracranial pressure and
Jacksonian epilepsy. Kidney cysts cause
renal dysfunction. The contents of a cyst
may produce anaphylactic responses.
E. granulosus: Diagnosis
 Endemicity
 Symptoms
 X-ray and CT scan
 Serology
 Skin (Casoni) test
Serology
 Indirect hemagglutination (IHA), indirect
fluorescent antibody (IFA) tests, and enzyme
immunoassays (EIA)are sensitive tests for
detecting antibodies in serum of patients
with cystic disease
 Sensitivity rates vary from 60 – 90%
 Postivet reaction is confirmed by immunoblot
assay or any gel diffusion assay that
demonstrates the echinococcal “ Arc 5”
Cansoni test
 An intermediate hypersensitivity skin test
used to detect sensitization to hydatid
antigen
E. granulosus: Treatment and Control
 Surgical removal of cyst
 Praziquantel
 Avoidance or treatment of infected canine
For inoperate cysts – PAIR (Puncture, aspiration,
injection, reaspiration)
E. multilocularis
 Foxes are the natural
definitive host
 Small rodents are the
IH
 Humans infected by
eating raw plants
 Micro/PARA – Cestodes by Dra. Bunyi
contaminated with feces of infected canine
or cats
 Cyst wall – not clearly delineated from
surrounding tissue; porous, spongy mass of
small irregular cavities with a jelly like matrix
Echinococcosis
Page 10 of 10
E. multilocularis: Treatmend and Control
 Surgical removal of the cyst
 Resistant to praziquantel
 Albendazole has some effect
 Avoidance control of rodent population