CESTODES

Dr. R. Tan
 Classification of Parasites

Parasites

Protozoa Metazoa

Sarcodina Sporozoa Mastigophor Ciliata

(Amoebas) (Sporozoan a (Ciliate
s) (Flagellates) s)

Platyhelminthes Nemathelmithes
(Flatworms) (Roundworms)

Trematod Cestoda
a (Tapeworms
(Flukes) )
 PHYLUM PLATYHELMINTHES

CESTODES TREMATODES
(Tapeworms) (Flukes)

Pseudophyllidea Cyclophyllidea

Genus Diphyllobothrium Genera: Taenia, Hymenolopis,

Dipylidium, Echinococcus
 Cyclophyllidean Tapeworms
Family Genus Species
Taeniidae Taenia solium
saginata
Multiceps multiceps
Echinococcus granulosus
multilocularis
vogeli
Hymenolepidae Hymenolepis nana
diminuta
Dipylidiae Dipylidium caninum
Pseudophyllidean Tapeworms

Diphyllobothriiidae Diphyllobothrium latum

pacificum
Spirometra houghtoni
mansoni
mansonoides
 CESTODES
(TAPEWORMS)
 exclusively parasitic
 Adult worms are flattened, segmented with ribbon-like body
that inhabit the small intestine, where they live attached to
the mucosa
 do not have digestive system
 obtain their nutrition by direct absorption across their
teguments
 The tegument is the body surface of the adult tapeworm (the
surface structure layer of cell) from the host`s intestine
 Sexual organs are highly elaborated and complicated
sexes combined in a single parasite --- hermaphroditic
(both sex in one organ)
 Sexual reproduction occurs by either self-fertilization or by
cross-fertilization between proglottids

 Wide range of pH (4-11)

 portal of entry: mouth
 The disease produced is due to the fact that tapeworms
absorb significant quantities of nutrients and vitamins, excrete
toxic wastes and interfere with the normal passage of food
through the intestine
 Body parts:
 (1) Scolex / Head
 the anterior portion that contains the cephalic ganglion, or
“brain”
 has hooks and suckers that permit anchoring in the host`s
intestinal wall
 strictly an attachment organ
 The main nerve center of a cestode is in its scolex
 Motor and sensory innervation depends on the number

and complexity of the scolex

 cyclophyllideans
 rostellum is a retractable, conelike structure that is located

on the anterior end of the scolex, and in some species is

armed with hooks
 Acetabula (sucker-like organ, normally 4)

 pseudophyllideans
 bothria are long, narrow, weakly muscular grooves, called

"sucking grooves," and function like suction cups

 (2) Neck
 Constricted area
 is the organ for growth from which proglottids proliferate

 (3) Proglottids / Strobila

 Strobila : Chain of segments
 Proglottids: segments ( immature/mature/gravid)
 the strobila grows throughout the life of the tapeworm by
continuous proliferation of new proglottids in the neck region
 sexually complete unit
 is thin, resembling a strip of tape (tapeworm)
 Number of strobila varies with:
 size of worm
 age of host
 host-parasite compatibility
 harmful effects on the host

 Conditions that cause avulsion of the strobila:

 Increased peristalsis
 Starvation
 Intoxication
 (a.) immature proglottids
 immature proglottids continue to grow from the neck area and
push older maturing proglottids downwards
 Do not contain fully developed internal structures

 (b.) mature proglottids

 Are larger and found near the middle of the chain
 each may contain one or two sets of both male & female
reproductive organs

 (c.) gravid proglottids

 terminal portion of the strobila that is usually filled with eggs
 eggs are enclosed in the uterus
 gravid proglottid of some specie may become detached in the
intestine and pass out in the feces; but some maybe too small
to be seen in gross examination
 After leaving the host, the proglottids rupture and eggs are
released
 Precise identification of the tapeworm is usually made on
the basis of eggs or proglottids, the scolex of each specie
is quite characteristic and is sufficient for specific
diagnosis

 Pathogenicity is attributed to:

 Mechanical obstruction
 Tissue margination
 pyogenic actions/inflammatory reaction
 toxic action
 Cyclophyllidean Tapeworms

 Scolex
 transversely quadrate/globular
 4 cup-like muscular suckers w/ rostellum
(spine/hooks)
 Female reproductive System
Ov - Ovary
Oo - Ootype (where the egg is formed)
Ut - Uterus
Ut p. - Uterine pore
- absent in cyclophilledeans, Uterus ends blindly
V - Vagina (a long straight tube)
Vt - Vitelline glands
Vt d. - Vitelline duct (connecting the vitelline gland)
 Male Reproductive System
T - Testes Few and large (Hymenolepis)
* Numerous (500 or more) large and small (Taenia)
V - Vas deferens
C - Cirrus (a protrusible muscular organ, opening anterior
to the vagina in a common genital atrium)
Other Features
LG A - Lateral Genital Atrium/ Pore
- Margins of each proglottid may be located:
* both sides in an irregular pattern (Taenia spp.)
* same lateral side (Hymenolepis spp)
* one on each side (D. caninum)
L E C - The Lateral Excretory Canal
 Eggs
- have a very thick, resistant egg shell, with no operculum
- spherical, mature, embryonated when laid
- the cyclophyllidean eggs are released only when the
tapeworms shed gravid proglottids into the intestine
- Some proglottids disintegrate, releasing eggs that are
voided in the feces, whereas other proglottids are
passed intact

 embryo of Cyclophyllidean
- Hexacanth embryo / Oncosphere / 6-hooked embryo
(3 pairs of hooklets, - non-ciliated)

 Larva
T. Solium Cysticercus cellulosa
T. Saginata Cysticercus bovis
H. nana/diminuta Cysticercoid larva
D. Caninum Cysticercoid larva
E. granulosus Hydatid cyst

Host - one intermediate host; one definitive host

 Pseudophyllidean Tapeworms
 Scolex
 narrow, spoon-shaped, elongated 2 sucking
grooves (bothria)
 Female Reproductive System
Ov - Ovary (central, bilobed in D. latum.)
Oo - Ootype
Ut - Uterus
- mature uterus - Coiled tube opening on surface
via the uterine pore
- gravid uterus – filled with eggs
Ut p. - Uterine pore
- located at center of proglottids on ventral surface
V - Vagina (a long straight tube)
Vt - Vitelline glands/ vitellaria
- secreting substances that will make up the egg yolk and shell
- numerous, small scattered laterally (D. latum)
Vt d. - Vitelline duct (connecting the vitelline gland)
M - The Mehlis gland (A cluster of unicellular shell glands,
absent in some species)
 Male Reproductive System
T - Testes (dorso-lateral, numerous (500 or more) and small,
arranged on the lateral margins )
V - Vas deferens
C - Cirrus (a protrusible muscular organ, opening anterior to the
vagina in a common genital atrium)
Other Features
G A - Genital Atrium/ Pore (a cup shaped sinus, where the cirrus
and vagina have common openings)
- located at the center of segment
L E C - The Lateral Excretory Canal

 Eggs
- ovoidal, immature, non-embryonated with a thin shell wall, and
an operculum, which on hatching opens to release the
free swimming larvae
-Eggs exit through a uterine pore in the center of the ventral
surface rather than through a genital atrium

 embryo of Pseudophyllidean: Coracidium (ciliated)

 Larva: Procercoid , Plerocercoid

 Host: 2 intermediate hosts and 1 definitive host

Pseudophyllidean
Tapeworms
 Diphyllobothrium latum

 Broad or fish tapeworm, or broad fish tapeworm

 Disease: Diphyllobothriosis
 longest tapeworm in humans, averaging 10 meters long
 Adults can shed up to a million eggs a day
 Geog. Dist:
 worldwide
 Occurring in northern temperate areas of the world where
pickled or insufficiently cooked fresh-water fish are
prominent in the diet
 High prevalence in Scandinavia, Finland, Alaska and
Canada
 Many recent cases in South-East Asia and South America
 The life cycle requires 2 intermediate host
 1st intermediate host: copepods (fresh-water crustaceans)
 2nd intermediate host: fish, snakes, toads
 Definitive host: In addition to humans, canids, felines,
bears, and many other mammals can
also serve as definitive hosts for D. latum
 Morphology:
 Adult worm
 measures 3-10 meters or more
(ave. 10meters)
 Longest human tapeworm
 May have as many as 4,000 proglottids

 Scolex
 Elongate, spoon-shaped
 the anterior organ of attachment is a bothria,
a pair of shallow, elongated muscular grooves
 Proglottids
 Immature segments

 Mature segments
 Wider than long

 numerous testes and vitellaria arranged on

the lateral margins

 with a central bilobed ovary
 Gravid segments
 wider than long
 Uterus is a coiled tube confined to a
relatively small area in the center of the
segment likened to a “rosette formation”

 An important difference between this

parasite and the other tapeworms of man is
that the uterus open to the exterior via the
uterine pore
(cyclophyllidean tapeworms have closed uterus)

 Eggs are therefore actively deposited by the

parasite, in contrast to the disintegration of
the proglottids seen in the other human
tapeworms
 Egg
 58 to 76 µm L x 40 to 51 µm W
 Shell is ovoid or ellipsoidal, smooth, and of
moderate thickness
 possess an operculum at one end for the
escape of the larva
 At the opposite (abopercular) end is a small
knob that can be barely discernible
 Immature, unembryonated, operculated
eggs are discharged from the proglottids
(up to 1,000,000 eggs per day per worm)
and are passed in the feces
 Eggs appear in the feces 5 to 6 weeks after
infection
Life cycle of D. latum
 Coracidium
 emerging from the eggs, is internally similar to the
hexacanth larvae of the Cyclophyllideans, being
equipped with 6 hooks, but this hexacanth larvae is
covered in a ciliated embryophore
 is a free swimming stage, but cannot survive long, so
for further development it must be ingested by 1st IH

 Procercoid larva
 1st larval stage developing from the hexacanth larva
appearing as solid bodies with the remains of the
embryonic hooks from the onchosphere larvae at the
posterior of the parasite
 found in the first intermediate host

 Plerocercoid larva (sparganum)

 2nd larval stage developing from the procercoid larva
which has lost the hooks, the body is elongated,
wormlike with an anterior invagination
 found in the second intermediate host
 Infective stage for humans
Diphyllobothriasis
 Infection is relatively harmless and asymptomatic
 Symptoms: non-specific abdominal signs, including abdominal
pain and loss of weight
 D. latum absorbs much more vitamin B12, (10-50x more) from
the host’s intestinal tract than other tapeworms and interferes
with the patient's ability to absorb vitamin B12
(vit B12 having an important role in formation of RBC)
 Infection may therefore result in pernicius anemia

(a macrocytic, hypochromic anemia)

 Treatment
 Drugs of choice:
 Praziquantel 10mg/kg single dose (95% cure rate)

 Niclosamide

 Control
 Proper disposal of human feces
 Fish should be thoroughly cooked or frozen at -10°C for 24-48hrs
 RELATED SPECIES

Diphyllobothrium pacificum
 Found in the costal areas of Peru is the most common tapeworm
infecting humans
 It is a natural parasite of seals which acquire infection by eating fish
 Ceviche – a delicacy in Peru and other Latin American countries
using fish marinated in lime juice but not cooked

Diplogonoporus
 Related genus of tapeworms common in Japan, where it is probably
acquired by consumption of raw anchovies or sardines
 Spirometra
 Family: Diphyllobothriidae
Genus: Spirometra
Species: S. erinacei (cats, dogs)
S. felis (big zoo cats)
S. mansoni (cats, dogs)
S. mansonoides (cats, dogs, raccoons)
S. houghtoni
S. proliferum

 pseudophyllidean tapeworm similar to Diphyllobothrium spp.

that occurs in the intestines of wild carnivores and domestic cats
and dogs
 the plerocercoid larvae infest amphibians but humans can also
be infected, the resulting disease being known as sparganosis
 Sparganum
 plerocercoid larval form
 wrinkled, whitish, ribbon-shaped organism,
3 mm in width and up to 30 cms long
 The sparganum is a solid-bodied larva that lacks
a bladder, and has bothria at the anterior end
 The larva has an unsegmented strobila
20 to 30 cm in length, bundles of longitudinal
muscle fibers scattered throughout the
mesenchyme, and a thick tegument
Life cycle:
1st intermediate host is the copepod
(planktonic crustacean of the genus Cyclops)

ingests coracidia that develop from Spirometra eggs when they

reach the water with the feces of dogs or cats

In the tissues of the copepod, the coracidium turns into the

first larval form (procercoid larvae)

2nd intermediate host (a wide spectrum of vertebrates including

amphibians, reptiles, birds and small mammals) ingests an
infected copepod, the procercoid develops into a
second larval form (plerocercoid larvae or sparganum)

the sparganum develops into the adult Spirometra in the intestines

of dogs and cats, which are the definitive hosts
Sparganosis
 Humans can acquire mainly by:
 ingesting larvae contained in raw or undercooked meat of animals
(the 2nd intermediate hosts) infected with sparganum
 Drinking water containing copepods infected with the procercoid
larval stage larva penetrates the gut wall/ and works its
ways to the muscles or subcutaneous tissues
where it grows into the sparganum larva
 Eating raw snakes or tadpoles for medicinal reasons
 Placing poultices of frog or snake flesh on open wounds or other
lesions, especially the eyes

 Clinical Presentation:
 manifestations depend on which organs or tissues are involved
 Subcutaneous tissues are most likely to be infected by the parasite, but
visceral organs and the orbit of the eye, and rarely, the brain
 the early migratory stages is asymptomatic, but when it has reached its
final site and begins to grow, its presence elicits a painful inflammatory
reaction in the surrounding tissues
 ocular sparganosis
- Produces intense reaction, with periorbital edema, intense pain,
irritation, excessive lacrimation, and marked swelling of the eyelids
- If retrobulbar in position, the orbit maybe forced out, the lids do not
close and corneal ulcers develop
- Ocular sparganosis may result in blindness, as the parasite migrates
to the conjunctiva and enters the orbit

cerebral sparganosis
- characterized by seizures, fatigue, confusion,
headaches, memory loss, coma, fever,
paresthesias, hemiparesis, motor
weakness and other CNS symptoms
- Cerebral sparganosis most likely involves the
cerebral hemispheres, especially the
frontoparietal lobes, in some cases
extends to the cerebellum
- The disease may appear as a massive
cerebral hemorrhage
 Proliferative sparganosis
 Caused by a peculiar budding type of
larva known as Sparganum proliferum

 branched, proliferating larvae may

break up into segments capable of
further independent development
 begins with a subcutaneous tumor in the
thigh, shoulder, or neck, and eventually
spreads to other parts of the skin, the
muscles, and the internal organs, such as
the lungs, abdomen, and brain
 Nodules may open because of ulceration
or scarification
 Infection progresses over 5 to 25 years
 fatal in all reported cases
 Diagnosis:
 Made following surgical removal of the worm
 Presumptive preoperative diagnosis: painful migratory
subcutaneous nodule

 Management and Therapy:

 Surgical removal of sparganum larvae is usually curative
 Praziquantel 120-150 mg/kg body weight, over a 2-day period
 However, praziquantel has no effect on adult worms in the CNS
 There is no available treatment for proliferative sparganosis

 Prevention:
 people should be advised of the dangers of drinking water from
ponds and ditches, which may contain infected copepods
 Basic public health infrastructure should be strengthened so that all
people have access to clean drinking water
 the use of potentially infected animals for medicinal purposes must
be discouraged