Class 1.

Cestoda
-Tapeworms
2. Trematodes
CESTODES

GENERAL STUFF.
 General Characteristics of tapeworms:
 These worms parasitize the digestive tracts and
associated ducts of all classes of vertebrates.
 Cestodes differ from trematodes by the absence of a
digestive system: no mouth, no gut and no
 anus.
 Adult worms
Cestodes (Flatworms-) Tapeworms:
They are exclusively parasitic
Adults are hermaphroditic covered with none ciliated
integument
They may have oncospheres (embryos) hatched from eggs
They have scolex (head) provided with suckers and
frequently hooks for attachment to host tissue
They have no digestive tract
Body in most species divide transversely into proglottids
Tapeworm features:
 Adult worms: Consist of a chain of many egg
producing units called PROGLOTTIDS which develop
from the distal end of the SCOLEX (head), the region
of growth or NECK which is located immediately
behind the head (immature proglottids).
 The entire chain of proglottids is STROBILA
Spps differentiating characteristics are mainly based on
these features
Cestodes (Flatworms-) Tapeworms
Important tapeworms to man are:
Order- Pseudophyllidean
tapeworms
Characteristics:
 Scolex is a more or less distended
muscular organ,
 unarmed and
 has dorsal ventral sucking organs
(bothrium) without hooklets for
attachments and never has four suckers
 Eggs are operculate and immature when
oviposited
Example-
 Diphyllobotrium latum- the fish tape worm
Order Cyclophyllidean
Characteristics
-Scolex with four depressed cups or saucer
shaped suckers.
-Has rostellum armed with spines or hooks
(type, number and arrangement are
specifically characteristics)
-Has sex pores
Eggs are essentially spherical, none
operculate and almost fully embryonated
when they escape fro the mothe
proglottid.
Examples: Tenia saginata- The Beef
Tapeworm, Taenia solium- the Pork
Tapeworm
Muticeps multiceps
 D
A B C

A The egg of the pseudophyllidean tapeworm has a thin shell wall (A), and an
operculum, which on hatching opens to release the free swimming larvae:
coracidium

B B) has a very thick, resistant egg shell, with no operculum.

C coracidium has an outer layer of ciliated epidermal cells which probably help to swim
through the water before being ingested by the parasites first intermediate
host.

D The larval cyclophyllidean, as with the pseudophyllidean, is equiped with 3 pairs

of hooks (D).Both groups use these hooks to penetrate the gut wall of its
intermediate host after being ingested, before developing into other larval forms
Order Cyclophyllidean
Characteristics
 Scolex is usually armed.
 Usually have rostellum(hooks)
 Eggs non operculated
 Eggs fully embryonated when hatched
 Have suckers
Family Hymenolepididae
 Spp Hymenolepis nana (dwarf tapeworm, Hymenolepis
diminuta (rodent tapeworm, infrequently seen in
humans.
 Echinococcus granulosus and Echinococcus
multilocularis
,
Pathology/Symptoms:
 In adult, this may be attributed to
1)passive obstruction,
2)migration to unusual sites,
3)pyogenic action and
4)toxic action.
5)Pernicious anaemia in experienced in Diphyllobothrium
latum
Clinical aspect can be categorized as
1.Those associated with adult worm.
 Large number of worms may block the intestinal lumen

2. Those associated with larval worms.

This may often be more serious as migrating larvae may
lodge in critical foci like brain, orbit etc and cause acute
obstruction or may metastasize, toxic and allergic
manifestation may follow.
cestodes
 Adult worms are ribbon-shaped, multisegmented, hermaphroditic
flatworms. Each segment has a complete male and female reproductive
system.
 They are usually found in the small intestine producing infections with
little or no symptoms.
 They are well tolerated by the host causing sometimes abdominal
distress, dyspepsia, anorexia (or increased appetite), nausea, localized
pain, and diarrhea.
 We will discuss only the two groups of tapeworms that infect man i.e.
1. The Pseudophyllidean tapeworms
(e.g. Diphylobothrium latum)
2. The Cyclophyllidean tapeworms
(e.g. Taenia sp, Hymenolepis, Echinococcus).
 The larval forms of these worms are found in
extraintestinal tissues and produce systemic infections
with clinical signs related to the size, number, and location
of cysts. Taenia solium
 cysticercosis (infection with the cysticercus larval stage) is
often asymptomatic and chronic; neurocysticercosis,
ophthalmic cysticercosis, and subcutaneous and muscular
cysticercosis are ,however, frequently reported.
 Echinococcus granulosus hydatid larvae may form massive
cysts in liver, lungs, and other organs, including long bones
and the central nervous system
 HOSTS
 The tapeworm's life cycle involves a definitive host and one or more
intermediate hosts e.g Diphyllobothrium latum has two intermediate
hosts.
 Exception: Hymenolepis nana which only uses one host).
 The DEFINITIVE HOST (all classes of vertebrates) harbors the ADULT
WORMS in their intestine. These forms produce EGGS which are
passed in the stool of the host.
 The INTERMEDIATE HOST ingests the eggs which develop into
LARVAL FORMS and later into ENCYSTED FORMS in tissues.
 Each parasite has specialized larval forms (cysticercus, cysticercoid;
coenurus, hydatid; coracidium, procercoid, plerocercoid).e.g 1. The
cysticercus is the encysted form of the Taenia species. 2.The hydatid is
the encysted form of the Echinococcus.
 Both invertebrates and vertebrates serve as Intermediate Hosts for
tapeworms. Nearly every group of invertebrates has been discovered
harboring juvenile cestodes, but most common are crustacean, insects,
mollusks, mites, and annelids.
 As a general rule, when a tapeworm occurs in an aquatic definitive
host, the juvenile forms are found aquatic Intermediate Hosts. A
similar assumption can be made for terrestrial hosts.
 MORPHOLOGY
 The body of the typical cestode consists of
three distinct regions: scolex
 (a), neck (b) and strobila (c).
 Adults, which mature sexually in the
definitive host, are ribbon-shaped,
multisegmented,
 hermaphroditic flatworms. Each segment
has a complete male and female
reproductive system.
 The anterior or scolex or holdfast
contains several structures for attachment
including sucking depressions, hooks and Body of
glandular areas.. a tapeworm
STROBILA:
 As new proglottids are formed from the neck region, they push the
older ones progressively posterior, creating a chain of proglottids - the
strobila.
 The asexual process of forming segments is termed strobilation.
 As each proglottid is shifted posterior, its sexual reproductive system
matures progressively.
> The reproductive organs in immature proglottids are visible but
nonfunctional, while those of mature proglottids are fully functional.
 At the posterior end of the strobila are the gravid (egg-filled)
proglottids. Often the reproductive organs in gravid proglottids
atrophy.
 In some groups, the gravid proglottids detach and are released with the
host’s feces – apolysis. In this case, these eggs do not form protective
eggshells and are not very resistant to harsh conditions (e.g., to the
digestive enzymes from the host).
Proglotid of T. saginata (note many
uterine branches)
MORPHOLOGY
 The scolex is followed by a germinative portion or
"neck" and segments at successively later stages of
development.
 The scolex sctructure varies between species of
tapeworms.
e.g a. Diphyllobothrium latum has a scolex with
elongated, slit-like attachment organs.
 b. Taenia saginata has four muscular SUCKERS.
 c. Taenia solium has similar muscular SUCKERS
and a ROSTELLUM with rows of chitinous hooks.
 All tapeworms (cestodes) cycle through 3 stages—
eggs, larvae, and adults. Adults inhabit the intestines
of definitive hosts, mammalian carnivores. Several of
the adult tapeworms that infect humans are named
after their intermediate host: the fish tapeworm
(Diphyllobothrium latum), the beef tapeworm (Taenia
saginata), and the pork tapeworm (Taenia solium).
 Eggs are excreted with feces into the environment and
ingested by an intermediate host (typically another
species) in which larvae develop, enter the circulation,
and encyst in the musculature or other organs. When
the intermediate host is eaten, cysts develop into adult
tapeworms in the intestines of the definitive host,
restarting the cycle.
 With some cestode species (eg, T. solium), the
definitive host can also serve as an intermediate host
and develop tissue cysts instead of intestinal worms if
eggs are ingested.
 Adult cestodes are typically long, multisegmented flat
worms that lack a digestive tract and absorb nutrients
directly from the host's small bowel.
 Tapeworms have 3 recognizable portions. The scolex
(head) functions as an anchoring organ that attaches
to intestinal mucosa..
 The neck is an unsegmented region of high
regenerative capacity. If treatment fails to eliminate
the neck and scolex, the entire worm may regenerate.
 The rest of the worm consists of numerous proglottids
(segments).
 Proglottids closest to the neck are undifferentiated. As
proglottids move caudally, each develops
hermaphroditic sex organs.
 Distal proglottids are gravid and contain eggs in a
uterus.
Symptoms, Signs, and Diagnosis
 Adult tapeworms are so well adapted to their hosts
that they cause minimal symptoms.
 Larvae, however, may elicit intense immunologic
reactions as they travel through tissues (hence
inducing immunity) and cause severe disease when
they settle in extraintestinal sites
 Larvae may migrate to the brain orbit etc causing
serious damage.
Diagnosis:
Larvae can cause severe and even lethal disease, most
importantly in the brain, but also in the liver, lungs,
eyes, muscles, and subcutaneous tissues.
 In humans, T. solium causes cysticercosis,
Echinococcus granulosus and E. multilocularis cause
hydatid disease.
Diagnosis:
 Adult tapeworm infections are diagnosed by
identifying eggs or gravid proglottid segments in
stool.
 Larval disease is best identified by imaging studies,
such as brain CT or MRI, and for some species,
serologic tests
Treatment and Prevention
 praziquantel and Niclosamide,

 N.B Some extraintestinal infections respond to

anthelmintic treatment, whereas others require
surgical intervention.
 Prevention and control:
 Thorough cooking (to temperature > 57° C [>
135° F]) of pork, beef, lamb, game meat, and fish;
 regular de-worming of dogs and cats;
 preventing recycling through hosts, such as dogs
eating dead game or livestock;
 reduction and avoidance of intermediate hosts
such as rodents, fleas, and grain beetles;
 meat inspection; and sanitary treatment of
human waste.
 Prolonged freezing of meat is effective,
 Pickling is variably effective but smoking and
drying are ineffective Identification of tapeworms
•Identification of tapeworms
Pseudophyllidean proglotid. Cyclophyllidean proglotid. Note
Note the Uterine pore .
the absence of an uterine
pore.
 H. deminutum H. nana
Diphyllobothrium latum

Taenia solium and Taenia saginata

Diphyllobotrium latum-
(the fish tapeworm)
Pseudophyllidean tapeworms
1.Diphyllobotrium latum- (the fish tape worm)
 Life cycle. Immature eggs are passed in feces in
frsh water(1). Under appropriate conditions, the
eggs mature approximately 18 to 20 days) (2) and
yield oncospheres which develop into a
coracidia (3) and they are ingested by copepod,
the first intermediate host where the coracidia
develop into procercoid larvae (4).
Infected copepods are eaten by fish like, trout,
perch, pike etc and the procercoid penetrate the
muscles of fish.
Human infection
 Plerocercoid larvae are the infective stage for
humans. Humans can acquire the disease by
eating infected host fish raw or undercooked (7).
After ingestion of the infected fish,

 Plerocercoid develop into immature adults and then
into mature adult tapeworms which will reside in the
small intestine.
 The adults of D. latum attach to the intestinal mucosa
by means of the two bilateral groves (bothria) of their
scolex (8).

Procercoid
 Immature eggs are discharged from the proglottids
(up to 1,000,000 eggs per day per worm) (9) and
are passed in the feces to start the cycle in the
fresh water copepods (1).
 Eggs appear in the feces 5 to 6 weeks after
infection.
 In addition to humans, many other mammals can
also serve as definitive hosts for D. latum.
Morphology.
 The adult worm reaches up to 10 m with 3,000
proglottids. The scolex is elongated and spoon shaped
with two long sucking grooves. It measures 1 mm in
width by 2.5 mm in length.
 The mature and gravid proglottids are broader than
long, with the typical rosette-shaped uterus. They
measure up to 2 cm in width.
Diphyllobotrium latum-
Pathology and clinical symptoms.
Symptoms depend on the
1) Mass of the worm,
2) Amount of its by-products absorbed by the host,
3) The host's susceptibility to the foreign substances.
 Some infected people show no symptoms
 Main symptoms include
1)intestinal obstruction,
2)diarrhea,
3)abdominal pain,
4) anemia.
Diagnosis.
Diagnosis is based on the recovery of the characteristic eggs or
proglottids in the faeces
 Proglottids are often passed in chains of a few cm or longer.
 Rosette-shaped uterus in the proglottid morphology confirms the
species
Geographic distribution.
The distribution of this worm is worldwide, especially in
northern Italy, Switzerland, Germany, Baltic countries,
Finland, Sweden, central Siberia, North America,northern
Manchuria, Japan, Korea, and Chile.
 Prevention.
 Avoid ingestion of raw or undercooked salmon, trout, perch,
and pike
Cyclophyllidean worms
Tenia saginata,
The Beef Tapeworm
Tenia saginata, The Beef Tapeworm
 Adults are ribbon-like, flattened, segmented,
hermaphroditic flatworms that could reach up to 5 to
10 m long, consisting of scolex, neck, and immature,
mature, and ripe segments in linear
sequence.
 The adult tapeworm live in the intestine of the host
with it head embedded in the mucosa
 The head has four hemispherical suckers serving as
organ for attachment
 It has no rosteller (beak like) and hooks.
 The terminal one-third to one-half of the worm's
length consists of gravid (egg-filled) segments.
 These segments are muscular and can crawl
caterpillar-fashion through the anal sphincter to the
outside environment making them available to their
herbivore intermediate hosts.
 Multiplication and Life Cycle..3
 Gravid segments break off from the worm and are
carried with feces or by their own crawling activity
to the soil (1).
 The segments adhere to grass. If ingested by a
bovine intermediate host (2), the segments are
digested open in the animal’s gut, each releasing
50,000 to 100,000 eggs.
 The eggs hatch, releasing a six hooked larva, the
oncosphere (also called the hexacanth), (3) which
penetrates the gut wall and reaches the muscles via
the circulation.
 Multiplication and Life Cycle ..4
 The oncosphere fills with fluid and develops into
the 8-mm cysticercus.
 If a human eats raw or undercooked infected beef
(4), the cysticercus and the scolex is made free
 The scolex attaches to the wall of the small
intestine and begins to bud off the long chain of
segments.
 In about 3 months the worm reaches 4-5 m in
length and gravid segments begin to pass through
the anus.
 The worm can live for 5 to 20 years or more
 Clinical Manifestations
 The clinical effects of adult T. solium infection are
similar to those caused by T. saginata.
 Pathogenesis
 The hooked scolex of T. solium may cause greater
intestinal disturbance, pain, and inflammatory
response than that caused by T. saginata, but
symptoms are still generally mild and pathology is
minor.
Clinical Manifestations
 The clinical manifestations of infection with adult
T. saginata tapeworms are confined to occasional
1)nausea or vomiting,
2)appetite loss
3)epigastric or umbilical pain,
4)weight loss.
5)Moderate Eosinophilia may develop.
A disturbing manifestation of T. saginata infection is
the active crawling of the muscular segments out
of the anus.
 Rarely, intestinal perforation may occur from the
scolex of Taenia, or proglottides may be vomited
and then aspirated.
Pathogenesis
 Rare intestinal blockage or penetration have been
reported, but pathology is usually inconsequential.
 Host Defenses
 Because of its limited contact with the epithelial
lining, the gut-dwelling adult tapeworm induces
little host inflammatory, allergic, cell-mediated, or
humoral response
 The sucking action of the scolex appears to have
relatively limited immunogenic effect.
 Epidemiology
 Taenia saginata, the commonest large tapeworm of
humans, is transmitted as cysticerci in beef ("measly
beef").
 Partially cooked, smoked, or pickled beef can be
infective, although raw beef is the commonest bearer
of infection
 Taeniasis in countries such as Ethiopia and Argentina
where raw or undercooked beef is often eaten is
common.
Epidemiology…2
 Large worms may grow by 15 to 30 cm a day in the
human gut, passing 10 segments daily, which may
convey up to a million eggs a day into the environment
throughout the long life span of the worm.
 Eggs may also be found in pastures flooded by human
sewage or on which human sewage is used as fertilizer.
Taenia solium
(Pork Tapeworm)
Taenia solium, (Pork Tapeworm)
The Structure
 The scolex of T. solium (Figure)
differs from that of T. saginata in
possessing an anterior circle of
sharply spined hooks arranged in a
double row.
 These are under muscular control
and work with the four suckers to
adhere to the gut wall.
.
 Gravid segments of T. solium can be distinguished
from those of T. saginata by the number of out-
pocketing branches of the uterus.

 The adult worm is usually 3 to 5 m long. Gravid

segments tend to be less muscular and more square
than those of T. saginata.
The adult worm is usually 3 to 5 m long. Gravid
segments tend to be less muscular and more
square than those of T. saginata.
Multiplication and Life Cycle
 The life cycle of T. solium is similar to that of T
saginata except that the pig is the principal
intermediate host.
 Because the gravid segments are less motile than
those of T. saginata, they are usually eliminated in
the fecal matter.
Human cysticercosis
 Clinical cysticercosis occurs when a human host
ingests infective eggs by fecal contamination and
plays the role of intermediate host.
 When T. solium eggs are ingested they may hatch in
the gut and spread systemically, causing
cysticercosis.
 It has been postulated but still has not been proven
that in some cases human cysticercosis may also be
caused when reverse peristalsis, induced by adult T.
solium in the gut, returns gravid segments into the
duodenum, where the eggs hatch and release
invasive oncospheres.
 Cysticerci develop to potency in about 3 months and
may live many years. Cysticerci that die may become
calcified, rendering them demonstrable by
radiography.
 Cysticercosis is potentially dangerous with
pathological consequences that will depend on the
site and number of cysticerci present.
 The most common site of infection is the central
nervous system (CNS) producing
neurocysticercosis. It is also possible to find
infection in muscles, subcutaneous tissues and the
eye. In the CNS, the larvae is most commonly found
in the brain hemispheres. They may also be found in
the cisternae and ventricles.

Hydrocephalus may result from
obstruction of cerebrospinal fluid
flow. Infection in some sites can
induce epilepsy, mental
disturbances, or a meningeal
syndrome. However, up to half of
CNS infections are thought to be
asymptomatic. After death of the
scolex within the cyst often years
after infection the capsule becomes
fibrosed or calcified.
Epidemiology
 Human cysticercosis is a serious and widespread
disease, being especially common in Latin America.
The disease is frequently found among Mexican
agricultural workers in California and other Western
states…and Africa…………
 Human cysticercosis apparently does not develop
from eggs of T. saginata.
Diagnosis
 Diagnosis of adult worm infection is similar to that
for T. saginata.
 But Cysticercosis is difficult to diagnose and usually
requires
1)radiologic,
2)serologic,
3) clinical assessment.
 Subcutaneous nodules can usually be felt or observed,
and can be sampled by biopsy. . Cysts in muscles are
usually aligned with the fibers.
 Soft tissue or brain calcifications are strongly
indicative of cysticercosis. Plain skull films may show
cerebral calcifications or indicate intracranial
hypertension.
Diagnosis:..2

 Computed tomography is the most useful procedure,

as it detects calcified and none calcified cysts as well as
edema or intracranial hypertension.

 Computed tomography
 radiologic,
 serologic,
 clinical assessment.
 sampled by biopsy
Control
 The control of infection of humans as definitive
hosts is the same as that for T. saginata, except
that the control measures apply to pork not beef.
 The eggs are highly resistant and can withstand
many months of environmental exposure over a
broad temperature range.
 Treatment for adult T.solium is the same as for T.
saginata.
 Cysticercosis may require surgery for ophthalmic
or brain involvement, but chemotherapy should
precede surgery when possible.
.
Diagnosis
 Adult infections can be diagnosed by identifying
segments in the feces. The species of Taenia can be
identified only by the segments, because their eggs are
identical
Pseudophyllidean proglotid.
Note the Uterine pore .
Cyclophyllidean proglotid. Note
the absence of an uterine pore.
Control/Treatment
 Inspection of beef/pork for cysticerci is the best
preventive measure.
 Beef/pork must be thoroughly cooked in endemic
areas to at least 56°C throughout the meat, which
may be difficult to accomplish with large cuts of
fatty meat, particularly pork.
 Freezing at -10°C for 10 days usually is lethal to
Taenia cysticerci, but they can withstand 70 days at
0°C.
Treatment: This is readily available for the intestinal
adult worms. Niclosamide, is a nonabsorbed
oxidative phosphorylation inhibitor that kills the
scolex and anterior segments on contact, after
which the worm is expelled.
 Praziquantel is an equally effective and relatively
nontoxic compound.
 Scolex may not always be destroyed, and a new
worm can regenerate if the scolex and a minute
portion of the neck survive
 The patient should be observed for several months,
as egg-bearing segments can reappear in 10-12
weeks.
Echinococcus granulosus and
Echinococcus multilocularis
Echinococcus granulosus and Echinococcus
multilocularis (hydatid disease)
 Human echinococcosis (hydatidosis, or hydatid
disease) is caused by the larval stages of
tapeworms of the genus Echinococcus.
1) Echinococcus granulosus causes cystic
echinococcosis, the form most frequently
encountered;
2) Echinococcus . multilocularis causes alveolar
echinococcosis.
Infection flow: 1.Man

Definitive host 2.dog

Intermediate host 3.Cattle, Sheep etc

Definitive host 4.Man

Life Cycle: (1st definitive host)
 The adult E. granulosus (3 to 6 mm long) resides
in the small intestine of the definitive hosts, dogs
or other canids.
 Gravid proglottids release eggs that are passed in
the feces.
First intermediate host:
After ingestion by a suitable intermediate host
(sheep, goat, swine, cattle, horses, camel), the egg
hatches in the small intestine and releases
oncosphere that penetrates the intestinal wall
and migrates through the circulatory system into
various organs, especially the liver and lungs.
Life Cycle,,,2 In these organs, the oncosphere develops into
a cyst that enlarges gradually, producing protoscolices
and daughter cysts that fill the cyst interior
The definitive host (dog) becomes infected by ingesting the
cyst-containing organs of the infected intermediate host.
 After ingestion, the protoscolices evaginate the scolex,
attach to the intestinal mucosa, and develop into
adult stages in 32 to 80 days.
 The same life cycle occurs with E. multilocularis (1.2 to 3.7
mm), with the following differences: the definitive hosts
are foxes, and to a lesser extent dogs, cats, coyotes and
wolves;
 The intermediate host are small rodents; and larval growth
(in the liver) remains indefinitely in the proliferative stage,
resulting in invasion of the surrounding tissues.
Life cycle…3 The intermediate host are small
rodents. Larval growth (in the liver) remains
indefinitely in the proliferative stage, resulting
in invasion of the surrounding tissues.
N.B>: Humans become infected by ingesting eggs,
with resulting release of oncospheres in the
intestine and the development of cysts in various
organs.
Geographic Distribution:
 E. granulosus occurs practically worldwide, and
more frequently in rural, grazing areas where dogs
ingest organs from infected animals. E.
multilocularis occurs in the northern
hemisphere,including central Europe and the
northern parts of Europe, Asia, and North America.
Clinical Features:
 E. granulosus infections remain silent for years before the
large cysts cause symptoms in the affected organs.
 Hepatic involvement can result in
1)abdominal pain,
2)a mass in the liver,
3)biliary duct obstruction.
Pulmonary involvement can produce
1)chest pain,
2)cough,
3)hemoptysis.
 Rupture of the cysts can produce fever, urticaria,
eosinophilia, and anaphylactic shock, as well as cyst
dissemination.
 In addition to the liver and lungs, other organs (brain,
bone, heart) can also be involved.
 E. multilocularis affects the liver as a slow growing,
destructive tumor, with abdominal pain, biliary
obstruction, and occasionally metastatic lesions in lungs
and brain.
 Laboratory Diagnosis:
 Findings cysts by ultrasonography and/or other
imaging techniques.
 serologic tests.
 Fine needle biopsy
may be useful for confirmation of diagnosis in
seronegative patients with hepatic image findings;
 During such procedures precautions must be taken to
avoid leakage of hydatid fluid or protoscolices.
 Treatment:
 Surgery is the most common form of treatment for
echinococcosis, although removal of the parasite
mass is not usually 100% effective.
 After surgery, medication may be necessary to
keep the cyst from recurring.
 The drug of choice is albendazole (E. granulosus).
Some reports have suggested the use of
albendazole or mebendazole for E. multilocularis
infections.
Hymenolepis nana
Hymenolepis nana
Hymenolepiasis is caused by two cestode species:
 1) Hymenolepis nana (dwarf tapeworm, adults
measuring 15 to 40 mm in length) and
2) Hymenolepis diminuta (rat tapeworm, adults
measuring 20 to 60 cm in length). H. diminuta is a
cestode of rodents infrequently seen in humans.
Hymenolepis nana
Life Cycle:
 Eggs of H. nana are immediately infective when passed with
the stool and cannot survive more than 10 days in the external
environment.
 When eggs are ingested by an arthropod intermediate host
(various species of beetles and fleas), they develop into
cysticercoids, which can infect Humans or rodents upon
ingestion and develop into adults in the small intestine.
Hymenolepis nana…2
When eggs are ingested (in contaminated food or water
or from hands contaminated with feces), the
oncospheres contained in the eggs are released.
 The oncospheres (hexacanth larvae) penetrate the
intestinal villus and develop into cysticercoid larvae.
 Upon rupture of the villus, the cysticercoids return to
the intestinal lumen, evaginate their scoleces, attach
to the intestinal mucosa and develop into adults that
reside in the ileal portion of the small intestine
producing gravid proglottids.
 Eggs are passed in the stool when released from
proglottids through its genital atrium or when
proglottids disintegrate in the small intestine.
Hymenolepis nana…
An alternate mode of infection consists of internal
autoinfection, where the eggs release their hexacanth
embryo, which penetrates the villus through the
continuing the infective cycle without passage external
environment.
 The life span of adult worms is 4- 6 weeks, but internal
autoinfection allows the infection to persist for years.
Hymenolepis diminuta
Hymenolepis diminuta
Eggs of Hymenolepis. diminuta are passed out in the
feces of the infected definitive host (rodents,
man).
 The mature eggs are ingested by an intermediate
host (various arthropod adults or larvae), and
oncospheres are released from the eggs and
penetrate the intestinal wall of the host, which
develop into cysticercoid larvae.
 Species from the genus Tribolium are common
intermediate hosts for H. diminuta.
 The cysticercoid larvae persist through the
arthropod's morphogenesis to adulthood.
 H. diminuta infection is acquired by the
mammalian host after ingestion of an intermediate
host carrying the cysticercoid larvae
 Humans can be accidentally infected through the
ingestion of insects in precooked cereals, or other
food items, and directly from the environment
 After ingestion, the tissue of the infected
arthropod is digested releasing the cysticercoid
larvae in the stomach and small intestine.
 Eversion of the scoleces occurs shortly after the cysticercoid
larvae are released. Using the four suckers on the scolex,
the parasite attaches to the small intestine wall.
 Maturation of the parasites occurs within 20 days and the
adult worms can reach an average of 30 cm in length.
 Eggs are released in the small intestine from gravid
proglottids that disintegrate after breaking off from the
adult worms. The eggs are expelled to the environment
with host's feces.
 Geographic Distribution:
 Hymenolepis nana is the most common cause of all cestode infections,
and is encountered worldwide. In temperate areas its incidence is
higher in children and institutionalized groups.
 Hymenolepis diminuta, while less frequent, has been reported from
various areas of the world.
 Clinical Features:
 H. nana and H. diminuta infections are most often asymptomatic.
 Heavy infections with H. nana can cause weakness, headaches,
anorexia, abdominal pain, and diarrhea.
 Laboratory Diagnosis:
 The diagnosis depends on finding eggs in stool specimens.
Concentration techniques and repeated examinations will increase the
likelihood of detecting light infections.
 Treatment:
 Praziquantel is the drug of choice.
Epidemiology:
 Hymenolepis nana is probably the commonest human
cestode, owing to its wide distribution, particularly in
crowded areas, such as India and China.
 The direct infectiousness of the eggs frees the parasite from
its former dependence upon an insect intermediate host,
making rapid infection and person-to-person spread
possible.
 The short life span and rapid course of development also
facilitate the spread and ready availability of this worm.
 Congested areas, daycare centers, and crowded institutions
such as prisons frequently have high levels of infection with
H nana, despite its strong immunizing capacity and short
life span.
 Diagnosis
 H. nana infections can be diagnosed accurately
and rapidly by inspecting the stool for eggs.
 Control
 Preventing fecal contamination of food and water
in institutions and crowded areas is of primary
 Importance. General sanitation and rodent and
insect control (especially control of fleas and grain
insects) are also essential for prevention of H. nana
infection.
Treatment
 praziquantel or
 niclosamide is usually effective, and can be
repeated if necessary.