CESTODES INTRO

Platyhelminthes (dorso-ventrally flattened; bilateral

symmetry)
Has a ribbon like appearance
Are not provided with a digestive tract nor a circulatory
system
Adult tapeworms are hermaphroditic
Scolex main organ of attachment
Neck- region of growth (strobilization)
Strobila chains of proglottids
Grouped in 2 orders;
1. Psuedophyllidea
Spatulate scolex with sucking grooves (bothria)
Has a uterine pore which releases the egg
In infections, segments are not generally found
Eggs are operculated and immature that requires
aquatic development
Require 2 intermediate hosts (procecoid in the 1
st

then plerocercoid in the 2
nd
)
2. Cyclophyllidea
Scolex is globular with four suckers
Does not have a uterine pore but undergo apolysis
In infections, both segments and eggs are generally
found
Non-operculated egg are readily passed out
containing the hexacanth embryo
Only require 1 intermediate host (though different
species produce different types of encysted larvae
INTESTINAL CESTODES
Tinea saginata [cyclophillidean]
Beef Tapeworm
Humans are the definitive host and never the intermediate
Can live in the upper jejunum for about 25 years
Cuboidal scolex, NO rostellum
1000-4000 proglottids (may lead up to 25m in length)
[Chains of immature, mature & gravid]
Mature proglottids
Square in shape
Contains both male and female reproductive organs
Gravid proglottids
Longer and wide
Most distal portion
Ova in the uterus counts 15-20 branches (>15)
Normally contains 97,000 to 124,000 ova
Undergo apolysis
Ova
Spherical/subspherical in shape
Brownish in color
Thick embryophore
Inside are oncospheres with 3 pair of hooklets
Upon ingestion of the ova, it will release the oncospheres and will
actively penetrate the intestinal mucousa to enter a venule to be
carried throughout the body. Upon entering a muscle fiber it will
develop into the infective stage, Cysticercus bovis.
Cysticercus bovis
Infective stage
Ovoidal
milky white
10mm in diameter
has a single scolex
the adult tapeworm is irritated by alcohol
Pathogenesis and Symptomatology
Most common CC is passage of proglottids in stool
Causes mild irritation at the site of attachment
Patients may experience
Non-vague discomfort
Hunger pangs
Weakness
Weight loss
Loss of appetite
Pruritus ani (perianal itching)
Proglottids are atively motile and can cause obstruction
Diagnosis
Identify the characteristic proglottid, egg and scolex.
Fomalin-ether concentration technique used in
demonstrating eggs
Perianal swabs are useful as well
Treatment
Drug of choice praziquantel (5-10mg/kg)
Criteria for cure
a) Recovery of scolex
b) Negative stool exam
c) Months after treatment
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Tinea solium [cyclophyllidean]
Pork tapeworm
Inhabit the upper small intestines
Shorter than T. saginata and has lesser number of
proglottids
Scolex has 4 acetabula (smaller and more spherical than
beef tapeworm)
Scolex carries a rostrellum with a double crown of 25-30
hooks
Proglottids are the same with saginata except;
1. Presence of accessory ovarian lobe
2. Absence of vaginal sphincter
3. Smaller number of follicular testes (100-200)
4. Lesser number of uterine branches (<15)
Eggs are indistinguishable from saginata
Gravid proglottid contains 30,000-50,000 ova
Eggs are less active compared to saginata
Released oncosphere and penetrate the intestinal mucosa
Encyst in the muscles as Cysticercus cellulosae
Measly pork = infected meat
Man maybe the intermediate host
Eggs become Cysticerci upon ingestion
Oncospheres hatches in the duodenum
Autoinfection is possible in poor hygiene
Pathogenesis and symptomatology
Cysticercosis
Cysticerci are often located in multiple organ or tissue, upon death,
cystic fluids increase and there is a pronounced response to the
parasite. The parasite is eventually calcified.
Neurocysticercosis [NCC]
Most serious manifestation
Most serious zoonotic disease
2 general forms of NCC
1. Parenchymal
Focal or generalized siezures
2. Extraparenchymal
a) Subarachnoid/meningitic
o May lead to Racemous Cysticercosis
o Cysts are at the base of the brain
b) Intraventricular
o Cysts are in the 3
rd
or 4
th
ventricle
o May often lead to obstructive hydrocephalus
c) Spinal
o This form is rare
Cerebral cysticercosis
Convulsions, most common manifestations
Visual & motor deficits, headache & vomiting may occur
CSF tap shows, opening pressure, protein,
mononuclear cells and glucose
Opthalmic Cysticercosis
Located often retinal or subretinal
May float in the vitreous humor
Chrorioretinitis & vasculitis affects vision
Intraorbital pain, photopsia & blurring or loss of vision
noted in patients
Diagnosis
Intestinal
Identifying the proglottids, eggs or the scolex (same as
saginata)
Cysticercosis
CAT scan & MRI for NCC
3 patterns for CAT SCAN:
1. Round low density area without administration of contrast
dye (viable larva but no inflammation)
2. Ring like enhancement after injection of contrast dye
(dead larva)
3. Small calcified area within the cystic space (dead scolex)
Opthalmoscopy for Opthalmic Cysticercosis
DOT ELISA test is a very good screening test for
cysticercosis
Treatment
Intestinal
Drug of choice is Praziquantel (5-10mg/kg) and
Niclosamide
Criteria for treatment;
a) Recovery of scolex
b) Negative stool examination 3 months after treatment
Cysticercosis
Parenchymal NCC
50-75mg/kg for 30 days of Praziquantel
400mg twice a day for 8-30days
Steroids are given after the last dose
Parenchymal forms with encephalitis/massive parasitic
infection
High dose corticosteroid therapy
Mannitol in ICP
Extraparenchymal Subarachnoid
Surgical removal/albendezole therapy
Occular Cysticercosis
Surgical removal then administration of Praziquantel and
Albendazole
Prevention and Control
Cooking of meat is a primary measure
Freezing at 20C for 10 days kills the cysticerci
Sanitary inspection of slaughtered pigs, cows and cattle.
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Hymenolepis nana [cyclophyllidean]
Dwarf tapeworm
The only tapeworm that can complete its lifecycle in a
single host
The adults are found in the ileum
Delicate strobili
Scolex is subglobular with 4 cup shaped suckers
Retractable rostrellum with a single row of 20-30 Y-shaped
hooklets
Neck is long and slender
Anterior proglottids are short; posterior proglottids are
broad
Genital pores are found along the same side of the
segments
Mature proglottids
Contain 3 ovoid testes and 1 ovary in a straight pattern
Gravid proglottids
Testes and ovary disappear
Uterus hollows out and filled with eggs
Separates from the strobila and releases eggs
Eggs
Spherical or subspherical
Oncosphere
has a thin outer membrane and a thich outermembrane
Has 4-8 hair like polar filaments in the inner membrane
Life cycle is either by direct or indirect pathway
Direct pathway
a) Host ingests eggs that hatch in the duodenum
b) Released oncospheres penetrate mucosa and become
cysticercoid larvae
c) 4-5days after, the larvae breaks out and attaches to the
mucosa to develop into adults
Indirect pathway
a) Host ingest intermediate host
rice/flour beetles; Tenebrio molitor, Tenebrio obscuris
and Tenebrio confusum
Rat flea (Xenophyslla cheopis) (carries H. nana var
fraterna)
b) The cysticercoid larvae will be develop into adults
c) 20-30 days from ingestion for eggs to appear in the feces
d) Eggs are viable after discharged
e) Autoinfection can occur through fecal-oral route
Pathogenesis and symptomatology
Symptoms are from the immune response in the presence
of the parasite
Light worm burden are asymptomatic
Headache
Dizziness
Anorexia
Pruritus of nose and anus
Diarrhea
Abdominal pain
Pallor
Sleep disturbances (sometimes)
Convulsions (rare)
Heavy infections
cause enteritis due to necrosis of intestinal epithelial cell
with time, H. nana can be cleared out by the immune
system
Diagnosis
Specific diagnosis is made by demonstration of the characteristic
eggs in the patients stools (spherical with 4-8 hiar like polar
filaments)
Treatment
Drug of choice is praziquantel (25mg/kg single dose)
Prevention and Control
Personal hygiene is emphasized
Environmental sanitation
Rodent control
Food must be properly stored and protected from the
intermediate hosts
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Hymenolepis diminuta
Rat tapeworm
Accidental human infection causes hymenolepiasis
Adult is larger than H. nana
Proglottids are the same in H. nana
Genital pores are unilateral
Gravid proglottid contains a sac-like uterus filled with eggs
Eggs
Circular and bile stained
Oncosphere
Enclosed in an inner membrane
Has bipolar thickening but NO bipolar filaments
Hooklets have a fan like arrangement
Pathogenesis and symptomatology
Worm burden in rodents is relatively low
Clinical manifestations are minimal and non-specific
Diagnosis
Identification of eggs in the stool
H. diminuta eggs are more circular, larger and lack of
bipolar filaments than H. nana.
Expelled scolex can be used as an aid in distinguishing and
diagnosing
Prevention and Control
Rodent control
Elimination of insect intermediate host
Protection of food
Treatment of human cases
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Dipylidium caninum
Dog tapeworm/Double-pored tapeworm
Dipylidiasis is accidental in humans
Pale reddish worm
Scolex is small and globular with 4 deeply cupped suckers
A protrusible Rostrellum with 1-7 rows of rose-thorn
shaped hooklets
Proglottids
Are narrow
2 sets of male and female reproductive organs
Bilateral genital pores
Gravid proglottid
Size and shape of pumpkin seeds
Filled with capsule or packets of about 8-15 eggs
Eggs
Spherical
Thin shelled with hexacanth embryo
Intermediate hosts that may ingest eggs
1. Dog flea (Ctenocephalides canis)
2. Cat flea (Ctenocephalides felis)
3. Human flea (Pulex irritans)
4. Dog louse (Trichodes canis)
In the body cavity of the arthropod, the haxacanth embryo develops
into the cysticercoid larvae
Upon ingestion of the insect by mammalian hosts, they will develop
into adults in 3-4 weeks
Pathogenesis and symptomatology
Infection is rarely multiple and symptoms are minimal
o Slight intestinal discomfort
o Epigastric pain
o Diarrhea
o Anal pruritus
o Allergic reactions
o Some patients are asymptomatic
Diagnosis
Is established upon recovery of characteristics gravid
proglottids passed out singly or in chain
Stool examination for the presence of the egg capsules is
not recommended
Eggs in capsule are rarly recovered from the stool
Treatment
Drug of choice is praziquantel (5-10mg/kg single dose)
Prevention and Control
Periodic deworming of pet cats and dogs is recommended
Insecticide dusting of dogs and cats are effectively against
fleas
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Raillietina garrisoni
Belong to the family Davaineidae
60cm in length
Subglobular scolex with 4 acetabula
Rostrellum has 2 alternating circular rows of 90-140
hammer-shaped hooks
Several rows of spine surround the rostrellum
Mature proglottid
Surrounded by 36-50 ovoid testes
Genital pore is open at one side near the anterior lateral
obrder of the segment
Gravid proglottids
2mm in length
Contains 200-400 egg capsules with 1-4 spindle shaped
eggs
Oncosphere
Surrounded by 2 thin membranes
Outer elongated
Inner spherical
Detach from the rest of the strobili by apolysis
Segments are motile, white and appear like rice
Segments may be ingested by Tribolium confusum (flour beetle)
It will then develop in to a cysticercoid larvae in 2 weeks
Infected insects are accidentally ingested and the cysticercoid larva
attaches to the intestinal villi to develop into an adult
Pathogenesis and symptomatology
Patients are normally asymptomatic
Normally need medical consultation when proglottids are
passed out in the feces
Diagnosis
Made by finding the characteristic proglottids or ova in
stools.
Treatment
Can sometimes be expelled spontaneously without
treatment
Praziquantel maybe given to expel the worm.
This is a common intestinal cestode in the Philippines
Prevention and control
Elimination of rodents from the households
Proper storage of grain products
Sanitary waste disposal would help prevent infection
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Diphyllobothrium latum [psuedophyllidea]
Fish tapeworm/broad tapeworm
Diphyllobothriasis intestinal infection of adult worm
3-10 m in length; 4000 proglottids
Scolex is spatulate
It has 2 bothria (dorsal and ventral)
Neck is long and attenuated
The terminal 4/5 of the worm is composed of mature and
gravid proglottids
Mature proglottids
Longer width than length
Contains one set of reproductive organs
Testes
Located in the dorsolateral part of the proglottid
Uterus
dark, rosette-like, coiled
located in the middle of the gravid proglottid
Ovary
Symmetrically bilobed
Present at the posterioir third of the proglottid
immediately the Mehlis gland
Proglottids disintegrate when segment has completed
reproductive function
1,000,000 ova may be released daily
Ova
Usually yellowish brown
Thick shell with (inconspicuous) operculum
Opposite to the operculum is a small knob-like thickening
Complete their development in water and become Coracidium
Coracidium are ingested by Copepods (Cyclops & Diaptomus genera)
and become Procercoid
Procercoid
Develops in the copepod
Retains 3 hooklets in the cercomer [a caudal attachment
organ]
Copepods are ingested by fish (trout. Salmon, perch and
pike)
Procercoid migrate from the copepod to the fish to
become Plerocercoid/Sparganum
Plerocercoid larvae/Sparganum (Infective stage)
Appears glistening, opaque white and unsegmented
Fish with infected plerocercoid will be ingested by a
definitive host eventually.
Carnivorous fishes (Carcharodon carcharias) may serve as
paratenic or transport host.
In the definitive host, attaches to intestinal wall until
maturity
Pathogenesis and symptomatology
Infections are usually limited to one worm
Infected individuals show no signs
Some may experience;
o Nervous disturbances
o Digestive disorders
o Abdominal discomfort
o Weight loss
o Weakness
o Anemia
Diphyllobothriasis
Hyperchromic, megaloblastic anemia with
thrombocytopenia & leukopenia
Similar to vitamin B12 deficiency
Maybe mistaken for Pernicious Anemia
Worms in the upper jejunum will compete with host for
Vit B12
Diagnosis
Definite diagnosis is made on finding the characteristic
operculated egg or proglottid in stool
Kato Technique is also useful
Treatment
Praziquantel 5-10mg/kg single dose
Prevention and control
All fresh water fishes should be thoroughly cooked
Freezing for 24-48 hours at -18C kills all plerocercoids
Proper waste disposal
Proper marketing of fish

EXTRAINTESTINAL CESTODES
Echinococcus spp.[cyclophyllidean]
Hydatid worm
Human echinococcosis
considered as one of the emerging zoonotic disease
caused by larval stage of Echinococcus spp.
E. granulosus causes cystic echinococcus
E. multilocularis causes alveolar echinococcosis
E. multilocularis is less common because its life cycle is
sylvaltic
Dogs and other canines are the most common definitive
host
The adult inhabits the small intestines of canines
Scolex
Pyriform in shape
Taeniid in that it has 4 acetabula
Armed with 30-36 hooks
Short neck
3 proglotids [1 immature, 1 mature & 1 gravid]
Gravid proglottid
widest and longest
Uterus is midline with lateral invaginations
Eggs
May be released outside or inside the host
Swallowed by intermediate hosts such as
o Goats
o Horses
o Camels
o Sheep
They hatch in the duodenum
Man may accidentally ingest these eggs
Oncosphere
Penetrates the mucosal wall and migrates to the
mesenteric venules
Hydatid cyst
The larval stage
Formed by central vesiculation and gradual enlargement
Numerous protoscolices may be found
Development is completed when the cysts in the tissues
are ingested by carnivores or omnivores
Once inside the definitive host, protoscolices evaginate,
attach to the intestinal wall and develop into adults
Normally reside in the small bowels
The cyst has an outer laminated layer and an inner
nucleated germinal layer
Protoscolices may be found in the brood capsule
When protoscolices lie free in the cyst these are referred
to as Hydatid sand
Pathogenesis and symptomatology
Pathology is caused by developing larval cysts in tissues
Liver (70%) is the most common and important site of
involvement (mostly affected is the right love)
Lungs are involved by 20-30%
Brain is 10%
Cysts of E. granulosus are called unilocular hydatid cyst
o Develop inflammatory reactions
o Down regulates inflammatory cytokines
Cysts of E. multilocularis are called alveolar cysts
Simple or uncomplicated cysts may not produce any
symptoms
Hepatics cysts
mainly found in the inferior right lobe
Rupture of the hepatic cyst produces the triad;
1. Intermittent jaundice
2. Fever
3. Eosinophilia
Abdominal cysts
cause discomfort when the cyst is large enough
cysts may rupture from coughing, stain or trauma then
protoscolices, brood capsules & daughter cells metastasize
Cysts may also become intrathoracic if the are located in
the superior lobe of the liver
Peribronchial cysts
May discharge in to a bronchus and result in coughing
Sputum may contain frothy blood, mucus, hydatid fluid &
bits of membrane
Brain
Involvement of the brain may cause increase ICP and
Jacksonian epilepsy
Renal
Renal involvement may cause;
o Intermittinet pain
o Hematuria
o Kidney dysfunction
o Hydatid material in the urine
Secondary infections of the cyst may also occur
Bacteria may enter the cyst and lead to pyogenic abscess
Patients with this condition presents high fever and chills
Secondary cysts have higher mortality rates
Rupture of primary cysts may result to serious anaphylaxis
Diagnosis
Radiographic findings and ultrasonography with a history
of residence in an endemic area and close association with
dogs
Serologic tests such as;
1. IHA
2. IFA
3. EIA
Use of rapid dot ELISA to detect antigens of E. granulosus
Treatment
Surgical resection is the treatment of choice
Surgical management involves instilling a scolicidal agent;
o Hibitane
o 95% ethanol
o 30% hypertonic saline solution
For inoperable cysts, albendazole may be given at 400mg
twice a day for 1-6 months at cycle of 4 weeks each with 2
weeks no therapy in between cycles
Prevention and control
Achieved by reducing the infected population
Minimize opportunity for transmission
Proper Health education
Echinococcus multilocularis
Foxes are the natural definitive host
Small rodents are the intermediate host
Human infections normally occur in the northern
hemisphere
Eggs
Are ingested and the cystic larvae are established in tissue
Cysts
Wall is not clearly delineated from surrounding tissue
Usually sterile (absence of protoscolices)
Common site is the liver, may present as a tumor
Treatment is surgery or the PAIR procedure
Inoperable cases are given albendazole or mebendazole.
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Sparganosis
Refers to the larval infection of the plerocercoid larva AKA
spargana of psuedophyllidean tapeworms under the genus
Spirometra.
o Spirometra mansoni
o Spirometra erinacei
o Spirometra ranarum
These are usually mistaken for adult D. latum
Humans can be infected by;
a) Drinking water containing infected copepods
b) Eating infected 2
nd
intermediate host
c) Applying infected flesh as poultices
d) Consumption of infected flesh of paratenic hosts
Larvae
Opaque, glistening white
May be found anywhere in the body
Diagnosis
Made by finding larvae in the lesion
Species identification is done
Treatment
Surgical removal of the plerocercoid
Prevention and control
Prevented by drinking boiled or filtrated water
Cooking possible paratenic hosts thoroughly
Avoid applying flesh of frogs to inflamed areas.





~Happy New Year~ ^o^
-Nach