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Intestinal cestodes
x ¦ saginata
x ¦ solium
x Ô nana
x Ô diminuta
x M caninum
x M latum

Extraintestinal Cestodes
x Echinococcus sp
x gpirometra

¦AENIA gAGINA¦A
6 Gnown as the beef tapeworm
6 Ôumans serve ONLY as definitive host
pNO¦ as intermediate host
pÔuman cysticercosis MOEg NO¦ occur

Adult worm
ÿInhabits upper jejunum
 Gravid proglottids undergo apolysis ù passed out/crawls out
ÿ-ay live up to 25 years
ù eggs are released
ÿ-easure 4 ± 10 m in length (25m); 1,000-4,000 proglottids
 Cysticercus bovis: infective stage; ovoidal, milky white,
10mm diameter, single scolex invaginated into a fluid-filled
bladder
 Only 1 adult tapeworm is present in ¦ saginata infections

¦AENIA gOLI
-
6 Gnown as the pork tapeworm of man
6 -an serve as both a definitive host and an intermediate host
6 Both intestinal and tissue infections occur in man
6 Adult worm inhabits the upper small intestines
6 ghorter than ¦ saginata, less number of proglottids
gCOLEX 6 Adults measure 2-4 m in length; 800 ± 1000 proglottids
 cuboidal scolex
 1-2 mm in diameter
 4 acetabula
 Mevoid of hooks or rostellum

PROGLO¦¦IMg
-A¦
RE GRAVIM
 contain mature male and  Proglottids are longer than
female they are wide
 reproductive organs 
terus is distended with ova gCOLEX
 2 large ovaries and a median and has 15 to 20 lateral  acetabula; smaller; more spherical
clubbeduterus branches  Cushion-like rostellum with a double crown of 25-30 large
 Follicular testes 300-400  Genital pores of proglottids and small hooks
 Vagina has a sphincter are irregularly shaped
PROGLO¦¦IMg
-A¦
RE GRAVIM
OVA  presence of accessory  Contains 7-15 uterine lateral
 gpherical or subspherical in ovarian lobe branches
shape  absence of vaginal sphincter  Also undergo apolysis but not
 in color, with a thick embryophore  smaller number of follicular very motile
which appears striated because testes (100 to 200)
of numerous pits
 Inside the eggshell is the EGGg
oncosphere or embryo 30-45 um 6 Indistinguishable from ¦ saginata
in diameter
 Brownish provided with 3 pair of
hooklets

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 injection of contrast dye (dead larva)
3 gmall calcified area within a cystic space (dead scolex)

MIAGNOgIg
¦AENIAgIg CYg¦ICERCOgIg
 symptoms  CNg and/or symptoms
 history of eating undercooked involving other organs
beef or pork  history of ingesting food with
 recovery of proglottids and/or ¦ solium eggs
eggs in the stool  radiographic localization of
cysticercal lesions in tissues

¦REA¦-EN¦
¦aeniasis
6 Praziquantel : 5-10 mg per kg as single dose for both adults
and children
6 gcolex expulsion is essential
6 Criteria for cure :
ÿ Recovery of the scolex
ÿ A negative stool examination 3 months after treatment

Cysticercosis
 Neurocysticercosis:

 Praziquantel : 50-75 mg/kg divided into 3 doses for
30 days or

 Albendazole : 400 mg 2xday for 8-30 days

 gteroids
Misease caused:
 gurgical removal
6 Ingestion of eggs ùCYg¦ICERCOgIg  Ocular cysticercosis:
6 Ingestion of cysticercus ù¦AENIAgIg
 gurgical removal

¦AENIAgIg gY-P¦O-g: EPIME-IOLOGY

 Related to the habit of eating raw or improperly cooked meat
 ¦ solium: glavic countries, Latin America, gouteast Asia,
China and India
 ¦ saginata: Etiopia and East Africa, Japan, gEA, Europe,
Australia, Canada,
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 Philippines: Prevalence of taeniasis: 0 56%; Northern Luzon

¦aeniasis prevention:
6 Adequate cooking of meat
6 Freezing meat below 10º C

ÔY-ENOLEPIg NANA

Common Name: dwarf tapeworm

Misease: Ôymenolepiasis nana, dwarf tapeworm infection

Geographic Mistribution
1 primarily limited in human beings to children in warm
Cysticercosis climates
2 prevalent throughout India, parts of the
ggR, countries
bordering the -editerranean, all countries of Latin America,
Ôawaii and some of the islands of gouth and gouthwest
Pacific
3 Common tapeworm in southeastern
nited gtates

-ORPÔOLOGY
Length: 25-40 mm
No of Proglottids: 200
Neurocysticercosis
C¦ gcan findings: gCOLEX
1  Round low-density area without 6 small and globular
surrounding enhancement after 6 bears a short retractile rostellum with
administration of contrast dye a single ring of 20-30 minute hooklet
(viable larva without inflammation) 6 provided with four cup shaped suckers
2  Ring-like enhancement after

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 6 Intermediate hosts are fleas and beetles
6 Infection of definitive host results from the ingestion of
NECG intermediate hosts harboring the cysticercoid larva
6 long and slender
-OMEg OF ¦RANg-IggION
ÿ Mirect hand to mouth
ÿ Less frequently, by contaminated food or water
ÿ Possibly, by indirect intermediate hosts

gY-P¦O-A¦OLOGY
1 Infection with a few Ôymenolepis nana may produce no symptoms
PROGLO¦¦IMg 2 It my be responsible for:
I--A¦
RE -A¦
RE GRAVIM a diarrhea

ndifferentiated  trapezoidal about 4x  Contains the b anorexia
as broad as long sacculate c vomiting
 has a single genital uterus filled d insomnia
pore on its left side with eggs e loss of appetite and weight
towards the anterior f iriirtability
border g pruritus of the anus and nose
 has three round h urticaria
testes and a bilobed I Choreiform symptoms
ovary 3 Ôeavy infection is invariably pathogenic
a moderate to profuse diarrheic stools
b abdominal pain
OVA c anorexia and exaggerated disorders
6 grayish hyaline, nearly spherical d extreme apathy
e epileptiform seizures
6 20-40 um in diameter
6 two thin membranous shells
LABORA¦ORY MIAGNOgIg
6 inner membrane with two polar thickenings each provided 1 Recovery of the characteristic ova in the stools
with 4-8 threadlike filaments extending into the space 2  Light cases with the aid of acid ether concentration technique
between the two shells
6 hexacanth embryo with six hooklets enclosed by two ¦REA¦-EN¦
membranes 1 Praziquantel ± 25 mg/kg in single dose
2 Niclosamide ± 2 g each day, for 5-7 days
children ± half of the adult dose
3 Paromomycin ± 45 mg/kg daily, given in four doses at hour
intervals for a period of 5 days

PREVEN¦ION
1 Ôuman strain
a avoid ingestion of eggs by not eating raw vegetable salads
b personal hygiene
c cleanliness of toilet seats
2 -urine 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

ÔY-ENOLEPIg MI-IN
¦A

Common Name: rat tapeworm

Misease: rat tapeworm infection
EPIME-IOLOGY Geographic Mistribution
Ôuman strain 1  cosmopolitan parasite of rats, mice and other rodents
6 Only human tapeworm that does not require an intermediate 2  has been reported from human hosts usually from children in
host to complete its life cycle India, Indonesia,
ggR, Japan, Philippines, gouthern
6 -an is the natural final host Europe, Latin America from Argentina to -exico and Cuba
6 Infective stage is the embryonated ova transmitted toman and from several parts of the
nited gtates
through the agency of foods and drinks particularly raw leafy
vegetables usually eaten as raw salad -ORPÔOLOGY
6 It is more common in children and in institutionalized group Length 10 to 60 cm by 3 to 5 mm
6 Ôumanity is the chief source of infection No of proglottids 800-1000

-urine strain , Ôymenolepis nana var fraterna

6 Final hosts are rats and mice
6 -an is an accidental final host

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gCOLEX
6 Gnoblike; club-shaped
6 Provided with a rudimentary apical unarmed rostellum or a
deep apical suctorial pocket without rostral hooklets
6 Provided with four relatively small cup shaped suckers

NECG
6 ghort and stout

EPIME-IOLOGY
6 -an is only an accidental final host
PROGLO¦¦IMg 6 Rats and other murines are the natural final hosts
I--A¦
RE -A¦
RE GRAVIM 6 Principal intermediate hosts are the larval rat, mouse fleas

ndifferentiated  0 8 by 2 5 mm  sacculate and adult mealworm beetle
 same as 6 Other intermediate hosts ± fleas, myriapods, cockroaches,
uterus filled
Ôymenolepis nana beetles, lepidopterans
with egg
only the segments 6 Infective stage to the final host is the cysticercoid larva in
masses the arthropod host
are larger
6 Ôumans are infected accidentally by food or hands
contaminated with infected insects

gY-P¦O-A¦OLOGY
6 Ôymenolepis diminuta usually produces no symptoms
6 Indigestion and abdominal pain are the presenting
complaints in infants

LABORA¦ORY MIAGNOgIg
6 Recovery of the characteristic ova in the stools

¦REA¦-EN¦
6 game as Ôymenolepis nana
OVA
6 hyaline with straw colored hue
PREVEN¦ION
6 broadly ovoidal or subspherical 6 Eradicate the rats and mice around the house
6 58 by 86 um 6 Residual spraying of their nests and burrows with
6 two egg membranes, outer and inner insecticides
6 inner membrane with two polar thickenings but with the 6 Protection of cooked foods from arthropods
absence of filaments
6 considerable space between outer and inner
MIPYLIMI
- CANIN
-
6 hexacanth embryo enclosed by two membranes
Common name: double pored dog tapeworm
Misease: Mipylidiasis, dog tapeworm infection

Geographic Mistribution
1 A common tapeworm of the dogs and cats throughout the world;
also reported from wild cats and foxes
2 Ôuman infection rare but reported from European
countries, the
nited gtates, Argentina, Rhodesia,
China and the Philippines
3 In the Philippines, survey of dogs ± prevalence of
5 19% to 36%; dog and cat fleas ± 2 4%

-ORPÔOLOGY
1 pale reddish adult worm
measuring 15 to 70 cm In length
2 strobila ± a chain of melon
shaped proglottids
3 No of proglottids ± 60 to 175

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 Mog flea ± Ctenocephalides canis
gCOLEX Cat flea ± Ctenocephalides felis
6 rhomboidal Ôuman flea ± Pulex irritans
6 retractile conical rostellum armed with 30 to 150 rose thorn dog louse ± ¦richodectes canis
shaped hooklets arranged in transverse rows 4 Ingestion of the infected fleas cause infection of the final host
6 four prominent oval suckers 5 Infants and young children are usually infected because of
their close contact with their pet cats
NECG
6 ghort and slender gY-P¦O-A¦OLOGY
Y  Light infections ± asymptomatic
D  -ay cause:
a slight intestinal discomfort
b epigastric pain
PROGLO¦¦IMg c diarrhea
I--A¦
RE -A¦
RE GRAVIM d anal pruritus
 Broader than  vase shaped,  Vase shaped, melon e allergic reactions
long when melon seed seed-shaped or
shaped or MIAGNOgIg
very young pumpkin seed shaped 1  Clinical - difficult since symptoms are nonspecific
pumpkin seed
 gquare as  filled with polygonal 2  Laboratory
shaped
they become  double sets of shaped uterine egg a based upon the demonstration of:
older reproductive pockets or egg 1  A single or chain of melon shaped
organs capsule containing 8 2  proglottids
 genital atrium on to 15 eggs 3  Egg pockets or egg capsules
each side of the 4  Embryonated ova
segment 5  Ripe or gravid proglottid

¦REA¦-EN¦
1  Praziquantel ± 10 mg per kg in a single dose
2  Niclosamide ± 4 tablets(2 g) chewed thoroughly in a single
OVA
dose after a light meal
6 gpherical 3  Paromomycin ± 1 g every 4 hours for 4 doses
6 thick albuminous covering 4  uinacrine hydrochloride- 0 8 g given over a half hour
6 hexacanth embryo with three pairs of lancet shaped interval
hooklets
PREVEN¦ION
1  Periodic deworming of pet cats and dogs is recommended
2  Insecticide dusting of dogs and cats are effective against
fleas
3  ¦he potential danger of playing with pets must be included in
the health education of children
4  gmall children should not be allowed to fondle dogs and cats
infected with fleas and lice

MIPYLIMI
- LA¦
-
Common Name: broad or fish tapeworm
Misease: Miphyllobothriasis; fish tapeworm infection; broad
tapeworm infection

Geographic Mistribution
1  prevalent in regions of the temperate zones where freshwater
fish form an integral part of the diet
2  common in Northern Europe, Russia, North America,
-anchuria and Japan and gouth America
3  has been reported in man once from the Philippines

-ORPÔOLOGY
Ivory or grayish yellow
Length ± 3 to 10 meters
No of proglottids ± 3000

gCOLEX
6 spatulate, almond shaped
6 2-3 mm by 1 mm
EPIME-IOLOGY 6 no rostellum nor hooklets
1 Mefinitive hosts are dogs and cats and wild carnivora 6 two deep dorsoventral
2 -an especially children are only accidental final hosts suctorial grooves called bothria
3 Intermediate hosts are larval fleas of the dog, cat and human
being and the dog louse NECG

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 6 unsegmented, several times the length of the scolex

-A¦
RE PROGLO¦¦IM
6 broader than long
6 contains both male and female
reproductive organs
6 characteristic morphologic feature ±
dark rosette-like coiled uterus at the
center

RIPE OR GRAVIM PROGLO¦¦IM

6 game as mature proglottid

OVA
6 yellowish brown in color
6 measures 55-76 u by 41-56 um
6 inconspicuous operculum at
one end
6 small knoblike thickening at the
other end
6 contains plenty of yolk cells
6 immature when oviposited

EPIME-IOLOGY
6 ¦he final hosts are man and other piscivorous mammals
such as dog, cat, leopard, foxes, mink, pig and bears
6 First intermediate hosts ± copepods of the Genus Miaptomus
and Genus Cyclops
6 gecond intermediate hosts ± fresh water fish like pike, trout,
salmon,whitefish, turbot and carp in the Philippines
6 Infective stage to man and other final hosts ± plerocercoid
larva in the 2nd intermediate host
6
sual vehicle for transmission- raw, partially cooked or
frozen fish eaten raw

PA¦ÔOGENEgIg ANM gY-P¦O-A¦OLOGY

1  Mue to adult worm
a  systemic toxemia due to by products of thea dult
worm absorbed into the host¶s tissue
b  mechanical obstruction due to large numbers of
worms when they become entangled together
c  bothriocephalus anemia or tapeworm
pernicious anemia (Miphyllobothrium latum
competes with the host for the available supply of
Vitamin B12)

Miagnosis
1  Clinical
a  tapeworm appetite, abdominal pain and anemia
particularly in people living in endemic areas

2 Laboratory
a  demonstration of the characteristic egg in the stool
using acid ether concentration technique

¦REA¦-EN¦
1  Niclosamide ± 4 tablets (2 g) chewed thoroughly in a
single dose after a light meal
2  Paromomycin ± 1 g every 4 hours for 4 doses
3  Praziquantel ± 10 mg per kg in a single dose
4  uinacrine hydrochloride ± 0 8 g given over a half hour
interval

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PREVEN¦ION 6 By finding the larvae in the lesion
1  thorough cooking of all fresh water fish used for
human consumption ¦REA¦-EN¦
2  freezing of fish for 48 hours at a temperature of ± 10 C 6 gurgical removal of the larval plerocercoid
3  tasting of raw fresh water fish while being prepared for
the table should not be practiced PREVEN¦ION
4  proper treatment and disposal of sewage 1  Only potable water should be drank
2  Raw water from streams should be avoided as this may
gPARGANOgIg contain infected Cyclops
3 
se of cold blooded vertebrates as poultices should be
NONBRANCÔING gPARGANA avoided
gpargana or plerocercoid larva of several species of 4  Cold blooded vertebrates when eaten should be in a
gpirometra(Miphyllobothrium) mansonoides ± found also in Ôumans cooked state

Geographic Mistribution BRANCÔING gPARGANA

1  Found in East and goutheast Asia, Japan, Indochina and to Budding larval tapeworm ± gpirometra proliferum
a lesser extent North and gouth America
Geographic Mistribution:
-ORPÔOLOGY 1  Reported in Japan and
nited gtates
6 Elongated, ivory white ribbonlike larvae
6 Ôas an anteroposterior polarity -ORPÔOLOGY
6 Pseudosucker 1  Larva ± irregular, lateral, supernumerary processes that may
6 Elongated like a small tapeworm bud off as new spargan in the tissues
6 No scolex and no defined proglottids
LIFE CYCLE ± unknown
LIFE CYCLE ± similar to Miphyllobothrium latum
MIAGNOgIg: finding the larvae in the chylous nodular lesions
EPIME-IOLOGY
1  ¦he final hosts are dogs and cats ECÔINOCOCC
g
2  ¦he first intermediate hosts are the copepods of the Genus  Misease caused by the larval stage which is acquired when
Cyclops eggs are ingested
3  ¦he second intermediate hosts are the frogs, lizards, snakes, bird  Echinococcus granulosus : causes hydatid cysts
and monkey  Echinococcus multilocularis : alveolar echinococcosis
4  -an is an accidental intermediate host  Mogs and other canines are the most common definitive
5  ¦he infective stages are: hosts
 procercoid larva in the Cyclops
  plerocercoid larva (spargana) in the tissues of Echinococcus granulosis (ÔYMA¦IM)
6  cold blooded vertebrates Geographic distribution
7  Ôuman infection results from:
 ingestion of Cyclops infected with procercoid larva
  ingestion of raw flesh of cold blooded animals
harboring the plerocercoid larva
©  local application of the flesh of cold blooded
vertebrates harboring the plerocercoid larva

PA¦ÔOGENEgIg ANM gY-P¦O-A¦OLOGY

1  Found in any part of the body especially
a  Eyes
b  gubcutaneous and muscular tissues of the thorax
c  Abdomen
d  thighs
e  inguinal region
f  thoracic vertebra
2  Elongating and contracting larvae within a slimy matrix -ORPÔOLOGY
cause an inflammatory and painful edema of the
surrounding tissue Adult worm:
3  Megenerated larvae cause intense local inflammation and 6 3-6 mm length
necrosis but no fibrous tissue formation 6 possess pyriform scolex,short neck and 3 proglottids
4  Infected persons may show: (immature, mature and gravid)
a  local indurations
b  periodic giant urticaria Ôydatid cyst : usually measures 1-7 cm
c  edema in diameter; consists of protoscolices
d  erythema accompanied by chills, fever and high the cysts (2 to 30 cm) are constituted by
eosinophilia an external acellular cuticule and an
e  ocular infection ± painful edematous conjunctivitis inner cellular "germinal" layer (10-25 µ)
with lacrimation and ptosis that produces the brood capsules
containing 6-12 protoscolices or single
MIAGNOgIg protoscolices (Germinal layer with a
protoscolex)

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"Ôydatid sand" : free protoscolices in the cyst

Fluid aspirated from a hydatid cyst will shows multiple protoscolices

(size approximately 100 µm), each of which has typical hooklet ¦he
protoscolices are normally invaginated (left), and evaginate (middle,
then right) when put in saline

MIAGNOgIg
LIFE CYCLE  Endemicity
 gymptoms
 X-ray and C¦ scan
 gerology
 gkin (Casoni) test

gEROLOGY
 Indirect hemagglutination (IÔA), 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 to 90% positive reaction is
confirmed by immunoblot assay or any gel diffusion assay
that demonstrates the echinococcal "Arc 5"

Casoni test (an immediate hypersensitivity skin test used to detect

sensitization to hydatid antigen)

¦REA¦-EN¦ ANM CON¦ROL

 gurgical removal of the cyst
 Praziquantel
 Avoidance or treatment of infected canine
 For inoperable cysts ± PAIR ( puncture, aspiration, injection,
reaspiration)

6 Pathology caused by developing larval cyst in the Echinococcus multilocularis

intermediate host
6 LIVER : most common and most important site of  Foxes are the natural definitive host
involvement (70%); 85% located in the right lobe  gmall rodents are the intermediate hosts
 Ôumans infected by eating raw plants contaminated with
gY-P¦O-g feces of infected canines or cats
 Cyst wall: not clearly delineated form surrounding tissue;
porous, spongy mass of small irregular cavities with a jelly
like matrix

gimilar to E granulosus, except:

 ¦hat secondary hosts and reservoir are rodents
 ¦he egg produce multilocularis cysts
 ¦he cestode is more resistant to chemotherapy

¦REA¦-EN¦ ANM CON¦ROL

 gurgical removal of the cyst

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  Resistant to praziquantel; Albendazole has some effect ³With all your heart you must trust the Lord and not your own
 Avoidance control of rodent population judgment Always let Ôim lead you, and Ôe will clear the road for you to
follow  Proverbs 3:5-8
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