CESTODES

Tapeworms

General Characteristics
Majority are long, segmented and
tape-like
They are called tapeworms
Dorso-ventrally flattened
Size varies from a few mm to
several meters
Adult worms are found in the
intestinal canal of man and
animals

There are 3 regions in an adult worm:

Head or scolex: for attachment,
maybe provided with hooks or
rostellum
Neck: region of growth
Strobila: (body or trunk) Consist of
a series of segment called
proglottids
immature-undifferentiated
mesenchyme
Mature- complete sex organs
Gravid- distended with eggs

Sexes are not separate

Body cavity is absent
Alimentary canal is entirely
absent
Excretory and nervous systems
are present
Reproductive system is present
and complete in each segment.

Classification of Cestodes
I. Pseudophyllidea- Possess false
suckers or slit-like grooves called
bothria.
Adult worms in Intestine
Diphyllobothrium latum
Sparganum mansoni
Sparganum proliferum

II. Cyclophyllidea- Possess cup-like and

round suckers called acetabula.
Adult Worms in the Intestine
Taenia saginata
Taenia solium
Hymenolepis nana
Hymenolepis diminuta
Diphylidium caninum
Echinococcus granulosus

Larval Stages in Man

Hydatid cyst of Echinococcus granulosus
and Echinococcus multilocularis
Cysticercus cellulosa of Taenia solium
Coenurus cerebralis of Multiceps
multiceps
Coenurus glomeratus of Multiceps
glomeratus

Differences Between a Pseudophyllidean

and a Cyclophyllidean Cestode
Pseudophyllid Cyclophyllidea
ean
n

Head or scolex

Bears 2 slit-like Bears 4cup-like

grooves
suckers

uterus

No branching
Branching
Convoluted
May or may not
uterine tubes
be present
assume the
form of rosettes

Order Pseudophyllidea
Characteristics
Large worms consisting of a long
chain of segments
head has two slit-like sucking
grooves called bothria instead of
suckers
Uterine glands are widely scattered in
the parenchyma and is composed of
many acini
Genital pores are on the ventral
surface of the segment and are not
marginal

Uterus opens to the exterior through which

eggs come out
Eggs are operculated and can develop
only in water; immature when oviposited
and oncosphere gives rise to ciliated
embryo
Larval development proceeds in two
intermediate hosts:
First larval stage is called procercoid
Second larval stage is called
plerocercoid

Diphyllobothrium latum
Common Name:
Fish Tapeworm
Broad Tapeworm

Morphology
Adult worm is yellowish
grey in color
Dark central markings
in the strobila are due
to the egg-filled uterus
Measures 3 to 10
meters in length
Life-span is for a period
of 5 to 15 years

Diphyllobothrium latum
Scolex is almondshaped or spatulate
Scolex bears 2 slit-like
grooves called bothria
(1 on the dorsal surface
and 1 on the ventral
surface)
Scolex has no rostellum
and no hooklets
Neck is thin and
unsegmented and is
much longer than the
head

Diphyllobothrium latum
Morphology
3,000 to 4,000
A mature segment is filled
with male and female
reproductive organs
Terminal segments shrink
and becomes empty as
eggs are constantly
discharged
Dried up segments break
off from the body in chains
and are passed out in the
hosts feces
Uterus at the center of the
segment appears in the
form of a rosette

Diphyllobothrium latum
Diagnostic
CharacteristicsDark rosette coiled
like uterus at the
middle of mature
proglottid.

Diphyllobothrium latum
Ova
Passed out in the hosts
feces in large numbers
Oval
Bile stained
Contains abundant
granules and
unsegmented ovum
Inconspicuous operculum
at one end and a small
knob at the other end
Does not float in saturated
solutions of common salt
A single egg gives rise to
a single larva
Not infective to man

Diphyllobothrium latum
larva
Passed first in water and then in the
respective intermediate hosts
3 stage
First stage larva
Coracidium
Ciliated oncosphere that
develops from egg in water

Second stage larva

Procercoid
Spindle-like solid body with
cephalic invagination
Found inside the cyclops (the
first intermediate host)
Third stage larva
Plerocercoid
Head is invaginated in the neck
Found in the fresh water fish, the
second intermediate host

Diphyllobothrium latum

Diphyllobothrium latum
Final Host
Man, dog, cat
Small intestine
1st I.H.
Cyclops or Diaptomus
2nd I.H.
Fresh water fish, pike, trout, salmon,
perch

Mode of Infection
Ingestion of imperfectly cooked
infected fish containing plerocercoid
larvae
Infection
Diphyllobothriasis
G.I. disturbances and anemia
Diagnosis
Microscopic examination of feces for
the characteristic operculated eggs

Order Cyclophyllidea
Characteristics
Large or small worms consisting of chains
of segments
Scolex is quadrate with four cup-like round
suckers
An apical rostellum with hooklets may be
present

Vitelline glands concentrated in a single

mass
Common genital pore is marginal (on
lateral side of segment)
No uterine opening for the exit of eggs
from the gravid uterus
Eggs only escape from the rupture or
disintegration of ripe segments

Eggs are not operculated and can develop

only in the intermediate host, fully
embryonated

Oncosphere is never a ciliated embryo

Larval development proceeds in one
intermediate host

Taenia saginata
Beef Tapeworm
Unarmed
Tapeworm of Man
Adult worms are
white and semitransparent
Measures about 510 meters or
sometimes up to
24 meters

Taenia saginata
1,000 to 2,000
proglottids
Common genital pore
is marginally situated
Vagina is provided
with a sphincter
muscle
Gravid proglottid
consists of a uterus
and a central
longitudinal stem with
15 30 branches on
each side

Taenia saginata
Highly branched proglottids
Gravid proglottid contains
97,000 to 124,000 ova
Gravid segments are
expelled singly and force
their way through the anal
sphincter
Free gravid proglottid
crawls out of the anal
orifice and oviposits on the
perianal skin

Taenia saginata
Ova

Liberated by rupture
of ripe proglottids
No uterine opening
Spherical
Thin, outer
transparent shell
Inner embryophore
is brown, thick
walled and radially
striated

Has an oncosphere with 3 pairs of

hooklets
Does not float in saturated salt
solutions
Eggs are resistant and remain viable
for 8 weeks
Infective only to cattle
Iife span is up to 10 years or more

Taenia saginata
Final Host: Man
Intermediate Host: cattle, cow buffalo
Mode of Infection; eating beef containing
Cysticercus bovis
Pathogenesis
Taeniasis
Passage of proglottids in stool
Mild irritation at site of attachment
Epigastric pain

Hunger fangs
Weakness
Weight loss
Loss of appetite
Pruritis
Obstruction in intestine but also in bile
and pancreatic ducts and appendix
because proglottids are actively motile

Taenia saginata
Diagnosis
Identifying characteristic eggs,
proglottids or scolex
Usual specimen is gravid proglottids
( lateral branches 15-30)
Concentration techniques for eggs
(eggs rarely passed out in stool)
Perianal swabs

Treatment
Praziquantel
5-10mg/kg single dose
Criteria for cure
Recovery of the scolex
Negative stool examination 3 months
after treatment

Taenia solium
Pork Tape worm
Armed Tapeworm of Man
Taeniasis is common among
those eating raw or insufficiently
cooked measly pork
Uncommon among non-pork
eaters

Taenia solium
Scolex is globular
in outline with 4
circular suckers

Scolex has a
rostellum armed
with a double row
of alternating large
and small hooklets

Taenia solium
Rostellar hooklets are
shaped like daggers or
Arabian poniards

Taenia solium

Taenia solium
Adult worms
measure 2-3
meters
Adult worms live
up to 25 years

Taenia solium
800-900 proglottids
Common genital
pore is marginal
and thick lipped
Vaginal opening is
not guarded by a
muscular sphincter

Gravid segments are expelled passively in

chains of 5-6 at a time and not singly.
Gravid proglottids contains approx. 30,000
to 50,000 eggs

Taenia solium
Ova
Same as those of
Taenia saginata
Infective to man as
well as pigs
Thick brown striated
embryophore
surrounding a
hexacanth embryo

Taenia solium
Final Host: Man
Intermediate Host: Pig
Mode of infection; eating measly pork
containing Cysticercus cellulosae
Diagnosis: stool examination for
proglottids/eggs

Taenia solium
Pathogenesis
Mild, non-specific abdominal complaints
Proglottids are not as motile as T. saginata so
organ obstruction is less likely.
Cysticercosis
Multiple
Develop in any organ or tissue
Neurocysticercosis (most serious zoonotic
disease)
Chorioretinitis
vasculitis

Taenia solium
Diagnosis
Intestinal
Identifying the characteristic
proglottids, eggs or scolex
Cysticercosis
Computed Axial Tomography
Magnetic Resonance Imaging

Treatment
Praziquantel: 5-10 mg/kg single dose
for children and adults
Niclosamide not available locally
Criteria for cure:
Recovery of scolex
Negative stool exam 3 months after
treatment

Comparison Between
T. saginata and T. solium

Taenia
saginata

Taenia
solium

length

5-10 meters

2-5 meters

Head or scolex

Large, quadrate, Armed; with

no rostellum and rostellum; with
hooks
hooklets

Number of
proglottids

1,000 to 2,000

Below 1000

Expulsion

Expelled singly

Explelled

Echinococcus granulosus
Hydatid Worm
Man harbors the larval form and not the
adult worms which however is found in the
intestine of dogs and canines

Echinococcus granulosus
Adult worms are small
(3-6 mm in length)
It is composed of a
Scolex
Neck
Strobila
3 segments (occassionally 4)
Immature
Mature
Gravid

Echinococcus granulosus
Scolex bears 4
suckers and a
protrusible
rostellum with 2
circular rows of
hooks.

Echinococcus granulosus
Ova
Ovoid in shape
Resemble Taenia ova
Hexacanth embryo with
3 pairs of hooks

Infective to:
Man
Cattle
Sheep and other
herbivorous animals

Echinococcus granulosus
Larva
Found within the hydatid cyst developing inside the
intermediate host
Represents the structure of the scolex of the future
adult worm
Young larva are transformed into a hollow bladder
(hydatid , drop of water)
Brood capsules develop within the cysts and may
contain thousands of scolices
On entering the final host, the scolex armed with a
rostellum and 4 suckers become adult worms

Echinococcus granulosus

Echinococcus granulosus
Definitive Host
Dog
Wolf
Fox
Jackal

Intermediate Host
Sheep
Pig
Cattle
Horse
Goat

Echinococcus granulosus
Pathogenesis
Echinococcosis
Pathology is caused by the developing larval cyst
in the intermediate host
Most common site of involvement is the liver
Echinococcus granulosus cyst: Unilocular hydatid
cyst
Echinococcus multilocularis: alveolar cyst
Some may be asymptomatic for years
Rupture of cyst in the lungs may present coughing
accompanied by allergic reactions

Echinococcus granulosus

Echinococcus granulosus

Encysted scolices of Echinococcus granulosus

in lung "hydatid sand"

Echinococcus granulosus

Encysted scolices of Echinococcus granulosus

in lung "hydatid sand"

Echinococcus granulosus

Encysted scolices of Echinococcus granulosus

in lung "hydatid sand"

Echinococcus granulosus
Diagnosis
Radiographic findings
Immunodiagnosis
Antibody detection
IHA
IFA
EIA

Antigen detection

Echinococcus granulosus
Treatment
Surgical resection: not 100% effective
Solicidal agent
Hibitane
95% ethanol
Hypertonic 30% Normal Saline Solution

PAIR technique for inoperable cyst

Puncture, Aspiration, Injection, Reaspiration
Intervention
Albendazole

Hymenolepis species
Genus is derived from the membranous
character of the egg shell hymen
3 testes in each mature segment
Uterus is sac-like and transverse
Eggs possess two membranes outer
membrane is thin and transparent

larval stage is called cysticercoid

Small bladder containing the invaginated
head proximally and a solid, elongted
portion as a caudal appendage
There are 2 species;
Hymenolepis nana
Hymenolepis diminuta

Hymenolepis nana
Dwarf Tapeworm
Smallest tapeworm infecting man
Found worldwide
Mainly among children
Only human tapeworm that can complete its life
cycle in a single host
Man can harbor both the adult and larval stages
of the parasite
Exception to the general rule that
Helminths do not multiply inside the body of
the definitive host

Hymenolepis nana
Adult
Found in the ileum
Delicate strobila
25 mm to 45 mm
Worms may be present in
large numbers from 1,000
to 8,000
Short life span, about 2
weeks
Up to 200 proglottids
Transverse uterus
3 testes

Hymenolepis nana
Scolex
Subglobular
4 suckers
Provided with a
short retractile
rostellum armed
with a single row of
20-30 hooklets
Rostellar hooklets
are shaped like
tuning forks

Hymenolepis nana
Ova

Spherical or
oval
Floats in
saturated
solutions
of
common
salt

2 distinct membranes
Outer membrane is thin
transparent and colorless
Inner embryophore that encloses
an oncosphere with 3 pairs of
lancet shaped hooklets
Intermembranous space is filled
with yolk granules and 4-8 polar
filaments emating from little
knobs at either end of the
embryophore

Hymenolepis nana

Hymenolepis nana
Mode of transmission is thru
Direct
Host ingests eggs that hatches in the duodenum

Indirect pathway
Accidental ingestion of infected arthropod
intermediate host like rice and flour beetles in
which cysticercoid are released and develop into
adult worms in the small intestine of the host

Hymenolepis nana
Pathogenesis
Symptoms are produced due to patients immunological
response to the parasite
Asymptomatic for light worm burden
Headache
Dizziness
Anorexia
Pruritus of the nose and anus
Abdominal pain
Pallor
Desquamation of intestinal epithelial cell or as serious as
necrosis may occur

Regulatory immunity will eventually limit the

infection

Hymenolepis nana
Diagnosis
Demonstration of characteristic ova in the stool
Proglottids are not recovered because they
undergo degeneration prior to passage

Treatment
Praziquantel
25mg/kg single dose
Drug dosage is higher than that of taeniasis
because of resistant cysticercoids in intestinal
tissue

Hymenolepis nana
Epidemiology
Countries with warm temperature
Southern USA
Latin America
Mediterranean
East Asia
Philippines

Hymenolepis diminuta
Rat tapeworm
Common parasite of rats and mice
Accidental human infections
Differs from Hymenolepis nana in morphology
and life cycle because it requires an
intermediate host
2 Hosts
Larval stage: cysticercoid is passed in fleas
Adult stage: in rats and mice and accidentally in humans
especially children who accidentally ingest infected fleas

Hymenolepis diminuta
Adult
Larger than
Hymenolepis nana
Measures 60 cm in
length

Hymenolepis diminuta
Scolex
Unarmed
rostellum
4 suckers

Hymenolepis diminuta

Hymenolepis diminuta
Proglottid
800 1,000
Mature
proglottids of
Hymenolepis
diminuta from
the laboratory
rat.

The three spherical bodies are testes

which surround the ovaries, ootype and
vitelline glands. The genital pores are on
the left margin

Hymenolepis diminuta
Ova
Larger than H.
nana
Outer shell is
yellowish in color
Inner
embryohore has
2 knob-like
thickenings
No polar
filaments

Hymenolepis diminuta
cysticercoid of Hymenolepis
diminuta.
The suffix indicates it is like a
cysticercus but this larva has
no bladder but instead has a
tail.
The dark body within the
spherical portion is the scolex.
The longer the tail, the more
mature the cysticercoid.
This stage is found inside an
insect such as the mealworm,

Hymenolepis diminuta

Hymenolepis diminuta
Pathogenesis
Hymenolepiasis
Worm burden in rodents is relatively
low
In man, highest worm burden is 19
Clinical manifestations are minimal
and non-specific

Hymenolepis diminuta
Treatment
Praziquantel
25mg/kg body weight single dose
Epidemiology
World wide
Common among children due to ingestion of
infected grain beetles, dried fruits, flour and
cereals
Prevalence of H. diminuta in Philippine rats is
about 8%

Dipylidium caninum
Double Pored Dog Tapeworm
Presence of bilateral genital pores in each
segment (di: 2; pylis: gate): 2 entrances
Common intestinal parasite of dogs

Dipylidium caninum

Adult
10-70 cm in
length
Pale reddish

Dipylidium caninum
Scolex
Small and globular
4 deeply cupped
elliptical suckers
Protrusible/retractile
rostellum
Rostellum has 1-7 rows
of rose thorn shaped
hooklets

Dipylidium caninum

Dipylidium caninum

Strobila
200
proglottids
Narrow
Vase shape

Dipylidium caninum
Mature
proglottids
2 sets of male
and female
reproductive
organs
Bilatera
genital pores

Dipylidium caninum
Gravid
proglottids
Have size and
shape of
pumpkin seeds
Filled with
capsules or
packets of 8-15
eggs enclosed n
an embryonic
membrane

Dipylidium caninum

Proglottids

Dipylidium caninum

Dipylidium caninum
Ova

Passed out in the feces

along with the proglottids
Released by contraction
of proglottids or
disintegration outside the
host
Spherical
Thin shelled
With a hexacanth embryo

Dipylidium caninum
Intermediate hosts
Ctenocephalides canis : dog flea
Ctenocephalides felis : cat flea
Pulex irritans : human flea
Trichoedectes canis : dog flea

Dipylidium caninum
Pathogenesis
Dipylidiasis
Rarely multiple
Symptoms are minimal
Slight intestinal discomfort
Epigastric pain
Diarrhea
Anal pruritus
Allergic reactions

Dipylidium caninum
Treatment
Praziquantel
5-10 mg/kg body weight single dose
Epidemiology
USA
Rhodesia
Argentina
China
Philippines

Dipylidium caninum