Lecture 7

Ass. Lecturer Israa Al.

Yasiri
CESTODES (TAPE WORMS):
Clinically important cestodes pathogenic to man are Tenia solium (pork
tapeworm), T. saginata (beef tapeworm), Diphyllobothrium lattum (fish or
broad tapeworm), Hymenolepis nana (dwarf tapeworm) and Echinococcus
granulosus and E. multilocularis (hydatid).

Tenia solium or T. saginata (Teniasis):

Epidemiology: Worldwide distribution, higher in developing countries: as
low as 1/1000 in most North America and as high as 10% in the 3rd world.
Pork tapeworm incidence higher, depending on dietary habits.
Morphology: T. saginata: 4-6 meters long and 12 mm broad; pear-shaped
(head) scolex with four suckers but no hooks, neck, and long flat body with
several hundred segments (proglottids), 18x6 mm each with branched uterus
(15-30 branches). Roundish 35x45 yellow-brown egg has peripheral radial
striations and contains an embryo with 3 hooklets.
T. solium: Slightly smaller than T. saginata; globular scolex with four
suckers and a circular row of hooks (rostellum) that gives it a solar
appearance; neck, long flat body (0.1 meter); proglottids 5x10 mm with 7-12
branch uterus. Eggs are not distinguishable.

Lecture 7

Ass. Lecturer Israa Al.

Yasiri
Life cycle: Tapeworm larval cyst (cysticercus) is ingested with poorly
cooked infected meat, the larva escapes the cyst and passes to the small
intestine where it attaches to the mucosa by the scolex suckers. The
proglottids develop as the worm matures in 3-4 months. The adult may live
in the small intestine as long as 25 years and pass gravid proglottids with
feces. Eggs extruded from the proglottid contaminate and persist on
vegetation for several days and are consumed by cattle or pigs in which they
hatch and form cysticerci.
Symptoms: Light infections remain asymptomatic, but heavier infections
may produce abdominal discomfort, epigastric pain, vomiting and diarrhea.
Cysticercosis: T. solium eggs can also infect humans and cause cysticercosis
(larval cysts in lung, liver, eye and brain) resulting in blindness and
neurological disorders. The incidence of cerebral cysticercosis can be as
high 1/1000 and may account for up to 20% of neurological case in some
countries (e.g., Mexico); ocular cysticercosis is 2.5% and muscular
involvement is as high as 10% (India).
Pathology and Immunology: Gastrointestinal symptoms are due to the
presence of the tape worm. Cysticercosis symptoms are a result of
inflammatory/immune responses. Antibodies are produced in cysticercosis
and are useful epidemiological tools.
Diagnosis: Diagnosis is based on the recovery of eggs or proglottids in stool
or from the perianal area. Cysticercosis is confirmed by the presence of
antibodies.

Lecture 7

Ass. Lecturer Israa Al.

Yasiri
Treatment and control: Praziquantel is the drug of choice. Expulsion of
scolex must be assured to assume a satisfactory treatment. A thorough
inspection of beef and pork, adequate cooking or freezing of meat are
effective precautions, since cysticerci do not survive temperatures below
-10o C and above 50o C.

Diphyllobothrium latum (fish or broad tapeworm)

Epidemiology: The infection is distributed worldwide, in the subarctic and
temperate regions; associated with eating of raw or improperly cooked fresh
water fish.
Morphology: It is the longest tapeworm of man, ranging from 3-10 meters
with more than 3000 proglottids. The scolex resembles two almond-shaped
leaves and the proglottids are more broad than long, a morphology reflected
by the tape=s name. Eggs are 30x50 in size and contain an embryo with 3
pairs of hooklets.
Life cycle: Man and other animals are infected by eating uncooked fish that
contains plerocercoid larvae (15x2 mm) which attach to small intestinal wall
and mature into adult worms in 3-5 weeks. Eggs discharged from gravid
proglottids in the small intestine are passed in the feces. The egg hatches in
fresh water to produce a ciliated coracidium which needs to be ingested by a
water flea (Cyclops) where it develops into a procercoid larva. When
infected Cyclops are ingested by the freshwater fish, the procercoid larva

Lecture 7

Ass. Lecturer Israa Al.

Yasiri
penetrates the intestinal wall and develops into plerocercoid larva, infectious
to man.
Symptoms: Clinical symptoms may be mild, depending on the number of
worms. They include abdominal discomfort, loss of weight, loss of appetite
and some malnutrition. Anemia and neurological problems associated with
vitamin B12 deficiency are seen in heavily infected individuals.
Diagnosis: Diagnosis is based on finding many typical eggs and empty
proglottids in feces. History of raw fish consumption and residence in
endemic locality is helpful.
Treatment and control: Praziquantel is the drug of choice. Freezing for 24
hours, thorough cooking or pickling of fish kills the larvae. Fish reservoirs
should be kept free of raw sewage.
Hymenolepis nana (dwarf tapeworm)
This is a small tapeworm (20 x 0.7 mm) which infects children. Rodents are
the reservoir. Infection is by the oro-fecal mode, and hence cross infection
and auto infection by eggs in feces in normal. The worm develops into adult,
from ingested eggs, in the small intestine and resides there for several
weeks. Light infections produce vague abdominal disturbances but heavier
infections may cause enteritis. Diagnosis is based on finding eggs in the
feces. Nicolsamide is the drug of choice. Hygiene is the best control.
Echinococcosis (hydatid)

Lecture 7

Ass. Lecturer Israa Al.

Yasiri
Echinococcus granulosus and E. multilocularis are causative agents of
hydatid cysts.

Echinococcus granulosus
Epidemiology: The organism is common in Asia, Australia, Eastern Africa,
southern Spain, southern parts of South America and northern parts of North
America. The incidence of human infection about 1-2/1000 and may be
higher in rural areas of affected regions.
Morphology: This is the smallest of all tapeworms (3-9 mm long) with only
3 proglottids.
Life cycle: The adult worm lives in domestic and wild carnivorous animals.
Eggs, passed by infected animals, are ingested by the grazing farm animals
or man, localize in different organs and develop into hydatid cysts
containing many larvae (proto-scolices or hydatid sand). When other
animals consume infected organs of these animals, proto-scolices escape the
cyst, enter the small intestine and develop into adult worms. Echinococcus
eggs, when swallowed by man, produce embryos that penetrate small
intestine, enter circulation and form cysts in liver, lung, bones, and
sometimes, brain. The cyst is round and measures 1-7 cm. in diameter,
although it may grow to be 30 cm. The cyst consists of an outer anuclear
hyaline cuticula, an inner nucleated germinal layer containing clear yellow

Lecture 7

Ass. Lecturer Israa Al.

Yasiri
fluid. Attached to the germinal layer, there are daughter cysts although some
cysts, known as brood cysts, may only have hydatid sand. Man is a dead end
host.

Symptoms: The symptoms, comparable to those of a slowly growing tumor,

depend upon the location of the cyst. Abdominal cysts, when large produce
increasing discomfort. Liver cysts cause obstructive jaundice. Peribronchial
cysts may produce pulmonary abscess. Brain cysts produce intracranial
pressure and Jacksonian epilepsy. Kidney cysts cause renal dysfunction.
Contents of cyst produce anaphylactic responses.
Diagnosis: Clinical symptoms of a slow-growing tumor accompanied by
eosinophilia are suggestive. Intradermal (Casoni) test with hydatid fluid is
useful. Pulmonary cysts and calcified cysts can be visualized by x-ray.
Antibodies against hydatid fluid antigens have been detected in a sizable
population of infected individuals by ELISA or indirect hemagglutination
test.
Treatment and control: Treatment involves surgical removal of cyst or
inactivation of hydatid sand by injecting the cyst with 10% formalin and its
removal within 5 minutes. High dose of Mebendazole have claimed some
success. Preventive measure involve avoiding contact with infected dogs and
cats and elimination of their infection.

Lecture 7

Ass. Lecturer Israa Al.

Yasiri

The adult Echinococcus granulosus (3 to 6 mm long) (1) resides in the small bowel of the definitive hosts, dogs or
other canids. Gravid proglottids release eggs (2) that are passed in the feces. After ingestion by a suitable intermediate
host (under natural conditions: sheep, goat, swine, cattle, horses, camel), the egg hatches in the small bowel and
releases an oncosphere (3) that penetrates the intestinal wall and migrates through the circulatory system into various
organs, especially the liver and lungs. Inthese organs, the oncosphere develops into a cyst (4) that enlarges gradually,
producing protoscolices and daughter cysts that fill the cyst interior. The definitive host becomes infected by ingesting
the cyst-containing organs of the infected intermediate host. After ingestion, the protoscolices (5) evaginate, attach to
the intestinal mucosa (6), and develop into adult stages (1) 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. With E. vogeli (up to 5.6 mm long), the definitive
hosts are bush dogs and dogs; the intermediate hosts are rodents; and the larval stage (in the liver, lungs and other
organs) develops both externally and internally, resulting in multiple vesicles. E. oligarthrus (up to 2.9 mm long) has a
life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by
ingesting eggs (2), with resulting release of oncospheres (3) in the intestine and the development of cysts (4) in various
organs .