INTRODUCTION TO CESTODES (PSEUDOPHYLLIDEAN)

Classification of Parasites
 Platyhelminths/flat worms is under the metazoa and
trematodes and cestodes belongs to the
platyhelminths/flat worms. Cestodes are also known
as tapeworms.
 Members of phylum platyhelminths in general are
dorso-ventrally flattened with bilateral symmetry.
 The cestodes are segmented with a ribbon-like
appearance while the trematodes are leaf-like
and unsegmented.
 Cestodes are not provided with a digestive tract
while trematodes have an incomplete one. Both
cestodes and trematodes do not have a
circulatory system.

Cestodes (Tapeworms) General Characteristics

 Exclusively parasitic
 Adult worms are flattened, segmented with ribbon-like body that inhabit the small
intestine, where they live attached to the mucosa.
 Do not have digestive system
 Obtain their nutrition by direct absorption across their teguments.
o The tegument is the body surface of the adult tapeworm (the surface structure layer
of the cell) from the host’s intestine
 Sexual organs are highly elaborated and complicated sexes combined in a single
parasite- hermaphroditic (both sex in one organ).
 Adult tapeworms are hermaphroditic and they are found in the intestines of the definitive host and the larval stage is encysted in the
tissues of the intermediate host. They are provided with an interior structure called scolex, which is the main organ of attachment of
the worm to the definitive host.
 Sexual reproduction occurs by either self-fertilization or by cross-fertilization between the proglottids
 Wide range of the pH (4-11)
 Portal of entry: mouth
 The disease produced is due to the fact that tapeworms absorb significant quantities of nutrients and
vitamins, excrete toxic wastes, and interfere with the normal passage of food through the intestine.
 The neck is considered as the region of growth because from it will start segmentation or stabilization.
 The segments/proglottids are the proglottids that are near the neck are immature and the most distal from the neck are the gravid
segment.

Morphology
 Scolex- main organ of attachment of the worm to the definitive host
 Neck- constricted area; where the organ for growth from which proglottids proliferate
 Proglottids/Strobila
o Strobila: Chain of segments
o Proglottids: segments ( mmature/mature/gravid)
o The strobila grows throughout the life of the tapeworm by continuous proliferation of new proglottids in the neck region
o Sexually complete unit; is thin, resembling a strip of tape (tapeworm)
o Number of strobila varies with: Size of worm, age of host, host-parasite compatibility, harmful effects on the
host
o Conditions that cause avulsion of the strobila: Increased peristalsis, Starvation, Intoxication
A. Immature Proglottids
 Immature proglottids continue to grow from the neck area and push older maturing proglottids downwards
 Do not contain fully developed internal structures
B. Mature Proglottids
 Are larger and found near the middle of the chain
 Each may contain one or two sets of both male & female reproductive organs
 Female reproductive organs: Two large ovaries, median-lobed uterus, vagina has a sphincter
 Male reproductive organs: Follicular testes contain 300-400
C. Gravid Proglottids
 Terminal portion of the strobila that is usually filled with eggs
  Eggs are enclosed in the uterus
 Gravid proglottid of some specie may become detached in the intestine and pass out in the feces; but some
maybe too small to be seen in gross examination
 After leaving the host, the proglottids rupture and eggs are released.
 Proglottids are longer than they are wide
 Uterus is distended with ova and has 15-21 lateral branches
 Genital pores of Taenia saginata are irregularly shaped.
 Precise identification of the tapeworm is usually made on the basis of eggs or proglottids, the scolex of each
specie is quite characteristic and is sufficient for specific diagnosis
 Pathogenicity is attributed to: Mechanical obstruction, Tissue margination, Pyogenic actions/inflammatory
reaction, and toxic action

Cyclophyllidean Tapeworms
 Scolex
o Transversely quadrate/globular
o 4 cup-like muscular suckers w/ rostellum (spine/hooks)
 Eggs
o Have a very thick, resistant egg shell, with no operculum
o Spherical, mature, and embryonated when laid
o The Cyclophyllidean eggs are released only when the tapeworms shed gravid proglottids into the
intestine
o Some proglottids disintegrate, releasing eggs that are voided in the feces, whereas other proglottids
are passed intact
 Embryo of Cyclophyllidean
o Hexacanth embryo / Oncosphere / 6-hooked embryo (3 pairs of hooklets, - non-ciliated)
 Larva
 Taenia solium Cysticercus cellulosa  Dipylidium caninum Cysticercus larva
 Taenia saginata Cysticercus bovis  Echinococcus granulosus Hydatid cyst
 Hymenolepis nana/diminuta Cysticercus larva
 Host- one intermediate host; one definitive host

Phylum-Platyhelminths (Flatworms) General Characteristics:

 Platyhelminthes are generally dorso-ventrally flattened with bilateral symmetry
o Trematodes: leaf-like and unsegmented with incomplete digestive tract
o Cestodes: ribbon-like and segmented without a digestive tract (no gut, no mouth, no anus)
 These worms parasitize the digestive tracts and associated ducts of all classes of vertebrates

Cestodes [Flatworms-Tapeworms]:
 They are exclusively parasitic
 Adult tapeworms are hermaphroditic covered with non-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 (only tapeworms) and no circulatory system
 Body in most species divide transversely into proglottids
 Tapeworm Features:
o 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).
o The entire chain of proglottids is strobila
o Species-differentiating characteristics are mainly based on these features
 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.
 Two groups of tapeworms that infect humans:
1. Pseudophyllidean tapeworms (e.g. Diphyllobothrium latum)
2. Cyclophyllidean tapeworms (e.g. Taenia sp., Hymenolepis, Echinococcus)

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).
o The cysticercus is the encysted form of Taenia species
o 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 in aquatic intermediate hosts. A
similar assumption can be made for terrestrial hosts.
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. It 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 parasite's first intermediate host.
D. The larval Cyclophyllidean, as with the pseudophyllidean, is equipped with 3 pairs of hooks. Both groups use these hooks to penetrate
the gut wall of its intermediate host after being ingested, before developing into other larval forms.

Morphology
 The body of the typical cestode consists of three distinct regions: (a) scolex (b) neck (c) strobila made up of proglottids
 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 glandular areas.
 Strobila
o As new proglottids are formed from the neck region, they push the older ones progressively posterior, creating a chain
of proglottids- the strobila.
o The asexual process of forming segments is termed strobilation.
o As each proglottid is shifted posterior, its sexual reproductive system matures progressively.
o The reproductive organs in immature proglottids are visible but nonfunctional, while those of mature proglottids are fully functional.
o At the posterior end of the strobila are the gravid (egg-filled) proglottids. Often the reproductive organs in gravid proglottids atrophy.
o 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).
 Scolex
o The scolex is followed by a germinative portion or “neck” and segments at successively later stages of development.
o The scolex structure varies between species of tapeworms.
 Diphyllobothrium latum has a scolex with elongated, slit-like attachment organs.
 Taenia saginata has four muscular suckers.
 Taenia solium has similar muscular suckers and a rostellum with rows of chitinous hooks
 Adult cestodes are typically long, multisegmented flatworms that lack a digestive tract and absorb nutrients directly
from the host's small bowel.
 Tapeworms have 3 recognizable portions:
o The scolex (head) functions as an anchoring organ that attaches to intestinal mucosa.
o The neck is an unsegmented region of high regenerative capacity. If treatment fails to eliminate the neck and scolex, the entire worm
may regenerate.
o 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.

Life Cycle
 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.
o Cestode eggs consist of hexacanth embryos whose oncosphere (motile; first larvae characterized by the presence of 6 hooklets
arranged in pairs) are responsible for piercing the intestines of definitive host
 With some cestode species (e.g., T. solium), the definitive host can also serve as an intermediate host and develop tissue cysts instead
of intestinal worms if eggs are ingested.
Signs & Symptoms
 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, causing serious damage.
 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 Echinococcus 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 & Prevention

 Praziquantel and Niclosamide
 N.B Some extraintestinal infections respond to anthelmintic treatment, whereas others require surgical intervention.

Prevention & Control

 Thorough cooking (to temperature > 57°C [> 135°F]) of pork, beef, lamb, game meat, and fish;
 Regular deworming 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

Pseudophyllidean Tapeworms
 Scolex- narrow, spoon-shaped (spatulate), elongated 2 sucking grooves (bothria)
 Proglottids
o Have genital pores and an additional uterine pore that allows the release of eggs from the gravid uterus
o May not be recovered from clinical specimen and generally require two intermediate hosts in their life cycle
 Female Reproductive System
o Ov (Ovary)- central, bilobed in D. latum. o Oo (Ootype)
o Ut (Uterus)
 Mature uterus- Coiled tube opening on surface via the uterine pore
 Gravid uterus- filled with eggs
o Ut p. (Uterine pore)- located at center of proglottids on ventral surface
o V (Vagina)- a long straight tube
o Vt - Vitelline glands/ vitellaria
 Secreting substances that will make up the egg yolk and shell
 Numerous, small scattered laterally (D. latum)
o Vt d. (Vitelline duct)- connecting the vitelline gland
o M (The Mehlis gland)- A cluster of unicellular shell glands, absent in some species
 Male Reproductive System
o T (Testes): dorso-lateral, numerous (500 or more) and small, arranged on the lateral margins
o V (Vas deferens)
o C (Cirrus): a protrusible muscular organ, opening anterior to the vagina in a common genital atrium
o Other Features
 G A (Genital Atrium/Pore): a cup shaped sinus, where the cirrus and vagina have common openings- located at the center of
segment
 L E C- Lateral Excretory Canal
 Eggs
o Ovoidal, immature, non-embryonated with a thin shell wall, and an operculum, which on hatching opens to release the free swimming
larvae
o Require an aquatic development of the embryo
o Eggs exit through a uterine pore in the center of the ventral surface rather than through a genital atrium
o Coracidium- ciliated first stage aquatic embryo of pseudophyllidea and other cestodes with an aquatic cycle
o Embryo of Pseudophyllidean: Coracidium (ciliated)
o Larva: Procercoid (1st Intermediate Host); Plerocercoid (2nd Intermediate Host)
o Host: 2 intermediate hosts and 1 definitive host (human)
Diphyllobothrium latum (Common name: Fish Tapeworm/Broad Tapeworm/Broad Fish Tapeworm)
A. General Characteristics
 One of the 13 species of Diphyllobothrium that infects human.
 Intestinal infection with the adult worm: Diphyllobothriasis
 Longest human tapeworm, averaging 10 meters long
 Adults can shed up to a million eggs a day
 Geographical Distribution:
o Worldwide
o Occurring in northern temperate areas of the world where pickled or insufficiently cooked fresh-water fish are prominent in the diet
o High prevalence in Scandinavia, Finland, Alaska and Canada
o Many recent cases in South-East Asia and South America
B. Stages
 Adult worm
o Measures 3-10 meters or more (ave. 10 meters) and may have as many as 4,000 proglottids
o Longest human tapeworm
 Scolex
o Elongate, spoon-shaped (spatulate) and measures 2 to 3 mm in length by 1 mm in diameter
o The anterior organ of attachment is a bothria, a pair of shallow, elongated muscular sucking grooves. The bothria
are located dorsally and ventrally
o The neck is long and attenuated, and is followed by immature proglottids
 Proglottids
o Immature segments
o Mature (Gravid) segments
 The terminal four-fifths of the worm is composed of mature and gravid proglottids.
 Wider than long; it measures 2-4 mm in length by 10-12 mm in width and contains one set of reproductive organs
 Testes are found in the dorsolateral part of the proglottid
 The vas efferens converge to form a vas deferens and enlarge into a seminal vesicle and terminates in a muscular cirrus found
at the mid-ventral common genital pore
 The dark, rosette-like, coiled uterus located in the middle of the gravid proglottid extends from the ootype and opens through a
uterine pore in the midventral line behind the common genital pore.
 A symmetrical bilobed ovary is present at the posterior third of the proglottid immediately above the Mehlis’ gland.
 From the common genital pore, the vagina extends up to join the oviduct and the vitelline duct.
 Numerous testes and vitellaria arranged on the lateral margins with a central bilobed ovary.
 Unlike the Taeniidae, the proglottids of D. latum disintegrate only when the segment has completed its reproductive
function.
o Gravid segments
 Wider than long
 Uterus is a coiled tube confined to a relatively small area in the center of the segment likened to a “rosette formation”
 An important difference between this parasite and the other tapeworms of man is that the uterus open to the exterior via the
uterine pore (Cyclophyllidean tapeworms have closed uterus)
 Eggs are therefore actively deposited by the parasite, in contrast to the disintegration of the proglottids seen in the other human
tapeworms
 Egg
o 58 to 76 μm L x 40 to 51 μm W
o Shell is ovoid or ellipsoidal, smooth, and of moderate thickness; it appears yellowish brown
o Possess an operculum at one end for the escape of the larva
o At the opposite (abopercular) end is a small knob that can be barely discernible
o Immature, unembryonated, operculated eggs are discharged from the proglottids (up to 1,000,000 eggs per day per worm) and
are passed in the feces
o Eggs mature in 18-20 days. Eggs appear in the feces 5 to 6 weeks after infection
o The egg ova/embryo is termed as coracidium and it is usually yellowish brown, with a moderately thick shell and an inconspicuous
operculum.
 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.
 Coracidium (embryo)
o Emerging from the eggs, is internally similar to the hexacanth larva of the Cyclophyllideans, being equipped with 6 hooks, but
this hexacanth larvae are covered in a ciliated embryophore
o A free swimming stage, but cannot survive long, so for further development, it must be ingested by 1st intermediate host
 Procercoid larva
o 1st larval stage developing from the hexacanth larva appearing as solid bodies with the remains of the embryonic hooks from the
oncosphere larvae at the posterior of the parasite
o Found in the 1st intermediate host
  Plerocercoid larva (sparganum)
o 2nd larval stage developing from the procercoid larva which has lost the hooks, the body is elongated, wormlike with an anterior
invagination
o Found in the 2nd intermediate host and is the infective stage for humans
C. Life Cycle
 The life cycle requires 2 intermediate host:
o 1st intermediate host: copepods (fresh-water crustaceans)
o 2nd intermediate host: fish, snakes, toads
 Definitive host: In addition to humans, canids, felines, bears, and many other
mammals can also serve as definitive hosts for D. latum
1. Immature eggs are passed in feces in freshwater
2. Under appropriate conditions, the eggs mature in 18-20 days and yield oncospheres
which develop into the coricidia.
3. The coricidia is ingested by copepods
4. In the first intermediate host, the coricidia develop into procercoid larvae
5. Infective copepods are ingested by fish and procercoid penetrate the fish’s muscles. The parasite develops into the plerocercoid larva
(infective stage for humans)
6. Humans acquire the disease by eating infected fish, raw or undercooked. Plerocercoid larvae develop into immature adult
tapeworms then into mature adult tapeworms which reside in the small intestine
7. Adult worms attach to the intestinal mucosa by means of two bilateral grooves (Bothria of scolex)
8. Immature eggs (up to 1,000,000/day per worm) are discharged from the proglottids
9. Eggs are passed in the feces 5-6 weeks after infection.
D. Pathogenesis and Clinical Manifestations (Diphyllobothriasis)
 Infection is relatively harmless and asymptomatic
 Symptoms: non-specific abdominal signs, including abdominal pain and loss of weight
 D. latum absorbs much more vitamin B12, (10-50x more) from the host’s intestinal tract than other tapeworms and interferes with
the patient’s ability to absorb vitamin B12 (vit B12 having an important role in formation of RBC)
 Infection may therefore result in pernicious anemia (a macrocytic, hypochromic anemia)
 Infections are usually limited to one worm, although there have been reports of mechanical obstruction due to a large number of
worms.
 Infected individuals may show no signs of disease. Some, however, may experience nervous disturbances, digestive disorders,
abdominal discomfort, weight loss, weakness, and anemia.
 Infection results in hyperchromic, megaloblastic anemia with thrombocytopenia and leukopenia. Anemia seen in
diphyllobothriasis is typically similar to that seen in Vitamin B12 deficiency and could be mistaken for pernicious anemia.
 Worms located high up in the jejunum compete effectively with the host for the Vitamin B12 in the diet.
 The vitamin B12 content of D. latum is approximately 50 times that of T. saginata.
 Symptoms depends on the:
1. Mass of the worm, 3. The host’s susceptibility to the foreign substances.
2. Amount of its by-products absorbed by the host,
 Some infected people show no symptoms
 Main symptoms: (due to absorbed toxins or mucosal irritation) intestinal obstruction, diarrhea, abdominal pain, anemia
E. Diagnosis
 Definite diagnosis is made on finding the characteristic operculated eggs or on occasion, proglottids in stools.
 Sometimes, proglottids may be vomited. Proglottids are often passed in chains of a few cm or longer.
 Rosette-shaped uterus in the proglottid morphology confirms the species
 Since eggs are usually numerous, direct fecal smears are sufficient
 Kato Technique is useful to distinguish between Diphyllobothriasis and Pernicious Anemia
 To differentiate anemia due to diphyllobothriasis from pernicious anemia:
o Examination of gastric juices for the presence of hydrochloric acid
o Pernicious anemia is associated with achlorhydria
F. Treatment
 Praziquantel (Drug of Choice): 5-10mg/kg single dose (95% cure rate), Niclosamide
 Criteria for cure:
o Recovery of the scolex in feces after treatment
o Negative stool examination 3 months after treatment
G. Prevention and Control
 Proper disposal of human feces  Thoroughly cooking freshwater fish
 Fish should be thoroughly cooked or frozen at -10°C for  Freezing at -18°C for 24-48 hours kills all plerocercoids
24-48 hours
 In endemic areas, prevention should center on:
o Controlling the source of infection o Proper marketing of fish
o Proper disposal of sewage
Related Species
 Diphyllobothrium pacificum
o Found in the coastal areas of Peru is the most common tapeworm infecting humans
o It is a natural parasite of seals which acquire infection by eating fish
o Ceviche- a delicacy in Peru and other Latin American countries using fish marinated in lime juice but not cooked
 Diplogonoporus
o Related genus of tapeworms common in Japan, where it is probably acquired by consumption of raw anchovies or sardines

Spirometra spp.
A. General Characteristics
 Sparganosis- larval infection with the plerocercoid larvae (spargana) of pseudophyllidean tapeworms falling under the genus.
 There are many species of Spirometra but those involved in humans are: Spirometra mansoni, Spirometra erinacei, S. ranarum.
Adults of these worms are intestinal parasites of cats, dogs, and other carnivores.
 Its eggs embryonate in water and humans serve as intermediate hosts
B. Stages
 Gravid proglottids- have a spiral uterus compared to that of the fish tapeworm
 Eggs- operculated and immature, morphologically similar, but smaller compared to that of the fish
tapeworm.
o Eggs are passed out with the feces of the definitive host and become embryonated in water.
C. Life Cycle
1. Spirometra eggs are passed out in feces unembryonated
2. Eggs are embryonated in water.
3. Coracidia infect cyclops and develop into the procercoid larva
4. Secondary Intermediate Host(s) (frogs, snakes, chickens) consume cyclops, procercoid
larva→ plerocercoid larva/sparganum
5. In the definitive host, plerocercoid larva develops into the adult worm (which are often
mistaken for adult Diphyllobothrium latum; Spirometra spp. are shorter)
D. Pathogenesis and Clinical Manifestations
 Mode of Transmission
o Drinking water contaminated with cyclops or copepod infected with procercoid larvae.
o Eating infected 2nd intermediate hosts such as frogs, toads or snakes containing the plerocercoid larvae
o Applying plerocercoid-infected flesh of frogs and snakes as poultices on sores on the eye, vagina, and skin, resulting in subsequent
penetration into cutaneous tissues.
o Consumption of infected flesh of paratenic hosts like wild pigs.
 Condition: Sparganosis (also known as migrating tumor)
 Larvae may be found in any part of the body
 Common sites: eyes, subcutaneous, and muscular tissues of the thorax, abdomen, thighs, and inguinal region, and in the viscera
 Complain/Symptoms: Painful edema due to migrating of larvae (migrating tumor), local indurations, periodic giant urticaria, edema,
erythema, chills & fever, and high eosinophilia
E. Diagnosis
 Diagnosed through the recovery of plerocercoid larvae from the infected tissues.
 Larvae-opaque, glistening white (measure 3.5cm in length)
 If larvae is flattened, a spatulate scolex, with pseudosegmentation, and a slit like invagination at the interior end.
 Species identification can only be done through experimental animal infection
 Multi-Dot ELISA on the serum and CSF
F. Treatment
 Main form: Surgical removal of the larvae from infected tissues
 Possible drug: Praziquantel 5-10mg/kg single dose (efficacy in humans is not yet documented)
 Criteria for cure:
o Recovery of scolex in the feces after treatment
o Negative stool examinations 3 months after treatment