Pathogenesis

Cestodes Taeniasis
Usually asymptomatic, or have mild indigestion, vomiting, loss of appetite,
abdominal pain/discomfort
Pruritis ani is caused by proglottids crawling to the anal folds
Seeing proglottids in perianal area or undergarments can cause stress
Tapeworms or anxiety
Monoecious Entangled proglottids can cause intestinal, and bile and pancreatic duct
Platyhelminths obstruction
No mouth and GI tract Diagnosis
Gains nutrients through diffusion Diagnosis is based on identifying proglottids, eggs, or scolex either in stool or
Inhabits small intestine undergarments
Cyclophyllidea (True tapeworms) First specimen is usually gravid proglottids
Able to detach proglottids (apolytic) India ink is used to count lateral branches of uterus
Eggs are non-operculated and embryonated Concentration techniques for eggs in stool
Genital pore instead of uterine pore Perianal swabs for eggs
Only 1 larval stage, depending on spp Treatment
Only Taenia saginata has no rostellum Drug of choice is praziquantel
Taenia saginata Not necessary to recover scolex unless if species identification is required
Beef tapeworm Taenia solium
Intermediate hosts: cattle Pork tapeworm
Final hosts: Humans Intermediate hosts: Pigs and humans
Inhabits the small intestine (upper jejunum) Final hosts: Humans
Infective stage: cysticercus bovis in undercooked beef Inhabits the upper small intestine
Diagnostic stage: Eggs or proglottids in stool/perianal area/undergarment Infective stage: cysticercus cellulosae in undercooked pork or embryonated eggs from
MOT infected food/drinks
Ingestion of cysticercus bovis from undercooked beef Diagnostic stage: Eggs or proglottids in stool/perianal area/undergarment
Morphology MOT
Adults Ingestion of cysticercus cellulosae from undercooked pork (measly pork)
Have a cubital scolex with four prominent acetabula; no rostellum/hooks Ingestion of embryonated eggs from contaminated food or drink
Proglottids arise from the neck Morphology
Mature proglottids are square shaped Adults
Bilobed ovary, and a club shaped uterus Shorter than saginata
Has a sphincter in its vagina Has a scolex that carries a cushion-like rostellum with a double crown row
Gravid proglottids are longer than wider of hooks; has 4 acetabula that are smaller and more spherical in shape
Has 15-20 treelike uterine branches Proglottids arise from the neck
Irregularly alternated genital pores Presence of accessory ovarian lobe plus bilobed ovary (trilobed)
Actively motile Absence of vaginal sphincters
Ova are Indistinguishable from solium Less active than saginata, and does not actively crawl about
Striated, spherical, and brown collored Gravid proglattids
Oncosphere has 6 hooklets inside Wider than they are tall
Outer membrane may be lost upon passage from proglottid Only the uterus can be seen
Cysticercus bovis has 5-13 fingerlike uterine branches
Ovoidal, milky white, and scolex is invaginated inside Ova are indistinguishable with saginata
scolex evaginates upon entering humans (no saginata that causes Life Cycle
cysticercosis in humans); only found in cattle Pigs ingest embryonated eggs or gravid proglottids
Life Cycle Oncosphere is released and penetrates the intestinal mucosa, and can be
Cattle ingest embryonated eggs or gravid proglattids commonly found in the muscles, tongue, heart, diaphragm, spleen and mesentery
Oncosphere is released and penetrates the intestinal mucosa, and enters a muscle Measly pork is ingested by humans, and cysticercus cellulosae evaginates and
fiber where it develops into cysticercus bovis in about 2 months attaches to the intestine, where it will mature for about 12 weeks
Humans ingest undercooked beef and cysticercus bovis evaginates to attach in Gravid proglottids migrate to the anus and releases eggs, which are passed in
the small intestines, and matures into adults in about 12 weeks stool and into the environment to reset the cycle
Gravid proglottids migrate to the anus and releases eggs, which are passed in Humans can acts as intermediate hosts, wherein they ingest the embryonated
stool, and into the environment to reset the cycle eggs from contaminated food or drinks
 Oncosphere is released in the duodenum, and spreads into different organs visualization via ophthalmoscopy, but may induce movement and/or
through the circulation evagination
Autoinfection occurs via the fecal-oral route through poor hygienic practices Muscular and subcutaneous cysticercosis
Pathology Presence of a palpable region, where cysts can be seen through tissue
Intestinal infection biopsy
Brought about by mature or gravid proglottids Treatment
Taeniasis Praziquantel and niclosamide for taeniasis
Unlikely causes obstruction due to it being less motile Praziquantel or albendazole for cysticercosi
Cysticercosis Surgery for subarachnoid, ocular, and ventricular form
Develops in any organ tissue and can be multiple at once Hymenolepis nana
Most commonly located in striated muscles and the brain, but can be found Dwarf tapeworm
in subcutaneous tissues, eyes, heart, lungs, and peritoneum Smallest tapeworm of man
Survives for up to 5 years, and death results into tissue response Most common cestode infection
Symptoms depends on the number, size, and location of the lesion Intermediate hosts
Neurocysticerosis can occur Ctenocephalides canis (Dog Flea)
one of the most serious zoonotic diseases worldwide Pulex irritans (Human Flea)
Convulsions are common especially cerebral form Xenopsylla cheopsis (Rat Flea)
Cysticerci with scolex found in the brain parenchyma or floating Tenebrio (Rice Beetle)
freely in the ventricles Tribolium (Flour Beetle)
Parenchymal Humans
Can cause focal deficits and seizure especially when cysts are Final hosts: Humans
at the cortex Only human tapeworm that can complete its life cycle in a single human host (does not
Extraparenchymal require an obligatory intermediate host to complete cycle)
Subarachnoid Infective stage: Cysticercoid (indirect life cycle), embryonated eggs (direct life cycle)
Can lead to a more aggresive form: Racemous Diagnostic stage: Embryonated eggs in stool
cysticercosis MOT
A proliferation of cysts forms in the base of the Direct life cycle: ingestion of embryonated eggs
brain Indirect life cycle: ingestion of cysticercoid in insect vectors
poor prognosis Morphology
Meningitic Adults
Intraventricular Delicate strobila
Cysts are commonly present in the 3rd or 4th ventricle Scolex is subglobular with four cup-shaped suckers with a retractable
Can lead to obstructive hydrocephalus armed rostellum, with 20-30 y-shaped hooklets
Spinal Long and slender neck
Rare form Anterior proglottids are short and the posterior ones are broader than long
CSF shows increased protein and mononuclear cells, and decreased Genital pores along the same side of the segments
glucose Mature proglottids have three testes and one ovary, which disappear once
Death of larvae can lead to inflammation gravid, and uterus hollows out and fills with eggs
Cysticerci in the eyes Eggs
often retinal or subretinal Spherical or subspherical, colorless or clay-colored
May float freely in the vitreous or aqueous humors Has a thin outer membrane and a thick inner membrane with bipolar
Chorioretinits and vasculitis impedes vision thickenings, which give rise to polar filaments in the oncosphere
Retina can also detach 6 hooks can be seen in embryo
Intraorbital pain, photopsia, blurring of vision dies immediately once on the environment
Diagnosis Larvae are cysticercoid (cysticercus in taenia spp)
Taeniasis Life Cycle
Same as saginata Direct
Cysticercosis Embryonated eggs are ingested by the host
Neurocysticercosis Eggs hatch in the duodenum, penetrates the villi, and cysticercoid stage
presumptive diagnosis is based on symptoms and lab results arise
(elevated protein and mononuclear cells, reduced glucose) After 4-5 days, larvae goes to the mucosa and develop into adults
CAT or MRI scans Gravid proglottids disintegrate and release eggs which are passed in stool
Ophthalmic cysticercosis to reset the cycle
Indirect
 Host ingests infected insect vector, or contaminated fomites, water, or food, Dipylidium caninum
which contains cysticercoid stage Double pored tapeworm, dog tapeworm, flea tapeworm, cucumber tapeworm
Cysticercoid develops into adults in the small intestine Inhabits small intestine
Gravid proglottids disintegrate and release eggs which are passed in stool More common in children, due to age tolerance
and into the environment Intermediate hosts: Larval stages of dog, cat, and human fleas, and dog lice
Insect vector ingests eggs, and develop into cysticercoid stage, which reset Final hosts: dogs and cats
the cycle Accidental hosts: Humans
Pathology Infective stage: Cysticercoid
Symptoms are related to immunological response to parasite Diagnostic stage: Gravid proglottids that are passed out in stool or perianal area
Light infection produces no symptoms MOT
Symptoms may produce headache, dizziness, anorexia, pruritus of nose and anus, Ingestion of cysticercoid from infective adult vectors
diarrhea, vommitting, abdominal pain, pallor, and weight loss Morphology
Heavy infections cause enteritis due to necrosis and desquamation of intestinal Adults
epithelial cells Pale red
Convulsion can occur Scolex is small and globular with four acetebula and a protrusible rosellum
immune system can eventually clear the parasite with one to seven rows of thorn-shaped hooks
Infections in children usually clear in adolescence spontaneously Proglottids are narrow with two pairs of male and female reproductive
Diagnosis organs
demonstration of the characteristic eggs in the patient’s stool Proglottids have bilateral geniral pores (double pored tapeworm)
Proglottids cannot be seen Gravid proglottids have the shape of a pumpkin seed, and are filled with
Treatment egg sacs
Praziquantel Eggs
Higher dosage than in taeniasis due to resistance of cysticercoids Spherical, thin-shelled, striated with a hexacanth embryo
Hymenolepis diminuta Are contained in an egg sac, with about 8-15 in each sac
Rat tapeworm Life Cycle
Intermediate hosts Eggs are ingested by larval stages of vectors
fleas, beetles, cockroaches, mealworms, and earwigs Embryo develops into cysticercoid as vector develops into adults
Accidental hosts: Humans Insect vector is ingested, and cysticercoid is released, and becomes an adult in 3-
Final hosts rodents 4 weeks in the small intestine
Infective stage: Cysticercoid Gravid proglottids actively crawl and migrates into the anus and are passed out in
Diagnostic stage: Embryonated eggs in feces feces and into the environment, resetting the cycle
MOT Pathogenesis
Ingestion of cysticercoid Infection is rarely heavy and symptoms are minimal
Morphology Symptoms include intestinal discomfort, epigastric pain, diarrhea, anal pruritus,
Adults and allergic reactions
Larger than nana Eosinophilia can be demonstrated occasionally
Scolex has an unarmed scolex Diagnosis
Proglottids are similar with nana Recovery of gravid proglottids in stool or perianal area
Genital pores are unilateral Gravid proglottids do not disintegrate inside host
Eggs Treatment
Circular, bigger than nana, bile-stained Praziquantel
Has bipolar thickenings, but does not give rise to bipolar filametns Echinococcus spp
Hooklets are arranged in a fan-like pattern Hydatid worm
Life Cycle Smallest tapeworm of dogs
Embryonated eggs are ingested by arthropod vector Family: taeniadiae
Embryonated hatches and cysticercoid develops E. granulosus and E. multilocularis cause cystic and alveolar echinococcosis
Humans or rodents ingest infected arthropods, and larvae is released and respectively
develops into adults in about 3 weeks E. vogeli and E. oligarthrus both cause polycystic echinococcosis
Pathology E. multiloculari, E. vogeli, and E. oligarthrus are less common due to sylvatic life cycle
Minimal and non-specific, probably due to short life span Inhabits small intestine of canines
Diagnosis Intermediate hosts: sheep, goat, swine, cattle, horses, camel,
Eggs in stool Accidental/Dead end hosts: Humans
Treatment Final hosts: Dogs and other canines
Like nana, use praziquantel Infective stage: Embryonated eggs in stool
Diagnostic stage: Hydatid cyst in organs of intermediate hosts Can be seen in the lungs, spleen, brain, orbit, heart, bone, and CNS
MOT Symptoms reflect the encysted site
Ingestion of embryonated eggs Cysts are ruptured by coughing, muscle strain, trauma, aspiration, and
Morphology operative procedures
Adults Causes metastasis
Has a pyriform scolex, with an armed rostellum that has 30-36 hooks; has Cysts can be infected by bacteria which can lead to pyrogenic abscess
4 acetebula formation
Has only 3 proglottids: immature, mature, and gravid (widest and longest) Rupture of cysts can cause serious anaphylaxis due to hydatid material in
Uterus is midline with lateral evaginations the blood stream
Eggs Intrabiliary rupture is the most common complication, followed by
Resembles taenia eggs suppuration
Hydatid cyst Secondary echinococcosis
Larval stage, formed through central vesiculation Ruptured hydatid cysts that reach other sites
Grows in diameter by the year Can cause multiorgan failure
Has an outer laminated hyaline layer, and an inner nucleated germinal
layer; Has an adventitial layer, which is part of the host and not the actual Diagnosis
cyst Radiographic and ultrasonagraphic techniques, and patient history
Brood capsule Serologic tests can be used as screening tests
Contains the protoscolex Detection of IgG is the gold standard for serology (ELISA)
Has a germinal layer Treatment
Can rupture and turn into new hydatid cyst Surgical resection for large liver cysts, secondary infection or cysts outside liver
Found inside the cyst Chemotherapy with benzimadole for small, isolated, uncomplicated cysts, and
Daughter cyst patients with negative serologic tests
Found inside the cyst Puncture, Aspirate, Inject, Reaspirate (PAIR) technique used in patients with
Replicas of the entire cyst multiple cysts in different sites, or those who are non responsive to surgery
Can become brood capsule Can be paired with albendazole or mebendazole to increase efficacy
When ruptured, releases hydatid fluid and is now called hydatid sand Psuedocyclophyllidea (False tapeworms)
Cysts of granulosus are termed unilocular cysts (sand) Proglottids are unable to detach (anapolytic)
Cysts of multilocularis are termed alveolar and osseous cysts (sand) Present uterine pore
Eggs are operculated and unembryonated
Life Cycle Diphyllobothrium latum
Embryonated eggs are swallowed by intermediate hosts Fish tapeworm, broad tapeworm
Eggs release oncospheres that penetrate the intestinal wall and migrate into 1st intermediate host: Copepods (Cyclops, Diaptomus)
mesenteric venules toward various organs and tissues 2nd intermediate host: Freshwater fish (Salmon, trout, pike, etc)
Oncosphere eventually lodges in organs and tissues and develops into hydatid Definitive host: Man, dogs, cats, other mammals
cysts Paratenic host: Carnivirous fish
Protoscolices evaginates and attaches to the intestinal mucosa, where it will Infective stage: Plerocercoid
mature into adults Diagnostic stage: Unembryonated eggs in feces
Adults lay eggs, which are passed in stool and into the environment, resetting the MOT
cycle Ingestion or undercooked infective freshwater fish
Humans can accidentally ingest embryonated eggs Morphology
Eggs hatch and release oncospheres into the intestine, which migrate various Adults
organs through venules and produces hydatid cysts Spatulate scolex with two bothria instead of acetebula, located
Hydatid cysts may rupture and brood capsules can create secondary cysts in other dorsally and ventrally
sites Proglottids only disintegrate once segment has finished reproductive
Pathology function
Human cystic echinococcosis Bilobed ovary
Mostly located in the right lobe of the liver Eggs
Hepatic enlargement, right epigastric pain, or jaundice if in inferior Bile stained
lobe Has an inconspicuous operculum, and a knob-like thickening
Causes intrathrocic involvement when cysts are found in the superior opposite of the operculum
lobe Only embryonates in fresh water
Rupture into biliary ducts causes intermittent jaundice, fever, and Mistaken for Paragonimus westermani egg
eosinophilia (triad)
 Paragonimus is bigger, contains an aborpercular thickening,
and has an opercular shoulder
Coracidia
Ciliated embryo that arises from embryonation of egg in fresh water
Free-swimming
Procercoid
1st larval stage
Retains the three hooklets in its cercomer
Found in 1st intermediate hosts
Plerocercoid
2nd larval stage
Glistening, opaque, unsegmented
Found in 2nd intermediate host
Life Cycle
Unembryonated eggs in stool are released and upon contact with
freshwater, embryonated
Hatches from eggs and turns into coracidia, which are ingested by
copepods
Develops into procercoid in copepods, and copepods are ingested by fish
Procercoid migrates into fish tissues and develops into plerocercoid in the
muscles and viscera
Carnivorous fish can ingest infected fish and acts as paratenic hosts
Humans and other mammals ingest undercooked infected fish, and
plerocercoid are released
Plerocercoid attaches to the intestinal wall, and matures in about 3 weeks
Gravid proglottids migrate and release eggs which are passed in stool and
into the environment, resetting the cycle
Pathology
Infections usually limited to one worm, but larger numbers causes
obstruction
Hyperchromic, megaloblastic anemia with thrombocytopenia and
leukopenia
Anemia can be mistaken for pernicious anemia
Diphyllobothriasis has hydrochloric acid in gastric juices, pernicious
anemia is associated with achlorhydria (absence of hydrochloric
acid)
Vitamin B12 deficiency
50 times more than in saginata

Diagnosis
Raw fish diet plus pernicious type anemia are suggestive of infection
Finding operculated eggs in stool is a definitive diagnosis (can sometimes
even find proglottids)
Treatment
praziquantel