CLINICAL PARASITOLOGY

Module 4 – Cestodes

Transcribed by PORPION
References: PowerPoint presentation, Canvas introduction,
and video discussion

TABLE OF CONTENTS
Taxonomy
Introduction
General Characteristics ✓ General Structures
Comparison of Pseudophyllidean and Cyclophyllidean
Parasites Habitat Small intestine
Order Pseudophyllidea ✓ Diphyllobothrium latum Mode of transmission Oral route
Order Cyclophyllidea ✓ Taenia spp. Eggs Generally non-operculated
✓ Hymenolepis spp. and mature/embryonated
✓ Dipyllidium caninum NOTE: Except for D. latum
✓ Echinococcus spp. Life cycle Egg -> larva -> adult
✓ Raillientina garrisoni
GENERAL STRUCTURES
TAXONOMY Scolex
Kingdom Animalia -> Subkingdom Metazoa -> Phylum
Platyhelminthes -> Class Cestoida -> Subclass Cestoda -> ✓ Attachment organ (to the lining of the small intestine)
Order Pseudophyllidea and Order Cyclophyllidea ✓ SHAPE – globular, pyriform,
spoon-like (spatulate-shaped
only in D. latum)
INTRODUCTION
✓ MAJORITY – with 4 cup-like
✓ Known as ‘tapeworms’
suckers/grooves/acetabulum
✓ They have an extensive size variation: 3mm – 10m
✓ Recovery of the scolex indicates
✓ They generally require intermediate hosts
success of treatment
✓ Their method of growth involves addition of segments
(proglottids) ✓ Rostellum
• Fleshy extension of scolex
• Each proglottid, when mature, produces infective
(crown area)
eggs for the intermediate host
• May be armed or unarmed
✓ The anterior headlike segment are known as scolex
• The scolex has suckers o Armed rostellum have hooklets
• Some species have hooklets on their scolex as a
Neck
means of attachment to intestinal mucosa
• Their necks are directly behind the scolex ✓ Region of growth
✓ Treatment is targeted at detaching the scolex from the • Location of germination
mucosa because the neck area is where proglottid process
production occurs ✓ Point of proliferation for the next
✓ Gravid proglottids at the distal end of the organism set of segments
discharge eggs into the feces ✓ The segments nearer to the neck
✓ Most tapeworm eggs contain hexacanth embryo or are the younger segments, the
oncospheres ones farther are the older
✓ Transmission to humans is through ingestion of their segments
larval stage, known as cysticercus, cysticercoid, or
plerocercoid larva
• These are found in raw or undercooked meat/fish or
in insects that harbor the larval stage Proglottids
• This larval stage contains an invaginated scolex ✓ Each segment
inside a protective membrane ✓ STROBILA – chain of proglottids/segments
✓ Diagnosis is done by finding the eggs in feces ✓ Types
• Proglottids can be used if intact when passed • IMMATURE – nearest to the neck
through feces • MATURE – middle portion; this is where the
reproductive structures are formed and found
GENERAL CHARACTERISTICS • GRAVID/RIPE – farthest from the neck
✓ Flat and ribbon-like o Filled with eggs (in the uterus)
✓ White yellow-ish in color o Can be detached through apolysis
✓ Segmented
✓ Monoecious (hermaphroditic and partially parthenogenic)
• They can self-fertilize but they usually need the
opposite sex
✓ No gastrointestinal tract
✓ No circulatory system
✓ Has well-developed reproductive organs
• Have testes, ovaries, and uterus
✓ Has tegument
• Outer-covering
• For entry of nutrients and exit of wastes

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 COMPARISON OF PSEUDOPHYLLIDEAN AND ✓ Fish tapeworm
CYCLOPHYLLIDEAN PARASITES Habitat Small intestine
Diagnostic stage Egg/scolex (because only
PSEUDOPHYLLIDEAN CYCLOPHYLLIDEAN this parasite has a spatulate
Species Diphyllobothrium T. solium scolex)
latum T. saginata Infective stage Plerocercoid larva
Spriometra Dipylidium caninum 1st Intermediate host Copepods (cyclops,
Hymenolepis nana diaptomus)
E. granulosus 2nd Intermediate host Freshwater fish (small
fishes)
NOTE: They are NOTE: They are Paratenic host Carnivorous fishes
known as false known as true
tapeworms tapeworms NOTE: These larger fishes
Scolex ✓ Spoon, ✓ Globular or eat small fishes, the larger
spatula, or pyriform shaped fishes are ultimately eaten
almond ✓ Quadrate (four by man
shaped cup-like suckers) Larval stages Coracidium -> Procercid ->
✓ With bothria ✓ With/without Plerocercoid
(sucking rostellum Mode of transmission Ingestion
grooves (with/without Treatment Praziquantel
✓ No hooklets hooklets) Prevention ✓ Freezing of fishes (-
Strobila ✓ Anapolytic ✓ Apolytic (sheds 18°C for 24-48 hours)
(doesn’t shed segments) ✓ Proper cooking of
segments) ✓ Only genital pore fishes (50°C for 10
✓ Segments is present minutes)
have uterine
pore and Eggs
genital pore
(both are ✓ 1 million eggs/ova per day
centrally ✓ Non-embryonated
located) • They embryonate in water
Gravid ✓ All Only uterus can be ✓ Operculum on one end with terminal
proglottid reproductive seen (in different knob (abopercular knob) on the
structures shapes/patterns) other end
are seen ✓ With underdeveloped coracidium
✓ Their uterus ✓ Mistaken with P. westermani eggs
has a
rosette-like Adults
appearance ✓ Their lifespan is 25 years
✓ Length
Ova Oval, Hexacanth • 3-5 meters to 10 meters
operculated, and embryo/oncosphere ✓ Mistaken for Spriometra
immature (spherical, non- • Species found in
operculated, canines/felines that can
embryonated, with infect man which leads to
hooklets) hearing loss
Larval stage/s 1st – Coracidium Cysticercus ✓ Scolex
2nd – Procercoid (specific for Taenia • Spatulate/spoon/almond
3rd – spp.), cysticercoid shaped
Plerocercoid/spar (for Hymenolepis • With 2 bothrium (slit-like sucking organ)
ganum spp.), hydatid (for E. ✓ Uterus
granulosus) • Rosette-like appearance
Intermediate 1st – Crustaceans Zero to one ✓ Strobila
host (copepods, intermediate host • Up to 4000 proglottids
cyclops) • Have uterine pore aside from the genital pore
2nd – Freshwater
fishes

NOTE: They have NOTE: They have

three hosts (2 IH one to two hosts (1
and 1 DH) IH and 1 DH)

ORDER PSEUDOPHYLLIDEA

Diphyllobothrium latum
✓ New name is Dibothriocephalus latus
✓ It is the largest tapeworm of man
Pathology
NOTE: Refer to the PowerPoint presentation for the life cycle
✓ Tapeworm/bothriocephalus anemia
• Adults may take up large amounts of vitamin B12
Common name ✓ Broad fish tapeworm
o Vitamin B12 is important for the production of
✓ Broad tapeworm RBCs
(Belizario de Leon)
• Macrocytic, megaloblastic anemia
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 o Increase in cell size of RBCs and increase in Strobila 1000-2000 <1000
size of immature RBC cells segments/proglottids segments/proglottids
• Presence of megaloblastic cells in the circulation Gravid 15-20 to 30 lateral 7-13 to 15 lateral
• Sometimes demonstrates Pernicious anemia proglottid branches branches
o This is also a macrocytic, megaloblastic anemia s (dichotomous/tree- (dendritic/finger-like)
o Impaired uptake of vitamin B12 from the like) with 97-104 with 30-50 thousand
intestine due to the lack of cells that produce NOTE: thousand ova ova
intrinsic factors (these factors facilitate the This is the
uptake of vitamin B12 in the intestine) uterus
- These cells also produce gastric acids (HCl)
which leads to achlorhydria (absence of
gastric HCl)

Laboratory Diagnosis
✓ Stool exam
• DFS, Kato-katz
• Look for eggs or scolex
✓ Examination for gastric juice
• Free hydrochloric acid
• To differentiate Diphyllobotriasis from Pernicious
anemia
o Presence of HCl indicates diphyllobotriasis

ORDER CYCLOPHYLLIDEA
Length 4-10 meters (upto 25 7 meters (2-4
Taenia spp. meters) meters)
NOTE: Refer to the PowerPoint presentation for the life cycle
NOTE: This makes it
T. saginata T. solium the longest cestode
Common ✓ Beef tapeworm ✓ Pork
name ✓ Unhooked tapeworm NOTE: Drinking alcohol can irritate adult Taenia spp., which
tapeworm ✓ Hooked causes the adult Taenia spp. to shed proglottids
tapeworm
Habitat Small intestine Eggs
Intermediate Cattle, cows, camels Pigs, man
✓ Spherical and striated
host
✓ Embryonated when laid/deposited
Larval stage Cysticercus bovis Cysticercus
✓ Has 6 hooklet paris
cellulosae
✓ Motile (the eggs are called 1st stage
Infective Cysticercus bovis Cysticercus larva due to their motility/movement)
stage cellulosae and ✓ Their eggs are indistinguishable
embryonated egg from each other
Mode of Ingestion of measly Ingestion of ✓ Adults may lay 594,000 ova per year
transmission beef with infective measly pork with
larva embryonated egg Pathology
Pathology Taeniasis saginata ✓ Taeniasis
solium (due ✓ T. saginata
• Causes Taeniasis saginata
to adult)
o Non-specific symptoms – epigastric pain,
✓ Cysticercosis
(due to larva) hunger pangs, weakness, weight loss, loss of
appetite, pruritus ani
Treatment Praziquantel, Niclosamide
o Intestinal obstruction due to tangled proglottids
✓ T. solium
Structural Differences
• Due to adult – Taeniasis solium
ADULT o Abdominal discomfort, hunger, malabsorption
T. saginata T. solium • Due to larva – Cysticercosis
Scolex ✓ With 4 cup-like ✓ With 4 cup-like o Accidental ingestion of egg
suckers suckers o More dangerous than Taeniasis solium
✓ No rostellum nor ✓ With armed o Can spread to other organs (if it migrates to the
hooklets rostellum (two brain, it is neurocysticercosis, the most
rows of large common parasitic CNS disease and the most
and small serious manifestation; it may lead to death)
hooklets)
Laboratory Diagnosis
✓ Stool exam
• Direct fecal smear, concentration techniques
(sedimentation)
• Look for eggs, proglottids, scolex
o Presence of eggs in stool is intermittent
o Eggs are just recorded as Taenia spp. because
they’re indistinguishable
✓ Double slide compression method
• Sample: Gravid proglottids
• Demonstration of lateral branches in the proglottids
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 • Gravid proglottid is placed between two glass slides Indirect – Cysticercoid
and the lateral branches are observed larva (in the case that it
✓ India ink stain has an intermediate host)
• Black stain MoT Ingestion of embryonated Ingestion of
• Used to visualize the lateral branches in the ova/cysticercoid larva cysticercoid larva
proglottids of Taenia spp.
• Observes the genital pore (lateral) which are NOTE: H. nana normally has no intermediate hosts. It is the
connected to the uterus, once stained, the branches true human tapeworm since its final host is man. It is also the
are easier to view most common cestode of man.
✓ Perianal swab
• Eggs may be left in the perianal region as stool is Structural Differences
passed ADULT
H. nana H. diminuta
NOTE: A patient positive for Taenia spp. must practice proper Scolex ✓ Subglobular in ✓ With 4 cup-like
hygiene because of the possible medical complications that shape suckers
may arise from the infection ✓ With 4 cup-like ✓ With unarmed
suckers rostellum
Taenia asiatica ✓ With retractable
✓ Old name is Taiwan Taenia spp. armed
✓ Third specie of Taenia rostellum
✓ Closely resembles T. saginata (single row of
20-30 Y-shaped
Common name Asian Taenia spp. hooklets)
Other name Taenia saginata asiatica
Intermediate host Pigs, cattle, goats, wild
boar, monkeys
Larval stage Cysticercus viscerotropica

Other Taenia spp.

T. T. T. T.
multiceps serialis brauni glomerata
Other Multiceps N/A N/A N/A
name multiceps
Common Bladder worm
name Strobila 175-220 segments/ 800-1000 segments/
Habitat Eyes, Subcut. N/A N/A proglottids proglottids
brain tissue Gravid Sac-like uterus filled with eggs
Larval Coenurus larva (a unilocular encysted larva) proglottids
stage
Infective Eggs
stage
IH Sheep Rabbits Herbivores
Final Host Canids Dogs, N/A N/A
foxes
A. Host Man Length 2-4cm 20-60cm
MoT Ingestion of eggs in food, water, or fomites
Pathology Human coenurosis (most commonly caused NOTE: They are the
by T. multiceps) smallest cestode

NOTES: Fomites are non-living materials that are infected NOTE: Their proglottids are in craspedote form (over-lapping)

Hymenolepis spp. Eggs

H. nana H. diminuta
H. nana H. diminuta Hooklets Three pairs Three pairs
Common Dwarf tapeworm Rat tapeworm (hexacanth embryo) (hexacanth
name embryo)
Habitat Small intestine Polar Present (two polars) Present
IH ✓ Direct – N/A Arthopods (Grain thickening
✓ Indirect – Rice/flour beetle, flea, Polar 4-8 polar filaments Absent
beetles (Tribolium & cockroach, filaments
Teneborio spp.); Dog mealworms, Embryophore Present (colorless) Present
flea (Ctenophalides earwigs, (colorless)
canis); Human flea myriapods, Picture
(Pulex irritans); Rat lepidopterans)
flea (Xenopsylla
cheopsis)
Final Man Rat, man
host (accidental host)
Larval Cysticercoid larva Cysticercoid
stage larva
Infective Direct – Embryonated Cysticercoid
stage ova (in man) larva

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NOTE: The egg of the H. diminuta is said to have the Common Hydatid worm, dog Alveolar hydatid
appearance of a sunny-side up fried egg name tapeworm, unilocular worm/cyst
hydatid cyst
Dipyllidium caninum Habitat Small intestine, Liver, lungs, brain
NOTE: Refer to the PowerPoint presentation for the life cycle connective tissue
IH Sheep, ox, goat, horse, Rodents
Common name ✓ Dog tapeworm camel
✓ Double-pored tapeworm Final host Dog Fox, wolf
✓ Flea tapeworm A. Host Man Man
✓ Cucumber tapeworm Larval Hydatid cyst Alveolar hydatid
✓ Pumpkin seed tapeworm stage cyst
Habitat Small intestine Infective Final host – Hydatid Embryonated ova
Intermediate hosts ✓ Dog louse (Trichodectes canis) stage cyst
✓ Dog flea (Ctenophalides canis) IH – Embryonated ova
✓ Cat flea (Ctenophalides felis) MoT Ingestion of egg Ingestion of egg
✓ Human flea (Pulex irritans) Pathology Hydatid disease, Alveolar hydatid
Final host Dog hydatidosis, cystic disease
Accidental host Man echinococcosis
Larval stage Cysticercoid Treatment ✓ Surgical removal of Albendazole,
Infective stage Cysticercoid cyst Mebendazole
✓ Albendazole,
Adult Mebendazole,
✓ Length Praziquantel
• 10-70cm
✓ Scolex NOTE: The alveolar hydatid disease is the most fatal form of
• Globular echinococcosis. It is also the most lethal of all helminthic
• With four suckers diseases because the cysts are formed in the liver, lungs, or
• With armed rostellum (club-shaped) brain. They are indistinguishable at all stages with E.
o 1-7 rows of rose-thorn shaped hooklets granulosus.
✓ Proglottids
• Double set of reproductive organs Adult E. granulosus
✓ Gravid proglottids ✓ Length
• Melon/pumpkin shaped • 3-6mm or 4.5mm
• With bilateral genital pore • They are the shortest
tapeworm of man
✓ Scolex
• Pyriform
• With prominent armed
rostellum
o 30-36 hooklets
✓ Proglottids
• Only 3 segments
(immature, mature, gravid)
Eggs ✓ Gravid proglottids
✓ Spherical • Widest and longest proglottid
✓ Thin-shelled • With midline uterus
✓ With 6 hooklets (hexacanth
embryo)
✓ Similar with Taenia egg
✓ Enclosed in egg capsule/packet
• 5-30 or 8-15 embryonated
• egg per packet
✓ Largest ova of cestodes due to
being enclosed in a packet

Laboratory Diagnosis
✓ Stool examination Eggs of E. granulosus
• Observe for eggs enclosed in packets, scolex, Similar to Taenia spp. eggs
proglottids

Echinococcus spp.
NOTE: Refer to the PowerPoint presentation for the life cycle

E. granulosus E. multilocularis
Old name Taenia granulosus N/A
New name Echinococcus N/A Larva of E. granulosus
granulosus sensu lato ✓ Hydatid cyst
✓ Found in human tissue
NOTE: This is a ✓ Slow-growing, fluid-filled, tumor-like,
collective term because and space-occupying structure
there are several ✓ Attached to laminated germinative
genotypes membrane

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✓ Brood capsules • With prominent armed rostellum (Two alternating
• Enclosed with laminated germinal membrane rows of 90 to 140 hammer-shaped hooks)
• Found in the membrane where prostoscolices ✓ Gravid proglottids
develop • Said to have a rice-gran appearance
o Prostoscolices are developing scolex • Contains 200-400 egg capsules with one to four
✓ Contains daughter cysts spindle-shaped eggs
• Miniaturized hydatid cysts inside the membrane Eggs
• Brood capsules that have separated from the Egg packets with 1-4 spindle-shaped ova
germinative membrane
✓ Hydatid sand
• Component of old E. granulosa larva
• From the disintegration of the brood capsule and
hydatid cysts in the main hydatid cysts when there
are too many daughter cysts causing liberation of the
prostoscolices and the toxic fluid
• Potentially toxic to man and may cause anaphylactic
shock and death

Laboratory Diagnosis of E. granulosus

✓ Roentgenogram (x-ray)
• Observed for bunch-of-grapes lesions
✓ Ultrasonography
✓ Immunologic tests
• Bentonite flocculation test
• Casoni intradermal test
o Injects hydatid cyst into patient and observes if
there is a reaction
✓ Exploratory cyst puncture
1. Puncture
2. Aspirate
o Removes content of the cyst
3. Inject
o Injects prostoscolicidal (a hypertonic solution)
which ruptures the brood capsules and
daughter cysts
4. Reaspirate
o Obtains what was ruptured
o Repeated until nothing else can be reaspirated

Raillientina garrisoni
✓ Most common intestinal cestode of rodents in the
Philippines
✓ Infected patients appear asymptomatic

Intermediate host Flour beetle (Tribolium

confusum)
Final host Rat
Accidental host Man
Larval stage Cysticercoid larva
Infective stage Final host – Cysticercoid
larva
IH – Gravid proglottid

Adult
✓ Length
• 60cm
✓ Scolex
• Subglobular
• With 4 suckers

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