CLINICAL PARASITOLOGY LECTURE

CESTODE INFECTIONS ●​ Thick embryo sphere which appears

Intestinal cestodes and Extraintestinal
in striated.
cestodes
●​ Inside the eggshell is the oncosphere
or embryo provided with three pair
INTESTINAL CESTODES
of hooklets.
●​ Taenia saginata
●​ Taenia solium
●​ Hymenolepis nana
●​ Hymenolepis diminuta
●​ Dipylidium caninum
●​ Raillietina garrisoni
●​ Diphyllobothrium latum

PATHOGENESIS AND
EXTRAINTESTINAL CESTODES
CLINICAL MANIFESTATIONS
●​ Echinococcus sp.
●​ Common chief complaints:
●​ Sparganosis
-​ passage of proglottids or
segments in stool.
I. Taenia saginata ●​ Non specific symptoms
Common name: Beef tapeworm -​ Epigastric pain
Habitat: Upper jejunum -​ Vague discomfort
Diagnostic stage: Eggs and proglottids -​ Hunger
Infective Stage: Cysticercus bovis -​ Pangs
-​ Weakness
PARASITE BIOLOGY OF T. saginata -​ Weight loss
ADULT WORM: -​ Loss of appetite
●​ Habitat is at upper jejunum -​ Pruritus ani
●​ may live up to 25 years
●​ aDULT measures 4-10 mm and has DIAGNOSIS
1000-4000 proglottids. ●​ FIrst Specimen usually brought to the
●​ Attached to the scolex lab (proglottids)
-​ The scolex is a short LABORATORY EXAMINATION
neck from which a ●​ Microscopy
chain of immature, ●​ Concentration techniques
mature and gravid ●​ Perianal swabs
proglottids develop
. EPIDEMIOLOGY
PROGLOTTIDS ●​ The man is not suitable as an
●​ Mature proglottids intermediate host for taenia
square in shape. saginata as it is for taenia solium.
●​ Contain male and ●​ Adult worms seem to be irritated by
female reproductive alcohol, passage of proglottids result
organs from drinking.​
●​ Gravid proglottids are
longer than they are TREATMENT
wide and are most distal from the neck. ●​ Praziquantel
●​ Criteria for cure include the following
OVA 1.​ Recovery of the scolex
●​ Spherical or sub 2.​ Negative stool examination
spherical in shape three months after the
●​ Brownish in color treatment.

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD

 CLINICAL PARASITOLOGY LECTURE
II. Taenia solium NCC called racemous
Common name: Pork tapeworm cysticercosis.
Habitat: small intestines ●​ Cerebral cysticercosis
Infective stage: cysticercus cellulosae ○​ Convulsions are the most
Intermediate host: pig and mn common manifestation.
definitive host: man ○​ VIsual and motor deficit,
headaches and vomiting may
occur
○​ CSF tap results:
-​ INcrease opening
pressure
​ -​ Elevated protein
-​ Decreased glucose
PARASITE BIOLOGY: -​ INcrease mononuclear
●​ 4 acetabula but it is cells
smaller and more -​ half of the cases show
spherical than that of CSF eosinophilia
beef tapeworm.
●​ Cushion like rostellum DIAGNOSIS
●​ Gravid proglottids ●​ intestinal
contain approximately ●​ Rests on identifying the
30,000 to 50,000 eggs characteristic proglottids, eggs or
●​ Undergoes apolysis the scolex
●​ Less active ●​ Cysticercosis
Gravid proglottids of T. solium ○​ NEurocysticercosis may be
suspected in patients with
EGGS epileptic seizure.
Its eggs are indistinguishable ●​ CAT scan patterns
from T. saginata. ○​ Round low-density area
without surrounding
enhancement after
PATHOGENESIS AND administration of contrast
CLINICAL MANIFESTATIONS: dye.
●​ Intestinal infection ○​ Ring-like enhancement after
○​ Mild, non-specific abdominal injection of contrast dye.
complaints ○​ Small calcified area within a
○​ Most commonly located in cystic space.
striated muscles and in the ●​ Ophthalmic cysticercosis can be
brian but the subcutaneous diagnosed through visualization of
tissues, eye, heart, lung, and the cysticerci using ophthalmoscopy
peritoneum, have all been
involved. SEROLOGICAL TESTS
○​ May produce inflammation ●​ Serum and CSF, ELISA and
and may survive up to 5 years. Electro-immune transfer blot (EITB)
●​ Neurocysticercosis (NCC) or Western blot for specific IgG and
○​ Most serious manifestation, IgM anticercal antibodies.
which is considered as one of ●​ DOT ELISA test is a very good
the most serious zoonotic screening test for cy cysticercosis.
diseases worldwide.. ●​ Positive for IgG - have been positive
○​ may be found in the brain for infection for a long time.
○​ THe subarachnoid form may
lead to an aggressive form of

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD

 CLINICAL PARASITOLOGY LECTURE
●​ Positive for IgM - recently acquired appearance of cysticercus resemble
infection. T. solium
TREATMENT IV. Hymenolepsis nana
●​ Intestinal Found worldwide, mainly among children. It
●​ Drug of choice: PRaziquantel and is the only human tapeworm which can
niclosamide complete its entire life cycle in a single host,
●​ Criteria for cure: indicating that it does not require an
○​ Recovery of the scolex obligatory intermediate host.
○​ Negative stool sample after
three months of treatment.
●​ Cysticercosis
●​ Management of NCC depends on
the form present in the patient.
●​ Praziquantel
●​ Steteroids are then given four hours
after the last dose. Common name: Dwarf tapeworm
●​ Ocular cysticercosis should be Disease: Dwarf tapeworm infection
treated surgically before being Habitat: Small intestine
treated surgically before giving Transmission: Person to person; fecal-oral
Praziquantel or albendazole. transmission
Pathology: Irritation of intestinal mucosa
EPIDEMIOLOGY and toxemia
●​ Highly related to the habit of eating Intermediate host: None
raw or improperly cooked meat.
●​ Abstinence from beed as part of PARASITE BIOLOGY OF H. nana
religious beliefs among the Hindus ●​ Adults are found in the ileum
prevent T. saginata infections while ●​ Scolex - 4 cup-shaped suckers
among the Muslims, prevention of T. ●​ Rectangular rostellum armed with a
solium infections happens because single row
of the abstinence from pork. ●​ Anterior proglottids short

PREVENTION AND CONTROL EGG

●​ Simple but may be difficult to ●​ Spherical or subspherical
implement ●​ Oncosphere has a thin outer
●​ Thorough cooking of meat is a membrane and a thick inner
primary measure membrane with conspicuous bipolar
●​ Freezing at -20 degree celsius for 10 thickenings, 4-8 hairlike polar
days kills the cysticerci filaments.
●​ Sanitary inspection of all slaughtered
pigs, cows and cattle should be LIFE CYCLE
done. Dual pathways:
●​ DIrect cycle
III. Taenia asiatica ○​ Host ingests eggs which hatch
●​ Reported among aborigines of in the duodenum.
Taiwan ●​ Indirect cycle
●​ IH varied ○​ Via the accidental ingestion of
●​ Cysticerci found in the liver of pigs, infected arthropod
cattle, goats, wild boars and intermediate hosts like rice
monkeys and flour beetles (Tenebrio
●​ Adult morphology of Taiwan Taenia sp.)
resembles saginata but the

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD

 CLINICAL PARASITOLOGY LECTURE
PATHOGENESIS AND CLINICAL ●​ Emphasis should be placed on
MANIFESTATIONS personal hygiene and environmental
●​ Symptoms sanitation.
●​ Light worm burden is generally ●​ Infected cases should be thoroughly
asymptomatic treated.
●​ CLinical manifestations ●​ Rodent control must be observed.
●​ Headaches, dizziness, anorexia, ●​ Food must be properly stored.
pruritus of nose and anus, diarrhea,
abdominal pain and pallor. V. Diphylidium caninum
●​ Some infected children are restless, ●​ A very common intestinal parasite of
irritable and exhibit sleep dogs and cats worldwide.
disturbances. ●​ Dipylidiasis in humans is accidental.
●​ Heavy infection enteritis due to
necrosis and desquamation of the EGG
epithelial cells.

DIAGNOSIS
●​ Demonstration of eggs in patient’s
stool
●​ On light infections, the concentration
of the stool specimens on alternate
days is useful
●​ Proglottids are not recovered PARASITE BIOLOGY OF D. caninum
because they undergo degeneration ●​ Pale reddish adult worm measures
prior to passage with stools. 10-70 cm in length.
●​ Scolex is small and
TREATMENT globular with 4 deeply
●​ Praziquantel cupped suckers and
●​ It causes vacuolization and protrusible rostellum,
disruption of the tegument in the armed with 1 to 7
neck region. rostellums.
●​ Treatment is usually repeated after 2 ●​ Proglottids are narrow with 2 sets of
weeks to cover for the worms male and female reproductive
emerging from the remaining viable organs.
cysticercoids. ●​ Egg capsules may remain in the fur
of the host in the host’s resting place.
EPIDEMIOLOGY Larval fleas ingest the ova as the
●​ Warm climate like the Southern USA, feed on the epidermal debris.
Latin America, Mediterranean, East
Asia and the Philippines. INTERMEDIATE HOSTS
●​ Poor sanitation overcrowding, and Larval stage of:
poor personal hygiene practices. ●​ Ctenocephalides canis (dog flea)
●​ Direct contact plays an important ●​ Ctenocephalides felis (cat flea)
role because eggs cannot survive ●​ Pulex irritans (human flea)
long outside the host. ●​ Trichodectes Canis (dog louse)
●​ It is familia and institutional infection
common in orphanages, day care PATHOGENESIS AND CLINICAL
centers, and mental institutions. MANIFESTATIONS
●​ Infection is rarely multiple amd
PREVENTION AND CONTROL symptoms are minimal

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD

 CLINICAL PARASITOLOGY LECTURE
●​ Slight intestinal discomfort, PATHOGENESIS AND
epigastric pain, diarrhea anal CLINICAL MANIFESTATIONS
pruritus and allergic reactions ●​ Patients are usually asymptomatic
●​ Children are brought for medical
DIAGNOSIS consultations when proglottids are
●​ Recovery of the characteristic gravid passed out with their feces.
proglottids passed out singly or in
chain. DIAGNOSIS
●​ Gravid proglottids may crawl out of ●​ Finding proglottids or ova in the stool
the anusnand may be passed out
involuntarily. TREATMENT
●​ Proglottids should be passed or ●​ Sometimes, ling strobila or the
flattened between 2 glass slides for complete tapeworm may be
examination. expelled from the child
●​ Egg capsules are rarely recovered spontaneously without any
from the stool. treatments.
●​ Praziquantel
TREATMENT
Recommended medicine is Praziquantel EPIDEMIOLOGY
●​ Common intestinal cestode of
EPIDEMIOLOGY rodents in the Philippines.
●​ Human infections is rare but has ●​ Transmission occurs when the IH
been reported in European countries, found in stored grain products is
the USA, Argentina, Rhodesia, China ingested accidentally.
and the Philippines. ●​ Almost all infections occurred in
●​ Infants and very young children are children who are below 3 years old
usually infected because of their
close contact with dogs (pets). PREVENTION AND CONTROL
●​ Elimination of rodents from
PREVENTION AND CONTROL households
●​ Periodic deworming of pet cats and ●​ Proper storage of grain products
dogs is recommended ●​ Sanitary waste disposal would help
●​ Insecticide dusting of dogs and cats prevent infection.
are effective against fleas.
●​ The potential danger of plating with VI. Diphyllibothrium latum
pets must be included in the health Common name: Fish tapeworm/Broad
education of children. tapeworm
Habitat: Small intestine
V. Raillientina garrisoni
●​ Tapeworm is about 60 cm in length PARASITE BIOLOGY
with a minute globular scolex with 4 Scolex
acetabula. ●​ Spatulate, it has 2
●​ Rostellum is armed with 2 alternating bothria or sucking
circular rows of 90 to 140 grooves. Its neck is long
hammer-shaped hooks. and attenuated and
●​ Mature proglottids has a bilobed followed by immature
ovary proglottids.
●​ Gravid segments may be ingested
by the insect intermediate host, the ●​ Mature proglottids has a longer
flour beetle (Tribolium confusum) width than its length

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD

 CLINICAL PARASITOLOGY LECTURE
●​ Testes are located in the dorsolateral
part of the proglottids TREATMENT
The drug of choice is Praziquantel.
EGGS
●​ Complete their own development in PREVENTION AND CONTROL
water and release free-swimming ●​ All freshwater fishes should be
coracidium which is a ciliated thoroughly cooked.
embryo that is ingested by ●​ Freezing for 24 or 48 hours at
freshwater copepods of the genera -18 degree celsius kills all
Cyclops and Diaptomus. plerocercoids.

PATHOGENESIS AND
EXTRAINTESTINAL CESTODES
CLINICAL MANIFESTATIONS
I. Echinococcus spp.
●​ Infected individuals may show no
signs of disease. ●​ Considered as one of
●​ Some may experience nervous the emerging zoonotic
disturbances, digestive disorders, diseases
abdominal discomfort, weight loss, ●​ Caused by larval
weakness and anemia. stages of Echinococcus
●​ Symptoms may be due to absorbed spp. which is acquired
toxins or by products of when the eggs of this
degenerating proglottids. parasite are ingested.
●​ Infection may result in hyperchronic,
megaloblastic anemia with PARASITE BIOLOGY
thrombocytopenia and leukopenia. ●​ Adult worms inhabit in the small
●​ The anemia that is seen in intestine of canines
diphyllobothriasis is typically similar ●​ Pyriform scolex: short neck and has 3
to that of Vit B12 deficiency proglottids: one immature, one
(Megaloblastic anemia). mature and one gravid.
●​ Eggs are swallowed by the suitable
DIAGNOSIS IH like goats, horses, camels and
●​ Residents may be suggestive of sheeps.
diphyllobothriasis if/when they: ●​ They hatch in the duodenum.
○​ are in or that travel in ●​ Humans are an accidental host of
endemic areas this cestode.
○​ practice raw fish diet ●​ Its larval stage is also referred to as
○​ have a pernicious type of Hydatid cyst.
anemia
●​ Definitive diagnosis: eggs or PATHOLOGY AND
proglottids. CLINICAL MANIFESTATIONS
●​ Sometimes, proglottids may be ●​ Pathology is caused by the
vomited. developing larval cyst in the tissues
●​ Kato technique is also useful in of the IH.
demonstrating eggs. ●​ Most common and important organ
●​ To differentiate anemia due to site of involvement is the Liver (70%)
diphyllobothriasis from pernicious ●​ Lungs are involved too (20-30%)
anemia, examination of the gastric ●​ The brain and the orbit (10%)
juice for the presence of free HCl is ●​ Unilocular hydatid cyst - the cyst of
useful. E. granulosus.
●​ Pernicious anemia is associated with ●​ Alveolar cysts - the cyst of
achlorhydria. E. multilocularis.

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD

 CLINICAL PARASITOLOGY LECTURE
DIAGNOSIS ●​ Dogs in endemic areas should be
●​ Radiographic findings and/or given taeniafuges once/twice a year.
ultrasonography combined with a ●​ Health education
history of residence in an endemic
area and association with dogs. II. Echinococcus multilocularis
●​ Positive serologic tests: ●​ Foxes are the natural definitive host
○​ ELISA (Enzyme-linked and small rodents are the IH.
immunosorbent assay) ●​ Humans may be infected by eating
○​ IHA (Indirect raw plants contaminated with feces
hemagglutination) of infected canines or cats.
○​ IFA (Immunofluorescence ●​ The only reliable definitive treatment
assay) for these cases is surgery or PAIR
●​ Positive cases will have to undergo procedure.
gel diffusion assay that would ●​ In inoperable cases, albendazole or
demonstrate the echinococcal mebendazole may be given.
“arc 5” for confirmation.
●​ Newer diagnostic methods also
SPARGANOSIS
detect Echinococcus antigens
Refers to the larval infection with the
plerocercoid larvae also known as
TREATMENT
spargana of pseudophyllidean tapeworm
●​ Surgical resection is still considered
falling under the genus Spirometra.
treatment of choice
Humans may be infected through:
●​ For patients with small calcified and
●​ Drinking water containing Cyclops or
uncomplicated cysts and w/
copepods infected with procercoid
negative serology, then no surgical
larvae.
treatment is urgently indicated.
●​ Eating infected second IH like frogs,
●​ Surgical management of hydatid
toads or snakes containing the
cysts involve a scolicidal agent
plerocercoid larvae.
○​ Hibitane, 95% ethanol or 30%
●​ Applying plerocercoid infected flesh
hypertonic saline sol’n, in
of frogs and snakes as poultices in
order to kill the daughter cysts
sores in the eye, vagina and skin
and germinal layer.
resulting in subsequent penetration
●​ Albendazole is recommended for
into cutaneous tissues.
inoperable cysts.
●​ Consumption of infected fishes of
●​ Patients with inoperable cysts may
paratenic hosts like wild pids
also undergo puncture, aspiration
injection, respiration intervention
DIAGNOSIS
(PAIR) while receiving antihelminthic
●​ Finding white larvae in lesions
therapy.
●​ Species identification is done
through experimental infection of
EPIDEMIOLOGY
animals.
●​ Infections usually occurs in
●​ Treatment is the surgical removal of
childhood through ingestion of eggs
plerocercoid.
(from the soil or from the fur of dogs)

PREVENTION
●​ Infection is prevented by drinking
PREVENTION AND CONTROL
boiled or filtered water.
●​ Reducing infected populations and
●​ Cooking possible intermediate or
by minimizing the opportunity for
paratenic hosts thoroughly.
transmission.
●​ Avoiding the practice of applying
fresh frogs to the inflamed areas.

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD

 CLINICAL PARASITOLOGY LECTURE
PICTURES

Anatomy of Taenia solium Life cycle of Echinococcus spp.

Life cycle of Taenia spp. (saginata and

solium)

Life cycle of H. nana

Life cycle of D. latum

STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD