CESTODES

General Characteristics
 Parasitic worms of the class Cestoda of the phylum Platyhelminthes
 Commonly known as tapeworms
 Adults are elongated, dorsoventrally flat and are ribbon-like
 Consist of three parts:
 Scolex or the head – point of attachment to the host
 Neck – region of growth
 Strobila – a chain of progressively developing segments called proglottids
 Mature proglottids contain both male and female sex organs
 Adults obtain nourishment from host from their intestinal content
 Adults lack sophisticated body parts and systems, such as mouth.
Digestive tract, and internal means of excretion.
Diphyllobothrium latum
Common Name: Broad Fish Tapeworm
Causative agent of Diphyllobothriasis or fish tapeworm disease
Humans are the definitive host
Ivory or grayish-yellow in color
Length ranges from 3 to 10 meters
Each worm may have more than 3,000 proglotttids.
proglotttids are broader than long
The scolex is small and almond-shaped with 2 suctorial groves
called bothria
Life span may reach up to 20 years
The uterus in each segment is coiled and rosette-like
Diphyllobothrium latum

Scolex with suctorial groves Rosette-like uteri

Diphyllobothrium latum
Eggs

• Yellowish-brown in
color
• 55-76 µ by 41-56 µ
in size
• Single-shelled
• Has an
inconspicuous
operculum at one
end and a knob-like
thickening at the
other end
Life Cycle
D. latum intermediate hosts

Primary Secondary
• Freshwater copepods • Trout
• Cyclops • Salmon
• Diaptomus
• Pike
• Perch
• Whitefish
• Turbot
Pathogenesis and Symptoms
• Infection is usually limited to a single worm
• Large number of worms are rarely involved and cause intestinal obstruction
• Infected individuals may show no signs of infection
• Worm attached to the upper jejunum compete with the host for vitamin B12
resulting in anemia similar to pernicious anemia
• Nervous disturbances, digestive disorders, abdominal discomfort, weight loss
and weakness may be experienced
Diagnosis
• History of travel to endemic areas accompanied by a raw fish diet
and pernicious type anemia is suggestive
• Finding the characteristic eggs in the stool through DFS or Kato
technique
• Examination of the gastric juice to differentiate between
diphyllobothriasis anemia and pernicious anemia
• Achlorhydria accompanies pernicious anemia
Treatment
• Praziquantel is the drug of choice
• Make sure that the scolex is expelled
• Niclosamide is also effective but it produces digested worms
• Re-examine the stool after 3 months if scolex was not seen
Prevention and Control
• Proper human fecal disposal
• Avoidance of eating raw or undercooked fish
• Thorough cooking of fish before consumption
Taenia saginata
Common Name: Beef Tapeworm
• Causative agent of taeniasis or beef tapeworm infection
• Humans are the only definitive hosts
• Adult worm is 4 to 6 meters long
• Each worm may have 1,000 to 2,000 proglottids
• Mature segment has bilobed ovary and multiple testes
• Gravid proglotttids are longer than wide (16 – 20 mm by 5 to 7
mm.)
• Scolex is cuboidal with 4 prominent suckers or acetabula
• Scolex has no hooks or rostellum
• Gravid uterus may contain as many as 100,000 eggs
Taenia saginata

Scolex Gravid Proglottid

Taenia saginata eggs
• Yellowish brown
• Spherical or subspherical in shape
• Consists of a thick covering called the embryophore
• Embryophore is striated
• The embryo or the oncosphere is enclosed within the embryophore
• Three pairs of hooklets can be seen in the embryo
• Eggs cannot be distinguished from Taenia solium
Taenia eggs
Life Cycle
Cysticercus in Cattle Flesh
Epidemiology
• Very common in places where people eat raw or poorly cooked beef
• Poor sanitation and flooded pastures along rivers
• Raw sewage disposed disposed in the river
• Use of nightsoil
Pathogenesis and Symptoms
• Usually involves single worm infection
• 6 – 28 worms in a single patient were reported
• No significant clinical manifestation
• Complaints due to highly motile proglottids
• Proglottids may cause obstruction in the biliary duct and may enter
the appendix
• Passing out of proglottids, or even the strobila, is very common
Diagnosis
 Identification of the gravid proglottids or the eggs
 Eggs are usually collected thru scotch tape (swab) method
 Gravid proglottids may be seen in beddings and
undergarments
 Counting the uterine branches in a proglottids is useful in
differentiating T. saginata from T. solium
 Segment is pressed between two slides and examined under
microscope (may be stained)
 15 to 30 uterine branches for T. saginata as to 7 to 15
branches for T. solium
Treatment
• Same as D. latum
• Recovery of the scolex
• No infection after three months
Prevention
• Cysticercus bovis in cattle meat may be destroyed by:
• freezing (-10°C) for 5 days
• Heating above 57°C (thermal death point)
• Soaking in 25% salt solution for 5 days
• Control source of infection
• Avoid soil contamination
• Proper meat inspection
Taenia solium
Common Name: Pork Tapeworm
 Causative agent of taeniasis or pork tapeworm infection
 Humans are the only definitive host but can become an
intermediate host
 Adult worm is 2 – 4 meters in length
 May contain 800 – 2000 proglottids
 Each gravid proglottid may contain 30,000 to 50,000 eggs
 Globular scolex with 4 cup-shaped suckers and a rostellium
with double crown (hooklets)
 Mature segment has trilobed ovary; testes lesser than T.
saginata
 Eggs of Taenia cannot be differentiated
 Life may be up to 25 years
T. solium

Scolex with rostellum Gravid proglottid

T. solium Rostellum (Electron
Micrograph)
 Life Cycle
Gravid proglottids of adult in the intestines of host separate from strobila
(groups of 5 or 6)
Proglottids rupture before or after leaving the host releasing the eggs
Eggs are ingested by hogs or wild boars thru contaminated food or water
Embryophore is digested and oncosphere is released, penetrate the
intestinal mucosa and enter the lymph or blood circulation
Oncosphere reaches the muscles and visceral organs and encyst forming the
larval form cysticercus cellulosae
Humans become definitive hosts upon ingestion of improperly cooked
infected meat
Larva is liberated from the cyst and scolex attaches to the intestinal mucosa
Maturity is achieved in about 12 weeks
Cysticercus cellulosae

Pig heart Pig Liver

Cysticercus cellulosae
 Cysticercosis
• Humans can harbor the larval stage of T. solium
• Humans ingest T. solium eggs from contaminated food or water
• May also be a result of autoinfection due to poor hygenic practices
• Oncosphere will penetrate the intestinal mucosa, enter the
circulation and encyst in various tissues (Cysticercus cellulosae)
• Cyst remain in the tissue for up to 5 years producing inflammatory
response
• Cyst is calcified upon the death of the larva
Cysticercosis in Humans

Cysts in chest Neurocysticercosis (NCC)

Epidemiology
• Common in places where hogs and humans have access to human feces
• Lack of sanitation
• Human feces are fed to hogs
Intestinal Infection
• Mild nonspecific abdominal complaints
• proglotttids of T. solium are not as active as T. saginata
• No anemia in pork tapeworm infection
Cysticercosis
 Symptoms depends upon intensity, size, and location
 Most serious manifestation involves cerebral cysticercosis or
neurocysticercosis (NCC)
 NCC is considered one of the most serious zoonotic disease
in the world.
 Convulsions/epileptic seizures are common manifestations of
NCC and may be accompanied by focal motor, sensory and
mental changes
 Mental disorders depend upon the site and intensity of
infection
Diagnosis
• Identification of characteristic gravid proglottids in the feces and
eggs in the perianal region
• Eggs cannot be differentiated from T. saginata
• Examination of gravid proglottids is used for specific diagnosis
NCC Diagnosis
• Sudden convulsions and epileptic seizures in teenagers and adults not
associated with other brain dysfunctions
• Patient’s location, travel history, feeding habit
• Biopsy
• CT scan and MRI
• ELISA and Western Blot
NCC in CT Scan
Treatment
• Same as T. saginata and D. latum for intestinal infection
• Recovery of scolex and negative stool exam in 3 months
• Praziquantel at 50 – 75 mg/kg for 30 days for NCC
• Steroids are given to relieve inflammatory response
• Ocular cysticercosis can be treated surgically
Prevention
• Same as T. saginata
• Freezing meat at (-20°C) for 10 days kills the cyst
Hymenolepis nana
Common Name: Dwarf Tapeworm
• Causative agent of dwarf tapeworm infection
• Short worm: 20 mm. long
• May have as many as 200 proglottids
• Small globular scolex bears short retractile rostellium with a single ring of
hooklets and 4 cup-shaped suckers
• Mature proglottids are ellipsoidal, about 4 times as broad as long
• Gravid segments contain sac-like uteri which may contain 80-100 eggs each.
H. nana

Scolex with retractile rostellum Gravid proglottids

Hymenolepis nana Eggs
• Oval or globular in shape
• Two membranes enclose
the embryo
• Inner membrane has two
polar thickenings, from each
of which 4 to 8 polar
filaments arise
Life Cycle
Cercocystis cyst in intestinal villus
Mode of Transmission
• Direct hand to mouth
• Rarely thru contaminated food and water
• Eggs are easily dessicated
Pathogenesis and Symptoms
• No significant damage to the intestinal mucosa
• Heavy infection may lead to enteritis
• No symptoms or only vague abdominal pain for light infection
• Children may experience lack of appetite, anorexia, vomiting and dizziness
• Autoinfection can occur
Diagnosis
• Finding of the characteristic eggs in the stool

Treatment
• Praziquantel and Niclosamide
Prevention and Control
• Treatment of infected persons
• Improving hygienic practices of children
• Sanitation
• Rodent control
Hymenolepis diminuta
Common Name: Rat Tapeworm
• Causative agent of rat tapeworm infection
• Adult worm is 10 to 60 cm long
• It may have 800 to 1000 proglottids
• Club-shaped scolex has rudimentary unarmed rostellum and four small suckers
• Proglottids resemble that of H. nana
• Gravid proglottids have sac-like uteri
H. diminuta

Scolex Proglottids
H. diminuta egg
• Almost resembles H. nana egg
• Slightly bigger than H. nana
• There are no polar filaments
in the inner membrane
Which is which?
Life Cycle
Symptoms
• Asymptomatic
• Mild abdominal pain
• Gastrointestinal complaints
Diagnosis
• Finding the characteristic eggs in
the feces

Treatment
The same as H. nana
Prevention and Control
• Control of infected individuals
• Control of intermediate hosts
• Rodent control
• Control of insect droppings
Dipylidium caninum
Common Name: Pumpkin Seed Tapeworm
• Causative agent of dipylidiasis or dog or cat tapeworm infection
• Causes tapeworm infection in dogs and cats
• Humans are accidental hosts
• Scolex is globular with rostellum containing 1 – 7 rows of rosethorn
shaped hooklets and 4 deeply cup-shaped suckers
• Gravid proglottids resemble pumpkin seeds
• 15 to 70 cm. in length
• 60 to 175 proglottids per worm
• Eggs are packed in egg capsule containing 15 to 25 eggs
• Each egg contains an oncosphere with six hooklets
D. caninum

Scolex Gravid Segment

D. caninum Eggs
Life Cycle
Mode of Transmission
• Accidental ingestion of infected dog or cat fleas or lice
• Ingestion may be thru contaminated food or hand to mouth
• Children are more susceptible
• High percentage of dogs are infected
Intermediate hosts
Pathogenesis and Symptoms
• Infected individuals are usually asymptomatic
• Symptoms if present are minimal
• Multiple worm infection is rare
• Presence of actively motile proglottids in the feces are usually observed

Treatment
• Same as other tapeworms
Prevention
• Deworming and flea control of pets
• Avoid close contact with pets especially if the pet is flea infested

OU TH
HA T HIS M
W S W
KN O A CT ED
DO G CO NT
Y TH E L AS T
ONL HAS
Extra-intestinal
Cestodes
Echinococcus granulosus
Common Name: Hydatid Tapeworm or Dog Tapeworm
 Causative agent of echinococcosis, hydatid disease or hydatid cyst
 Dogs and other canines are the most common definitive hosts
 Herbivores are intermediate hosts
 Has become a common zoonotic infection
 Humans become accidental intermediate hosts and dead end host
 Smallest tapeworm of medical importance
Morphology
• Globular scolex with prominent rostellum armed with 2 rows of 30 – 36 hooks
• Four prominent suckers
• Body of an adult has 3 proglottids (immature, mature, and gravid)
• Gravid proglottid has median uterus with 12 – 15 branches
• Uterus may contain up to 500 eggs
• Eggs resemble that of the Taenia
Echinococcus granulosus adult
 Life Cycle
• Adult worms inhabit the small intestines of definitive
hosts
• Eggs from proglottids may be released inside or outside
of the host
• Herbivores become intermediate hosts upon ingestion of
contaminated vegetation
• Humans may also become intermediate dead end hosts
• Oncospheres are released, penetrate the intestinal wall
and are carried to the bloodstream
• Oncospheres are carried by the blood to the different
parts of the body where they form the larval stage called
 Hydatid cyst
• Usually 1 – 7 cm. in diameter (may reach 20 cm.)
• Generally spherical in human hosts
• E. granulosus cyst is unilocular or one celled
• Composed of 6 parts/ layers
• External elastic non-nucleated hyaline cuticle secreted by the second
layer (semi-permeable)
• Inner nucleated germinal layer
• Colorless or light yellow hydatid fluid
• Brood capsules containing protoscolices
• Daughter cyst which resembles the mother cyst
• “Hydatid sand” refers to protoscolices that are not enclosed in
brood capsules
Epidemiology
• Common in places where dogs are fed with fresh meat or animal viscera
• Dog owners from endemic areas are highly susceptible
• High incidence in places where close contact with pets is practiced
• Eggs remain alive in soil that is moist and shaded
Mode of Transmission
• Hand to mouth after contact with contaminated soil
• Hand to mouth after contact with fur of infected dog
• Infected dog licking the face of humans
 Pathogenesis and
Symptoms
 Dependent upon the location of the cyst
 Distribution of cyst in humans
 Liver and peritoneal cavity: 66%
 Lungs: 22%
 Kidney: 3%
 Bone: 2%
 Brain: 1%
 Other tissues: 6%
 Damage to the tissue resulting from pressure caused by the
enlargement of the cyst
 Cyst may rupture in the tissue releasing protoscolices and resulting
in formation of secondary cysts in other organs (autoinfection)
Diagnosis
Pertinent patient information
Residence in endemic area
Close contact with definitive host
Finding protoscolices, brood capsules or daughter cyst in the hydatid
cyst after surgery
Serological tests
Enzyme Linked Immunosorbent Assay (ELISA)
Indirect Hemagglutination (IHA)
Indirect Fluorescence Antibody (IFA)
CT scan and ultrasound may reveal the cyst
Treatment
• Surgery
• Rupture of the cyst should be avoided during surgery
• Enucleation is usually done
• Removal of the hydatid fluid and replacing it with chemicals that destroy the
daughter cells and protoscolices before removal
• Chemotherapy with albendazole
• Cyclosporin A
Prevention
• Eradication of parasite in natural intermediate and definitive hosts
• Dogs should not be fed uncooked animal parts
• Control of stray dogs
• Personal hygiene
Echinococcus multilocularis
 Foxes, wolves and cats are definitive hosts
 Rodents are intermediate hosts
 Humans become intermediate and dead end host after
contact with soil or ingestion of raw vegetation
contaminated with feces of definitive hosts
 Ingested eggs release oncosphere which develop into cyst
 Cyst is multilocular or multicelled
 Encystation usually occurs in the liver
 Cysts usually do not complete normal development
 Protoscolices do not develop
 Spirometra
• Caused by the presence of plerocercoid larvae or sparganum of
the Genus Spirometra in humans
• Spirometra resembles D. latum but are smaller
• S. mansoni, S. erinacei, and S. ranarum commonly infect humans
• Life cycle has the same pattern with D. latum
• Dogs, cats and wild carnivores are definitive hosts
• Cyclops or copepods are primary intermediate hosts
• Rodents, frogs and snakes are secondary intermediate hosts
• More than 6 cases have been reported in the Philippines
Mode of Transmission
• Humans acquire the infection thru:
• Ingestion of water contaminated with the infected primary intermediate host
• Consuming frogs, snakes or rodents harboring the plerocercoid larva or
sparganum
• Use of infected frogs and snakes as poultice (plerocercoid larva or sparganum
penetrate the cutaneous tissue)
Pathogenesis and Symptoms
• Larva may migrate to any part of the body
• Eyes, subcutaneous tissues, muscles of the thorax, thighs,
abdomen, and inguinal regions are commonly affected
• Elongation and contraction of larvae cause inflammatory and
painful edema
• Degeneration of larva causes local inflammation and tissue
necrosis
• Periodic giant urticaria, local indurations, edema and
erythema may appear accompanied by chills, fevers and high
eosinophilia
Diagnosis and Treatment
• Finding the larva in lesions
• Feeding experiments to animals is necessary to identify the species.
• Surgical removal of the larva is the only treatment