Cestodes Lecture

Dr. Sulaiman Lakoh

 Objectives
• To know the general characteristics of
cestodes
• To understand the clinical features,
management and prevention of cestodes
 Characteristics of Cestodes (1)
• Cestodes (tape worms) are segmented worms
• Adult reside in the gastrointestinal tract (GIT)
• Lavae can be found in almost any organ
 Characteristics of Cestodes (2)
• Tape worms are
ribbon-shaped
• Has a head called
scolex with sucking
cusps or hooks located
on it
• Behind the scolex is a
short narrow neck
 Characteristics of Cestodes (3)
• Attached to the neck are prglottids (segments)
• A group of proglottids are called strobila,
constitutes the bulk of the tape worm
• Some tapeworms can have more than 1000
proglottids and may be several centimeters
long
• Each proglottids is hermaphroditic and
produce eggs which are subsequently released
 Characteristics of Cestodes (4)
• Divided based on the definitive host into three
major groups
Group 1: humans as definitive hosts with adult
tape worm in the GIT: Taenia saginata,
Diphyllobothrium, Hymenolepsis and Dipylidium
caninum
Group 2: humans as intermediate hosts with larva
stage parasites in tissues: Echinococcus,
Sparganum and Coenurosis
 Characteristics of Cestodes (5)
• Life cycle
- Divided into larval and adult tapeworm
development
- Most tapeworm infection require one
intermediate host for complete larval
development
- Adult tapeworm develops in the definitive
host
 Characteristics of Cestodes (6)
• Group 3: Humans as either definitive or
intermediate hosts: Taenia solium
 Characteristics of Cestodes (7)
• Larval development
-After ingestion of the eggs or proglottids by an
intermediate host, the larva oncosphere is
activated
-The onscophere escapes the egg and penetrate
the intestinal mucosa, migrate to tissues and
develops into an encysted forms:
 Characteristics of Cestodes (8)
cysticercus (single scolex), a coenurus (multiple
scolices) or a hydatid (cyst with daughter cysts,
each containing several protoscolices)
 Characteristics of Cestodes (9)
• Adult development
-Ingestion by the definitive host of tissues
containing a cyst enables a scolex to develop
into a tapeworm
-The tapeworm attaches to the intestinal
mucosa by means of sucking cusps or hooks
-And then produce eggs or release the
proglottids
 Taenia saginata: Introduction
• Causes taeniasis (beef tapeworm)
• Occurs in all countries where raw and
undercooked beef is eaten
• Most prevalent in sub-Saharan Africa and the
middle East
• It can reach 8m in length and has 1000 to
2000 proglottids
• The scolex has four prominent suckers
 Taenia saginata: Introduction
• Inhabit the upper jejunum
• Each gravid segments has 15-30 uterine
branches
• The eggs have a thick brown, striated shell and
contain the oncosphere
 Taenia saginata: life cycle
• Eggs deposited on vegetations can live for
months or years until they are ingested by
cattle or other herbivores
• The embryo released after ingestion invades
the intestinal wall and carried to striated
muscles or viscera, where it transforms into
the cysticercus
 Taenia saginata: life cycle
• The cysticercus infect humans and transform
into adult when ingested in raw or
undercooked meat
• After the cysticercus is ingested, it takes two
months for the mature adult worm to develop
 Taenia saginata: clinical features
• Asymptomatic
• Patients become aware of the infection mostly
commonly by noting passage of proglottids in
their feces
• Perianal discomfort when proglottids are
discharged
• Mild abdominal pain or discomfort
• Nausea, change in appetite, weakness, and
weight loss
 Taenia saginata: diagnosis
• Detection of eggs or proglottids in the stool
• Eggs may also be detected in the perianal area
using cellophane-tape swab
• Eosinophillia
• Elevated IgE
 Taenia saginata: treatment
• A single dose of prazinquantel
• Adequate cooking of beef or pork viscera
• Exposure to tempratures as low as 56 degrees
for 5 mins will cysticerci
• Refrigeration or salting for periods periods
• Inspection of beef and proper waste disposal
 Taenia asiatica
• Similar characteristics, clinical features and
management Taenia saginata
• Minor differences exist
-T. asiatica is found in Asia with pigs as
intermediate hosts
T. asiatica has an unarmed rostellum
 Taenia solium: Introduction
• Also called pork tapworm
• Causes two distinct forms of infections in
humans: adult tape worms in the intestine or
larval forms in the tissues (cysticercosis)
• Occurs in all countries
 Taenia solium: Introduction
• Most prevalent in Latin America, sub-Saharan
Africa, China, India, and Southeast Asia
• Cysticercosis occurs in industrialized nations
• Usually 3m in length and may have as many as
1000 proglottids
 Taenia solium: Introduction
• Each proglottids can produce up to 50,000
eggs that infect both humans and animals
• The eggs can survive in the environment for
several months
• The scolex attaches by both sucking discs and
two rows of hooklet
• Inhabit the upper jejunum
 Taenia solium: life cycle
• Eggs deposited on vegetations can live for
months or years until they are ingested by the
pig
• The embryo released after ingestion invades
the intestinal wall and carried to many tissues:
most frequently striated muscles of the neck,
tongue and trunk
 Taenia solium: life cycle
• Within 60-90 days, the encysted larval stage
develops
• These cysticerci can survive for months to
years
• The cysticercus infect humans and transform
into adult intestinal tapeworm when ingested
in raw or undercooked pork
 Taenia solium: life cycle
• Infections that cause human cysticercosis
follow ingestion of T. solium eggs, usually from
a close contact with a tapeworm carrier
• Autoinfection may occur if an individual with
an egg-producing tapeworm ingest egg
derived from his or her own feces
 Taenia solium: clinical features
• Intestinal T. solium infections may be
asymptomatic
• Fecal passage of proglottids may be noted
• Variable clinical manifestations in cysticercosis
• Cysticerci are most frequent in the brain,
cerebrospinal fluid, skeletal muscle,
subcutaneous tissue, or eye
 Taenia solium: clinical features
• Seizure: generalized, focal or jacksonian
• Hydrocephalus with signs of raised intracranial
pressure: headache, nausea, vomiting,
changes in vision, dizziness, ataxia,
papailledema, confusion or altered mental
status
 Taenia saginata: diagnosis
• Detection of eggs or proglottids in the stool
• Serology
• PCR
• Imaging: CT scan, MRI
 Taenia solium: treatment
• A single dose of praziquantel or niclosamide
for intestinal T. solium infection
• Management of cysticercosis praziquantel or
niclosamide, supportive therapy, and surgery
 Taenia solium: prevention
• Adequate cooking of beef or pork viscera
• Exposure to tempratures as low as 56 degrees
for 5 mins will cysticerci
• Refrigeration or salting for periods periods
• Inspection of beef and proper waste disposal
• Mass chemotherapy
• Vaccine on development
 Echinococcosis: introduction
• Caused Echinococcus granulosus, E.
multilocularis and E. vogeli
• E. granulosus produces a unilocular cystic
lesion and causes cystic hydatid disease
• E. granulosus is found in association with dog
but also with cattle, sheep, pigs, horses, and
camels
 Echinococcosis: Introduction
• E. granulosus is found in all continents
• Most prevalent in Central Asia, the
Mediterranean region, Eastern Africa, China, the
Middle East, India, and parts of South America
• E. multilocularis, which causes multilocular
cystic lesions is found in Alpine, sub-artic or
arctic regions, including Canada, the United
States, and Central and Northern Europe; China;
and Central Asia
 Echinococcosis: Introduction
• E. vogeli causes multilocular hydatid disease
and is found only in Central and South
America
• The adult E. granulosus worms live for 5-20
months in the jejunum
 Echinococcosis: Lifecycle
• Has both intermediate and definitive hosts
• Definitive hosts include dog (E. granulosus)
and foxes (E. multilocularis)
• Intermediate hosts: humans, sheep, cattle,
goat, camels, and horses
 Echinococcosis: Lifecycle
• The definitive hosts (canines) pass eggs in the
feces
• After ingestion of eggs by intermediate host
(humans, goats, sheep, cattle, camels, etc),
cyst develops
• When a dog or fox ingest infected meat
containing cyst, the lifecycle begins
 Echinococcosis: pathophysiology
• E. granulosus lives in the jejunum of dogs
• It has only three proglotids: mature, immature
and gravid
• After humans ingest the eggs, the embryos
escape the eggs and penetrate the intestinal
mucosa, enter the portal circulation and
carried to various organs (most commonly the
liver and the lungs)
 Echinococcosis:pathophysiology
• The larvae develop into a fluid-filled unilocular
hydatid cyst that consist of an external
membrane and an inner germinal layer
• Daughter cysts develops from the inner aspect
of the germinal layer (hydatid sand), as do
germinating cystic structures (brood capsules)
• New larvae (protoscoliosis) develop in large
number within the broad capsules
 Echinococcosis: clinical features
• Asymptomatic
• Mass effect: abdominal pain, palpable mass in
the right upper quadrant
• Leakage of cyst fluid into the biliary tree may
mimic recurrent cholelithiasis
• Biliary obstruction can cause jaundice
 Echinococcosis: clinical features
• Pulmonary hydatid cyst may rupture and
produce salty phlegm, cough, dyspnea, chest
pain, or hemoptysis
• Other mass effect: pathological fractures,
intracranial SOL, conduction defects,
pericarditis, and pelvic mass
 Echinococcosis: clinical features
• Imaging: plain x-ray, abdominal untrasound,
CT scan, MRI
• Serology
• Full blood count: evidence of eosinophillia
 Echinococcosis: treatment
• PAIR: percutaneous aspiration, infusion of
scolicidal agent and reaspiration
• Surgery
• Medical therapy: praziquantel
 Diphyllobothriasis: introduction
• Aetiology: Diphyllobthrium latum
• Found in lakes, rivers, and deltas of the
Northern Hemisphere, Central Africa and
South America
• The longest tapeworm (up to 25m)
• Attaches to the ileum and occasionally
jejunum by its suckers
 Diphyllobothriasis: introduction
• Adult has 3000-4000 proglottids which release
1 million eggs daily into the feces
• The egg hatches and releases a free-swimming
embryo that can be eaten by freshwater
crustaceans (Cyclops or Diaptomus)
• The larva migrate to the fish flesh after
ingestion and grows into a plerocercoid, or
spaganum
 Diphyllobothriasis: introduction
• Humans acquire the infection by ingesting
infected raw or smoked fish
• Within 3-5 weeks, the tapeworm mature into
adult in the human intestine
 Diphyllobothriasis: clinical features
• Mostly asymptomatic
• Transient abdominal discomfort, diarrhea,
vomiting, weakness, and weight loss
• Abdominal pain and intestinal obstruction
• Cholangitis, cholecystitis
• Megaloblastic anemia
Diphyllobothriasis: diagnosis and treatment

• Diagnosis: eggs in the stool

• Treat with prazinquantel and supplement Vit
B12
• Prevention: properly heat or freeze fish
 Hymenolepsiasis Nana: introduction

• H. nana (dwarf tapeworm) is the most

common of all the cestodes
• It is endemic in both temperate and tropical
regions
• The smallest tapeworm to infect humans
• Is 2cm long and dwells in the proximal ileum
 H. nana: life cycle
• It is the only cestode that does not require an
intermediate host
• Both the larval and adult phases of the life
cycle take place in the humans
• Infection is spread by fecal/oral contamination
and is most common among institutional
children
 H. nana: life cycle
• Proglottids are quiet small and rarely seen in
the stool.
• They release spherical eggs 30-40µm diameter
• Each contain an oncosphere with six hooklets
• The eggs are immediately infective and unable
to survive for >10 days in the external
environment
 H. nana: life cycle
• The eggs are ingested by a new hosts and the
oncosphere is released
• The released oncosphere penetrate the
intestinal villi, becoming a cystercercoid larva
• Larvae migrate back into the intestinal lumen,
attach to the mucosa, and mature to adult
worm over 10-12 days
• Autoinfection can also occur
 H. nana: clinical features
• Asymptomatic
• Anorexia, abdominal pain, and diarrhoea
 H. nana: diagnosis and treatment
• Microscopy: eggs in the stool
• Treatment: prazinquantel and nitazoxanide
• Prevention: personal hygiene, improved
sanitation, and mass chemotherapy
 Read
• Dypilidiasis
• Sparganosis
• Coenurosis