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This document provides information on different cestode tapeworms including their life cycles, morphology, pathogenesis, diagnosis and treatment. It discusses both intestinal tapeworms like Taenia saginata (beef tapeworm), Taenia solium (pork tapeworm), as well as non-intestinal tapeworms such as Hymenolepis nana (dwarf tapeworm) and Hymenolepis diminuta (rat tapeworm). The key features, symptoms and clinical manifestations of each tapeworm are summarized.
This document provides information on different cestode tapeworms including their life cycles, morphology, pathogenesis, diagnosis and treatment. It discusses both intestinal tapeworms like Taenia saginata (beef tapeworm), Taenia solium (pork tapeworm), as well as non-intestinal tapeworms such as Hymenolepis nana (dwarf tapeworm) and Hymenolepis diminuta (rat tapeworm). The key features, symptoms and clinical manifestations of each tapeworm are summarized.
This document provides information on different cestode tapeworms including their life cycles, morphology, pathogenesis, diagnosis and treatment. It discusses both intestinal tapeworms like Taenia saginata (beef tapeworm), Taenia solium (pork tapeworm), as well as non-intestinal tapeworms such as Hymenolepis nana (dwarf tapeworm) and Hymenolepis diminuta (rat tapeworm). The key features, symptoms and clinical manifestations of each tapeworm are summarized.
symmetry) Has a ribbon like appearance Are not provided with a digestive tract nor a circulatory system Adult tapeworms are hermaphroditic Scolex main organ of attachment Neck- region of growth (strobilization) Strobila chains of proglottids Grouped in 2 orders; 1. Psuedophyllidea Spatulate scolex with sucking grooves (bothria) Has a uterine pore which releases the egg In infections, segments are not generally found Eggs are operculated and immature that requires aquatic development Require 2 intermediate hosts (procecoid in the 1 st
then plerocercoid in the 2 nd ) 2. Cyclophyllidea Scolex is globular with four suckers Does not have a uterine pore but undergo apolysis In infections, both segments and eggs are generally found Non-operculated egg are readily passed out containing the hexacanth embryo Only require 1 intermediate host (though different species produce different types of encysted larvae INTESTINAL CESTODES Tinea saginata [cyclophillidean] Beef Tapeworm Humans are the definitive host and never the intermediate Can live in the upper jejunum for about 25 years Cuboidal scolex, NO rostellum 1000-4000 proglottids (may lead up to 25m in length) [Chains of immature, mature & gravid] Mature proglottids Square in shape Contains both male and female reproductive organs Gravid proglottids Longer and wide Most distal portion Ova in the uterus counts 15-20 branches (>15) Normally contains 97,000 to 124,000 ova Undergo apolysis Ova Spherical/subspherical in shape Brownish in color Thick embryophore Inside are oncospheres with 3 pair of hooklets Upon ingestion of the ova, it will release the oncospheres and will actively penetrate the intestinal mucousa to enter a venule to be carried throughout the body. Upon entering a muscle fiber it will develop into the infective stage, Cysticercus bovis. Cysticercus bovis Infective stage Ovoidal milky white 10mm in diameter has a single scolex the adult tapeworm is irritated by alcohol Pathogenesis and Symptomatology Most common CC is passage of proglottids in stool Causes mild irritation at the site of attachment Patients may experience Non-vague discomfort Hunger pangs Weakness Weight loss Loss of appetite Pruritus ani (perianal itching) Proglottids are atively motile and can cause obstruction Diagnosis Identify the characteristic proglottid, egg and scolex. Fomalin-ether concentration technique used in demonstrating eggs Perianal swabs are useful as well Treatment Drug of choice praziquantel (5-10mg/kg) Criteria for cure a) Recovery of scolex b) Negative stool exam c) Months after treatment ------------------------------------------------------------------------------------------- Tinea solium [cyclophyllidean] Pork tapeworm Inhabit the upper small intestines Shorter than T. saginata and has lesser number of proglottids Scolex has 4 acetabula (smaller and more spherical than beef tapeworm) Scolex carries a rostrellum with a double crown of 25-30 hooks Proglottids are the same with saginata except; 1. Presence of accessory ovarian lobe 2. Absence of vaginal sphincter 3. Smaller number of follicular testes (100-200) 4. Lesser number of uterine branches (<15) Eggs are indistinguishable from saginata Gravid proglottid contains 30,000-50,000 ova Eggs are less active compared to saginata Released oncosphere and penetrate the intestinal mucosa Encyst in the muscles as Cysticercus cellulosae Measly pork = infected meat Man maybe the intermediate host Eggs become Cysticerci upon ingestion Oncospheres hatches in the duodenum Autoinfection is possible in poor hygiene Pathogenesis and symptomatology Cysticercosis Cysticerci are often located in multiple organ or tissue, upon death, cystic fluids increase and there is a pronounced response to the parasite. The parasite is eventually calcified. Neurocysticercosis [NCC] Most serious manifestation Most serious zoonotic disease 2 general forms of NCC 1. Parenchymal Focal or generalized siezures 2. Extraparenchymal a) Subarachnoid/meningitic o May lead to Racemous Cysticercosis o Cysts are at the base of the brain b) Intraventricular o Cysts are in the 3 rd or 4 th ventricle o May often lead to obstructive hydrocephalus c) Spinal o This form is rare Cerebral cysticercosis Convulsions, most common manifestations Visual & motor deficits, headache & vomiting may occur CSF tap shows, opening pressure, protein, mononuclear cells and glucose Opthalmic Cysticercosis Located often retinal or subretinal May float in the vitreous humor Chrorioretinitis & vasculitis affects vision Intraorbital pain, photopsia & blurring or loss of vision noted in patients Diagnosis Intestinal Identifying the proglottids, eggs or the scolex (same as saginata) Cysticercosis CAT scan & MRI for NCC 3 patterns for CAT SCAN: 1. Round low density area without administration of contrast dye (viable larva but no inflammation) 2. Ring like enhancement after injection of contrast dye (dead larva) 3. Small calcified area within the cystic space (dead scolex) Opthalmoscopy for Opthalmic Cysticercosis DOT ELISA test is a very good screening test for cysticercosis Treatment Intestinal Drug of choice is Praziquantel (5-10mg/kg) and Niclosamide Criteria for treatment; a) Recovery of scolex b) Negative stool examination 3 months after treatment Cysticercosis Parenchymal NCC 50-75mg/kg for 30 days of Praziquantel 400mg twice a day for 8-30days Steroids are given after the last dose Parenchymal forms with encephalitis/massive parasitic infection High dose corticosteroid therapy Mannitol in ICP Extraparenchymal Subarachnoid Surgical removal/albendezole therapy Occular Cysticercosis Surgical removal then administration of Praziquantel and Albendazole Prevention and Control Cooking of meat is a primary measure Freezing at 20C for 10 days kills the cysticerci Sanitary inspection of slaughtered pigs, cows and cattle. ------------------------------------------------------------------------------------------- Hymenolepis nana [cyclophyllidean] Dwarf tapeworm The only tapeworm that can complete its lifecycle in a single host The adults are found in the ileum Delicate strobili Scolex is subglobular with 4 cup shaped suckers Retractable rostrellum with a single row of 20-30 Y-shaped hooklets Neck is long and slender Anterior proglottids are short; posterior proglottids are broad Genital pores are found along the same side of the segments Mature proglottids Contain 3 ovoid testes and 1 ovary in a straight pattern Gravid proglottids Testes and ovary disappear Uterus hollows out and filled with eggs Separates from the strobila and releases eggs Eggs Spherical or subspherical Oncosphere has a thin outer membrane and a thich outermembrane Has 4-8 hair like polar filaments in the inner membrane Life cycle is either by direct or indirect pathway Direct pathway a) Host ingests eggs that hatch in the duodenum b) Released oncospheres penetrate mucosa and become cysticercoid larvae c) 4-5days after, the larvae breaks out and attaches to the mucosa to develop into adults Indirect pathway a) Host ingest intermediate host rice/flour beetles; Tenebrio molitor, Tenebrio obscuris and Tenebrio confusum Rat flea (Xenophyslla cheopis) (carries H. nana var fraterna) b) The cysticercoid larvae will be develop into adults c) 20-30 days from ingestion for eggs to appear in the feces d) Eggs are viable after discharged e) Autoinfection can occur through fecal-oral route Pathogenesis and symptomatology Symptoms are from the immune response in the presence of the parasite Light worm burden are asymptomatic Headache Dizziness Anorexia Pruritus of nose and anus Diarrhea Abdominal pain Pallor Sleep disturbances (sometimes) Convulsions (rare) Heavy infections cause enteritis due to necrosis of intestinal epithelial cell with time, H. nana can be cleared out by the immune system Diagnosis Specific diagnosis is made by demonstration of the characteristic eggs in the patients stools (spherical with 4-8 hiar like polar filaments) Treatment Drug of choice is praziquantel (25mg/kg single dose) Prevention and Control Personal hygiene is emphasized Environmental sanitation Rodent control Food must be properly stored and protected from the intermediate hosts ------------------------------------------------------------------------------------------- Hymenolepis diminuta Rat tapeworm Accidental human infection causes hymenolepiasis Adult is larger than H. nana Proglottids are the same in H. nana Genital pores are unilateral Gravid proglottid contains a sac-like uterus filled with eggs Eggs Circular and bile stained Oncosphere Enclosed in an inner membrane Has bipolar thickening but NO bipolar filaments Hooklets have a fan like arrangement Pathogenesis and symptomatology Worm burden in rodents is relatively low Clinical manifestations are minimal and non-specific Diagnosis Identification of eggs in the stool H. diminuta eggs are more circular, larger and lack of bipolar filaments than H. nana. Expelled scolex can be used as an aid in distinguishing and diagnosing Prevention and Control Rodent control Elimination of insect intermediate host Protection of food Treatment of human cases ------------------------------------------------------------------------------------------- Dipylidium caninum Dog tapeworm/Double-pored tapeworm Dipylidiasis is accidental in humans Pale reddish worm Scolex is small and globular with 4 deeply cupped suckers A protrusible Rostrellum with 1-7 rows of rose-thorn shaped hooklets Proglottids Are narrow 2 sets of male and female reproductive organs Bilateral genital pores Gravid proglottid Size and shape of pumpkin seeds Filled with capsule or packets of about 8-15 eggs Eggs Spherical Thin shelled with hexacanth embryo Intermediate hosts that may ingest eggs 1. Dog flea (Ctenocephalides canis) 2. Cat flea (Ctenocephalides felis) 3. Human flea (Pulex irritans) 4. Dog louse (Trichodes canis) In the body cavity of the arthropod, the haxacanth embryo develops into the cysticercoid larvae Upon ingestion of the insect by mammalian hosts, they will develop into adults in 3-4 weeks Pathogenesis and symptomatology Infection is rarely multiple and symptoms are minimal o Slight intestinal discomfort o Epigastric pain o Diarrhea o Anal pruritus o Allergic reactions o Some patients are asymptomatic Diagnosis Is established upon recovery of characteristics gravid proglottids passed out singly or in chain Stool examination for the presence of the egg capsules is not recommended Eggs in capsule are rarly recovered from the stool Treatment Drug of choice is praziquantel (5-10mg/kg single dose) Prevention and Control Periodic deworming of pet cats and dogs is recommended Insecticide dusting of dogs and cats are effectively against fleas ------------------------------------------------------------------------------------------- Raillietina garrisoni Belong to the family Davaineidae 60cm in length Subglobular scolex with 4 acetabula Rostrellum has 2 alternating circular rows of 90-140 hammer-shaped hooks Several rows of spine surround the rostrellum Mature proglottid Surrounded by 36-50 ovoid testes Genital pore is open at one side near the anterior lateral obrder of the segment Gravid proglottids 2mm in length Contains 200-400 egg capsules with 1-4 spindle shaped eggs Oncosphere Surrounded by 2 thin membranes Outer elongated Inner spherical Detach from the rest of the strobili by apolysis Segments are motile, white and appear like rice Segments may be ingested by Tribolium confusum (flour beetle) It will then develop in to a cysticercoid larvae in 2 weeks Infected insects are accidentally ingested and the cysticercoid larva attaches to the intestinal villi to develop into an adult Pathogenesis and symptomatology Patients are normally asymptomatic Normally need medical consultation when proglottids are passed out in the feces Diagnosis Made by finding the characteristic proglottids or ova in stools. Treatment Can sometimes be expelled spontaneously without treatment Praziquantel maybe given to expel the worm. This is a common intestinal cestode in the Philippines Prevention and control Elimination of rodents from the households Proper storage of grain products Sanitary waste disposal would help prevent infection ------------------------------------------------------------------------------------------- Diphyllobothrium latum [psuedophyllidea] Fish tapeworm/broad tapeworm Diphyllobothriasis intestinal infection of adult worm 3-10 m in length; 4000 proglottids Scolex is spatulate It has 2 bothria (dorsal and ventral) Neck is long and attenuated The terminal 4/5 of the worm is composed of mature and gravid proglottids Mature proglottids Longer width than length Contains one set of reproductive organs Testes Located in the dorsolateral part of the proglottid Uterus dark, rosette-like, coiled located in the middle of the gravid proglottid Ovary Symmetrically bilobed Present at the posterioir third of the proglottid immediately the Mehlis gland Proglottids disintegrate when segment has completed reproductive function 1,000,000 ova may be released daily Ova Usually yellowish brown Thick shell with (inconspicuous) operculum Opposite to the operculum is a small knob-like thickening Complete their development in water and become Coracidium Coracidium are ingested by Copepods (Cyclops & Diaptomus genera) and become Procercoid Procercoid Develops in the copepod Retains 3 hooklets in the cercomer [a caudal attachment organ] Copepods are ingested by fish (trout. Salmon, perch and pike) Procercoid migrate from the copepod to the fish to become Plerocercoid/Sparganum Plerocercoid larvae/Sparganum (Infective stage) Appears glistening, opaque white and unsegmented Fish with infected plerocercoid will be ingested by a definitive host eventually. Carnivorous fishes (Carcharodon carcharias) may serve as paratenic or transport host. In the definitive host, attaches to intestinal wall until maturity Pathogenesis and symptomatology Infections are usually limited to one worm Infected individuals show no signs Some may experience; o Nervous disturbances o Digestive disorders o Abdominal discomfort o Weight loss o Weakness o Anemia Diphyllobothriasis Hyperchromic, megaloblastic anemia with thrombocytopenia & leukopenia Similar to vitamin B12 deficiency Maybe mistaken for Pernicious Anemia Worms in the upper jejunum will compete with host for Vit B12 Diagnosis Definite diagnosis is made on finding the characteristic operculated egg or proglottid in stool Kato Technique is also useful Treatment Praziquantel 5-10mg/kg single dose Prevention and control All fresh water fishes should be thoroughly cooked Freezing for 24-48 hours at -18C kills all plerocercoids Proper waste disposal Proper marketing of fish
EXTRAINTESTINAL CESTODES Echinococcus spp.[cyclophyllidean] Hydatid worm Human echinococcosis considered as one of the emerging zoonotic disease caused by larval stage of Echinococcus spp. E. granulosus causes cystic echinococcus E. multilocularis causes alveolar echinococcosis E. multilocularis is less common because its life cycle is sylvaltic Dogs and other canines are the most common definitive host The adult inhabits the small intestines of canines Scolex Pyriform in shape Taeniid in that it has 4 acetabula Armed with 30-36 hooks Short neck 3 proglotids [1 immature, 1 mature & 1 gravid] Gravid proglottid widest and longest Uterus is midline with lateral invaginations Eggs May be released outside or inside the host Swallowed by intermediate hosts such as o Goats o Horses o Camels o Sheep They hatch in the duodenum Man may accidentally ingest these eggs Oncosphere Penetrates the mucosal wall and migrates to the mesenteric venules Hydatid cyst The larval stage Formed by central vesiculation and gradual enlargement Numerous protoscolices may be found Development is completed when the cysts in the tissues are ingested by carnivores or omnivores Once inside the definitive host, protoscolices evaginate, attach to the intestinal wall and develop into adults Normally reside in the small bowels The cyst has an outer laminated layer and an inner nucleated germinal layer Protoscolices may be found in the brood capsule When protoscolices lie free in the cyst these are referred to as Hydatid sand Pathogenesis and symptomatology Pathology is caused by developing larval cysts in tissues Liver (70%) is the most common and important site of involvement (mostly affected is the right love) Lungs are involved by 20-30% Brain is 10% Cysts of E. granulosus are called unilocular hydatid cyst o Develop inflammatory reactions o Down regulates inflammatory cytokines Cysts of E. multilocularis are called alveolar cysts Simple or uncomplicated cysts may not produce any symptoms Hepatics cysts mainly found in the inferior right lobe Rupture of the hepatic cyst produces the triad; 1. Intermittent jaundice 2. Fever 3. Eosinophilia Abdominal cysts cause discomfort when the cyst is large enough cysts may rupture from coughing, stain or trauma then protoscolices, brood capsules & daughter cells metastasize Cysts may also become intrathoracic if the are located in the superior lobe of the liver Peribronchial cysts May discharge in to a bronchus and result in coughing Sputum may contain frothy blood, mucus, hydatid fluid & bits of membrane Brain Involvement of the brain may cause increase ICP and Jacksonian epilepsy Renal Renal involvement may cause; o Intermittinet pain o Hematuria o Kidney dysfunction o Hydatid material in the urine Secondary infections of the cyst may also occur Bacteria may enter the cyst and lead to pyogenic abscess Patients with this condition presents high fever and chills Secondary cysts have higher mortality rates Rupture of primary cysts may result to serious anaphylaxis Diagnosis Radiographic findings and ultrasonography with a history of residence in an endemic area and close association with dogs Serologic tests such as; 1. IHA 2. IFA 3. EIA Use of rapid dot ELISA to detect antigens of E. granulosus Treatment Surgical resection is the treatment of choice Surgical management involves instilling a scolicidal agent; o Hibitane o 95% ethanol o 30% hypertonic saline solution For inoperable cysts, albendazole may be given at 400mg twice a day for 1-6 months at cycle of 4 weeks each with 2 weeks no therapy in between cycles Prevention and control Achieved by reducing the infected population Minimize opportunity for transmission Proper Health education Echinococcus multilocularis Foxes are the natural definitive host Small rodents are the intermediate host Human infections normally occur in the northern hemisphere Eggs Are ingested and the cystic larvae are established in tissue Cysts Wall is not clearly delineated from surrounding tissue Usually sterile (absence of protoscolices) Common site is the liver, may present as a tumor Treatment is surgery or the PAIR procedure Inoperable cases are given albendazole or mebendazole. ------------------------------------------------------------------------------------------- Sparganosis Refers to the larval infection of the plerocercoid larva AKA spargana of psuedophyllidean tapeworms under the genus Spirometra. o Spirometra mansoni o Spirometra erinacei o Spirometra ranarum These are usually mistaken for adult D. latum Humans can be infected by; a) Drinking water containing infected copepods b) Eating infected 2 nd intermediate host c) Applying infected flesh as poultices d) Consumption of infected flesh of paratenic hosts Larvae Opaque, glistening white May be found anywhere in the body Diagnosis Made by finding larvae in the lesion Species identification is done Treatment Surgical removal of the plerocercoid Prevention and control Prevented by drinking boiled or filtrated water Cooking possible paratenic hosts thoroughly Avoid applying flesh of frogs to inflamed areas.