PARASITOLOGY SPUP MEDICINE

CESTODE
Jennifer Pichay-Alvarado, MD MAY 2019
EXIMIUS
2021
Order Psuedophyllidean Cyclophyllidean
Scolex Spatulate scolex with sucking grooves (bothria) Scolex is globular with 4 muscular suckers
Unterine pore release of eggs from gravid uterus No uterine pore
Segment have genital pores, have genital pores, , Both eggs and segments are recovered
may not be found in stools Undergo apolysis (gravid segments detached from main body and eggs are released
Egg Operculated and immature eggs Non operculated eggs
Host 2 intermediate hosts in their life cycle: aquatic development of the embryo (coracidium) 1 intermediate host
1st intermediate host –procercoid larva 2nd intermediate host – plerocercoid larva Taenia – cysticercus Hymenolepis, Dipylidium – Cysticercoid Echinococcus spp – hydatid cyst (human)

Order Psuedophyllidean Cyclophyllidean

Diphyllobothrium latum Spirometra species Dipylidium caninum Hymenolepis nana Echinococcus granulosus Taenia saginata Taenia solium Raillietina garrisoni
Other name Fish tapeworm or S. mansoni Double-pored Dwarf tapeworm - Beef tapeworm Pork tapeworm Common tapeworm of rats
broad tapeworm S. erinacei tapeworm smallest (Tubangui)
S. ranarum Family Davaineidae
Clijnical Diphyllobothriasis Sparganosis larval infection Mostly asymptomatic Symptoms – due to Hepatic cyst Adult tapeworm – irritated by Intestinal infection Asymptomatic
Manifestation hyperchromic, with plerocercoid (aka Slight intestinal patient’s immunological Abdominal cyst: alcohol Neurocysticercosis Brought when proglottids
megaloblastic anemia Spargana discomfort response to the parasite Peribronchial cyst Proglottids or segments in stool – Parenchymal NCC passed out with feces
with thrombocytopenia Migrating tumor – painful Epigastric pain Light worm burden Sputum – frothy blood, mucus, most common chief complaint R. madagascariensis – 1st
and leukopenia edema due to migrating Diarrhea  Headache, dizziness, hydated fluid, bits of Mild irritaion at attachment sites reported by Garrison (1911)
larva Pruritic allergic anorexia, pruritus ani, membrane Non specific s/s present in Filipino adult
Signs and symptoms reaction diarrhea, vomiting, Brain – increased ICP and  Epigastric pain R. garrisoni – present in
 Local induration Mild eosinophilia abdominal pain, epilepsy  Vague discomfort children
 Periodic giant urticaria pallor and weight loss Renal – intermittent pain,  Hunger pangs
 Chills, fever  Children : restless, hematuria, kidney dysfunction  Weakness
 High eosinophilia irritable and sleep and hydatid material in urine  Weight loss, anorexia
disturbance Pyogenic abscess formation –  Pruritus ani/ perianal itching
 Rarely - convulsion high fever and chills (bacteria  Intestinal obstruction – rare
 Heavy infection – enter cyst) Obstruction in bile and
enteritis (necrosis and Secondary and infected cyst – pancreatic ducts and appendix –
desquamation of higher mortality rate motile proglottids
intestinal epithelial Multiple cyst on major organs – Anxiety and distress – actively
cells) multiple organ failure ( 20% to motile proglottids (perianal area)
40% cases)
Intrabiliary rupture of cyst –
most common complication
followed by suppuration
Adult size 3 to 10 m length Pale reddish 25 to 45 mm length 4 to 10 cm length reaches 25m 2 to 4 m length 60 cm long
10 to 70 cm length 1 mm width
Proglottids 4000 proglottids Ant proglottids: short Immature, Mature , Gravid 1000 to 4000 proglottids 8000-10,000 proglottids
Post proglottids: broader
Scolex Spatulate, 2 sucking small, globular, subglobular with 4 cup- pyriform, 4 acetabula, 30-36 Cuboidal, 1-2 mm diameter 4 acetabula, 1 mm Minute subglobular scolex
grooves (bothria) 4 deeply cupped shaped sucker, hooks 4 prominent acetabula More spherical with 4 acetabula
dorsal and ventral suckers, protrussible retractable armed No hooks or rostellum Cushion-like rostellum Rostellum armed with 2
armed rostellum, rostellum with single row Double crown of 25 to 30 large alternating circular rows of
1 to 7 rows of rose- of 20-30 Y-shaped and small hooks (absent in T. 90 to 140 hammer-shaped
thorn shaped hooklets hooklets saginata hooks
Neck long and attenuated long and slender short
gravid Terminal 4th and 5th coiled uterus Size and shape of widest and longest Longer than wide Contains 7 to 13 branches Fully gravid proglottids 2 mm
proglottids pumpkin seed Contains 97,000-124,000 ova Less active long, contain 200 to 400 egg
Filled with capsules or Most distal from the nec 30,000 to 50,000 eggs capsules with one to four
packets of about 8 to spindle shaped eggs,
15 eggs enclosed in detach by apolysis and
embryonic membrane passed out in feces
Mature contains 1 set of Square-shaped, Contain mature Mature proglottids with
proglottid reproductive organ male & female reproductive bilobed ovary surrounded
organ by 36 to 50 ovoid testes
Testes dorsolateral part of
proglottid

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Uterus dark, rosette-like, midline median club shaped
coiled, located middle distended with ova, 15-20 lateral
of gravid proglottid branches
extends from ootype
Ovary symmetrically bilobed, 2 large lobes
posterior 3rd of
proglottid above
Mehli’s gland
Vagina extends up to join the sphincter
oviduct and vitelline
duct
Ova/Egg 1 M ova released per immature and Spherical, Thin shelled, spherical, or Lateral evaginations filled with Sub spherical to spherical Indistinguishable from T.
day, Yellowish brown, operculated, small With hexacanth subspherical, colorless or eggs 30-45 um diameter saginata
thickshelled,inconspicu embryo clay colored, 30-47um Brownish 30-40 um
ous operculum, Small diameter Embryophore striated and thick Thick, brown, striated
knoblike thickening Eggs die immediately Oncosphere with 3 pairs of embryophore surrounding
opposite operculum once passed out into hooklets hexacanth embryo
environment
Complete devt in
water and release free
swimming coracidium
OTHERS Procercoid found along same side Hydatid cyst : Larval stage, 1 to Genital pores – irregular, • Genital pore opens on
 550 um of the segments 7 cm dm, Formed through alternate the side near the
 Retain 3 hooklets in central vesiculations Cysticercus – ovoidal, milky white, anterior lateral border
the cercomer  Growth rate 1-5 cm dm/year 10mm diameter of the segment
(caudal attachment  Find numerous protoscolices • Oncosphere enclosed
organ)  Outer layer – laminated in 2 thin membrane
Plerocercoid hyaline • Segments are motile,
larva/Sparganum  Inner layer – nucleated white, appear like
 20 mm or more germinal grains of rice when
 Appears glistening, Hydatid sand: Protoscolices passed out in feces
opaque white and and brood capsules which lie
unsegmented freely in the cyst

1st IH fresh water cope pods Cyclops (Procercoid larva) Ctenocephalides canis goat, horse, camel, sheep Man flour beetle Trobolium
(Cyclops and –dog flea confusum)
Diaptomus) Ctenocephalides felis –
(Procercoid to cat flea
plerocercoid larva) Pulex irritans – human
flea
Trichodectes canis –
dog louse
2nd IH Fish (perch, trout, frog, snake, chicken
salmon and pike) (Procercoid to
plerocercoid larva)
definitive host man, dog, cat and of cats, dogs and other dogs and cats Canine humans Man mammalian host
other mammals carnivores
Accidental carnivorous fish Human (children) Man
host (paratenic host)
Habitat in DH Jejunum ileum duodenum upper jejunum for up to 25 years small intestine
Diagnosis  Definitive diagnosis –  Recovery of  Recovery of gravid  Recovery of eggs in  Radiographic finding Identify eggs, proglottids or scolex Taeniasis: Identification of Proglottids or ova in stools
eggs or proglottids in Plerocercoid larva from proglottids stool  Ultrasonography India ink – injected in the genital eggs, scolex and proglottids
stool or proglottids in infected tissue  Eggs are rarely  Light infection –  History of living in endemic pore – visualize lateral branches Cysticercosis:: NCC suspect
vomitus  Species identification – recovered from concentration of stool areas of the uterus SQ cysticercosis
 Kato katz tecnique – experimental animal stools specimen on  Close association with dogs  T. saginata – 15 to 20  With neurosymptoms –
demonstration of infection alternate days Serology:  T. solium – 7 to 13 presumptive evidence for
eggs  Proglottids – not  Screening test  Mature segment stained to NCC
 Gastric juice recovered in stool  Confirm presumptive demonstrate - vaginal sphincter  CAT scan and nuclear MRI

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examination – diagnosis (T. saginata); accessory ovarian 3 main CAT scan pattern:
differentiate anemia  IHA – indirect lobe (T. solium) • Viable larva w/o inflam’n
from hemaglutination Concentration techniques - eggs • Dead larva
Diphyllobothriasis  IFA- indirect fluorescent Perianal swab – eggs in the • Dead scolex
and Pernicious antibody perianal skin Ophthalmic CC
anemia  EIA- enzyme immunoassay  Visualization of cysticerci
using ophthalmoscopy
 May induce movement or
evagination of scolex
Serology
 Serum and CSF ELISA
 Electroimmunotransfer blot
 Western blot – specific IgG
and IgM anticysticercal
antibodies
 Dot-ELISA test -Uses crude
antigen from cysticerci from
pigs
Treatment Praziquante  Surgical removal of  Praziquantel – 5 Praziquantel – 25mg/kg  Surgical resection  Praziquantel 5-10 mg/kg Taeniasis Praziquantel
cured – recovery of larva from infected to 10 mg/kg single dose  Chemotherapy single dose (adult and  Praziquantel 5 to 10 mg/kg Long strobila or complete
scolex in stool after tissue single dose Nitazoxanide – 500mg  Percutaneous aspiration, children) single dose tapeworm expelled
treatment  Praziquantel oral for 3 days injection, re aspiration  Criteria for cure: Cysticercosis: Multiple spontaneously without
If scolex not found –  Stool exam (PAIR) tech  Recovery of scolex parenchymal cystic lesion treatment
repeat stool exam repeated after 2  PAIR plus Albendazole or  Negative stool exam 3 • Praziquantel 50-75mg/kg TID
after 3 months weeks Mebendazole – higher months after treatment for 30 days
 Treatment efficacy and lower rates • Albendazole 400mg BID for
repeated after 2 for morbidity and 8 to 30 days
weeks mortality and recurrence • Corticosteroids given (80 mg
 Treatment succes : Prednisone or 10 mg IM
negative stool Dexamethasone) 4 hrs after
exam at 1 month last dose
post treatment Cysticercotic encephalitis:
High dose corticosteroid
Surgical removal of lesions
orcyst in Subarachnoid(w/
albendazole), Ventricular
forms, Ocular cysticercosis(w/
praziquantel), Symptomatic
cyst outside the CNS
Prevention & All freshwater fishes Boil or filter water for Periodic deworming of Difficult to prevent: Reduce infected population Thorough cooking of meat Elimination of rodents from
control should be thoroughly drinking cats and dogs Single host & Direct Minimize opportunity for Freezing meat at -20 degrees centigrade for 10 days kills the households
cooked Cook intermediate and Insecticide dusting of transmission infection cysticerci Proper storage of grain
Freezing for 24-48 hrs at paratenic host thoroughly dogs and cats against Good personal hygiene Regular testing and quarantine Sanitary inspection of all slaughtered pigs, cows and cattle should products
-18 degrees °C kills all Avoid applying flesh of fleas Proper env’tall sanit’n and treatment of dogs with be done, include examination of the liver Sanitary waste disposal
plerocercoids frogs to inflammed area Health education of Infected cases should Praziquantel in endemic areas
Control the source of children regarding be thoroughly treated Dogs should not be allowed in
infection potential danger of Rodent control slaughterhouses
Proper disposal of playing with pets Proper food storage Health education
sewage and marketing and protection from
of fish grain beetles
Epidemiology Prevalent in temperate  Worldwide Infants and very young Warm climates temperate zone countries  T. saginata infection is more common Common intestinal cestodes
zone children – mostly Infection acquired –  0.56% prevalence of Taeniasis in the Philippines
affected poor sanitation,  T. saginata – 11-15% prevalence More than 20 human
Recover actively overcrowding and poor  Adult male from Northern Luzon infections in the Philippines
motile proglottids in personal hygiene  NCC and ocular form – some cases documented Children below 3 years old
children’s feces or practices
underwear

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