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Learning Objectives
At the end of this lecture, the students must be
able to apply to concepts of cestode parasitism
1. Identify the medically important Cestodes based on
Epidemiology
Morphology
Lecture Outline
I.
Cestodes (Tapeworms)
General Characteristics
Two Main Features
1. Tapeworms
2. Lacks alimentary
canal
Cestodes (Tapeworms)
Habitat Preference
Adult worms inhabit
alimentary canal of
their hosts
Cestodes (Tapeworms)
Three Main Morphologic Regions
1. Head or scolex
Cestodes (Tapeworms)
Three Main Morphologic Regions
2. Neck
Small narrow
undifferentiated part
behind the scolex
Cestodes (Tapeworms)
Three Main Morphologic Regions
3. Strobila
Cestodes (Tapeworms)
Cestoidean Biology
Alimentary canal is entirely absent
Lack digestive system differentiates tapeworms from
nematodes & trematodes
Once anchored to hosts intestinal wall, adult worms
absorb food from hosts intestine
habitat associated with high nutritional levels ensuring
high growth rate
Cestodes (Tapeworms)
Cestoidean Biology
Alimentary canal is entirely absent
Outer tegument of body serve not only as protective
coating but also as metabolically active layer
nutritive material can be absorbed, along with secretions and
waste material to be transported out of body
each segment contains independent absorption system
Cestodes (Tapeworms)
Cestoidean Biology
Nerve Center
Cerebral ganglion in its scolex
Motor and sensory innervation
Cestodes (Tapeworms)
Cestoidean Biology
Body cavity is absent
Excretory organs
Flame cells (protonephridia) located in proglottids
Cestodes (Tapeworms)
Cestoidean Biology
According to maturity of reproductive organs,
three types of segments of the strobila can be
recognized from the front backwards
1. Immature:
= first 200 segments
male and female organs are not differentiated
Cestodes (Tapeworms)
Cestoidean Biology
2. Mature:
3. Gravid:
. Tail proglottids
. all organs including sex organs are atrophied or have
disappeared due to distended uteri filled with eggs
. Gravid proglottids are oldest and are longer than broad and
have fertilized eggs only within branched uterus
Cestodes (Tapeworms)
Cestoidean Biology
Reproductive organs
Hermaphrodites: male and female reproductive
systems present in their bodies
Mature hermaphroditic segments can reproduce
independently
Cestodes (Tapeworms)
Cestoidean Biology
Reproductive organs
Each segment contains reproductive tract
Male: one or many testes, cirrus, vas deferens and seminal
vesicle
Female: single lobed or unlobed ovary with the connecting
oviduct and uterus
Genital pore: There is a common external opening for both
male and female reproductive systems
Cestodes (Tapeworms)
Cestoidean Biology
Reproductive organs
Older segments are pushed toward tip of the tail as new
segments are produced by neckpiece
Even though they are sexually hermaphroditic, selffertilization is a rare phenomenon
To permit hybridization, cross-fertilization between two
individuals is often practiced for reproduction.
During copulation, cirrus of one individual connects with that
of other through genital pore, and then exchange their
spermatozoa
Cestodes (Tapeworms)
Cestoidean Biology
Cestodes (Tapeworms)
Life Cycle
No asexual phases
Two-phase life cycle with two types of host
1. Adult lives in digestive tract of a definitive
(vertebrate) host
2. Juveniles live in bodies of (at least one) intermediate
host
Except for Hymenolepis nana, which can develop directly in
same host
Juveniles cause more damage to intermediate host than
adults do to definitive host
Cestodes (Tapeworms)
Classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order
Amphilinidea, Gyrocotylidea, Eucestoda,
Aporidea, Caryophyllidea, Cyclophyllidea,
Diphyllidea, Lecanicephalidea, Litobothridea,
Nippotaeniidea, Proteocephalidea,
Pseudophyllidea, Spathebothriidea, Tetraphyllidea,
Trypanorhyncha
Cestodes (Tapeworms)
Medically-Important Cestodes
Egg / Ova
Pseudophyllidae
Cyclophyllidae
Operculated
YES
NO
YES
NO
Water
Intermediate host
Immature when
oviposited
Fully emryonated
when released
from gravid
segment
TWO
ONE
Cestodes (Tapeworms)
Medically-Important Cestodes
Pseudophyllidae
Cyclophyllidae
Scolex
2 slit-like grooves
4cup-like suckers
Uterus
No branching
Convoluted uterine tubes
assume the form of rosettes
Branching
May or may not be present
Uterine
Pore
Present
Absent
Common
Genital
Pore
Lateral
Cestodes (Tapeworms)
Egg / Ova
Pseudophyllidae
Larval development
proceeds in two
intermediate hosts:
Cestodes (Tapeworms)
Head / Scolex
Pseudophyllidae
Possess false or slitlike grooves called
bothria
Bothria
Cestodes (Tapeworms)
Pseudophyllidea
Adult worms in Intestine
Diphyllobothrium latum
Cestodes (Tapeworms)
Pseudophyllidean Larval Morphology
CORACIDIUM
Ciliated aquatic embryo of
pseudophyllid and other cestodes
with aquatic cycles
w/in ciliated embryophore is
hooked larva (hexacanth)
develops in first intermediate
host or IH (usually an aquatic
crustacean like copepod water
flea) into next larval stage
(procercoid)
Cestodes (Tapeworms)
Pseudophyllidean Larval Morphology
PROCERCOID
Cestodes (Tapeworms)
Pseudophyllidean Larval Morphology
PLEROCERCOID
Cestodes (Tapeworms)
Egg / Ova
Cyclophyllidae
Larval development
proceeds in one
intermediate host
Lets Review!
Egg / Ova
Pseudophyllidae
Cyclophyllidae
Operculated
YES
NO
YES
NO
Water
Intermediate host
Immature when
oviposited
Fully emryonated
when released from
gravid segment
TWO
ONE
Cestodes (Tapeworms)
Head / Scolex
organs for attachment:
Rostellum , hooks & 4 suckers
Cyclophyllidae
Possess cup-like and
round suckers called
acetabula
Cestodes (Tapeworms)
Cyclophyllidea
Adult Worms in the Intestine
Taenia saginata
Taenia solium
Hymenolepis nana
Hymenolepis diminuta
Dipylidium caninum
Diphyllobothrium latum
Classification
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda Subclass: Eucestoda
Order: Pseudophyllidea
Family: Diphyllobothriidae
Genus: Diphyllobothrium
Species D. latum
D. pacificum, D. cordatum, D. ursi, D. dendriticum,
D. lanceolatum, D. dalliae, D. yonagoensis;
D. Nihonkaiense, D. klebanovskii
Diphyllobothrium latum
Classification
tapeworm which can cause Diphyllobothriasis in (high
risk) humans through consumption of raw or
undercooked fish (sushi, sashimi, carpaccio di persico,
tartare maison, ceviche, marinated herring , KILAWIN)
with plerocercoid larvae
A.k.a broad or fish tapeworm, or broad fish tapeworm
D. latum: Scandinavia, western Russia, Baltics, North America,
D. klebanovskii: Far East Russia (Pacific salmon as second
intermediate host)
D. dendriticum (the salmon tapeworm), D. pacificum, D.
cordatum, D. ursi, D. lanceolatum, D. dalliae, D. yonagoensis (all
infect humans only infrequently)
D. nihonkaiense = D. klebanovskii: Japan
Diphyllobothrium latum
Ova
knob
Inconspicuous
operculum
40-50um
A single egg gives
rise to a single larva
Not infective to man
60-75um
Diphyllobothrium latum
Larval Satges
Plerocercoid
Coracidium
Procercoid
Diphyllobothrium latum
Morphology: Adult Scolex and Neck
Neck is thin and unsegmented
and is much longer than the head
Each side (dorsal & ventral) has a slitlike groove (bothrium or tentacle)
for attachment to the small intestine
Diphyllobothrium latum
Morphology: Adult proglottid
Uterine glands are
widely scattered in the
parenchyma and is
composed of many acini
Midventral
genital
pore
Diphyllobothrium latum
Morphology: Whole worm
Longest tapeworm in humans
(ave=10m long)
Adult worm is yellowish grey in
color
Adults can shed up to a million
eggs a day
Dark central markings in the
strobila are due to the egg-filled
uterus
Life-span is for a period of 5 to 15
years
Paratenic host
2nd I.H.
Fresh water fish:
pike, trout,
salmon, perch
Final Host:
Man, dog, cat
3 weeks
1st I.H.
Cyclops
or Diaptomus
> 1 week
3 weeks
Diphyllobothrium latum
Clinical Fetaures
Diphyllobothriasis: generally mild, includes diarrhea,
abdominal pain, vomiting, weight loss, fatigue,
constipation and discomfort
Incubation period: 46 weeks (2 weeks to 2 years) tapeworm
can live up to 20 years
80% asymptomatic; may go many years without being detected
Few lead to severe vitamin B12 deficiency due to parasite
absorbing 80% or more of the hosts B12 intake, and a
megaloblastic anemia indistinguishable from pernicious
anemia
Chronic infestation depletes vit. B12 resulting in anemia
which lead to subtle demyelinating neurological symptoms
(subacute combined degeneration of spinal cord)
Diphyllobothrium latum
Diagnosis & Management
Diagnosis
Fecalysis: proglottid segments, operculated eggs
PCR: for speciation
Treatment
Praziquantel: 510 mg/kg PO once (S/E: malaise, headache,
dizziness, abdominal discomfort, nausea, rise in temperature and
occasionally allergic skin reactions)
Niclosamide (alternative): 2 g PO once for adults or 50 mg/kg PO
once (both adults & children)
Diphyllobothrium latum
Prevention
1. Prevention of water contamination
Taenia
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Taeniidae
Genus: Taenia
Species: T. saginata , T. solium
Binomial name Taenia saginata (Goeze, 1782)
Taenia solium (Linnaeus, 1758)
Taenia
Epidemiology
T. saginata
A.k.a. Taeniarhynchus
saginata or the beef
tapeworm
Africa, some parts of Eastern
Europe, Southeast Asia, and
Latin America where beef is
widely eaten
T. solium
Taenia
Morphology: Ova
Thick embryophore
with numerous tiny
pores
Morphologically same
for both Taenia
species; therefore is
not useful for
speciation
Taenia
Morphology: Scolex
T. saginata
T. solium
(+) nonretractable
rostellum with 2
rows of 22-32
hooks
Four suckers
Cuboidal shape
Spheroidal shape
Taenia
Morphology: Proglottid
Mature proglottid
1,000-2,000
contains the uterus (unbranched), ovary, genital pore, testes, and
vitelline gland.
does not have a digestive system, mouth, anus, or digestive tract.
Acoelomate: does not have a body cavity.
Gravid proglottid
uterus is branched and filled with 97,000to 124,000 eggs
The gravid segments detach and are passed in the feces. Each of
these segments can act as a worm. When they dry up, the
proglottid ruptures, and the eggs are released.
Taenia
Morphology: Proglottid
T. saginata
T. solium
Taenia
T. Saginata vs T. solium
Characteristic
Taenia saginata
Taenia solium
Intermediate Host
Cattle, reindeer
Site of Development
Muscle, viscera
No hooks
Hooks
Scolex: cysticercus
No rostellum
Proglottid: uterine
branches
23 (14 32)
9 (7-11)
Passing of proglottids
Single, spontaneous
In groups, passively
Ovary
2 lobes
3 lobes
Vagina: sphincter
muscle
Present
Absent
Taenia
Morphology Adult
Normally 4 m to 10 m in
length, (up to 12 m)
1000 to 2000 proglottids
each with approximately
50,000 eggs
lifespan of 25 years in a
host's intestine
Cysticercus bovis
Cysticercus cellulosae
T. solium
Taenia
Clinical Features
T. saginata
Taeniasis usually
asymptomatic
Heavy infection:
weight loss, dizziness,
abdominal pain, diarrhea,
headaches, nausea,
constipation, or chronic
indigestion, and loss of
appetite.
Intestinal obstruction
Allergic reaction due to
some antigens
T. solium
Cysticercosis
Subcutaneous tissue >
eyes > brain > muscles >
heart > liver > lungs >
coelom
Neurocysticercosis
Taenia
Clinical Features
Cysticercosis
Ingestion of eggs or
proglottid rupture within
the host intestine can
cause larvae (cysticerci or
baldder worms) to migrate
into host
Severe inflammation when
cysticercus dies may be
fatal if brain is involved
3 types: ordinary fluidfilled bladder cellulose,
intermediate with
scolex, and large
racemose without scolex
Taenia
Clinical Features
Neurocystercosis
Cysticercosis in CNS causing
epilepsy, seizures, lesions in
brain, blindness, tumor-like
growths, and low eosinophil
levels, hydrocephalus,
paraplegy, meningitis,
convulsions and even death
Other S/Sx: headaches,
dizziness, sensory deficits,
involuntary movements,
ocular cystation, brain system
dysfunction, occasional
seizures, dementia or
hypertension
Taenia
Diagnosis
T. saginata
T. solium
Fecalysis
PCR
Taenia
Management
Treatment
Praziquantel 5-10mg/kg single dose
Criteria for cure: Recovery of the scolex & Negative stool examination 3 months after
treatment
Niclosamide
Albendazole combined with steroids reduces the inflammation in
cysticercosis
Surgical intervention may be necessary to treat CNS lesions
Prevention
1. Adequate cooking of meat (>56C)
2. Freezing the meat at 5C for 7 days
3. High level of personal hygiene
4. Prevention of fecal contamination of pig foods
Echinococcus granulosus
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Taeniidae
Genus: Echinococcus
Species: E. granulosus
Binomial name Echinococcus granulosus (Batsch, 1786)
Echinococcus granulosus
Epidemiology
Tapeworm which parasitizes small intestine of canids as
an adult, but causes hydatid disease in intermediate
hosts such as livestock and humans through accidental
ingestion of food or other substances contaminated with
dog feces
A.k.a. Hydatid worm, Hyper Tape-worm, Dog Tapeworm
Echinococcus granulosus
Morphology: Ovum
Embryophore with
Double layer & striated
Outer layer
Hexacanth
oncosphere
Ovoid-round
Without
operculum
30-40 um
Note: ovum
morphologically
similar to Taenias
Echinococcus granulosus
Morphology: Scolez
4
29-50
30 mm
Echinococcus granulosus
Morphology: Adult Worm
Single, lateral
Equatorial genital
pore
0.5 mm
Uterus: irregular
lateral sac
2-7 mm
2 oval ovaries
46-60 minute
Spherical testes
2 months
Echinococcus granulosus
Clinical Features
Hydatid disease:
liver enlargement, hooklets
in sputum and possible
anaphylactic shock when
immune system reacts to
ruptured cysts
Echinococcus granulosus
Diagnosis and Management
Diagnosis
Cyst seen with ultrasound,
MRI, or
immunoelectrophoresis
Microscopy cannot
differentiate from Taenia and
Echinococcus eggs
Detection of antigens in feces
(coporoantigen) by ELISA is
currently the best available
technique.
Newer techniques like PCR is
also used to identify the
parasite from DNA isolated
from eggs or feces
Echinococcus granulosus
Management
Management
Treatment: Surgical
removal of the hydatid
cysts, taking special care
to leave the cyst intact so
new cysts do not form, and
mebendazole /
albendazole over a long
period of time at low
dosages
Prevention: Avoid ingesting
food or other substances
contaminated with dog
feces
Hymenolepis nana
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Hymenolepididae
Genus: Hymenolepis
Species: H. nana
Binomial name Hymenolepis nana
Hymenolepis diminuta (Rudolphi,
1819)
Hymenolepis
Epidemiology
H. nana
H. diminuta
tapeworm that infects mammals
using insects as intermediate
hosts and causes hymenolepiasis
A.k.a rat tapeworm
H. diminuta is prevalent
worldwide, but only a few
hundred human cases have been
reported.
Australia, United States, Spain, Italy,
Malaysia, Thailand, Jamaica,
Indonesia
Hymenolepis
Morphology: Ova
H. nana
H. diminuta
30 - 47 m
thin, hyaline, outer
30 - 47 m
Membrane hyaline
shell
6 hooks
No striated
embryphores
70-85mm
inner, thick membrane with
polar thickenings that bear
several filaments
Hymenolepis
Morphology: Scolex
H. nana
single circle of
5 rostellar
hooklets are
shaped like
tuning fork
Retractable
rostellum remains
invaginated in
apex of the organ
H. diminuta
Rostellum has NO hooks
Neck is long
and slender,
the region of
growth
Hymenolepis
Morphology: Proglottid
H. nana
H. diminuta
Up to 90 cm
4 weeks
H. nana
Hymenolepis
Clinical Features
Light infections are usually symptomless
Heavy infection due to autoinfection results in deprivation of
nutrient absorption in immunocompromised children
>2000 worms can cause enteritis, abdominal pain, diarrhea, loss of
appetite, restlessness, irritability, restless sleep, anal and nasal
pruritus. Rare symptoms include anorexia, increased appetite,
vomiting, nausea, bloody diarrhea, hives, extremity pain, headache,
dizziness and behavioral disturbances. Occasionally epileptic seizures
occur in infected children
Hymenolepis
Morphology: Diagnosis, Treatment & Prevention
Diagnosis
Treatment
Praziquantel
both adult worms and larvae
Niclosamide
Prevention
Dipylidium caninum
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Dipylidiidae
Genus: Dipylidium
Species: D. caninum
Binomial name Dipylidium caninum
Dipylidium caninum
Epidemiology
Tapeworm that infects organisms afflicted with
fleas, including canids, felids, and pet-owners,
especially children. Adult worms are about 18
inches long.
A.k.a. cucumber tapeworm or the double-pore
tapeworm
Dipylidium caninum
Morphology: Ova
Eggs hatch and
form oncospheres
With 6 hooks
Egg packet
contain
8-15 eggs
Dipylidium caninum
Morphology: Scolex
Four suckers
Retractable
pointed
rostellum with
four rows of
hooks
Dipylidium caninum
Epidemiology
Dipylidium caninum
Clinical Features, Diagnostics, Treatment & Prevention
Clinical Features
Similar to Hymenolepis
Diagnosis
Treatment
Niclosamide or praziquantel
Prevention
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