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Medical Parasitology,
CESTODES
Order pseudophyllidea:
Diphyllobothrium sp.
Diphyllobotrium latum
HOSTS
The tapeworm life cycle involves a definitive host and one or
more intermediate hosts (IH).
Exception: Hymenolepis nana only uses one
host and D. latum has 2 IHs
INTERMEDIATE: ingests the eggs
which develop into larval forms and
later into encysted forms in
extraintestinal tissues. Each parasite
species has specialized larval forms.
DEFINITIVE: Harbors the mature
forms of the parasite. Carnivorous or
omnivorous mammal that acquires
infection by consuming larval cysts in
the uncooked tissues of an IH
Tapeworms
scolex
neck
strobila
Morphology of tapeworms:
The scolex
Strobila
In most cestodes the scolex is tiny when
compared to the strobila which makes up
most of the actual worm
The strobila consists of a linear series of
proglottids
Tape worms are hermaphrodites and each
proglottid carries a set of female and male
reproductive organs
These segments are released and are
eliminated with the feces of the host.
Strobila
Strobilation: asexual
process of forming
segments
New proglottids are
continuously formed in the
neck just below the scolex
(A)
Along the length of the worm
the proglottids increase in
size and maturity, developing
from premature (B) to mature
(C, carrying fully functional
and active sexual organs), to
the gravid stage (D) in
which essentially the entire
proglottid is filled with the
uterus and eggs
The tegument
Cestodes do not have a
mouth or any form of
intestine
The entire uptake of
nutrients occurs through
multinucleate syncytial
tegument.
In reflection of this
important role in uptake
the absortive surface is
highly enlarged by small
microvilli or microtriches
Microfilaments (actin
polymers) are the
molecular backbone of
microtriches
Eggs
Developmental
stages
Developmental stages
(metacestodes)
(D. latum)
(D. latum)
(T. solium)
(Hymenolepis sp.)
(E. granulosus)
In pseudophyllidean
cestodes the larvae look
fairly similar to the adult.
The first host is infected
by a procercoid which
still carries the larval
hooks
In the second host a
plerocercoid forms (there
is no asexual
amplification)
The cyclophyllidean
larvae are more complex
and come in a quite a
variety
The medically important
larvae are cysticercoid,
cysticercus and hydatid
(some of these larvae
provided amplification)
Developmental stages
Most
cyclophyllidean
cestode larvae (or
metacestodes) are
some form of a liquid
filled bladder with an
invaginated scolex
(and this theme is
the varied in many
ways)
In most cases the
adult is very well
adopted to the host
and causes no
damage, it is the
larvae that are
dangerous
pathogens
CESTODES
Order pseudophyllidea:
Diphyllobothrium sp.
Diphyllobotrium latum
http://www.dpd.cdc.gov/DPDx/HTML/Diphyllobothriasis.htm
Diphyllobotrium
latum - the fish tape
worm
Definitive host:fish-eating
carnivores:dogs,bears, humans, etc.
Infection of humans cause no or little
symptoms (abdominal discomfort,
nausea diarrhea are rare)
The parasite takes up large amounts of
Vitamin B12
In patients with genetic deficiencies in
Vit B12 uptake the parasite competes
effectively for the entire vitamin leading
to severe pernicious anemia
Geographic distribution: Northern
Europe, Chile, Japan, Korea North
America
Proglottids of
Diphyllobothrium
latum. These
proglottids tend to be
passed in strands of
variable length in the
stool. The proglottids
tend to be broader than
long. Image
contributed by Georgia
TAENIA SAGINATA
Beef tapeworm
Ranges in length from 6-30 ft
Geographic distribution:
Taenia
saginata
adult
worm.
cosmopolitan.
Most common where poor sanitation
and no inspection of meat combine
Africa and South America
Transmission: Ingestion of larval
form in undercooked beef
In N. America 1 in 100 is infected. In
third-world nations could be up to 10%
No symptoms or some abdominal
discomfort
Diagnosis: finding eggs or
proglottids in feces
(A) Adult T. saginata in the ileum of a 25-year-old patient. Reflux of barium into the terminal ileum during
a barium enema examination revealed a markedly elongated ribbon-like radiolucent shadow
representing the adult tapeworm. (B) Adult T. saginata recovered intact following its passage after a
vermifuge was administered. Note the extraordinary length of this worm, which may at times reach 20-30
TAENIA
SOLIUM
The armed
scolex of T.
solium (note
hooks on top
of scolex).
CDC
TAENIA SOLIUM
Human cysticercosis
When humans plays the role of the
Intermediate Host
eggs
The oncosphere in the eggs is released by the action of gastric acid and
intestinal fluids
Cross the gut wall and enter the bloodstream
They are carried to the muscles and other tissues
They encyst as cysticerci at small terminal vessels (1 cm) (A) and (B)
Neurocysticercosis and ophtalmic cysticercosis
Racemose Cysticercosis-MRI
MRI of multiple
cysts. Image
courtesy of the
Centers for Disease
Control and
Prevention.
Neurocysticercosis
The parasite infects the CNS
Epileptic seizures (58-80% when parenchymal
brain cysts).
Intracranial hypertension, hydrocephalus, or both.
This syndrome is related to the location of parasites
in the cerebral ventricles or vasal cisterns.
Occasionally a cyst may grow larger (giant cyst)
Racemose form: high mortality. Large translucent
vesicle lobulated without scolex which develops in
the basis of the brain or in the ventricles.
Sometimes several small vesicles surround a
pedicle like a bunch of grapes.
Geographical variation in clinical manifestations
Neuroimaging: MRI of viable (A) and degenerating (B) cysts and CT of calcified cysticerci. The Lancet (2003) 361: 547
Cysticercosis diagnosis
Serologic diagnosis:
Antibody assays for cysticercosis: 8
kDa antigens, GP50, FAST-ELISA
with the 8 kDA antigen
Antigen-detection assays: circulating
antigens means live parasites.
Ongoing viable infection. Monoclonal
antibodies seem to detect AGs in
CSF.
Antibody assays for taeniasis:
TSE33 and TSE38 were recognized
by a panel of taeniasis but not
cysticercocis, patient serum samples.
Neuroimaging diagnosis: CT and
MRI provide objective evidence on
number and location of cysticerci. Also
their viability and the severity of the host
inflammatory reaction.
Cysticercosis treatment
Treatment should be individualized based on
cyst location, level of inflammation and clinical
presentation
Therapy should include analgesics, antiepileptic
drugs, cysticidal drugs, surgical resection of
lesions and placement of ventricular shunts
Parenchymal cysticercosis with viable cysts:
Albendazole 15 (mg/kg/day) with
dexamethasone (0.1 mg/kg/day). Praziquantel.
Subarachnoid ccs: antiparasitic therapy
No reason to use antiparasitic drugs to treat
dead calcified cysts. Symptomatic therapy.
Surgical therapy: ventricular shunting to resolve
hydrocephalus. Also excision of giant cysts or
intraventricular cysts
Albendazole
Transmission
It is not possible to acquire NCC by eating pork!
Ingestion of infected pork only causes adult
tapeworm infestation: taeniasis. WHY?
Infected pork contains only the larval cysts that
develop into adult worms in the human intestine
What is that transmits CCS?
The eggs
Most common source of infective eggs?
A symptom-free tapeworm carrier in the household
Echinococcosis
Echinococcus multilocularis:
alveolar echinococcosis.
Invasive solid
lesions of firm consistency, full of connective
tissue and a jelly-like material.
Echinococcus granulosus
The oncosphere
penetrate intestine
of intermediate host
and develops into a
hydatid
Hydatides are
spherical fluid-filled
cysts surrounded by
a granuloma formed
by the host
Thousands of
protoscolices can fill the
hydatid (hydatide sand)
Protoscolices are the
infective stage for dogs
Hydatides usually grow
slowly but steadily (1-5
cm per year)
They are usually well
tolerated until their size
becomes a problem or
they rupture
Cyst rupture or leakage
can result in allergic
reactions and metastasis
Echinococcosis:
Cystic hydatid disease
Hydatides can be
found in several
organs but are most
frequent in the liver
Echinococcosis:
Cystic hydatid disease
Liver cysts cause liver
swelling, right epigastric
pain, nausea, vomiting
Obstruction of bile ducts and
blood vessels can cause
cholangitis, jaundice,
cirrhosis and portal
hypertension
This upper abdominal CT scan shows multiple cysts in the liver, caused
by echinococcus. Note the large circular cyst (seen on the left side of
the screen) and multiple smaller cysts throughout the liver.
http://www.drkoop.com/ency/93/ImagePages/1177.html
Echinococcosis:
Cystic hydatid disease
Echinococcosis control
Sylvatic zoonosis in
Europe and northern
America
Fox is final host, life
cycle similar to E.
granulosus
Humans get infected by
eating contaminated
berries and mushrooms
collected in forests
populated by foxes
STAGE FOUND
COMMON
IN HUMANS
NAME
Diphylobothrium lutum Adult
Fish tapeworm
Pernicious anemia
Niclosamide; Praziquantel
Hymenolepis nana
Adult
Dwarf tapeworm
Rarely symptomatic
Niclosamide; Praziquantel
Taenia saginata
Adult
Beef tapeworm
Rarely symptomatic
Praziquantel
Taenia so lium
Adult
Pork tapeworm
Rarely symptomatic
Niclosamide; Praziquantel
Albendazole; Surgery
SPECIES
Larvae
PAT HOLOGY
THERAPY
Echinococcus
granulosus
Larvae
Hydatid cyst
disease
Surgery; Albendazole
Echinococcus
multilocularis
Larvae
Alveolar cyst
disease
Multilocular
cysts
Surgery; Albendazole