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S4 L4 Cestodes

S4 L4 Cestodes

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01/28/2013

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S4 L4: Cestodes by Dr. Camacho
 
Intestinal cestodes
 
T.
saginata
 
T.
solium
 
.
nana
 
.
diminuta
 
D
.
caninum
 
D
.
latumExtraintestinal Cestodes
 
Echinococcus sp
.
 
 
 pirometra
y
 
nown as the beef tapeworm
y
 
umans serve ONLY as definitive host 
o
 
NO
as intermediate host 
o
 
uman cysticercosis
D
OE 
NO
occur  Adult worm
 
Inhabits upper jejunum
 
ay live up to 25 years
 
easure 4 ± 10 m in length (25m); 1,000-4,000 proglottids
COLEX 
 
cuboidal scolex 
 
1-2 mm in diameter 
 
4 acetabula
 
D
evoid of hooks or rostellumPROGLO
TT 
DS 
 
 A
TU 
RE GRAVI 
D
 
contain mature male and female
reproductive organs
2 large ovaries and a medianclubbeduterus
Follicular testes 300-400 
Vagina has a sphincter 
Proglottids are longer thanthey are wide
terus is distended with ovaand has 15 to 20 lateral branches
Genital pores of proglottidsare irregularly shaped OVA
 pherical or subspherical inshape
in color, with a thick embryophorewhich appears striated becauseof numerous pits
Inside the eggshell is theoncosphere or embryo 30-45 umin diameter 
Brownish provided with 3 pair of hooklets
 
Gravid proglottids undergo apolysis
passed out/crawls out 
eggs are released 
 
Cysticercus bovis: infective stage; ovoidal, milky white,10mm diameter, single scolex invaginated into a fluid-filled bladder 
 
Only 1 adult tapeworm is present in
T.
saginata infections
y
 
nown as the pork tapeworm of man
y
 
an serve as both a definitive host and an intermediate host 
y
 
Both intestinal and tissue infections occur in man
y
 
 Adult worm inhabits the upper small intestines
y
 
horter than
T.
saginata, less number of proglottids
y
 
 Adults measure 2-4 m in length; 800 ± 1000 proglottids
COLEX 
 
acetabula; smaller; more spherical 
 
Cushion-like rostellum with a double crown of 25-30 largeand small hooksPROGLO
TT 
DS 
 
 A
TU 
RE GRAVI 
D
 
 presence of accessory ovarian lobe
absence of vaginal sphincter 
smaller number of follicular testes (100 to 200)
Contains 7-15 uterine lateral branches
 Also undergo apolysis but not very motileEGG 
 
y
 
Indistinguishable from
T.
saginata
 AENIA
OLI 
 
 AENIA
 AGINA
 A
   B   i   e   n
   A   g
   N   i   n   a
   I   a   n
   J   o    h   n
       G    
   R   a   c    h   e    l
   M   a   r    k
   J   o   c   e    l    l   e
   E   d   o
   G   i   e   n   a    h
   J    h   o
   K   a   t    h
   A   y   n   z
   J   e
   G    l   a   d
   N   i   c    k   i   e
   R   i   c   o    b   e   a   r
   T   e   a   c    h   e   r
   D   a   d   a   n   g
   N   i       a
   A   r    l   e   n   e
   V   i   v   s
   P   a   u    l   F .
   R   i   c   o   F .
   R   e   n
   M   a   i
   R   e   v   s
   M   a   v   i   s
   J   e   p   a   y
   Y   a   n   a
   M   a   y   i
   S   e   r   g   e
   H   u   n   g
   T   o   p   e
 
Page
2
of 
10
 
D
isease caused:
y
 
Ingestion of eggs
CY 
ICERCO
 
y
 
Ingestion of cysticercus
 AENIA
 
 AENIA
 
O
MS 
:CysticercosisNeurocysticercosis
 
can findings:1
.
 
Round low-density area without surrounding enhancement after administration of contrast dye(viable larva without inflammation)
.
 
Ring-like enhancement after injection of contrast dye (dead larva)3
.
 
mall calcified area within a cystic space (dead scolex)
D
IAGNO
 
 AENIA
CY 
ICERCO
 
symptoms
history of eating undercooked beef or pork 
recovery of proglottids and/or eggs in the stool 
CN 
and/or symptomsinvolving other organs
history of ingesting food with
T.
solium eggs
radiographic localization of cysticercal lesions in tissues
REA
EN 
 
aeniasis
y
 
Praziquantel : 5-10 mg per kg as single dose for both adultsand children
y
 
colex expulsion is essential 
y
 
Criteria for cure :
 
Recovery of the scolex 
 
 A negative stool examination 3 months after treatment Cysticercosis
Neurocysticercosis:
 ±
Praziquantel : 50-75 mg/kg divided into 3 doses for 30 days or 
 ±
 Albendazole : 400 mg 2xday for 8-30 days
 ±
teroids
 ±
urgical removal 
Ocular cysticercosis:
 ±
urgical removal EPI 
D
IOLOGY 
Related to the habit of eating raw or improperly cooked meat 
T.
solium:
lavic countries, Latin America,
outeast Asia,China and India
T.
saginata: Etiopia and East Africa, Japan,
EA, Europe, Australia, Canada,
 
Philippines: Prevalence of taeniasis: 0 
.
56%; Northern Luzon
aeniasis prevention:
y
 
 Adequate cooking of meat 
y
 
Freezing meat below 10º C Common Name: dwarf tapeworm
D
isease:
ymenolepiasis nana, dwarf tapeworm infectionGeographic 
D
istribution1
.
primarily limited in human beings to children in warmclimates
.
prevalent throughout India, parts of the
SS 
R, countriesbordering the
editerranean, all countries of Latin America,
awaii and some of the islands of 
outh and 
outhwest Pacific 3
.
Common tapeworm in southeastern
nited 
tates
ORP 
OLOGY Length: 25-40 mm
.
 No
.
of Proglottids: 200 
COLEX 
y
 
small and globular 
y
 
bears a short retractile rostellum witha single ring of 20-30 minute hooklet 
y
 
 provided with four cup shaped suckers
ENOLEPI 
NANA
 
 
Page
3
of 
10
 
NEC 
 
y
 
long and slender PROGLO
TT 
DS 
 
MM 
 A
TU 
RE 
 A
TU 
RE GRAVI 
D
 
ndifferentiated 
trapezoidal about 4x as broad as long
has a single genital  pore on its left sidetowards the anterior border 
has three round testes and a bilobed ovary 
Contains thesacculateuterus filled with eggsOVA
y
 
grayish hyaline, nearly spherical 
y
 
20-40 um in diameter 
y
 
two thin membranous shells
y
 
inner membrane with two polar thickenings each provided with 4-8 threadlike filaments extending into the spacebetween the two shells
y
 
hexacanth embryo with six hooklets enclosed by twomembranesEPI 
D
IOLOGY 
uman strain
y
 
Only human tapeworm that does not require an intermediatehost to complete its life cycle
y
 
an is the natural final host 
y
 
Infective stage is the embryonated ova transmitted tomanthrough the agency of foods and drinks particularly raw leafy vegetables usually eaten as raw salad 
y
 
It is more common in children and in institutionalized group
y
 
umanity is the chief source of infection
.
 
urine strain ,
ymenolepis nana var 
.
fraterna
y
 
Final hosts are rats and mice
.
 
y
 
an is an accidental final host 
.
 
y
 
Intermediate hosts are fleas and beetles
y
 
Infection of definitive host results from the ingestion of intermediate hosts harboring the cysticercoid larva
.
 
O
D
OF 
RAN 
SM 
SS 
ION 
 
D
irect hand to mouth
 
Less frequently, by contaminated food or water 
 
Possibly, by indirect intermediate hosts
O
 A
OLOGY 1
.
Infection with a few 
ymenolepis nana may produce no symptoms
.
 
.
It my be responsible for:a
.
diarrheab
.
anorexia
.
vomiting
.
insomniae
.
loss of appetite and weight 
.
iriirtability g
.
pruritus of the anus and noseh
.
urticaria
.
Choreiform symptoms3
.
 
eavy infection is invariably pathogenic 
.
 a
.
moderate to profuse diarrheic stoolsb
.
abdominal pain
.
anorexia and exaggerated disorders
.
extreme apathy e
.
epileptiform seizuresLABORA
ORY 
D
IAGNO
 1
.
 
Recovery of the characteristic ova in the stools
.
 
.
 
Light cases with the aid of acid ether concentration technique
.
 
REA
EN 
 1
.
Praziquantel ± 25 mg/kg in single dose
.
Niclosamide ± 2 g
.
each day, for 5-7 dayschildren ± half of the adult dose3
.
Paromomycin ± 45 mg/kg daily, given in four doses at hour intervals for a period of 5 daysPREVEN 
ION 1
.
 
uman straina
.
avoid ingestion of eggs by not eating raw vegetable saladsb
.
personal hygiene
.
cleanliness of toilet seats
.
 
urine straina
.
Eradicate the rats and mice around the house
.
 b
.
Residual spraying of their nests and burrows withinsecticides
.
 
.
Protection of cooked foods from arthropods
.
 Common Name: rat tapeworm
D
isease: rat tapeworm infectionGeographic 
D
istribution1
.
 
cosmopolitan parasite of rats, mice and other rodents
.
 
has been reported from human hosts usually from children inIndia, Indonesia,
SS 
R, Japan, Philippines,
outhernEurope, Latin America from Argentina to
exico and Cubaand from several parts of the
nited 
tates
ORP 
OLOGY Length 10 to 60 cm
.
by 3 to 5 mm
.
 No
.
of proglottids 800-1000 
ENOLEPI 
 
D
IN 
UT 
 A
 

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