PARASITOLOGY LECTURE 9 – Cestode Infections • larvae break out of villi and attaches to intestinal

Notes from W.U. DeLeon, J.A. Solon mucosa 4 to 5 days later

USTMED ’07 Sec C – AsM • develop into adults
HYMENOLEPIS NANA (dwarf tapeworm) 2. Indirect

• smallest tapeworm infecting man

• only human tapeworm which can complete its entire life
cycle in a single host
• does not require an obligatory intermediate host
• man can harbor both adult and larval stages of parasite
• infection is usually via accidental ingestion of infected
arthropod intermediate hosts like rice and flour beetles
(Tenebrio sp.)
• cysticercoid larvae are released and will eventually
develop into adult tapeworms in the intestines of the
host

DISTRIBUTION

• worldwide among children

DISEASES

• hymenolepiasis

MORPHOLOGY

1. Adult Worm
- found in the ileum
- delicate strobila that measures 25 to 45 mm x 1 mm (lw)
- Scolex
o Subglobular
o 4 cup-shaped
suckers
o retractable
rostellum with a
single row of 20 to
30 y-shaped
hooklets
- Neck
o long and slender
- Proglottids
o Anterior = short
o Posterior = broader
o Measures 0.15 to 0.3 mm - takes 20 to 30 days from time of ingestion for eggs to
x 0.8 to 1.0 mm (lw) appear in the feces
o Mature proglottids : - eggs are viable immediately after discharge from bowel
contain 3 ovoid testes and - autoinfection can occur through the fecal-oral route or
one ovary w/in the small bowel
o Gravid proglottids : - oncospheres from eggs are released and they invade the
 testes and ovary disappear host villi to start new generation
 uterus hollows out and becomes
PATHOGENESIS AND CLINICAL MANIFESTATION
filled with eggs
 segments are separated from the
strobila and disintegrate as they • symptoms are produced because of patient’s
pass out of the intestines, releasing immunological response to the presence of the parasite
eggs in stool • asymptomatic – light worm burden
- Segments • clinical manifestations:
o 175 to 220 segments o headache
o genital pores found along the side of segments o dizziness
o anorexia
2. Eggs o pruritus of nose and anus
o diarrhea
o abdominal pain
o pallor
• infected children
o restless
o irritable
o exhibit sleep disturbances
o convulsions (rare)
• Heavy infections
- Shape : spherical or subspherical o Enteritis due to necrosis and desquamation of
- Measures 30 to 47 um in diameter the intestinal epithelial cells
- Oncosphere • Regulatory immunity
o thin outer membrane o (time) clears H. nana spontaneously.
o thick inner membrane with conspicuous
bipolar thickenings DIAGNOSIS
 4 to 8 hair-like polar filaments arise
 filaments are embedded in the inner • specific diagnosis = demonstration of characteristic eggs
membrane in stool
• light infections = need to concentrate stool specimens
• proglottids are not recovered because they undergo
H. nana cysticercoid degeneration prior to passage with stools
LIFE CYCLE TREATMENT

- Dual pathway • *Praziquantel = 25mg/kg single dose

o causes vacuolization and disruption of
1. Direct
tegument in the neck region
• host ingests eggs which hatch in the duodenum
o dosage for hymenolepiasis is higher than for
• liberated embryos penetrate mucosal villi taeniasis because of relative resistant
• develop into infective cysticercoid larvae cysticercoids in the intestinal tissue
 • examine stool after 2 weeks
o repeat treatment to cover for the worms
emerging from remaining viable cysticercoids

EPIDEMIOLOGY

• found in warm countries

o Southern USA
o Latin America
o Mediterranean
o East Asia
o Philippines
• Transmission : poor sanitation, overcrowding, poor LIFE CYCLE
personal hygiene
• Direct contact plays an important role because eggs • Gravid proglottids separate from the main body of worm
cannot survive long outside host
disintegrates release eggs in feces
• Familial and institutional infection
• Eggs are ingested by a wide range of adult and larval
• Found in mice and rats insects
o Fleas, beetles, cockroaches, mealworms and
PREVENTION AND CONTROL
earwigs
• involves a single host and transmission is direct • Once ingested, they
develop into cysticercoid
• personal hygiene and environmental sanitation
larvae
• rodent control
• When infected insects are
• prevent food from infections by grain beetles ingested by rats or man,
larva is released
• Develops into adult worm
HYMENOLEPIS DIMINUTA (rat tapeworm)
in ~ 3 weeks

• cosmopolitan parasite primarily of rats

• differs from H. nana in that it requires an intermediate
host

DISEASE

• Hymenolepiasis – due to accidental human infections

MORPHOLOGY

1. Adult
- larger than H. nana
- Measures : 60 cm in length
- Scolex :
o Has a rudimentary
unarmed rostellum
- Proglottids :
o Broader than long
o Arrangement of sexual organs is similar to
H.nana PATHOGENESIS AND CLINICAL MANIFESTATIONS
o Larger than H. nana may reach 7.5mm x 3.5
mm (lw) • worm burden in rodents is relatively low
o Unilateral genital pores • in man, the highest number recorded is 19 worms
o Gravid proglottids: • manifestations are minimal and non-specific
 @ contains a sac-like uterus filled
with eggs. DIAGNOSIS

• based on identification of eggs from stool

• H. diminuta eggs are more circular, larger and lack
bipolar filaments
• At times the whole worm is expelled and the scolex may
be used in diagnosis

TREATMENT

• similar to H. nana = Praziquantel 25mg/kg single dose

EPIDEMIOLOGY
2. Eggs
- Shape : circular • human infections occur worldwide but more common
- Measures 60 to 80 um among children
- Bile-stained • in poor countries with rat infestations
- Oncosphere • occurs by accidental ingestion of grain beetles infesting
o Enclosed in an inner
dried grains, dried fruits, flour and cereals
membrane
• prevalence in Phil in rats is 8%
o Has bipolar thickenings
o Lacks bipolar filaments PREVENTION AND CONTROL
- Hooklets have a fan-like arrangements
• rodent control
• elimination of insect intermediate hosts
• protection of food
• sanitary disposal of waste

DIPYLIDIUM CANINUM (double pored tapeworm)

 • very common intestinal parasite of dogs and cats

DISEASE

• Dipylidiasis in humans is accidental

MORPHOLOGY

1. Adult worm
- Color : pale reddish
- Measures 10 to 70 cm in
length

- Scolex :
o Small
o Globular • Intermediate hosts
o 4 deeply cupped o Ctenocephalides canis (dog flea)
suckers o Ctenocephalides felis (cat flea)
o protrusible
rostellum
o Pulex irritans (human flea)
o 1-7 rows of o Trichodectes canis (dog louse)
rosethorn-shaped • In the arthropod host, the hexacanth embryo develops
hooklets into cysticercoid larvae
o Able to survive flea’s development
- Proglottids: o When ingested, the cysticercoid is liberated
o Narrow and becomes an adult in 3 to 4 weeks
o 2 sets of male and female
reproductive organs
PATHOGENESIS AND CLINICAL MANIFESTATIONS
o bilateral genital pores
(hence double pored • infection rarely multiple
tapeworm)
• symptoms are minimal
o Gravid proglottids
o slight intestinal discomfort
 Shape : pumpkin
o epigastric pain
seed
o diarrhea
 Filled with
capsules or o anal pruritus
packets of 8 to 15 o allergic reactions
eggs enclosed in • some are asymptomatic
an embryonic membrane
DIAGNOSIS

• recovery of gravid proglottids passed out single or in

chains
• proglottids may crawl out of anus or passed out
involuntarily
• proglottids should be pressed or flatted between 2 glass
slides for examination
• Stool examination is not recommended since gravid
proglottids do not disintegrate in intestines but in the
environment
• Egg capsules are rarely recovered

TREATMENT

• Praziquantel = 5 to 10 mg/kg single dose

2. Eggs EPIDEMIOLOGY
- Shape : spherical
- Thin-shelled • human infections rare but reported in:
- Hexacanth embryo o Europe
o USA
o Argentina
LIFE CYCLE o Rhodesia
o China
• when gravid segments are detached, they either: o Philippines
o migrate out of the anus • Infants and young children usually infected
o passed out with feces • Observe actively motile proglottids in feces or
• ova are released by: underwear
o contraction of the proglottid or • Adults are not commonly infected because of age
o disintegration outside the host tolerance against the parasite
• egg capsules may remain in the fur of the host
PREVENTION AND CONTROL
o larval fleas feed on epidermal debris
• periodic deworming of pet cats and dogs
• insecticide dusting of dogs and cats against fleas

DIPHYLLOBOTHRIUM LATUM (fish tapeworm or broad tapeworm)

• belongs to order Pseudophyllidea

• one of 13 species that infects humans

DISEASE

• Diphyllobothriasis – intestinal infection with the adult

 worm LIFE CYCLE

MORPHOLOGY • with disintegration of uterus, the uterine pore is relaxed

and unembryonated ova are discharged
1. Adult • approx. 1,000,000 may be released daily
- Measures 3 to 10 m length • ova complete development in water
- Up to 4000 proglottids • release free-swimming coracidium (a ciliated embryo)
• ingested by copepods of genera Cyclops and Diaptomus
• a procercoid larva develops in copepods
o still retains 3 hooklets in the cercomer (a
caudal attachment organ)
• copepod ingested by fish
• procercoid larva migrates to tissues and
develops into plerocercoid larva in
muscles and viscera
- Scolex : • plerocercoid larva appears glistening,
o Shape: spatulate opaque, white and unsegmented
o Measures 2 to 3 mm x 1 mm (ld) • fish is ingested raw by definitive host :man, dog, cat,
o Has 2 bothria or sucking grooves located other mammals
dorsally and ventrally • Paratenic hosts : carnivorous fish
• 2nd Intermediate hosts (fish)=perch, trout, salmon & pike
• The plerocercoid attaches to the intestinal wall and
reaches maturity in 3 weeks within the definitive host

- Neck :
o Long and attenuated

- Proglottids:
o Immature
o Mature
 Longer width than length
 Measures 2 to 4 mm x 10 to 12 mm
(lw)
 Contains one set of reproductive
organs
 Testes
• Located at dorsolateral
part of proglottid
• Vas efferens converge to
form a vas deferens
enlarge into seminal
vesicle terminates in
muscular cirrus
midventral genital pore)
 Ovary
• Symmetrical
• Bilobed
• Present at posterior third
immediately above Mehlis’
gland
o Gravid
 Uterus
• Dark
• Rosette-like
• Coiled
• Located at middle
• Extends from ootyle and
opens through uterine
pore behind common
genital pore
 Proglottids disintegrate only when
the segment has completed its
reproductive function
2. Eggs
- Color: yellowish brown
- Moderately thick shell
- Inconspicuous operculum
- Opposite operculum is a knob-like thickening
- Measures 66 x 44 um
PATHOGENESIS AND CLINICAL MANIFESTATIONS
• usually limited to one worm
(at • infected individuals may be asymptomatic
• symptoms
o nervous disturbances
o digestive disorders
o abdominal discomfort
o weight loss
o weakness
o anemia
• symptoms may be due to absorbed toxins or byproducts
of degenerating proglottids or due to mucosal irritation
• infection results in
o hyperchromic, megaloblastic anemia with
thrombocytopenia and leucopenia
o anemia seen is typically similar to that seen in
Vit B12 deficiency
• worms in jejunum compete effectively with the host for
Vit B12
• if worms are pushed down the intestines with
treatment, anemia is relieved
• Vit B12 content of D. latum is 50 x of T. saginata
DIAGNOSIS
- suggestive:
• residence or travel to endemic area
• raw fish diet
• pernicious type of anemia

- definite diagnosis:
o finding characteristic operculated eggs
o or proglottids in stools
o sometimes proglottids may be vomited
 o direct fecal smear
o Kato technique to demonstrate eggs LIFE CYCLE

- differential diagnosis (anemia due to diphyllobothriasis

from pernicious anemia)
o examination of gastric juice for presence of
free hydrocholoric acid
o pernicious anemia is associated with
achlorhydria

TREATMENT

• Praziquantel – 5 to 10 mg/kg single dose

• Criterior : recovery of scolex in feces after treatment
• If scolex is not recovered, repeat stool examination
after 3 months to be certain that patient is no longer
infected

EPIDEMIOLOGY

• human infection is dependent on:

1. presence of human or animal definitive hosts
2. presence of suitable intermediate hosts
3. dietary habits
4. amount of pollution of fresh waters
5. preference for eating raw fish
6. lack of sanitary toilet facilities

• Reservoir hosts
o Dogs
• Human infected through
o Cats
o Bears 1. drinking water containing Cyclops or copepods
infected with procercoid larvae
• prevalent in temperate zones 2. eating infected 2nd intermediate hosts like frogs,
• Baltic countries: Switzerland, Romania, Danube basin toads or snakes containing plerocercoird larvae
• Asia : Russia, Turkistan, Israel, Manchuria, Japan 3. applying plerocercoid infected flesh of frogs and
• Americas: Chile, Argentina, N. American states, Canada snakes as poultices in sores in the eye, vagina, and
skin penetration into cutaneous tissues
• Philippines – 7 cases
4. consumption of infected flesh of pratenic hosts
(wild pigs)
SPARGANOSIS PATHOGENESIS AND CLINICAL MANIFESTATION

• larval infection with plerocercoid larvae (aka spargana - Symptoms

of pseudophyllidean tapeworms
Spirometra)
• involved in human sparganosis
o Spirometra mansoni
o Spirometra erinacei
o Spirometra ranarum
under Genus o Complain of painful edema due to migrating
larvae
o Local indurations
o Periodic giant urticaria
o Edema
o Erythema with chills, fever
o High eosinophilia

MORHOPHOLOGY DIAGNOSIS

• Adults are intestinal parasites of cats, dogs, and other • Finding white larvae in the lesion
carnivores • Species identification done by experimental infection of
• Adults are usually mistaken for D. latum animals
• Spargana showed typical solid body with worm-like
TREATMENT
appearance
• Pseudosegmentation with a slit-like invagination at the
- Surgical removal of plerocercoid
head end
• Larvae
- In cases reported, spargana were motile upon excision
of the mass
o Opaque, glistening, white
o Found in any part of the body PREVENTION AND CONTROL
o Most commonly found in the eye,
subcutaneous tissue, muscular tissues of - Drinking boiled or filtered water
thorax, abdomen, thighs, inguinal region and - Proper cooking
in viscera - Avoid applying flesh of frogs to inflamed areas

-fin-

auds

audsmartinez@gmail.com
ustmedc3@yahoogroups.com

proglottid scolex

S. mansoni eggs