NOMENCLATURE 2 H.

nana is considered by some to

represent a different genus, Vampirolepis (V. nana),

because the adult tapeworm has a rostellum with
hooklets on its scolex. In addition, many parasitologists recognize 2 subspecies of H. nana: H. nana
nana, which infects humans, and H. nana fraterna,
which infects rodents.

July 2006

0607-1 Stool: Hymenolepis nana

The objective of this challenge was to identify Hymenolepis nana ova.
CMPT QA The 2 reference laboratories reported H. nana, T. trichiura, E. coli, I. butschlii, E. nana, B. hominis, and CLC's.
GRADING CMPT will only be grading the presence of Hymenolepis
nana ova, therefore 92% (24/26) of laboratories received an acceptable
grade. Two laboratories did not report H. nana. Although not graded,
some laboratories also reported Trichiura trichiura and Giardia lamblia
in the sample; the presence of these two pathogens in the sample
could not be ruled out.
Grades assigned based on the combined results of smear and concentrate reporting are shown below in Table 1.
Table 1. 0607-1 Combined results (concentrate & smear)
Number
Reported

%
Reporting

Hymenolepis nana only

8%

H. nana, E. coli (1) and B. hominis, C. mesnili

8%

H. nana, B. hominis

4%

H. nana, E. coli, E. nana (2), and/or

C. mesnili, and/or B. hominis and/or I. butschlii

12

46%

H .nana, T. trichiura and/or, E. coli,

E. nana, B. hominis, and I. butschlii

15%

H. nana, T. trichiuria, G. lamblia and/or,

E. coli, E. nana, B. hominis, I. butschlii,
E. harmanni, C. mesnili

8%

H. nana, G. lamblia, E. coli, C. mesnili,

E. nana, B. hominis

4%

E. histolytica/dispar, E. nana, E. hartmanni,

B. hominis

4%

A. lumbricoides, E. coli, E. nana

4%

26

Parasite Emboldened = Major Pathogens

Total

1-3

Tables 2 and 3 (adapted from the CDC DPDx web

site 4) compare features of H. nana to other cestode
members. Excellent illustrations comparing gravid
proglottids and scoleces of cestode parasites of humans are also available on the same web site 7.
1-4

H. nana is the only tapeworm that

can be transmitted directly from person to person. Eggs of H. nana are immediately infective
when passed with the stool and cannot survive more
than 10 days in the external environment. When
eggs are ingested by an arthropod intermediate host
(various species of beetles and fleas may serve as
intermediate hosts), they develop into cysticercoids,
which can infect humans or rodents upon ingestion
and develop into adults in the small intestine. A morphologically identical variant, H. nana var. fraterna,
infects rodents and uses arthropods as intermediate
hosts. When eggs are ingested (in contaminated food
or water or from hands contaminated with feces), the
oncospheres contained in the eggs are released. The
oncospheres penetrate the intestinal villus and develop into cysticercoid larvae. Upon rupture of the
villus, the cysticercoids return to the intestinal lumen,
evaginate their scoleces, attach to the intestinal mucosa and develop into adults that reside in the ileal
portion of the small intestine producing gravid
LIFE CYCLE

Hymenolepis nana, the dwarf tapeworm, is the

smallest tapeworm to infect humans. This cestode belongs to a large
family known as Hymenolepididae. The diagnosis of H. nana depends on the demonstration of eggs in stool specimens. Concentration techniques and repeated examinations (of the same concentrate,
or repeat specimens, or both) will increase the likelihood of detecting light infections. Of note, specimens preserved in formalin-based
fixatives are recommended over polyvinyl alcohol.
IDENTIFICATION

Microscopic examination H. nana eggs are usually

spherical or ovoid with a thin hyaline shell and measure
30-47 m in diameter. The oncosphere with its 3 pairs of
hooklets lies in the center of the egg and is separated
from the outer shell by considerable space. The oncosphere has an internal membrane with polar thickenings
from which arise 4 to 8 filaments extending into the
space between it and the colourless hyaline shell. Eggs
of H. nana must be distinguished from those of H. diminuta, the rat tapeworm. Eggs of H. diminuta have a
moderately thick shell, are larger (70-85 m by 6080 m) and the oncosphere lacks polar thickenings or
filaments. Macroscopic examination The adult H.
nana tapeworm ranges from 7-50 mm in length with
up to 200 proglottids, although proglottids are rarely
found in feces samples, as they do not ordinarily
break off from the main strobila. The proglottids are
almost 4 times wider than they are long. The scolex
is knob like in shape, has a rostellum with hooklets
and 4 suckers. H. diminuta tapeworm adults can
measure up to 90 cm (usual range 20 to 60 cm) in
length. H. diminuta is a cestode of rodents, which is
infrequently seen in humans.

(Continued on page 2)

CMPT Enteric Parasitology 0607-1 Hymenolepis nana ova (continued from page 1)

proglottids. Eggs are passed in the stool when released from

proglottids through its genital atrium or when proglottids
disintegrate in the small intestine. There is a high likelihood
of internal autoinfection, without passage through the external environment. The life span of adult worms is 4 to 6
weeks, but internal autoinfection allows the infection to persist for years.
The life cycle of H. diminuta requires an intermediate arthropod host e.g., earwigs, larval fleas and various beetles.
Humans can be accidentally infected through the ingestion
of insects in precooked cereals, or other food items, and
directly from the environment (especially children).
Geographic Distribution Hymenolepis nana is the most
common cause of all cestode infections, and is encountered
worldwide in both temperate and tropical regions but most
prevalent in conditions of poor sanitation where people
share the same living quarters. In temperate areas its incidence is higher in children and institutionalized groups. Of
note, it is estimated that 11% of wild brown rats carry H.
nana 5. Hymenolepis diminuta, while less frequent, has
been reported from various areas of the world.
CLINICAL SIGNIFICANCE H. nana, known as the human

tapeworm, has a cosmopolitan distribution and is thought to

be the most common tapeworm throughout the world.
Adults do become infected, although heavy infection is
more commonly seen in children6. Symptoms include weakness, headache, anorexia, abdominal pain, and diarrhea,
however, symptoms often go unnoticed.
6

Praziquantel or niclosamide are the drugs

most frequently used to treat H. nana infection. Developing H. nana cysticercoids are not as susceptible to drug
therapy as adult tapeworms therefore either a higher dose
of antiparasitic or prolonged duration of antiparasitic to
eliminate emerging tapeworms is required to successfully treat infection.

TREATMENT

REFERENCES
1. Ash LR, Orihel TC. 2003. pp. 2031-2046. (p. 243) Intestinal
Helminths. In PR Murray PR et al. (eds.) Manual of Clinical
Microbiology. 8th ed. Vol. 2. ASM Press, Washington, DC.
2. Bogitsh BJ, Carter CE, Oeltmann TN. 2005. pp. 274-278. Human Parasitology. 3rd ed. Elsevier Academic Press. London.
3. Heelan JS. 2004. pp. 165-166. Cases in Human Parasitology.
ASM Press, Washington, DC.
4. DPDx CDC Laboratory Identification of Parasites of Public
Health Concern. (see reference 7 below)
5. Webster JP, Macdonal DW. 1995. Parasites of wild brown
rats, Rattus norvegicus. Parasitology 109: 37-43.
6. King CH. 2005. Cestodes (Tapeworms) pp. 3285-3293. In GL
Mandell, JE Bennett, R Dolin (eds.) Principles and Practice of
Infectious Diseases. 6th ed. Elsevier Academic Press. London.

Recommended web sites:

7. http://www.dpd.cdc.gov/dpdx/Default.htm
8. http://www.thinkwildlife.org.uk/content/table_01.htm
9. http://www.soton.ac.uk/~ceb/Diagnosis/volume4.htm
10. http://www.path.cam.ac.uk/~schisto/Tapes/Hymenolepis.html

Notes
1. An interesting feature of Hymenolepis tapeworms is that
they undergo a diurnal migration within the gut, which is
associated with the feeding patterns of the host. From ~ 4
pm to 4 am few parasites are seen in the lower part of the
small intestine, while from ~ 4 am to 4 pm many parasites are seen in the upper part of the small intestine. This
was first observed in H. diminuta and subsequently in
other species, and is indicative of a nocturnal feeding
pattern by the parasite 10.
2. If rats are infected with different numbers of worms and
the worms are removed after 18 days the size (length or
weight) of the worms recovered is inversely related to the
number present. This is known as the crowding effect
and has been studied extensively 10.
3. H. diminuta is the most studied of all tapeworms and
has been the choice parasite for experimental studies
for decades as its life cycle is easily maintained in the
laboratory setting2.

Page 3: Table 2. Differentiation of eggs from tapeworms

found in humans.
Page 4: Table 3. Differentiation of adult tapeworm
proglottids found in humans.
(Tables 2 and 3 Adapted from: http://www.dpd.cdc.gov/
dpdx/HTML/MorphologyTables.htm)

CMPT Enteric Parasitology 0607-1 Hymenolepis nana ova (continued from page 2)

Table 2. Differentiation of eggs (ova) from tapeworms found in humans.

Species

Egg Size

Hymenolepis nana 47 m x 37
m
(Human tapeworm;
dwarf tapeworm )

Hymenolepis
diminuta
(Rat tapeworm)

Taenia saginata
(Beef tapeworm)
Taenia solium
(Pig tapeworm)

Range, 40-60
m x 30-50
m

72 m
Range, 70-86
m x 60-80
m

35 m

Color

66 m x 44
m

(Fish tapeworm)

Range, 58-76
m x 40-51
m

Dipylidium
caninum

35-40 m
Range, 31-50
m x 27-48
m

Stage of Development
When Passed

Specific Features
and Variations

Oval., spherical Shell

consists of 2 distinct
membranes. On inner
membrane are two
small "knobs" or poles
from which 4 to 8 filaments arise and spread
out between the two
membranes.

Colorless,
Embryonated. 6-hooked
almost
oncosphere inside shell.
transparent.

Round or slightly
oval. Striated outer
membrane and thin
inner membrane with
slight poles. Space
between membranes
may appear smooth or
faintly granular.

Yellow.

Embryonated. 6-hooked
oncosphere inside shell.

Spherical with thick

striated shell.

Walnut
brown.

Embryonated. 6-hooked Thick, striated shell.

oncosphere present inside Eggs of T. solium and T. saginata are indistinguishable and
a thick shell.
species identification should
be made from proglottids or
scoleces. "Taenia" spp. should
be reported if only eggs are
found.

Oval or ellipsoidal
with an inconspicuous
operculum at one end
and a small "knob" at
the other end.

Yellow to
brown.

Unembryonated. Germi- Egg resembles hookworm egg

nal cell is surrounded by but has a thicker shell and an
operculum.
a mass of yolk cells
which completely fills
inner area of shell.
Germinal cell is usually
not visible.

Range, 31-43
m

Diphyllobothrium
latum

(Dog tapeworm)

Shape

Spherical or oval. 5-15 Colorless.

eggs (or more) are
enclosed in a sac or
capsule.

Embryonated. 6-hooked
oncosphere inside shell.

(Adapted from: http://www.dpd.cdc.gov/dpdx/HTML/MorphologyTables.htm)

Polar filaments.

Resembles H. nana but lacks

polar filaments. Poles are rudimentary and often hard to see.

Eggs are contained in a sac or

capsule which ranges in size
from 58 m to 60 m x 170
m . Occasionally capsules are
ruptured and eggs are free.

CMPT Enteric Parasitology 0607-1 Hymenolepis nana ova (continued from page 3)

Table 3. Differentiation of adult tapeworm proglottids found in humans.

Species
(Commonly known as)
Hymenolepis nana

Size
0.2-0.3 mm long

Appearance of Uterus
Uterus not visible.

x 0.8-0.9 mm wide.
(Human tapeworm;
dwarf tapeworm )
Hymenolepis diminuta

Broader than long.

0.7-0.8 mm long

Proglottid filled with eggs.

Taenia solium

Broader than long.

12 mm in length
x 5-7 mm wide.

(Pork tapeworm)
Taenia saginata

16-20 mm long
5-7 mm wide.

(Beef tapeworm)

Diphyllobothrium latum

2-4 mm long
10-12 mm wide.

(Fish tapeworm)

Broader than long.

Proglottids usually disintegrate in the intestinal tract

and are rarely seen in
stools. Egg is usual diagnostic stage.

Proglottid filled with eggs.

Proglottids usually disintegrate in the intestinal tract

and are rarely seen in
stools. Egg is usual diagnostic stage.

Central "stem" or trunk with 713 main lateral branches on

each side.

Usually on surface of fecal

material. May be in short
chains of 2-3 proglottids.

Central "stem" or trunk with

15-20 main lateral branches on
each side.

Usually on surface of fecal

material. May be single
detached proglottids.

Uterus not visible.

3-4 mm wide.
(Rat tapeworm)

Other

Coiled into a rosette appearance. Occasionally, portion of

worm may be passed. Egg
is usual diagnostic stage.

(Adapted from: http://www.dpd.cdc.gov/dpdx/HTML/MorphologyTables.htm)