CESTODES Taenia saginata

Common Name Beef tapeworm

Disease Taeniasis
Habitat Small intestine
Infective Stage Cysticercus bovis
Diagnostic Stage (3) Egg; proglottids; scolex
Final Host Man
Intermediate Host Cattle
Diagnosis (4) India ink; Stool exam; FEECT; perianal swabs
DOC Praziquantel
Mode of Transmission Ingestion of raw or undercooked beef with cysticercys bovis
Pathology (4) Passage of proglottids in stool/underwear; Intestinal obstruction; Bile and Pan

Differential Morphologies
Egg EMBRYONATED; spherical; brownish; radially-striated; hexacanth
Larvae
Adult worm Upper jejunum; 1k-4k proglottids; 4-10 (up to 25 m) length
Scolex cuboidal; 4 prominent acetabula
Rostellum of the scolex absent; no hooks
Mature proglottid square; visible vaginal sphincter
Gravid proglottid longer than wide; 15-20 lateral branches

INTESTINAL NEMATODES Ascaris lumbricoides

Common Name Intestinal giant roundworm
Definitive Host Man
Intermediate Host
Habitat Small Intestine
Mode of Infection Inhalation, Ingestion
Diagnostic Stage fertilized and unfertilized egg; adult worm
Infective Stage embryonated egg with L3; soil-transmitted helminth (STH)
Pathology Ascariasis; with heart-lung migration
Diagnosis stool exam; concentration technique
DOC Albendazole, Mebendazole, Pyrantel pamoate, Ivermectin, Nitozoxanide

Differential Morphologies
Somatic Muscle Arrangement Polymyarian
Adult worm F: larger, smooth striated cuticles with blunt end, paired reproduct
M: ventrally curved posterior end with spicules; reproductive organ is single, lon
Egg Unfertile: longer and narrower; with thin shell and irregular mamillated coating w
Fertile: outer, coarsely mammilated albuminous covering (absent in decorticated
Larva
EXTRAINTESTINAL NEMATODES
BLOOD Wuchereria bancrofti
Other Name Bancroft's filarial worm
Definitive Host Man
Intermediate Host Mosquitoes (Aedes, Culex, Anopheles)
Diagnostic Stage Microfilaria
Infective Stage L3
Mode of Transmission Mosquito bite
Diagnosis thick and thin smears taken at 8 pm - 4 am (stimulated by DEC provo
Tissue inhabited by the worm lymphatic vessels and nodes
Endpoint of microfilariae blood
Pathology Bancroftian filariasis (lymphedema, elephantiasis, hydrocele)
Periodicity nocturnally periodic; can also be diurnally periodic
DOC Diethylcarbamazine, Ivermectin, Doxycycline, Albendazole

Differential Morphologies
Filarial Worm
Sheath in giemsa unstained
Nuclei regularly spaced, separately situated
Tail single row of nuclei; does not reach tail end
Terminal nuclei -
Appearance in blood smoothly curved
Adult creamy, white, long, filariform
Microfilaria hyaline sheath longer than microfilariae itself; central axis with d

TISSUE Trichinella spiralis

Other Name Trichina
Definitive Host carnivores/omnivores (host harbors the adult worms and the encys
Intermediate Host carnivores/omnivores
Diagnostic Stage encysted larva in muscle (man)
Infective Stage encysted larva in striated muscle (other hosts)
Mode of Transmission ingestion of meat containing encysted larvae
Habitat small intestine
Pathology Trichinellosis
Diagnosis muscle biopsy, ELISA, latex agglutination technique, Beck's serodiagnosis
Prevention/Control health education, cooked at a min of 77'C, freezing, animal monit
DOC Mebendazole, Albendazole

Differential Morphologies
Larva spear-like, burrowing anterior tip
Adult M: single testis found posteriorly, joined in the mid-body by the genital tube exte
F: single ovary found posteriorly; (+) oviduct, seminal receptacle, coiled uterus, v

Egg
 Taenia solium
Pork tapeworm
(2) Taeniasis; Human cysticercosis
Small intestine
Cysticercus cellulosae
(3) Proglottids; Eggs; Cyst (in cysticercosis)
Man
(2) Pig; Man (accidental)
(4) Stool exam; CSF test; CAT; MRI
(3) Praziquantel; Niclosamide; Corticosteroids
Ingestion of improperly cooked pork; fecal-oral route; autoinfection
(2) Human cysticercosis (neuro- and ophthalmic cysticercosis); Non-specific abdominal sx (Taeniasis)

similar with T. saginata

2-4 m in length; 8k-10k proglottids

4 acetabula smaller and more spherical than T. saginata
cushion-like; double crown of 30 large and small hooks
contains accessory ovarian lobe; absent vaginal sphincter; fewer testes
7-13 uterine branches; less active than T. saginata

Trichiuris trichiura
Whipworm
Man

Large intestine (cecum and colon)

Ingestion
unembryonated egg
embryonated egg with L3; STH
(3) rectal prolapse; IDA; diarrhea
stool exam; concentration technique; clinical dx on VERY HEAVY CHRONIC in
Mebendazole (Albendazole is alternative)

Holomyarian
Attenuated anterior 3/5 traversed by a narrow esophagus resembling a string
F: blunt posterior end, longer; M: coiled posterior end
lemon/barrel/football/Japanese lantern-shaped
ng (absent in decorticated eggs); thick, transparent, hyaline shell with a thick outer layer (support) and delicate vitelline
 Brugia malayi/timori
Malayan filarial worm
Man
Mosquitoes (Mansonia)
Microfilaria
L3
Mosquito bite
thick and thin smears
lymphatic vessels and nodes
blood
Malayan filariasis (with lymphedema and elephantiasis but not as severe);
nocturnally periodic; can also be subperiodic
Diethylcarbamazine, Albendazole, Doxycycline

pink
irregularly spaced, overlapping
single row of nuclei reaching the tail end
2 nuclei bulging at the cuticle
kinky

sheathed; angular curvatures with secondary kinks; 2 nuclei at tip of tail

Parastrongylus cantonensis
Rat lungworm
Rat; man are incidental hosts
Mollusks (Achatina fulica, Hemiplecta sagittifera, Helicostyla macrostoma, Vaginilus plebeius, Veronicella altae)

ingestion (for humans, they ingest uncooked snails/slugs, vegetables with mollusk secretions, infected paratenic ani

human eosinophilic meningitis

ck's serodiagnosis
food preparation and foot eating habits

L1: lungs of rodent host, infective stage for the molluscan IH; L3: 2 well-developed chitinous rods below buccal cavit
dy by the genital tube extending back to the cloaca; posteriorly located cloaca has a pair of caudal appendages and 2 pairs of p
pale and filiform
M: well-developed caudal bursa which is kidney-shaped and single-lobed
F: uterine tubules are wound spirally around the intestine, showing a barber's pole pattern
elongated and ovoidal, unembryonated when released, delicate hyaline shells
 Hymenolepis nana
Dwarf tapeworm
Hymenolepiasis
Ileum (small intestine)
Embryonated egg; cysticerci larvae in arthropod
Embryonated egg
(2) Human strain - Man; Murine strain - rodents, man (accidental)
(2) Human strain - none; Murine strain - fleas and beetles
Stool exam
(2) Praziquantel; Niclosamide
Ingestion of cysticercoid-infected arthropod
(3) Hymenolepiasis; GI and neurologic sx; enteritis

EMBRYONATED; colorless; oval (smaller than H. diminuta); has 2 membranes with thin shell; innermembrane has 2

25-45 mm length; 1 mm width; 175-220 segments

small, subglobular; 4 acetabulum; neck is long and slender
short, retractable rostellum with a single row of 20-30 Y-shaped hooklets
segments are wider than long; genital pore found along the same side of segments; 3 ovoid testes and 1 ovary
absent testes and ovary; uterus filled with eggs

Ancylostoma duodenale
Old World Hookworm
Man

Small intestine
Skin penetration; can be transmitted percutaneously and orally
Egg
L3 (filariform larva); STH
cutaneous larval migration; wakana disease; severe anemia; hypoalbuminemia; with heart-lung migration
Harada Mori technique; stool exam; concentration technique
Albendazole (Mebendazole alternative)

Meromyarian
2 pairs of teeth; C-shaped; tripartite male bursa; each adult has single-paired reproductive organs; plain, bristle-like

ovoid-shaped with very thin transparent hyaline shell; 2-8 germ cells in fragmentation
k outer layer (support) and delicate vitelline
 Loa loa
African eye worm
Man
Deerflies (Chrysops sp.)
Microfilaria
L3
Deerfies bite
identification of adult worms
subcutaneous tissues
blood
Loiasis
diurnally periodic (peripheral blood during the day; in the lungs at night)
Ivermectin

Parastrongylus costaricensis

crostoma, Vaginilus plebeius, Veronicella altae)

bles with mollusk secretions, infected paratenic animals)

abdominal parastrongyliasis

2 well-developed chitinous rods below buccal cavity with expanded knob-like tips, infective stage for the rat (DH)
ca has a pair of caudal appendages and 2 pairs of papillae

ng a barber's pole pattern

hyaline shells
Hymenolepis diminuta
Rat tapeworm
Hymenolepiasis
Small intestine
Cysticercoid larvae
Embryonated egg; scolex
(2) natural - rat; accidental - man
various arthropod adults/larvae
Stool exam
Praziquantel
Ingestion of cysticerci in body cavity of insect
(2) Asymptomatic hymenolepiasis; Infants: indigestion and abdominal pain

EMBRYONATED; yellow; round/slightly oval; strated outer membrane with thin inner membr

10-60 cm long; 3-5 mm wide; larger than H. nana; 800-1k proglottids

knob-like and club-shaped; 4 acetabula; neck is short and stout
rudimentary with no hooks
broader; 3 ovoid testes and 1 ovary; genital pore is unilateral
testes and ovary disappear; each gravid proglottid contains a sac-like uterus filled with eggs

Necator americanus
New World Hookworm
Man

Small intestine
Skin penetration
Egg
L3 (filariform larva); STH
cutaneous larval migration; wakana disease; severe anemia; hypoalbuminemia; with heart-l
Harada Mori technique; stool exam; concentration technique
Albendazole (Mebendazole alternative)

1 pair of semilunar cutting plates; S-shaped; small, cylindrical, fusiform, grayish-white; F

ovoid-shaped with very thin transparent hyaline shell; 2-8 germ cells in fragmentation
Onchocerca volvulus

Man
Blackflies (Simulium sp.)
Microfilaria
L3
Blackflies bite
skin snips; identification of adult worms
nodules in subcutaneous tissues
skin + eye
Onchocerciasis/River blindness

Ivermectin

wire-like, whitish, lie coiled within fibrous tissue capsules

unsheathed

unsheathed

Toxocara sp.
Cat or Dog roundworm
cats or dogs; humans are accidental hosts
rabbits, chickens
larvae
embryonated eggs
ingestion of embryonated eggs
various organs
Toxocariasis
tissue biopsy

Mebendazole, Albendazole
Dipylidium caninum
Double-pored dog tapeworm
(2) Dipyllidiasis; Dog tapeworm infection
Small intestine
Cysticercoid larva
Proglottids
(2) natural - dogs, cats, carnivores; accidental - man
(4) dog flea, dog louse, cat flea, human flea
Stool exam
Praziquantel
Ingestion of flea with cysticercoid
(9) Usually asymptomatic; Eosinophilia; intestinal discomfort; epigastric pain; anal pruritus; allergic reactions; dipylid

EMBRYONATED; colorless; round-oval; thin-shelled hexacanth embryo with thick alb

small and rhomboid; 4 acetabula; neck is short and slender

protrusible rostellum with 1-7 rows of rose thorn-shaped hooklets
vase/melon/pumpkin seed-shaped; bilateral genital atrium/pores
filled with capsules or packets of 8-15 eggs enclosed within embryonic membrane

Strongyloides stercoralis
Threadworm
Man; monkey and ape

Small intestine
Skin penetration; autoinfection
L1
L3; fecally-transmitted helminth
Conchin China diarrhea; Honeycomb ulcer; villi atrophy; malabsorption; pneumoniti
stool exam; enterotube test; Harada Mori culture
Ivermectin; Albendazole; Thiabendazole

Parasitic female: colorless, semi-transparent, finely striated cuticle; slender tapering anterior end; short conical poin
Free-living female: smaller than parasitic female
clear, thin shell; similar to hookworms

Parasitic female (filariform/L3): longer, closed mouth, slender, non-feeding, longer buccal cavity, distinct cleft at th
Free-living female (rhabtidiform/L1): open mouth, short and stout, feeding, larger genital primordium, elongated e
Mansonella streptocerca

Man
Midges (Culicoides)
Microfilaria
L3
Midges bite
skin snips
dermis and subcutaneous tissues
skin

aperiodic

unsheathed

bluntly rounded
nuclei extended to the tip of the tail which is bent in the form of a shepherd's crook

inhabit the dermis

slender shape, hooked tail filled with nuclei

Anisakis sp.

Humans
Fish, squid
larvae
L3
ingestion
small intestine
Anisakiasis
gastroscopy, endoscopy

Physical extraction
 Diphyllobothrium latum
Fish tapeworm
Diphyllobothriasis
Small intestine
Plerocercoid larva
Unembryonated egg
(3) man, birds, mammals
(2) crustaceans; small fish
Stool exam
Praziquantel
Ingestion of infected fish
(2) Diphyllobothriasis; Hyperchromic, megaloblastic anemia with thrombocytopenia and leukopenia
Pseudophyllidea

UNEMBYONATED; yellow to brown; oval or ellipsoid; with operculum an

2-15 m; proglottids are wider than long

2 grooves (bothria)
absent rostellum or hooks
one genital pore in the mid-ventral surface; ovaries are rosette-shaped
can produce 1M eggs/worm/day; coiled into a rosette appearance

Enterobius vermicularis
Pinworm; Seatworm; Society worm; Oxyuriasis
Man

Large intestine (cecum)

Ingestion, Inhalation, Autoinfection, Retroinfection (rare)
Egg
Embryonated egg
Enterobiasis/Oxyuriasis
Scotch tape swab method
Mebendazole; Albendazole; Pyrantel pamoate

(+) cephalic alae, bulbus

M: curved tail and single spicule; rarely seen since they die after copulation; F: long pointed tail, uteri of gravid fema
D-shaped, asymmetrically flattened; translucent shell

ding, longer buccal cavity, distinct cleft at the tip of tail

ding, larger genital primordium, elongated esophagus with pyriform posterior bulbs
 Mansonella ozzardi

Midges (Cullicoides) and blackflies (Simulium)

Microfilaria
L3
Midges bite

subcutaneous tissue and mesenteries

blood

aperiodic

unsheathed

long, slender, pointed, anucleate; button hook

herd's crook

inhabit the subcutaneous tissues

small size, long, slender tail
 Echinococcus sp.
(2) Dog tapeworm; Hydatid tapeworm
Human echinococcosis
(2) Final host: Adult - small intestine; Man: Cyst - various organs (liver, lungs, brain)
Embryonated egg
Hydatid cyst
Carnivores/Omnivores
(2) Goats, horses, camels, sheep; Humans (accidental)
(3) radiography, UTZ, serology, Casoni test
Surgery, chemotx (Albendazole, Mebendazole), percutaneous aspiration injection reaspiration (
Ingestion of feces contaminated with embryonated eggs
Human cystic echinococcosis

EMBRYONATED; small and round; thick-shelled; hexacanth oncosphere

hydatid cyst/metacestodes; outer laminated hyaline layer and inner nucleated germinal layer; thick-walled in E. gra
3 proglottids (1 immature, 1 mature, 1 gravid) with no more than 6 proglottids
pyriform with 4 acetabula
30-36 (25-50) hooks; anchors worm to the intestinal mucosa
with testes, ovaries, and cirrus sac (sperm duct or sperm storage); no eggs
branched uterus with numerous eggs; largest and widest proglottid; terminally located

Capillaria philippinensis
Pudoc worm
Man (incidental); Fish-eating birds (natural)
Freshwater fish: Bagsang, Birot, Ipon
Small intestine
Ingestion of infected fish; Autoinfection
Egg
Filariform larva (L3)
Intestinal capillariasis (abdominal pain, chronic diarrhea, borborygmi)
stool exam; duodenal fluid exam
Mebendazole, Albendazole

thin filamentous anterior end; slightly thicker and shorter posterior end (like Trichuris)
M: single spicule and has unspined sheath; F: vulva located at the junction of the anterior and middle third of the bo
Peanut-shaped with striated shells and flattened bipolar plugs

erior bulbs
Mansonella perstans

Midges (Culicoides)
Microfilaria
L3
Midges bite

body cavities and surrounding tissues

blood

aperiodic

unsheathed

bluntly rounded
nuclei to end to tail

inhabit mesenteries, connective tissue of abdominal organs

small size, blunt tail filled with nuclei
 Spirometra sp.
-
Sparganosis
(2) Man: muscle and connective tissue; Dogs & cats: small intestine
(2) procercoid larva in Cyclops; spargana in tissues of cold-blooded vertebrates
Plerocercoid larvae
dogs, cats, carnivores
(2) 1st: copepod (Cyclops, Diaptomus); 2nd: frogs, lizards, snakes, chickens, humans (accidental)
Recovery of plerocercoid larvae from infected tissues (tissue biopsy)
Praziquantel; surgery
Ingestion of intermediate host or infected paratenic host; others
(7) Migrating tumor; Sparganosis; Edema; Local indurations; Periodic giant urticaria; Erythema with chills; Ocular inf
Pseudophyllidea

UNEMBRYONATED; oval shape, with distinct operculum at one end; immature; similar to Diphyllobothrium, but sma
plerocercoid larvae/sparganum; found in intermediate hosts (muscles and CT); cleft-like invagination
elongated; ivory white and ribbon-like; NO DEFINED proglottids
lacks acetabula; possess 2 shallow longitudinal grooves (bothria)

spiral uterus

erior and middle third of the body; Both: esophagus has rows of secretory cells (stichocytes) and the entire esophagus is called
ema with chills; Ocular infection

Diphyllobothrium, but smaller; becomes embryonated in water

vagination

entire esophagus is called a stichosome