Cestodes

General Characteristics Diphyllobothrium latum: Broad/fish tapeworm

- Majority are long, segmented, and - Larval stages: plerocercoid in man
resembles tape (tapeworms) (infective stage)
- Dorso-ventrally flattened
- Size varies from a few mm to several m 2. Cyclophyllidean Cestodes
(Taenia saginata grows several m long) - Possess cup-like and round suckers called
- Adult worms are found in the intestinal acetabula
canal of man and animals
Adult worms in the intestine
Three (3) regions in an adult worm Taenia saginata
Head: (scolex) provided with suckers & Taenia solium
sometimes with hooks that serves as organs of Hymenolepis nana
Hymenolepis diminuta
attachment
Dipylidium caninum
Neck
Body/trunk: (strobila) consist of a series of
According to habitat
segment (proglottids or packages of eggs) Cyclophyllidean Cestodes
- Sexes are not separate (monoecious) - Larval stages in man
- Body cavity is absent o Hydatid cyst of Echinococcus
- Alimentary canal is entirely absent granulosus and Echinococcus
- Excretory and nervous systems are multilocularis
present o Cysticercus cellulose of Taenia
- Reproductive system is present and solium
complete in each segment o Coenurus cerebralis of Multiceps
multiceps
According reproductive organ maturity, o Coernus glomeratus of Multiceps
Three (3) types of segment of the strobila glomeratus
can be recognized from the front
backwards Pseudophyllidean Cyclophyllidean
Immature segment: male and female organs are
not differentiated; near neck Head or Bears 2 slit-like Bears 2 cup-like
Mature segment: male and female organs have scolex grooves (bothria) suckers
become differentiated; near distal part of body (acetabula)
Gravid segment: uteri are filled with eggs; most Uterus No branching Branching
Convoluted May or may not
distal part
uterine tubes be present
assume the form
of rosettes
Uterine Present Absent
pore
Common Ventral; in the Lateral
genital midline
pore
Eggs Operculated: only Not operculated:
develop with do not give rise
presence of water, to ciliated larvae
being
embryonated with
watery
environment
Classifications of Cestodes Infecting Man
1. Pseudophyllidean Cestodes Order Pseudophyllidean Characteristics
- Possess false or slit-like grooves called - Large worms consisting of a long chain of
bothria segments
- Adult worms in intestine
 - “head” has two slit-like sucking grooves
called bothria instead of suckers
- Uterine glands are widely scattered in the
parenchyma and is composed of many
acini
- Genital pores are on the ventral surface
of the segment and are not marginal
- Uterus opens to the exterior through
which eggs come out
- Eggs are operculated and can develop
only in water; immature when oviposited
and oncosphere gives rise to ciliated
embryo
Larval development proceeds in to intermediate
hosts:
- First larval stage is called procercoid
(within body cavity of IH)
- Second larval stage is called plerocercoid
(within muscle tissue of IH)
Diphyllobotrium latum
(Pseudophyllidean)
Common name:
fish worm or
broad worm
- a
mature segment
is filled with
male and female
reproductive
organs
- terminal segments shrink and becomes
empty as eggs are constantly discharge
- dried up segments break off from the
body in chains and are passed out in the
hosts feces
- uterus at the center of the segment
appears in the form of a rosette
Morphology
- adult worm is yellowish grey in color
- dark central markings in the strobila are
due to the egg-filled uterus
- measures 3 to 10 m in length
- life-span is for a period of 5 to 15 years
- scolex is spoon-shaped or spatulate
- scolex bears 2 slit-like grooves called
bothria (1 on the dorsal surface and 1 on
the ventral surface)
- scolex has no rostellum and no hooklets
- Neck is thin and unsegmented and is
much longer than the head
Ova
- passed out in the hosts faces in large
numbers
- oval
- bile stained (Yellow Brown)
- contains abundant granules and
unsegmented ovum
- inconspicuous (not very clear)
operculum at the end and a small knob at
the other end
- does not float in saturated solutions of
common salt
- single egg gives rise to a single larva
Larva
- passed first in water and then in the
respective intermediate hosts
3 LARVAL STAGES
1st stage (ingested by copepods)
- coracidium (free-swimming)
- ciliated oncosphere (embyo) that
develops from eggs in the water
2nd stage
- procercoid
- spindle-like solid body with cephalic
invagination
- found inside the cyclops (the first
intermediate host)
3rd stage
- plerocercoid (sparganum)
- head is invaginated in the neck
- found in the fresh water fish, the second
intermediate host (perch, trout, salmon,
pike)
HOSTS
1ST intermediate host
- cyclops or diaptomus
2nd intermediate host
- fresh water fish, pike, torut, salmon,
perch
Final host
- man, dog, cat (small intestine)
MOI: ingestion of imperfectly cooked infected fish
or roe containing plerocercoid larvae
Laboratory Diagnosis
- microscopic exam of feces for the
characteristic operculated eggs (DFS,
Kato technique)
Pathogenicity
Infection
- diphyllobothriasis
- GI disturbances and anemia
- causes megaloblastic anemia since vit
B12 is absorbed by worm
SPARGANOSIS: disease caused by drinking water
containing infected copepods
 - usual specimen is gravid proglottids
Taenia saginata -
lateral branches is 15 to 30
concentration techniques for eggs rarely
(Cyclophyllidean)
passed out in stool
- perianal swab
Common name:
beef tapeworm
Pathogenicity
Intermediate Adult worm: Irritated by alcohol
Host: cattles or Pathogenesis
cows - taeniasis
- unarmed - passage of proglottids in stool
tapeworm of man - mild irritation at site of attachment
without hooks or - epigastric pain
hooklets - hunger pangs
- adult worms are - weakness
white and semi - weight loss
transparent - loss of appetite
- measures about 4 to 10m or sometimes - pruritis ani
up to 25m - obstruction in intestine but also in bile
- live up to 10 years or more and pancreatic ducts and appendix
because proglottids are actively motile
Morphology
- 1000 to 4000 proglottids Prevention and Control
- common genital pore is marginally Treatment
situated - Praziquantel
- vagina is provided with sphincter muscle - 5 – 10 mg/kg single dose
- gravid proglottid consists of a uterus and
a central longitudinal stem with 15 to 20 Criteria for cure
lateral branches - recovery of the scolex
- highly branched proglottids - negative stool exam 3 months after
- gravid proglottid contains 97,000 to treatment
124,000 ova
- gravid segments are expelled singly and
force their way through the anal
Taenia solium
sphincter (Cyclophyllidean)
- free gravid proglottid crawls out of the Common name:
anal orifice and oviposits on the perianal pork tapeworm
skin
Ova Armed
- liberated by rupture of ripe proglottids tapeworm: with
- no uterine opening hook or hooklets
- spherical (kiwi fruit) - taeniasis is
- thin, outer transparent shell common among
- inner embryophore is brown, thick walled those raw or
and radially straited insufficiently cooked “measly pork”
(infected meat)
- has an oncosphere with three pairs of
hooklets inside the egg shell - uncommon among non-pork eaters
- does not float in saturated salt solutions - man: DH/IH (taenia eggs in ingested and
there is development of cysticercus)
- eggs are resistant and remain viable for
eight weeks - oncosphere hatches in duodenum and
- infective only two cattle other organs through circulation
resulting in human cysticercosis and
become calcified in striated muscled of
HOSTS human
Intermediate hosts: cattle, cow, buffalo
Final host: man Morphology
MOI: eating beef containing Cysticercus bovis - scolex is globular in outline with 4
(infective stage of T. saginata) circular suckers
- scolex has rostellum armed with a double
Laboratory Diagnosis row of alternating large and small
Scotch Tape Perianal Swab technique hooklets (armed)
- rostellar hooklets are shaped like daggers
Diagnosis or Arabian poniards
- Identifying characteristics eggs
(resembles kiwi slice) proglottids or - adult worms measure 2-4 m
scolex - adult worms live up to 25 years
 the anal chains of 5
- 800 – 1000 proglottids sphincter or 6
- common genital poor is marginal and Uterus Highly Lateral
thick lipped branched with branches 5 –
- vaginal opening is not guarded by a 15 – 30 lateral 10 on each
muscular sphincter branches on side, thin,
- gravid segments are expelled passively in each side; thin; dendritic
chains of 5 to 6 at a time and not singly dichotomous and vaginal
- gravid proglottids contains sphincter is
approximately 30,000 to 50,000 eggs absent
Ova Testes 300 – 400 150 – 200
- same as those of Taenia saginata follicles follicles
-
-
infective to man as well as pigs
thick brown straited embryophore Echinococcus granulosus
surrounding a hexacanth embryo (Cyclophyllidean)
HOSTS
Intermediate host: pig Taenia echinococcus
Final host: man Common name: dog
MOI: eating measly pork containing Cysticercus tapeworm or hydatid worm
cellulosae (infective stage of T. solium) Man harbors the cyst and not
Laboratory Diagnosis the adult worms which
Stool exam for proglottids/eggs however is found in the
intestine of dogs and canines
Intestinal Man has direct contact with
- Identifying the characteristic proglottids, infective dog
eggs, or scolex
Cysticercosis Morphology
- computed axial tomography - adult worms are small
- magnetic resonance imaging (3-6 mm length)
Pathogenicity - composed of a: scolex,
- mild, nonspecific abdominal complaints neck, and strobila
- proglottids are not as motile as T. - has 3 segments in the
saginata so organ obstruction is less strobila: immature,
likely mature, gravid
Cysticercosis - neck is short and thick
- multiple - scolex bears 4 suckers
- develop in any organ or tissue and a protrusible rostellum with 2 circular
- neurocysticercosis (most serious rows of hooks
zoonotic disease) Ova
- chorioretinitis - ovoid in shape
- -vasculitis - resemble taenia ova (indistinguishable)
Prevention and Control - hexacanth embryo with 3 pairs of hooks
Praziquantel: 5 – 10 mg/kg single dose for HOSTS
children and adults Intermediate host: Man, cattle, sheep and other
herbivorous animals, pig horse, goat
Niclosamide not available locally Definitive host: dogs, wolf fox, jackal
MOI: direct contact of embryonated form,
Criteria for cure: penetrate intestinal wall, carried to liver, enter
- recovery of scolex pulmonary circulation, brain, heart, etc.; hydatid
- negative stool exam 3 months after cyst develops in viscera of man
treatment Laboratory Diagnosis
Comparison Between T. saginata and T. - radiographic findings
solium - serological tests
- differential leukocyte count
T. saginata T. solium Pathogenicity
Length 4 to 10 m 2–4m - echinococcosis
Head or Large, Armed; with - pathology is caused by the developing larval
quadrate, no rostellum; cyst in the intermediate host
scolex
rostellum and with - most common site of involvement is the
hooks hooklets liver
Number of 1,000 to 4,000 Below 1000 - E. granulosos cyst: unilocular hydatid cyst
proglottids - E. multilocularis: alveolar cyst
Expulsion Expelled singly Expelled - Some may be asymptomatic for years
and may be passively in - Rupture of cyst in the lungs may present
forced through coughing accompanied by allergic reactions
 Prevention and Control - Inner embryophore that encloses an
- Surgical resection: not 100% effective oncosphere with 3 pairs of lancet shaped
- Solicidal agent hooklets
o Hibitane - Intermembranous space us filled with yolk
o 95% ethanol granules and 4 – 8 polar filaments emating
o Hypertonic 30% normal saline from little knobs at either end of the
solution embryophore
- PAIR technique for inoperable cyst HOSTS
o Puncture, aspiration, injection, Indirect host: insect/arthropods and food
respiration intervention, albendazole Direct host: man
MOI: Direct cycle: man acquires infection in the
Hymenolepis species duodenum (embryonated ova) through ingestion
of contaminated food in the SM; egg develops
- Genus is derived from the membranous inside body; Indirect cycle: eggs is ingested by
character of the eggshell “hymen” insects and develops into cysticercoid
- Three testes in each mature segment (insect/arthropods) that can be ingested by
- Uterus is sac-like and transverse rodents or man
- Eggs possess two membranes’ outer Pathogenicity
membrane is thin and transparent - symptoms are produced due to patient’s
- Larval stage is called cysticercoid immunological response to the parasite
- Small bladder containing the invaginated - asymptotic for light worm burden
head proximally and a solid elongated - headache
portion as a caudal appendage - dizziness
- There are 2 species: - anorexia
o Hymenolepis nana
- pruritus of the nose and anus
o Hymenolepis diminuta
- abdominal pain
Hymenolepis nana - pallor
Common name: dwarf tapeworm - desquamation of intestinal epithelial cell or
- Smallest tapeworm infecting man as serious as necrosis may occur
- Found worldwide - regulatory immunity will eventually limit
- Mainly among children the infection
- Only human tapeworm that can complete its Laboratory Diagnosis
life cycle in a single host
- Man can harbor both the adult and the
- demo of characteristic ova in the stool
larval stages of the parasite - proglottids are not recovered because
Morphology they undergo degeneration prior to
- Adult passage
- Found in the ileum Prevention and Control
- Delicate strobila - praziquantel
- 25 mm to 45 mm o 25mg/kg single dose
- Worms may be o Drug dosage is higher than that of
present in large taeniasis because of resistant
numbers from 1,000 cysticercoids in the intestinal tissue
to 8,000
Hymenolepis diminuta
- Short life span about 2
Common name: rat tapeworm
weeks
- Common parasite of rats and mice
- Up to 200 proglottids
- Accidental human infections
- Transverse uterus
- Differs from H. nana in morphology and life
- 3 testes
cycle because it requires an intermediate
Scolex host
- Subglobular Two hosts:
- 4 suckers - Laval stage: cysticercoid is passed in fleas
- Provided with a - Adult stage: in rats and mice and
short retractile accidentally in humans especially children
rostellum armed with a single row of 20 – who accidentally ingest infected fleas
30 hooklets
Morphology
- Rostellar hooklets are
Adult
shaped like a tuning
fork - Larger than H. nana
Ova - Measures 60 cm in length
- Spherical or oval: floats Scolex
on salt solution - Unarmed with 4 suckers

Two distinct membranes

- Outer membrane is thin transparent and
colorless
Proglottid - Rostellum has 1 – 7 rows of rose thorn
- 800 to 1,000 mature proglottids from the shaped hooklets
laboratory rat Strobila
- The three spherical bodies are testes which - 200 proglottids and
surround the ovaries, ootype and vitelline narrow
glands. The genital pores are on the left - Mature proglottids: 2
margin sets of male and female
Ova reproductive organs
- Larger than H. nana that has bilateral pores
- Outer shell is yellowish in - Gravid proglottids: have size and shape of
color pumpkin seeds filled with capsules of 8 – 15
- Inner embryophore has 2 eggs enclosed in an embryonic membrane
knob-like thickenings Ova
- No polar filaments - Passed out
Cysticercoid in the feces
- The suffix indicates it is along with
like a cystericus but this the
larva has no bladder but proglottids
instead has a tail released by
- The dark body within the contraction
spherical portion in the of
scolex proglottids or disintegration outside the
- The longer the tail, the more mature the host
cysticercoid - Spherical, thin shelled, with a hexacanth
- This stage is found inside an insect such as embryo
the mealworm HOSTS
HOSTS MOI: eggs released by dog, cat, or man release egg
MOI: Indirect cycle: requires intermediate host packets to the environment and ingested by larval
which are the insects, not infectious person to stage of flea, oncosphere of D. caninum hatch and
person unlike H. nana, considered as scavengers develop into cysticercoid carried by flea in its body
Accidental ingestion: man, and rodents; once cavity and flea can be ingested by cat/dog and man
person is infected the egg in the stool may be (accidentally)
ingested by arthropod and become cysticercoid 1st Intermediate hosts:
inside insects which infect humans - Ctenocephalides canis: dog flea
Pathogenicity - Ctenocephalides felis: cat flea
- Hymenolepiasis - Pulex irritans: human flea
- Worm burden in rodents is relatively low - Trichoedectes canis: dog flea
- In man, highest worm burden is 19 2nd Intermediate hosts:
- Clinical manifestations are minimal and non- - Dog (cysticercoid)
specific Accidental host: man
Prevention and Control Pathogenicity
- Praziquantel - Diphylidiasis
- 25mg/kg body weight single dose - Rarely multiple
- Epidemiology: worldwide - Symptoms are minimal
- Common among children due to ingestion of o Slight intestinal discomfort
infected grain beetles, dried fruits, flour and o Epigastric pain
cereals o Diarrhea
o Anal pruritis
- Prevalence of H. diminuta in the Philippine
rat is about 8% o Allergic reactions

Diphylidium caninum -
Prevention and Control
Praziquantel
Common name: double pored dog tapeworm - 5 -10 mg/kg body weight single dose
- Presence of bilateral genital pores in each Epidemiology: USA, Rhodesia, Argentina, China,
segment (di: 2; pylis: gate): 2 entrances Philippines
- Common intestinal parasite of dogs
Morphology
Adult
- 10 – 70 cm in length
- Pale reddish
Scolex
- Small and globular
- 4 deeply cupped
elliptical suckers
- Protrusible/retractile
rostellum
SUMMARY OF SCOLEX MORPHOLOGY
Cyclophyllidea Scolex Acetabula (sucker) Rostellum Hooklets

Taenia saginata (beef Cuboidal 4, prominent Absent Absent

tapeworm)
Taenia solium (pork Spherical 4 Present, 25 – 30 double
tapeworm) cushion-like crowns large and
small
Hymenolepis nana (dwarf Sub-globular 4, cup-shaped Present, 20 – 30 Y-shaped
tapeworm) retractable
Hymenolepis diminuta (rat Sub-globular 4, cup-shaped Present, Absent
tapeworm) retractable
Dipylidium caninum (double Globular 4, deeply cupped Present, 1 – 7 rows thorn-
pored dog tapeworm) protrusible shaped
Echinococcus granulosus (dog Pyriform 4 30 – 36 hooks
or hydatid tapeworm)
Pseudophyllidea Scolex Bothria (sucking
groove)
Diphyllobotrium latum (fish Spatulate 2, dorsal and ventral
or broad tapeworm)

SUMMARY OF STROBILA AND EGG MORPHOLOGY

Parasite Proglottids in Strobila Ova Oncosphere (embryo) Length
Taenia saginata Square, club-shaped uterus, Spherical or 3 pairs of hooklets 4 – 10
(beef tapeworm) follicular testes, vagina has sub-spherical, m
sphincter, 15 – 20 lateral brownish,
branches, genital pores are thick
irregularly alternate embryophore,
straited
Taenia solium Square, club-shaped uterus, - Found in muscle tissue 2–4m
(pork tapeworm) follicular testes, vagina has
sphincter, 15 – 20 lateral
branches, genital pores are
irregularly alternate
*difference
Presence of accessory ovarian
lobe, no vaginal sphincter,
smaller # of follicular testes, less
active!!!
Hymenolepis nana Genital pores found alongside Spherical or Thin outer membrane 25 – 45
(dwarf tapeworm) segments, 3 ovoid testes, 1 ovary sub-spherical, thick inner, bipolar mm
colorless/clay- filament, 4 – 8 hair-like
colored polar filaments in
inner mem.
Hymenolepis Broader, genital pores unilateral, Circular, bile- Enclosed in inner 60 cm
diminuta (rat 3 ovoid testes, 1 ovary stained mem., bipolar
tapeworm) filaments, polar is
absent, hooklets in a
fan-like arrangement
Dipylidium Narrow, 2 sets of male and Spherical, Hexacanth 70 cm
caninum (double female RO, bilateral genital thin shelled
pored dog pores, size and shape pf pumpkin
tapeworm) seed, pale reddish
Diphyllobotrium Terminal 4/5 is gravid; the testes Yellowish Ciliated, procercoid 3 – 10
latum (fish or are located in the dorsolateral brown, thick has 3 hooklets m
broad tapeworm) part; vas efferens converge to shell,
form vas deferens this enlarges operculum, Plerocercoid larva
into a seminal vesicle terminates knob-like (sparganum) glistens
in a muscular cirrus, dark and thickening on an opaque
rosette-like uterus in the middle the opposite
Echinococcus 3 proglottids: immature, mature, CYST: outer laminated 3–6
granulosus (dog or and gravid, gravid is widest and hyaline layer and mm
hydatid longest inner nucleated
tapeworm) germinal layer