CYCLOPHYLLIDEAN

CESTODES
 CYCLOPHYLLIDEAN
CESTODES

1.Echinococcus
Limuel S. Entero Jr. BSN 1-C
granulosus
2.Echinococcus
multilucularis

Parasitology
Echinococcus granulosus
Introduction
◻ Echinococcus granulosus, also called hydatid worm
belongs to class Cestoda
◻ It causes cystic echinococcosis in livestock and
humans being intermediate hosts and parasitize the
small intestines of adult canids
◻ it is a zoonotic disease
◻ Definitive hosts are carnivorous predators like dogs,
wolves, foxes and lions. while sheep, goat, cattle,
pigs and rodens are intermediate hosts. birds and
arthropods act as mechanical vectors.
 Morphology
◻ The adult tapeworm ranges in length from 2mm to 7 mm
and has three proglottid, mature proglottid and a gravid
progottid.
◻ it has scolex with four suckers and also has a rostellum with
hooks.
◻ Echinococcus is triploblastic, anus is absent and it has no
digestive system.
◻ Its body is covered by tegument and the worm is divided
into a scolex, a short neck, and three to six proglottids. its
body shape is ribbon-like.
Transmission
◻ Adult E. granulosus release eggs within the intestine
which will be transported out of the body via feces
◻ when contaminated waste is excreted into the
environment, intermediate host has the potential to
contract the parasite by grazing in contaminated
pasture.
◻ It is transmitted from the intermediate host (sheep)
to the definitive host (dogs) by frequent feeding of
offal. Consuming offal containing Echinococcus
granulosus can lead to infection.
 Life Cycle
◻ the adult is in the small intestines of the definitive host (dogs)
◻ gravid proglottids release eggs that are passed in the feces.
◻ the intermediate hosts are infected by ingesting eggs, the egg
hatches in the small bowel and releases an oncosphere
◻ the oncosphere penetrates the intestinal wall and moves
through the circulatory system to various organs
◻ in the organs they develop into cysts and enlarge gradually.
◻ the cysts produce protoscolices and daughter cysts
◻ definitive host eats the infected organs and becomes infected
◻ after ingestion the prostoscolices evaginate, attach to the
intestinal mucosa and develop into adult stages
◻ in 32-80 days, cycle starts over
◻ life cycle photo
◻ Characterized by an asymptomatic incubation period
of 5–15 years and the slow development of a
primary tumor-like lesion which is usually located in
the liver. Clinical signs include weight loss,
abdominal pain, general malaise and signs of hepatic
failure.
Pathogenesis
◻ Ingested eggs from animal hatch in the gut and release
oncospheres
◻ Oncospheres penetrate the intestinal wall, migrate via
the circulation, and lodge in the liver or lungs or, less
frequently, in the brain, bone, or other organs.
◻ in tissue E. granulosus oncospheres develop into cysts,
which grow slowly (usually over many years) into large
fluid-filled lesions --- hydatid cysts
◻ large cysts may contain >1 L of highly antigenic hydatid
fluid as well as millions of protoscolices.
◻ if a cyst in the liver leaks or ruptures, infection can
spread to the peritoneum.
Signs
◻ signs depend upon the site of infection
◻ liver cysts cause abdominal pain or a palpable mass.
Jaundice may occur if the bile duct is obstructed.
Rupture into the bile duct peritoneal cavity, or lung
may cause fever, urticaria, or a serious anaphylactic
reaction
◻ Pulmonary cysts can cause cough, chest pain, and
hemoptysis.
◻ Brain and spinal cord; cause epilepsy and blindness.
Diagnosis
◻ Diagnosis in the definitive host, the dog, is difficult
by ordinary microscopy as it cannot demarcate
between Taenia and Echinococcus eggs.
◻ Detection of antigens in feces by ELISA is currently
the best available technique
◻ other techniques are;
◻ Imaging
◻ Serologic testing
◻ Examination of cyst fluid
◻ echinococcus eggs in feaces photo
Treatment
◻ surgical removal of hydatid cysts 90% effective but can
be risky depending on location, size, and advancement
of cyst
◻ it may need chemotherapy to prevent recurrence.
◻ Chemotherapy: Albedazole is preferred treatment
because it penetrates into hydatid cysts. Dosage:
10mg/kg body weight or 400mg 2x daily for 4 weeks
◻ Mebendazole Dosage: 40 mg/kg body weight 3x daily for
3-6 months
◻ Dogs are effective treated with praziquental
◻ PAIR treatment puncture, aspiration, injection,
reparation
◻ inject protoscolicidal substances into cyst
Prevention
◻ in order to prevent transmission to dogs from
intermediate hosts, dogs can be given anthelminthic
vaccinations.
◻ clean slaughter and high surveillance of potential
intermediate host during slaughter is key in
preventing the spread this cestode to its definitive
host
◻ proper disposal of carcass and offal after slaughter
to prevent dogs access to offal from livestock.
◻ boiling liver and lungs which contain hydatid cysts
for 30 minutes has been proposed as a simple,
efficient and saving way to kill the infectious larvae.
◻ Prevention measures include limiting the areas where dogs are
allowed and preventing animals from consuming meat infected
with cysts.
◻ Prevent dogs from feeding on the carcasses of infected sheep.
◻ Control stray dog populations.
◻ Restrict home slaughter of sheep and other livestock.
◻ Do not consume any food or water that may have been
contaminated by fecal matter from dogs.
◻ Wash your hands with soap and warm water after handling dogs,
and before handling food.
◻ Teach children the importance of washing hands to prevent
infection.
terminology
◻ hyatid : cyst containing watery fuid.
◻ cyst: a tough protective capsule enclosing the larva of a parasitic worm or
the resting stage of an organism.
◻ rostella: protruding part at the scolex armed with hooks and used for
attachment with the intestinal wall of the hosts.
◻ cestode : tapeworm
◻ protoscolex : the juvenille scloex formed from the germinal layer of a
hydated metacestode
◻ oncosphere: tapeworm embryo that has six hooks and is the earliest
differntiated stage of a cyclophyllidean tapeworm– called also hexacanth
embryo. OR immature form of the parasite enclosed in an embryonic
envelope
◻ cyst morphology: fluid filled sphere with the germinal membrane
proliferating endogenously to form brood capsule
◻ echinococcus species: E. multilocularis, E. equinus, E. oligarthrus
◻ offal means organ meat.
Echinococcus
multilucularis
 Morphology
◻ E. multilucularis is morphologically similar to E.
granulosus except it is smaller in size; 1.2-3.7 mm
length.
◻ Most of the E. multilucularis are said to be sterile
because they don’t have protoscolices in their
parent cyst.
◻ In general the rupture of hydatid cyst release the
hydatid sand.
Transmission
◻ Ingestion of infected eggs passed in feces of infected
Canidae and Felidae; fecally soiled dog hair, harness
and environmental fomites serve as vehicles of
infection; vegetables and water contaminated with
the parasites eggs
 Life cycle
◻ The adult Echinococcus multilocularis (1.2—4.5 mm long) resides in the small
intestine of the definitive host. Gravid proglottids release eggs that are passed in
the feces, and are immediately infectious. After ingestion by a suitable
intermediate host, eggs hatch in the small intestine and releases a six-hooked
oncosphere that penetrates the intestinal wall and migrates through the
circulatory system into various organs (primarily the liver for E. multilocularis). The
oncosphere develops into a multi-chambered (“multilocular”), thin-walled
(alveolar) hydatid cyst that proliferates by successive outward budding. Numerous
protoscolices develop within these cysts. The definitive host becomes infected by
ingesting the cyst-containing organs of the infected intermediate host. After
ingestion, the protoscolices evaginate, attach to the intestinal mucosa , and
develop into adult stages in 32 to 80 days.
◻ Humans are aberrant intermediate hosts, and become infected by ingesting eggs .
Oncospheres are released in the intestine and cysts develop within in the liver .
Metastasis or dissemination to other organs (e.g., lungs, brain, heart, bone) may
occur if protoscolices are released from cysts, sometimes called “secondary
echinococcosis.”
◻ Definitive host: Foxes and wolves (and also dogs and
cats)
◻ Intermediate hosts: small wild rodents like squirrels,
voles, mice, etc.
◻ Man is an accidental intermediate host.
◻ Disease depends on the size and location of the
larval masses; cysts grow slowly in humans
(abnormal host), since a person may be infected for
30 years before symptoms appear; primary lesion in
alveolar hydatid disease is always the liver and
contiguous organs to produce chronic space-
occupying lesions; pieces of the germinal membrane
may metastasize to infect the brain, lungs and
mediastinum; disease is often fatal if not treated
 Signs and Symptoms
◻ Human alveolar echinococcosis is characterized by a lengthy
incubation period of 5 to 15 years in immunocompetent
individuals.
◻ The progression of disease is potentiated in immunocompromised
patient. following the ingestion of eggs of E. multilocularis, the
metacestode (larval) stage of the parasite typically embeds in the
liver.
◻ As the disease progresses, the larval stage proliferates exogenous
within the tissue, behaving similar to hepatic neoplasia.
◻ A patients with human alveolar echinococcosis typically present
with headache, nausea, vomiting, abdominal pain, jaundice is rare,
but hepatomegaly is a common physical finding.
Incubation period
◻ multilocularis is characterized by an initial
asymptomatic incubation period of 5–15 years.
Treatment
◻ radical surgery and / or administer appropriate drug
therapy
◻ Liver transplantation is a therapeutic option for
patients unsuitable for radical surgery with hepatic
failure
Prevention and Control
◻ Can be prevented by avoiding contact with wild animals such
as foxes, coyotes, and dogs and their fecal matter and by
limiting the interactions between dogs and rodent
populations.
◻ Do not allow dogs to feed on rodents and other wild animals.
◻ Avoid contact with wild animals such as foxes, coyotes and
stray dogs.
◻ Do not encourage wild animals to come close to your home
or keep them as pets.
◻ Wash your hands with soap and warm water after handling
dogs or cats, and before handling food.
◻ Teach children the importance of washing hands to prevent
infection.
 Taenia
saginata and
Taenia solium
EISEEN JOYCE P. FINLAC
BSN 1-C
 INTRODUCTION
Taenia saginata, or beef tapeworm is a cestode parasite acquired in
humans through the ingestion of raw or poorly cooked meat of infected
cows. Humans act as the host only to the adult tapeworms and can grow up
to 25 meters in the lumen of the intestine, but are usually closer to 5 meters
in length.
Taenia solium is a hemaphroditic cestode (tapeworm) affecting both
humans and pigs. The parasite is more commonly known as the pork
tapeworm, because the infection is primarily caused by the consumption of
cured or uncooked pork. Such an infection in humans leads to the
pathogenesis of either taeniasis or cysticercosis.
 MORPHOLOGY

ADULT
The adult worm inhabits the upper jejunum and
can live for up to 25 years. It derives nourishment
from intestinal contents. It is white,
semitransparent and it measures 5 to 24 meters
in length. Scolex (head) measures 1 t0 2 mm,
quadrate in shape, has four circular suckers but
has no rostellum or hooked. Neck is narrow and
long proglottids (segments) are from 1000 to
2000.
 MALES and FEMALES
As the tapeworm grows in the human intestine,
mature proglottis called gravid proglottis will be
casted off out of the human body. Each gravid
proglottids contains both male and female
reproductive organs and houses 80 thousand eggs.
Mature proglottids are approximately square in
shape, and they contain mature male and female
reproductive organs.
 EGGS
• The eggs of Taenia spp. are indistinguishable
from each other, as well as from other
members of the Taeniidae. The eggs measure
30-35 micrometers in diameter and are
radially-striated.
• Eggs develop in hyaline capsules and are
shed after leaving the proglottid. These eggs
are ingested by cattle or other intermediate
hosts and once they reach the duodenum,
hatch and penetrate the intestinal wall.
 DIAGNOSTIC
FEATURES
• The larval stages (metacestodes) of T. saginata and T. solium form distinctive
pearly-white cysts (cysticerci) which appear as small (8-10mm in diameter)
fluid-filled bladders (hence the common name of bladder-worms), each
containing a single invaginated protoscolex (infective stage).
• Cyclophyllidean tape-worms (T. saginata and T. solium) have flat ribbon-like
bodies, with an anterior scolex (hold-fast organ with suckers and sometimes
hooks) and a posterior tape (strobila) made up of segments (proglottids). Adult
worms lack a gut (they absorb nutrients) and they are hermaphroditic
(segments containing both male and female reproductive organs). They have
indirect life-cycles involving encystment of larvae (metacestodes) in the tissues
of intermediate hosts and their transmission to definitive hosts by carnivorism.
 Infective Stage:
T. saginata- Cysticercus bovis
T. solium- Cysticercus cellulosae and egg

T.Saginata
Definitive Host: Humans
Intermediate Host: Cattle
T. Solium
Definitive Host: Humans
Intermediate Host: Pigs, Humans
 MODE OF
• Eggs of T. saginata passedTRANSMISSION
in the feces of an infected person are only infectious to
cattle. Humans are infected by ingestion of raw or undercooked beef infected
with Cysticercus bovis, the larval stage of T. saginata. In humans, the adult tapeworm
develops in the intestine over 2–3 months. The cycle of infection repeats when
infectious eggs are passed in the feces and later ingested by cattle, slowly migrating
into the flesh and transforming into the larval stage.

• T. solium taeniasis is acquired by humans through the ingestion of the parasite's larval
cysts (cysticerci) in undercooked and infected pork. Human tapeworm carriers
excrete tapeworm eggs in their faeces and contaminate the environment when they
defecate in open areas. Consumption of raw and/or undercooked pork products.
Human-to-human or pig-to-human transfer of T. solium eggs through direct contact
with feces.
 DISEASE PRODUCED

• Taeniasis is a tapeworm (cestode) infection acquired by the ingestion of

raw or undercooked meat of infected animals. Although many species
exist, two species, Taenia saginata and Taenia solium,
cause pathology in humans.

• Taenia solium tapeworm infections can lead to cysticercosis, which is

a disease that can cause seizures, so it is important seek treatment.
 PATHOLOGY AND
SYMPTOMATOLOGY
• Tapeworms can cause digestive problems including abdominal pain, loss of
appetite, weight loss, and upset stomach. The most visible symptom of taeniasis
is the active passing of proglottids (tapeworm segments) through the anus and
in the feces. In rare cases, tapeworm segments become lodged in the appendix,
or the bile and pancreatic ducts.

• Taenia saginata and Taenia solium (Taeniasis) infection is asymptomatic, but

heavy infection causes weight loss, dizziness, abdominal pain, diarrhea,
headaches, nausea, constipation, chronic indigestion, and loss of appetite. It
can cause antigen reaction that induce allergic reaction.
 INCUBATION PERIOD
• The incubation period is 8–10 weeks for T. solium and 10–
14 weeks for T. saginata.

• Symptoms may include abdominal discomfort, weight loss,

anorexia, nausea, insomnia, weakness, perianal pruritus,
and nervousness. Symptoms are less likely for T.
solium infection than for T. saginata infection.
LIFE CYCLE
 LABORATORY
Diagnosis of Taenia tapeworm infections is made by examination of stool
samples; individuals shouldDIAGNOSIS
•

also be asked if they have passed tapeworm

segments. Stool specimens should be collected on three different days and
examined in the lab for Taenia eggs using a microscope. The stool should be
examined for proglottids and ova; ova may also be present on anal swabs.

• Microscopic examination of stool for ova and proglottids:

A. Direct Fecal Smear
B. Brine Floatation Technique
C. Cellophane-tape Technique

Acid fast stain is used to distinguish the eggs, T. saginata is aid fast positive (red)
while T. solium is negative (blue) or by detection of proglottids and scolex in feces.
 TREATMENT
• Medications for the treatment of taeniasis include praziquantel
(Biltricide) and albendazole (Albenza).

• Both drugs are antihelmintics, which means that they kill parasitic
worms and their eggs. In most cases, these medications are provided in
a single dose. They can take a few weeks to fully clear an infection. The
tapeworm will be excreted as waste.

• Common side effects associated with these medications

include dizziness and upset stomach.
 PREVENTION AND
CONTROL
One way to prevent taeniasis is to cook meat to safe temperatures. A food
thermometer should be used to measure the internal temperature of
cooked meat. Do not sample meat until it is cooked. USDA recommends
the following for meat preparation.

For Whole Cuts of Meat (excluding poultry)

Cook to at least 145° F (63° C) as measured with a food thermometer
placed in the thickest part of the meat, then allow the meat to rest* for
three minutes before carving or consuming.

For Ground Meat (excluding poultry)

Cook to at least 160° F (71° C); ground meats do not require a rest time.
Taenia Asiatica
and
Dipylidium Caninum

Kieth Flejoles BSN 1C

Taenia Asiatica Introduction
❑Commonly known as Asian taenia or Asian
tapeworm.
❑ Cause intestinal teniasis in humans and
cysticercosis in animals. has close morphological
resemblance to Taenia saginata and has a life
cycle resembling Taenia solium. T. asiatica has
been identified to parasitise human intestinal
lumen in eight Asian countries i.e. China, Korea,
Indonesia, Philippines, Taiwan, Thailand, Vietnam
and Japan, with the prevalence being as high as
21% causing significant economic burden.
Morphology
• The length of the adult may vary between 4 to 8 m with 300 to
1,000 segments. Similar to Taenia saginata, the scolex is devoid
of hooklets but there is a prominent rostellum. The gravid
proglottids have posterior protuberance with 11 to 32 lateral
branches arising from the main uterus. The mature segments,
on the other hand, were found to carry a vaginal sphincter.
Due to the number of uterine branches and the presence of
vaginal sphincter, Taenia asiatica may be misidentified as
Taenia saginata
• Eggs: are spherical and measure 31 - 43 μm in diameter
Diagnostic Features
› Taenia asiatica is a yellowish white in color divided into the anterior
scolex, followed by short neck. The scolex bears four simple suckers
as attachment organs to the intestinal wall of the host. The rostellum
is usually sorrounded by two rows of rudimentary hooklets.
Mode of transmission
› Humans are infected by eating cysticerci (larvae) in raw or
undercooked pork. After ingestion, the cysticerci mature into adult
worms in the small intestine of humans.
Disease produced
› Cysticercosis – a rare infectious disease caused by the presence and
accumulation of the larval cysts of tapeworm.
› Intestinal Teniasis- is an intestinal tapeworm infection caused by
eating contaminated beef or pork.
Pathology and Symptomatology
› T. asiatica causes intestinal infection. Humans infected with adult T.
asiatica worms are asymptomatic or have mild gastrointestinal
symptoms. They may see proglottids (tapeworm segments) in their
stool.

› Gastrointestinal symptoms like diarrhea, nausea, epigastric pain and

intestinal obstruction.
Incubation period
› Takes 5 to 12 weeks for worm to mature into adulthood in the human
intestine
Life cycle
Laboratory Diagnosis
› The laboratory diagnosis of human intestinal taeniasis for decades
had been based on the detection of bile stained eggs and the gravid
proglottids of the adult worm passed in the feces.
› Recent studies reveal that microscopic examination of eggs or the
gravid proglottids alone is not a reliable method of differentiating T.
saginata from T. asiatica because of their similarities. Hence it is
hypothesized that the exact epidemiologic prevalence of T.
asiatica might be underestimated. Newer methods of reliable
detection and differentiation of these parasites include serological
and molecular methods.
› Serological diagnosis- These techniques are particularly well
developed for detection of cases of human cysticercosis, which
include specific antibody detection or circulating parasite antigen
from serum and cerebrospinal fluid samples.
› Molecular diagnosis- These methods also have been developed in
the accurate detection and differentiation of Taenia species.
Treatment
All children with intestinal tapeworm should be treated.
•
Single-dose praziquantel (5–10 mg/kg) is the treatment
of choice.
•
Alternate agents include niclosamide (not available in
the United States) and nitazoxanide.
•
.
Prevention and control
› Thorough cooking of meat is a key measure for the prevention of
infection with Taenia. Transmission of taeniasis can be reduced by
improving sanitation and husbandry practices, along with strict
inspection of pork or beef before sale or consumption.
› Public health measures such as sanitary disposal of human feces and
restriction of cattle and pigs from land contaminated by human feces
may also prevent transmission. Freezing meat at −20°C kills cysticerci
but often is not practical in endemic areas.
Dipylidium Caninum
Introduction
› Dipylidium caninum, is a very common intestinal parasite of dogs and
cats worldwide, especially in dog populations where ectoparasitism is
high. Dipylidiasis in humans is accidental and is observed to be more
common in children than in adults

› also called the dog tapeworm, the flea tapeworm or the double-pore
tapeworm
› It is a small-to-medium-sized (10–50 cm) tapeworm, pink in color, with
double-pored, barrel-shaped segments. It can infect humans when a
person accidentally swallows an infected flea (Ctenocephalides
canis or Ctenocephalide felis)
D. caninum strobila of proglottids D. caninum proglottid D. caninum egg packet
Morphology
› Egg: Groups of eggs (egg packets) may be found in the
stool. Each egg measures from 25 to 40 µm and contains
the six-hooked oncosphere. The individual eggs may
closely resemble those of Taenia saginata, particularly if
they are released from the egg packet.

› Adult worm: The adult worms measure from 10 to 70 cm

long and have a scolex with four suckers and an armed
rostellum. The single proglottids have been described as
looking like cucumber seeds when moist and like rice grains
when dry.
› The proglottids of D. caninum are longer than they are
wide. A characteristic feature of these proglottids is that
they contain two sets of male and female reproductive
organs. They therefore demonstrate two genital pores that
lead to their name as the “double-pored” tapeworm.
 Seed-like proglottid segments

Proglottids
Diagnostic features
› Spherical eggs contain a six hooked embryo, measure from 24 - 40
μm in diameter and occur singly or in packets
› Scolex (head) is somewhat elongated with four suckers and a small
retractable rostellum
› Proglottids are barrel shaped and possess two genital pores, one on
each lateral margin, which give rise to the common name double
pored tapeworm
Mode of transmission
› Transmitted by ingestion of an infected flea
› Dogs get infection by accidently ingesting infected flea or lice that contain
D caninum cysticercoids (larva).
› Dogs infected with D. caninum shed proglottids in their feces and these
proglottids containing eggs in the environment are consumed by flea
larvae .This parasite is not very harmful in adult dogs, though at point of
attachment there may be haemorrhage leading to enteritis and diarrhea.
› Humans are accidentally infected when they swallow dog flea harbouring
tapeworm metacestode stage, cysticercoid. D. caninum infections are
reported mostly in children.
› Fecal-oral transmission, more specifically ingestion of vector
Disease produced

› Dipylidiasis (Human)- occurs most in children under

eight years of age. They are most frequently infected
when licked by a dog or cat with infected fleas. A high
percentage of children infected are under six months of
age. This disease occurs throughout the world. There
have been documented cases in Africa, Argentina,
Australia, Chile, China, Europe, Guatemala, India, Japan,
Philippines, and the United States.
Pathology and Symptomatology
› D. caninum is the common tapeworm of dogs and cats and
occasionally humans. Cat fleas, Ctenocephalides felis are the
intermediate hosts. Adults embed into the mucosa of the small
intestine, small numbers may cause no symptoms but larger numbers
can cause haemorragic enteritis and occasionally death in young
animals.
› Most infections are asymptomatic but mild gastrointestinal
disturbances may occur
› Most striking feature in animals and children consists of the passage
of proglottids, found in the perianal region, in feces, on diapers and
occasionally on floor coverings and furniture
› Proglottids are motile when freshly passed and may be mistaken for
maggots or fly larvae
› Pets may exhibit behavior to relieve anal pruritis, such as scraping
anal region across grass or carpeting
Incubation period
› It takes approximately 10-25 days for the larva to mature into adulthood
within the small intestine. As an adult, the lifespan is approximately one
year.

Life cycle
Laboratory diagnosis
› Stool: The standard O&P examination is the recommended
procedure for recovery and identification of D. caninum eggs in stool
specimens, primarily from the wet preparation examination of the
concentration sediment. The eggs are most easily seen on a direct
wet smear or a wet preparation of the concentration sediment.

› Adult worms The mature and gravid proglottids are wider than long,
with the main reproductive structures (mainly the uterus) located in
the center of the gravid proglottid. This configuration of the uterine
structure has been called a rosette.
Treatment
› Infection is self limiting in humans and typically clears spontaneously
in 6 weeks
› Praziquantel:
– Adults, 5 - 10 mg/kg orally in a single dose
– Not approved for children less than 4 years old but has been used successfully
in children as young as 6 months
› Niclosamide is effective but unavailable in United States
› No purge or follow up stool examination is indicated but appearance
of proglottids after therapy is indication for retreatment
Prevention and Control
› Have your veterinarian treat your dogs and cats promptly if they
have tapeworms.
› Clean up after your pet, especially in playgrounds and public
parks. Bury the feces, or place it in a plastic bag and dispose it in
the trash.
› Do not allow children to play in areas that are soiled with pet or
other animal feces.
› Teach children to always wash their hands after playing with
dogs and cats, and after playing outdoors.
HYMENOLEPIS
NANA

(DWARF TAPEWORM)
HYMENOLEPIS NANA
• commonly known as the dwarf tapeworm, is a cyclophyllidean
tapeworm and is the smallest tapeworm infecting humans.
• The parasite is the only human tapeworm, which can complete its
entire life cycle in a single host, indicating that it does not require
an obligatory intermediate host.
• Man can harbor both the adult and the larval stages of the parasite.
PARASITE BIOLOGY

• The adults, with a delicate strobili measuring from 25 to 45 mm in length and 1 mm in width, reside in the ileum.
• The scolex is subglobular with four cup-shaped suckers . There is a retractable rostellum armed with a single row of 20 to 30 Y-
shaped hooklets.
• The neck is long and slender.
• The anterior proglottids are short and the posterior ones are broader than long. No more than 175 to 220 segments compose
the entire length of the strobila. The proglottids measure 0.15 to 0.3 mm in length and 0.8 to 1.0 mm in width. The genital
pores are found along the same side of the segments.
• Mature proglottids contain three ovoid testes and one ovary in a more or less
straight pattern across the segment. When segments become gravid, the
testes and the ovary disappear while the uterus hollows out and becomes
filled with eggs. Gravid segments are separated from the strobila and
disintegrate as they pass out of the intestines, releasing eggs in the stool.

gravid segment
• Eggs are spherical or subspherical, colorless or clay-colored, measuring 30 to
47 μm in diameter. The oncosphere has a thin outer membrane and a thick
inner membrane with conspicuous bipolar thickenings, from each of which
arise four to eight hair-like polar filaments embedded in the inner membrane.
These eggs, however, die immediately once passed out into the environment.

Hymenolepis nana egg

• The life cycle has a dual pathway: a direct and an indirect development . In the direct cycle, the
host ingests eggs, which hatch in the duodenum. The liberated embryos penetrate the
mucosal villi and develop into the infective cysticercoid larvae. After 4 to 5 days, the larvae
break out of the villi and attach to the intestinal mucosa to develop into adults. Infection
through the indirect cycle is usually via the accidental ingestion of infected arthropod
intermediate hosts like the rice and flour beetles and sometimes through fomites, water, or
food contaminated with the larvae. The cysticercoid larvae are released and will eventually
develop into the adult tapeworms in the intestines of the host. It takes 20 to 30 days from the
time of ingestion for the eggs to appear in the feces. Eggs are optimally viable immediately
after discharge from the bowel. Autoinfection can occur through the fecal-oral route or within
the small bowel. Oncospheres from the eggs are released and they invade the host villi to start
a new generation.
PATHOGENESIS AND CLINICAL MANIFESTATIONS

• Symptoms are generally produced because of the patient’s

immunological response to the parasite. Light worm burden is generally
asymptomatic. Rarely, convulsions occur. Heavy infections may result in
enteritis due to necrosis and desquamation of the intestinal epithelial
cells. With time, regulatory immunity may limit or eventually clear the H.
nana population spontaneously. Infections in children resolve
spontaneously in adolescence.
DIAGNOSIS
• Specific diagnosis is made by demonstration of the characteristic
eggs in the patient’s stool. In light infections, concentration of the
stool specimens on alternate days is useful. Generally, proglottids
are not recovered because they undergo degeneration prior to
passage with stools.
TREATMENT
• Praziquantel, adults and children, 25mg/kg in a single-dose therapy.
• Stool examination may be repeated after 2 weeks. Treatment is usually repeated after 2 weeks
to cover for the worms emerging from the remaining viable cysticercoids. Treatment is
considered successful if stools are negative for H. nana eggs at one month post treatment
Alternatives:
- Niclosamide: adults, 2 gm in a single dose for 7 days; children 11-34 kg, 1 gm in a single dose
on day then 500 mg per day orally for 6 days; children > 34 kg, 1.5 gm in a single dose on day
then 1 gm per day orally for 6 days.
- Nitazoxanide: adults, 500 mg orally twice daily for 3 days; children aged 12-47 months, 100 mg
orally twice daily for 3 days; children 4-11 years, 200 mg orally twice daily for 3 days.
EPIDEMIOLOGY
• Hymenolepis nana is found in areas with warm climate like Southern USA, Latin America, the
Mediterranean, East Asia, and the Philippines. An estimated 20 million people are infected.
Transmission generally occurs where there is poor sanitation, overcrowding, and poor personal
hygiene practices. Direct contact plays an important role because the eggs cannot survive long
outside the host. It is a familial and institutional infection common in orphanages, day care
centers, and mental institutions. Prevalence varies from 5 to 20% among children and young
adults in communities where direct transfer of embryonated eggs from hand to mouth is likely
to occur. This human tapeworm is also found among the mice and less frequently among the
rats. The species in mice and rats is considered to be a distinct subspecies called H. nana var.
fraterna. Although very rare, some strains were found to be infectious to humans as well.
Therefore, infected mice and rats may be potential sources of infection. In the Philippines, two
independent surveys of Jueco in 1983 and Cross, et al. in 1984 showed a prevalence of less
than 1% in humans. Infection among rodents was found to be low as well
 PREVENTION AND CONTROL
• The life cycle involves a single host and transmission is direct. This
makes prevention more difficult, especially in crowded dwellings.
Emphasis should be placed on personal hygiene and environmental
sanitation. Infected cases should be thoroughly treated. Rodent
control must be observed. Food must be properly stored and
protected from possible infestation with grain beetles.
HYMENOLEPIS DIMINUTA

• Hymenolepis diminuta is a cosmopolitan parasite primarily of rats,

hence the common name, rat tapeworm. Accidental human
infections do occur resulting in hymenolepiasis. Aside from
morphological differences with H. nana, H. diminuta differs in that
it requires an intermediate host.
PARASITE BIOLOGY
• The adult tapeworm is larger than H. nana. The worm measures about 60 cm in length.
• The scolex differs from that of the H. nana by having a rudimentary unarmed rostellum. As in H. nana,
mature proglottids are broader than they are long, and the arrangement and number of sexual organs
are similar: three ovoid testes and one ovary in a more or less straight pattern across the segment. The
proglottids are larger and may reach 0.75 mm in length and 3.5 mm in width. The genital pores are
unilateral. Each gravid proglottid contains a sac-like uterus filled with eggs. H. diminuta eggs are circular,
about 60 to 80 μm in diameter and are bile-stained. The oncosphere is enclosed in an inner membrane,
which has bipolar thickenings but lacks the bipolar filaments. The hooklets usually have a fan-like
arrangement.

Hymenolepis diminuta egg

• The gravid proglottids separate from the main body of the worm,
disintegrate, and release eggs into the feces. Eggs, when ingested
by a wide range of adult and larval insects like fleas, beetles,
cockroaches, mealworms, and earwigs, develop into the infective
cysticercoid larvae. When these infected insects are ingested by the
rat or accidentally ingested by man, the larva is released and
develops into the adult worm in about three weeks.
LIFE CYCLE OF HYMENOLEPIS DIMINUTA
 PATHOGENESIS AND CLINICAL MANIFESTATIONS

• The worm burden in rodents is relatively low. In man, the highest

number recorded is 19 worms. Clinical manifestations are minimal
and non-specific. The life span of H. diminuta in humans is short,
which possibly explains why human infections are usually light.
 DIAGNOSIS
Diagnosis is based on the identification of eggs from the stool. H.
diminuta eggs are distinguished from H. nana eggs by their more
circular shape, larger size, and lack of bipolar filaments. At times, the
whole worm is expelled and the morphology of the scolex may be used
as an aid in diagnosis.
 TREATMENT
• Treatment is similar to Hymenolepis nana. Praziquantel is given as a
25 mg/kg single dose.
 EPIDEMIOLOGY
• Human infection occurs worldwide but is more common among
children than adults in poor communities with rat infestation. It
probably occurs by accidental ingestion of grain beetles infesting
dried grains, dried fruits, flour, and cereals. In a nationwide survey of
rats in the Philippines, prevalence of H. diminuta was found to be
about 8%.
 PREVENTION AND CONTROL
• include rodent control, elimination of the insect intermediate hosts,
protection of food, especially the precooked cereals from such
insects, sanitary disposal of human waste, and treatment of human
cases.