OUTLINE MORPHOLOGY

I. Liver Flukes A. EGG

II. Lung Flukes
III. Intestinal Flukes Operculated Egg
IV. Blood Flukes
V. Major and Minor Cestodes

CLASS: Trematoda (Flukes)

A. Species which inhabit the portal blood stream of
vertebrates
1. Schistosoma japonicum
2. Schistosoma mansoni
3. Schistosoma haematobium
B. Species which inhabit the liver of vertebrates • DIAGNOSTIC STAGE
1. Fasciola hepatica
• The eggs are discharged from ADULT WORM in the
2. Clonorchis sinensis
BILIARY DUCTS
3. Opistorchis felineus
• The eggs are then passed from the Infected Person via
C. Species which inhabit the small intestines of
the FECES
vertebrates
• OPERCULATED EGG
1. Fasciolopsis buski
2. Echinostoma ilocanum • Yellow-Brown Eggs → 130-150 um x 63-90 um
3. Heterophyid group • Cannot distinguish this egg from Fasciolopsis buski
D. Species which inhabit the lungs of vertebrates (Intestinal Fluke)
1. Paragonismus westermani

I. LIVER FLUKES
A. Fasciola hepatica
B. Clonorchis sinensis
C. Opistorchis filineus
D. Opistorchis viverrini
GENERALITIES: Platyhelminths / Trematodes

• Hermaproditic Forms (both M/F)

a. Liver Flukes
b. Intestinal Flukes
c. Lung Flukes
• Separate Sexes (Male and Female)
a. Blood Flukes – Schistosomes B. MIRACIDIUM
• All have Suckers Infecting Man:
a. Oral Suckers – directly attaches to the DIGESTIVE
TRACT
b. Ventral Suckers – serve as ATTACHMENT
A. FASCIOLA HEPATICA
Oriental Liver Fluke
Common Name Sheep Liver Fluke
Temperate Liver Fluke
Sheep Liver Fluke → Fascioliasis
Diseases
Temperate Liver Fluke → Sheep Liver
Produced
Rot
Ingestion of Metacercaria encysted • Comes out from egg within the water source → looks
Mode of on aquatic plants for the 1ST INTERMEDIATE HOST
Transmission Drinking water with viable • SNAIL – Family of Lymnaeidae
Metacercaria 1ST INTERMEDIATE 1. Lymnaea philippinensis
Central and Latin America, South HOST 2. Lymnaea auricular
Distribution America, Middle East, France, rubbiginosa
England, etc.
 F. ADULT LIVER FLUKE

C. CERCARIA

• Large, Broad, and Flat Body

• Cephalic Cone
• 2 Suckers
• Testes
• Ovary
o Dendritic, and anterior to the testis
• Marked widening at the base of the
Cephalic Cone
cone
• Comes out from the SNAIL after series of Radial • Small near at the conical projection
2 Suckers
Development/Asexual and central body
1. Free swimming within the water source • Highly branched and fills 2nd-3rd
Testes
2. Looks for the 2ND INTERMEDIATED HOST (Water quarters of the body
Plant) Ovary • Dendritic, and anterior to the testis
3. Free swimming Cercaria Uterus • Coiled and short
• AQUATIC PLANTS • Extend to the lateral field of the hind
Vitellaria
ND 1. Ipomea obscura body
2 INTERMEDIATE
(Kangkong) • Length: 20-50 mm
HOST Measures
2. Nasturtium officcinate • Width: 6-12 mm
(Watercress)
D. ENCYSTED METACERCARIA

G. CEPHALIC CONE

• INFECTIVE STAGE
• Ingestion of the Metacercaria ENCYSTED on the RAW
edible water plant → 2ND INTERMEDIATE HOST
• DRINKING of a water with floating Metacercaria
E. EXCYSTED METACERCARIA
1. The adult worm lives in the BILIARY TREE of the LIVER
2. Migration of the LARVA through the Liver elicits
painful inflammatory reaction
3. Soon, this will become fibrosed

• Liver Parenchyma
 • Ectopic Fascioliasis
o When the parasite wonders hematogenously
o Cause necrosis, abscess, and fibrosis
(Lungs/Brain/Orbit)
• Halzoun (Pharyngeal Fascioliasis)
o Arabic term ingesting raw sheep’s liver to cause
temporary lodgment into the pharynx
B. CLONORCHIS SINENSIS
Oriental Liver Fluke
Common Name
Chinese Liver Fluke
MORPHOLOGY
EGG

1. Liver infected with an adult Fasciola

hepatica
2. Background with necrosis
Microscopic 3. Inflammatory infiltrates within the
background
4. Arrow: Larva
5. Arrow Head: Eggs • Features:
LIFE CYCLE: FASCIOLIASIS 1. Small yellow-brown, embryonated egg
2. Verry difficult to distinguish between
Opisthorchis and Heterophid sp.
3. Measure: 25-35 um x 12-20 um
4. Operculated – “Shouldered” Opercula
5. Aboperculated End – Small Knob
• When the speciation is NOT POSSIBLE
o Report: Clonorchis/Opisthorchis/Heterophyes
Metagonimus Egg
C. sinensis egg: the small
knob at the abopercular
end is visible in this image.

• Immature eggs are discharged in the biliary ducts and C. sinensis egg. Note the
passed in the stool operculum resting on
• Eggs become embryonated in freshwater over ~2 "shoulders;" image taken
weeks ; embryonated eggs release miracidia , at 400× magnification.
which invade a suitable snail intermediate host
• In the snail, the parasites undergo several
developmental stages (sporocysts , rediae , and
cercariae )
• The cercariae are released from the snail and
encyst as metacercariae on aquatic vegetation or
other substrates.
• Humans and other mammals become infected by
ingesting metacercariae-contaminated vegetation
(e.g., watercress)
• After ingestion, the metacercariae excyst in the
duodenum and penetrate through the intestinal
wall into the peritoneal cavity.
• The immature flukes then migrate through the liver
parenchyma into biliary ducts, where they mature into
adult flukes and produce eggs
• In humans, maturation from metacercariae into adult
flukes usually takes about 3–4 months; development
of F. gigantica may take somewhat longer than F.
hepatica.
OTHER CLINICAL CASES
• Hepatic Fascioliasis
o Asymptomatic with fever, RUQ Abdominal Pains,
Increased PBS for Eosinophil, Hepatomegaly
 MIRACIDIUM OPISTHORCHIS SP VS CLONORCHIS - ADULT
COMMONALITY

•Snail Hosts: Clonorchis sinensis

1. Parafossarulus
manchouricus
st 2. Parafossarulus
1 Intermediate
anomaloispiralis DIFFERENCES
Host
3. Parafossarulus stratulus
• Snail Hosts: Opisthorchis felineus
and Opisthrochiss viverrine • Shape (Opisthorchis): Leaf-Like appearance, shorter
1. Genus: Bithynia sized trematode measuring 8-12 mm (length), 1.5-3
METACERCARIA (INFECTIVE STAGE) mm (wide)
• Ingestion of the Metacercaria encysted on the • Tegument: transparent
UNDERCOOKED FRESH WATER FISH (2nd INTERMEDIATE • Location of the Vitellaria at the
Similarity of
HOST) middle 3rd of the body at the level of
the 3 Species
the Uterus
• Morphology of the Testes:
Differences of
1. Branched – Clonorchis
the 3 Species
2. Lobate – Opisthorchis

• Freshwater Fish (31 Types) of

species belonging to family:
2nd Intermediate Cyprinidae
Host 1. Pseudorasbora parva
• Freshwater Shrimp: Clonorchis
sinensis
ADULT: Clonorchis
LIFE CYCLE: CLONORCHIS SINENSIS
• Shape: Leaf-Like
Appearance
o Moderate-sized
Trematode measuring
10-25 mm x 3-5 mm
• Tegument – Transparent
• The main morphological
feature is the elongated and
coiled uterus which lies in
the center of the worm
• The ovary lies posterior to
the uterus and there is a
distinct seminal receptacle
• A pair of Dendritic Testes
lies in tandem to each other
in the posterior region

• Clonorchis sinensis eggs are discharged in the biliary

ducts and in the stool in an embryonated state
• Eggs are ingested by a suitable snail intermediate
host
• Eggs release miracidia , which go through several
developmental stages (sporocysts , rediae , and
cercariae )
• The cercariae are released from the snail and, after a
short period of free-swimming time in water, they
come in contact and penetrate the flesh of freshwater
fish, where they encyst as metacercariae .
• Infection of humans occurs by ingestion of
undercooked, salted, pickled, or smoked freshwater
fish
• Clearly visible in this image are the oral sucker (OS),
pharynx (PH), ceca (CE), ventral sucker (acetabulum)
(VS), uterus (UT), vitellaria (VT), and testes (TE).
• After ingestion, the metacercariae excyst in the INTERMEDIATE HOSTS
duodenum and ascend the biliary tract through the
ampulla of Vater
• Maturation takes approximately one month.
1st
• The adult flukes (measuring 10 to 25 mm by 3 to 5 mm)
INTERMEDIATE
reside in small and medium sized biliary ducts.
HOST
CLINICAL
• Symptoms: Antamelania asperata
Antemelania dactylus (former name:
1. Fatigue, weakness, weight loss, abdominal
distress, and altered appetite Brotia aspirate)
2. Acute Infection: fever, eosinophilia,
hepatomegaly
3. Chronic Infection: cirrhosis and portal
hypertension, myocardial metabolic changes, 2nd
neurocirculatory dystonia INTERMEDIATE
4. Complication: suppurative cholangitis, hepatitis, HOST
pancreatitis Mountain Crab – Sundathelphusa
5. Carcinoma of the Liver, Cholangiocarcinoma, and philippina (former name:
Adenocarcinoma of the Gallbladder → Clonorchis Parathelphusa grapsoides)
6. DM patients → risk for complications due to MORPHOLOGY
failure to produce bile and high lithogenicity EGG - OPERCULATED
• NB: Common Duct, Liver Bile Ducts → they can stay for • It has a PROMINENT
as long as 20 years → CHRONIC INFLAMMATION FLATTENED
OPERCULUM → fits on
the shoulder /
opercular rim of the
shell) and with
ABOPERCULAR
THICKENING AT END
• Ovoidal or elongated in
shape, yellowish-brown
thick egg shells are
smooth
• Measuring 80-118 um x 48-60 um
• Specimen: Sputum or Stool
• Development Stage when Passed: UNEMBRYONATED

II. LUNG FLUKES

A. PARAGONISMUS WESTERMANI
• Paragonimiasis – disease
causing Paragonismus sp.
Disease Causing
• Pulmonary Distomiasis
Paragonismus sp. EGG – SPUTUM SAMPLE
• Endemic Hemoptysis
• Parasitic Hemoptysis
• Name depends on the country of
origin (China, Thailand,
Vietnam)
1. Paragonismus westermani
(Oriental Lung Fluke)
Parasites
2. Paragonismus
philippinensis
3. Paragonismus siamensis
(disease causing to Feline
species)
 first intermediate host, a snail, and penetrate its soft
tissues
• Miracidia go through several developmental stages
inside the snail : sporocysts , rediae , with the
latter giving rise to many cercariae , which emerge
from the snail.
• The cercariae invade the second intermediate host, a
crustacean such as a crab or crayfish, where they
encyst and become metacercariae.
• This is the infective stage for the mammalian host
• Human infection with P. westermani occurs by eating
inadequately cooked or pickled crab or crayfish that
harbor metacercariae of the parasite
• The metacercariae excyst in the duodenum ,
INTERMULLUSCAN DEVELOPMENT: S-R1-R2-C penetrate through the intestinal wall into the
peritoneal cavity, then through the abdominal wall
and diaphragm into the lungs, where they become
encapsulated and develop into adults (7.5 to 12 mm
by 4 to 6 mm).
• The worms can also reach other organs and tissues,
such as the brain and striated muscles, respectively.
• However, when this takes place completion of the life
cycles is not achieved, because the eggs laid cannot
exit these sites.
• Time from infection to oviposition is 65 to 90 days.
Infections may persist for 20 years in humans.
METACERCARIA (CRAB OR CRAYFISH) – INFECTIVE STAGE
• Animals such as pigs, dogs, and a variety of feline
species can also harbor P. westermani.
CLINICAL PRESENTATION
• The ACUTE PHASE (invasion and migration) may be
marked by diarrhea, abdominal pain, fever, cough,
urticaria, hepatosplenomegaly, pulmonary
abnormalities, and eosinophilia.
• During the CHRONIC PHASE, pulmonary
manifestations include cough, expectoration of
discolored sputum, hemoptysis, and chest
ADULT radiographic abnormalities.
• Extrapulmonary locations of the adult worms result in
more severe manifestations, especially when the
brain is involved.

II. INTESTINAL FLUKES

A. Fasciolopsis buski
B. Echinostoma ilocanum
C. Heterophyes heterophyes
• Usually found in PAIRS in lung parenchyma leading to D. Metagonismus yokogawai
form a FIBROTIC TISSUE by the host E. Haplorchis yokogawai
• Can also go to other sites like the BRAIN and STRIATED A. FASCIOLOPSIS BUSKI
MUSCLES • LARGEST INTESTINAL FLUKE of humans
• Measures: 12 mm x 6 mm • Found in areas where humans raise pigs and consume
LIFE CYCLE: PARAGONISMUS WESTERMANI freshwater plants
• Most are LIGHT INFECTION and ASYMPTOMATIC
• Heavy Infections → diarrhea, abdominal pain, fever,
ascites, anasarca, and intestinal obstruction
LIFE CYCLE: FASCIOLOPSIS BUSKI

• The eggs are excreted unembryonated in the sputum,

or alternately they are swallowed and passed with
stool
• In the external environment, the eggs become • Immature eggs are discharged into the intestine and
embryonated , and miracidia hatch and seek the stool
• Eggs become embryonated in water , eggs release • Size ranges from 130-140 um x 80-85 um
miracidia , which invade a suitable snail • Large and ovoid or ellipsoidal like a Hen’s eggs with
intermediate host BROAD OPERCULUM
• In the snail the parasites undergo several • Yellow to brown in color → very much similar to egg of
developmental stages (sporocysts , rediae , and Fasciola hepatica
cercariae ) • Oval with thin-shelled eggs
• Eggs Passed in the Stool: UNEMBRYONATED
• The cercariae are released from the snail and
• RESEMBLES F. HEPATICA EGG
encyst as metacercariae on aquatic plants
• The mammalian hosts become infected by ingesting
metacercariae on the aquatic plants.
• After ingestion, the metacercariae excyst in the
duodenum and attach to the intestinal wall.
• There they develop into adult flukes (20 to 75 mm by 8
to 20 mm) in approximately 3 months, attached to the
intestinal wall of the mammalian hosts (humans and
pigs)
• The adults have a life span of about one year.
MORPHOLOGY
METACERCARIA (INFECTIVE STAGE) F. BUSKI VS F. HEPATICA - EGG

• Eggs cannot be distinguished from F. hepatica;

• MODE OF TRANSMISSION: however, geographic history (piggery) can help
o Ingestion of encysted METACERCARIAE from the identify this case
AQUATIC PLANTS → attaches to the DUODENUM → ADULT
matures for 3 months → Produces EGGS
o Eggs → Miracidium (water)
• SNAIL
st • Sementina or Hippeutis
1 INTERMEDIATE
HOST • The Miracidium transforms into
Sporocysts and mother and
daughter Rediae → CERCARIA • Size is about 20-75 mm x 8-20 mm x 0.5-3 mm
Intramulluscan • S-R1-R2-C • Large, fleshy, elongate-ovoid
Development • “GIANT INTESTINAL FLUKE”
• WATER PLANTS • Reside in the Intestine of the Mammalian Host
a. Tropa bicornis • NO CEPHALIC CONE
2nd INTERMEDIATE
b. Eliocharis tuberosa
HOST
c. Ipomea obscura
d. Nymphacea lotu
• Cercaria → Metacercaria → Attaches/encyst to Water
Plant (Tropa bicornis)
CERCARIA (SIMPLE TAILED

• May cause OBSTRUCTION

F. BUSKI VS F. HEPATICA - ADULT

EGG

• F. buski has no CEPHALIC CONE

 B. ECHINOSTOMA ILOCANUM • The definitive host becomes infected after eating
metacercariae in infected second intermediate
hosts
• Metacercariae excyst in the duodenum and adults
reside in the small intestine (for some species,
occasionally in the bile ducts or large intestine)
MORPHOLOGY
EGG – UNEMBRYONATED

• Classification: Echinostomids → presence of COLLAR

SPINES (Spiny Collared) within the oral suckers
1. Echinostoma ilocanum
2. Artyfechinostomum malayamum
INGESTION of METACERCARIA
Infective Stage
encysted in snails
Location Small Intestines
Definitive Host Human and other mammals
Disease Echinostomiasis
R1-R2-C E. ILOCANUM [E] E. MALAYAMUM [F]
Color Straw Colored Golden Brown
Ovoid and Larger and
Shape
Operculated Operculated
83-116 um x 58-69 120-130 um x 80-90
Measuring
um um
Intramulluscan EGG – GERM BALL APPEARANCE
Development

Cercaria Lophocercus / Simple Tailed

LIFE CYCLE

LOBULATED TESTES

• Like many trematodes, echinostomid flukes undergo

a multi-host (indirect) life cycle
• Unembryonated eggs are passed in feces of infected
definitive hosts and develop in water
• Miracidia usually take about 3 weeks to mature before
hatching , after which they swim freely and
penetrate the first intermediate host, a snail
• The intramolluscan stages include a sporocyst
stage , one or two generations of rediae , and
cercariae , which are released from the snail.
• The cercariae may encyst as metacercariae within the
same first intermediate host or leave the host and
penetrate a new second intermediate host
• (A) An adult specimen of E. ilocanum showing almost
globular testes.
• (B) Another E. ilocanum specimen showing slightly
lobed anterior testis and oblong posterior testis.
• (C) Another E. ilocanum specimen showing
moderately (anterior testis) or deeply lobed testes
(posterior testis).
• (D) Head collar showing a total of 51 collar spines,
including 5 corner spines on each side, 3 oral and 2
 aboral. Tegumental spines are quite large but smaller LIFE CYCLE: HETEROPHYES
in comparison with collar spines.
• (E) An egg of E. ilocanum in the feces. The operculum
is small and inconspicuous at the anterior end, and
abopercular wrinkles are also small and minute.
• (F) Another egg of E. ilocanum showing similar
findings.
LOBULATED TESTES VS BRANCHED TESTES

• Adults release embryonated eggs each with a fully-

developed miracidium, and eggs are passed in the
host’s feces
• After ingestion by a suitable snail (first intermediate
host), the eggs hatch and release miracidia which
penetrate the snail’s intestine
Color Reddish Gray • Genera Cerithidia and Pironella are important snail
Measures 2.5-6.0 mm (length), 1-1.35 mm (width) hosts in Asia and the Middle East respectively.
Posterior End Composed of 49-51 Collar Spines • The miracidia undergo several developmental stages
Oral Suckers Center of Circumoral Disk in the snail, i.e. sporocysts , rediae , and cercariae
Ventral Anterior 5th of the body
Suckers • Many cercariae are produced from each redia. The
INTERMEDIATE HOSTS cercariae are released from the snail and encyst as
metacercariae in the tissues of a suitable
fresh/brackish water fish (second intermediate host)

• The definitive host becomes infected by ingesting

undercooked or salted fish containing metacercariae
1st INTERMEDIATE
HOST • After ingestion, the metacercariae excyst, attach to
the mucosa of the small intestine and mature into
adults (measuring 1.0 to 1.7 mm by 0.3 to 0.4 mm)
• In addition to humans, various fish-eating mammals
(e.g., cats and dogs) and birds can be infected
Gyraulus convexiusculus by Heterophyes heterophyes
MORPHOLOGY
EGG

2nd INTERMEDIATE
HOST

Pila luzonica (Kuhol)

C. HETEROPHYES AND METAGONIMUS
• These are 1-3 mm in length of Intestinal Flukes
• When Passed in Stool: EMBRYONATED with fully
• Infection occurs after ingestion of the infective stage
developed MIRACIDIUM inside
Metacercaria on a FRESH WATER FISH
• Operculated
• The infection produces diarrhea and colicky
• 20-30 um x 15-17 um → VERY SMALL
abdominal pain but self-limiting because the parasite
• Differentiation with Clonorchis and Opisthorchis →
has a short lifespan
VERY DIFFICULT
Intramulluscan S-R-C or S-R1-R2-R3 → depending on
Development the environment ADULT
Cercaria Lophocercus / Keel Tailed
• Adult Heterophyid Fluke → elongated to oval or
pyriform
• Measures: 2 mm in length
• Tegument: Fine Scales → like spines
• Genital Suckers – located at left posterior boarder of S. japonicum
the ventral sucker

IV. BLOOD FLUKES • Eggs are more round with a vague

• Genus Schistosoma:
A. Schistosoma haematobium
B. Schistosoma japonicum
C. Schistosoma mansoni
D. Schistosoma intercalatum
E. Schistosoma mekongi
• Schistosoma has only one
Intermediated Host
• No Reservoir
• Schistosoma EGGS → bile-
stained, not operculated
Comparison
• CERCARIA → Fork-Tailed →
with Other
INFECTIVE FORM
Trematodes
• Cylindrical Worm (not flat or leaf-
like)
• Only Trematode in which sex is
SEPARATED (Diecious) → other
Trematodes are Hermaphrodites
(Monoecious)
INTRODUCTION
• Geographic Distribution:
A. Schistosoma haematobium – Africa
B. Schistosoma mansoni – Africa and America
C. Schistosoma japonicum – Far East Asia, some
parts of Africa
• Epidemiology
o Approximately 250 million people are infected
with Schistosomes and 600 million are at risk.
MORPHOLOGY
• Adult worms are 10 to
20 mm long
• Schistosomes have
separate sexes
• The male has a CANAL
in which the slender
female worm resides
spine on the side
S. haematobium S. mansoni
Diagnostic Stage Eggs in Urine Eggs in Stool
Forked Tailed Cercaria swimming in
Infective Stage
Fresh Water
Cercaria penetrates human skin
upon exposure to fresh water
containing cercaria and cause
itching at site of penetration.
Mode of
After 2-3 weeks of infection, fever,
Infection
chills and diarrhea occurs due to
presence of the Schistosoma larva in
blood, which migrate to the liver
venules
CERCARIA
• Man is infected by FORK TAILED CERCARIA in fresh
water by SKIN PENETRATION
• The cercaria travel through the venous circulation to
the heart, lungs, and portal circulation
• They mature and reach:
o The MESENTERIC VEINS (S. japonicum and S.
mansoni)
o The BLADDER VESSELS (S. haematobium) where
they live and ovulate for the duration of the host's
life.

INFECTIVE
STAGE

• Schistosoma cercaria (forked tail).

EGG • Found in fresh water
• The eggs are VERY CHARACTERISTIC and confirm • Penetrate the skin of human upon
diagnosis contact with water containing it.
INTERMEDIATE HOST

S. mansoni

• Eggs in feces have a SPINE ON THE

SIDE

• SNAIL
S. haematobium • S. haematobium → Bulinus truncates
• S. mansoni → Biomphlaria alexandria
• Eggs in urine have an APICAL
SPINE
 SITES FOR LOCALIZATION
Superior Mesenteric Veins draining the
S. japonicum
Small Intestine
Superior Mesenteric Veins draining the
S. mansoni
Large Intestine
S. Venous Plexus of Bladder
haematobium Can also be found in the Rectal Venules
MORPHOLOGY (CONT.)
ADULT WORM

SCHISTOSOMA COUPLE

CERCARIA

SCHISTOSOMA EGGS

EGG
CLINICAL PRESENTATION
• A 13 y/o boy with
Schistosomiasis
• Presentation:
S. haematobium Eggs a. Hepato-
in Section of Bladder splenomegaly
b. Ascites
c. Muscle Atrophy
d. Anemia
e. Diarrhea
f. Hemorrhage from
the GI Tract

S. mansoni Eggs in
the Wall of the Gut
 LAB DIAGNOSIS • The stages in the snail include two generations of
• Stool, urine samples sporocysts and the production of cercariae
• Bile-stained eggs in stool • Upon release from the snail, the infective cercariae
• Schistosoma haematobium – Terminal spine
swim, penetrate the skin of the human host , and
• Schistosoma mansoni – Lateral spine
• Schistosoma japonicum – Lateral knob shed their forked tails, becoming schistosomulae
DIAGNOSTIC STAGE • The schistosomulae migrate via venous circulation to
lungs, then to the heart, and then develop in the liver,
• S. haematobium
exiting the liver via the portal vein system when
o Eggs found in
urine of Urinary mature,
Schistosomiasis • Male and female adult worms copulate and reside in
patients the mesenteric venules, the location of which varies
o Oval Egg in by species (with some exceptions)
TERMINAL SPINE • For instance, S. japonicum is more frequently found
in the superior mesenteric veins draining the small
intestine , and S. mansoni occurs more often in the
inferior mesenteric veins draining the large
intestine
• However, both species can occupy either location and
are capable of moving between sites.
• S. intercalatum and S. guineensis also inhabit the
inferior mesenteric plexus but lower in the bowel
than S. mansoni
• S. haematobium most often inhabits in the vesicular
and pelvic venous plexus of the bladder , but it can
• S. mansoni
also be found in the rectal venules.
o Eggs found in
• The females (size ranges from 7–28 mm, depending
STOOL of
on species) deposit eggs in the small venules of the
Intestinal
portal and perivesical systems.
Schistosomiasis
• The eggs are moved progressively toward the lumen
patients
of the intestine (S. mansoni,S. japonicum, S. mekongi,
o Oval Egg in
LATERAL SPINE S. intercalatum/guineensis) and of the bladder and
ureters (S. haematobium), and are eliminated with
feces or urine, respectively

V. CESTODES
MAJOR CESTODES MINOR CESTODES
Taenia saginata Diphylidium caninum
Taenia solium Echinococcus granulosus
Diphyllobothrium latum Hymenolepsis nana
Hymenolepsis diminuta
CHARACTERISTICS

LIFE CYCLE: SCHISTOSOMIASIS

• FLATTENED DORSOVENTRALLY, Ribbon-Like with

• Schistosoma eggs are eliminated with feces or urine,
depending on species
• Under appropriate conditions the eggs hatch and
release miracidia , which swim and penetrate
specific snail intermediate hosts
variable length (mm -meters)
• DOESN’T HAVE alimentary or digestive system.
• Requires 1 or more intermediate host.
• Each Strobila is MONOECIOUS
• Body is covered with CUTICLE/TEGUMENT (with
MICROTRICHIA) which is continuous from one
segment to another
• Require 1 or more Intermediate Host (Except
Hymenolepsis nana)
GENERAL TAPEWORM MORPHOLOGY
• Polyzoic → consists of 3 regions
• Scolex
o Bothria – 2 elongated suctorial grooves
o 4 cup-like sucking discs
o Rostellum – Armed or Unarmed
• Neck A. DIPHYLLOBOTRIUM LATUM
• Strobila Common Name Broad Fish Tapeworm
o Composed of Proglottids • Ivory colored
a. Immature • 3-10 meters or more in length
b. Mature • As many as 3-4,000or more
c. Gravid proglottids
o Length ranges from 3 mm to 10 meters (3-4000 Characteristics
• It has SCOLEX, bearing BILATEREL
Proglottids) BOTHRIA (GROOVES) → for
o Linear series of segments or proglottids ATTACHMENT
o Proglottids are continuously formed posterior to • NO ACETABULUM
the neck region in a process called Disease • Diphyllobothriasis
STROBILIZATION
• You can get infected eating
o As new proglottids are formed, the older NB
UNCOOKED CONTAMINATED FISH
proglottids move posteriorly and become sexually
Infective Stage • Plerocercoid Larva (Sparganum)
mature
to Man encysted in fish
• Crowding Effect – size and number of worms may be
inversely related to the number of worms present in 1st Intermediate • Copepods (Cyclops sp and
the gut Host Diaptomus)
2nd Intermediate • Fresh Water Fish (perch, trout,
Host salmon, pike)
Other Reservoir • Dogs, Cats, Bear
Host
• Humans and Fish-Eating
Definitive Host
Mammals

TAPEWORM TEGUMENT
• Structure of the Tapeworm Tegument is similar to that
of Trematodes
• Syntegument
o Outer anucleate syncytial cytoplasmic layer
containing mitochondria and secretory bodies
• Hermaphroditic – each mature Proglottid contains at
least one set of male and female reproductive organs
• Fertilization
• With a COMMON GENITAL PORE
a. Ventral
b. Lateral
o Same side of each proglottid (Hymenolepsis)
o Irregularly alternate (Taenia)
o Bilateral (Dipylidium)
• Egg → Larva → Adult
• 2 Main Classes of Larvae:
1. Solid – Proceroid and Plerocercoid
2. Vesicular or Bladder – Cysticercoid and
Cysticercus • Small, SPATULATE Scolex (2.5x1 mm) with 2 BOTHRIA
PATHOGENICITY (sucking organs) → Dorsally and Ventrally
• Minimal intestinal irritation and vague intestinal • About 4/5th of the entire worm contains maturing or
symptoms mature proglottids
• Vitamin B12 Deficiency → D. latum • Mature Proglottid is BROADER than longer and has
• Symptoms similar to Brain Tumors → T. solium ROSETTE UTERUS → characteristic
• Space occupying lesions → Echinococcus • Size can reach 10 mm in length
DIAGNOSIS
• Identification of the Proglottids, Eggs, and Scolex
MAJOR CESTODES
Order Pseudophyllidian Order Cyclophyllidian
Diphyllobothrium latum Taenia saginata
Taenia solium
Contains 2 BOTHRIA → Contains SCOLEX with 4
false or slit-like / sucking Suckers and Hooklets
grooves
 LIFE CYCLE: D. LATUM • These appear after 5-6 weeks
after infection
• EGGS → passed in the feces as
UNEMBRYONATED FORM
• These become
embryonated/mature form in
18-20 days with suitable
environment
• Passed out in the
environment: 1,000,000
eggs/days/worm
• CORACIDIA – released from
the eggs

• Eggs are passed unembryonated in feces

• Under appropriate conditions, the eggs mature
(approximately 18 to 20 days) and yield
oncospheres which develop into a coracidia
• After ingestion by a suitable crustacean (first
intermediate host) the coracidia develop into
procercoid larvae • Eggs of Diphyllobothriids in
an iodine-stained wet mount.
• Procercoid larvae are released from the crustacean
upon predation by the second intermediate host • Note the knob at the
abopercular end.
(usually a small fish) and migrate into the deeper
tissues where they develop into a plerocercoid larvae
(spargana), which is the infectious stage for the
definitive host
• Because humans do not generally eat these small fish
species raw, the second intermediate host probably
does not represent an important source of human
infection.
• However, these small second intermediate hosts can
be eaten by larger predator species that then serve as
paratenic hosts
• In this case, the plerocercoid migrates to the
musculature of the larger predator fish; humans (and
other definitive host species) acquire the parasite via
consumption of undercooked paratenic host fish
• In the definitive host, the plerocercoid develops into
adult tapeworms in the small intestine.
• Adult diphyllobothriids attach to the intestinal
mucosa by means of two bilateral groves (bothria) of
their scolex
• The adults can reach more than 10 m in length, with
more than 3,000 proglottids.
• Immature eggs are discharged from the proglottids
(up to 1,000,000 eggs per day per worm) and are
passed in the feces.
• Eggs appear in the feces 5 to 6 weeks after infection. Eggs of Diphyllobothriids within a proglottid
MORPHOLOGY
EGG
 • Close-up of a few of the
Proglottids showing the
ROSETTE-SHAPED UTERUS
at the center of each
proglottid

• Figure A: closer
view of the
specimen showing
broad proglottids
with Craspedote
(overhanging)
margins
• Figure B: the
elongate scolex
FREE SWIMMING CORACIDIUM
and neck region of
D. latus
• Figure C: Carmine-
shaped proglottids
of D. latus, showing
the rosette-shaped
ovaries

• 1st Intermediate Host:

o Coracidia →
PROCERCOID is
developed
o Ingested by the
Small Fish →
Precercoid
(Sparganum) →
Infective Stage CLINICAL PRESENTATION
• 2nd Intermediate Host:
o Paratenic Host
o Fresh Water Fish

ADULT
• Section of an adult
Dibothriocephalus latus
containing many
proglottids.
• The scolex was not present
in this specimen

• Attaches to the wall of the Ileum, less common to the

Jejunum, seldom to other levels of intestines and
gallbladder
• Diarrhea, Abdominal Pain
• Mechanical Obstruction of the bowl (Bolus)
• Vitamin B12 Deficiency resulting to MEGALOBLASTIC
ANEMIA → BOTHRIOCEPHALUS ANEMIA
• Thrombocytopenia and Leukopenia
• Slight Leukocytosis with Eosinophilia
• The infection can last 24 years but most are
asymptomatic
• Aberrant migration of the adult worm’s proglottid can
cause CHOLECYSTITIS and CHOLANGITIS and
sometimes INTESTINAL OBSTRUCTION
DIAGNOSIS
• Stool examination for characteristic eggs and gravid
segment
 TREATMENT • Cystecercus bovis –
• Niclosamide 2gm single dose 2 months
• Praziquantel 5-10 mg/kg/BW single dose • INFECTIOUS STAGE
• Japan → Bithionol 30 mg/kg/BW → milky white,
• Saline purgation if worm has not been evacuated after ovoidal – 10 mm in
2 hour-dose orally diameter
PREVENTION • Note: any muscle
• Thoroughly cooking the fish fiber or cardiac
• Freezing fish for 24-48 hrs at -18C kills Plerocercoid muscle, other
• Pets should be dewormed periodically organs
B. TAENIA SAGINATA CLINICAL PRESENTATION
• Common → passage of Proglottids or Segments in the
Stool
• Irritation in the Intestinal Attachment
• Non-Specific Symptoms:
1. Epigastric Pain
2. Vague Discomfort
3. Hunger Pangs
4. Weakness
5. Weight Loss
6. Loss of Appetite
7. Perianal Itching
• T. saginata → NO ROSTELLUM and HOOKS
8. Tangled Proglottids – OBSTRUCTION (Pancreatic
• T. solium → WITH ROSTELLUM and HOOKS Ducts, Bile, Appendix)
• The neck is short where immature and mature gravid
proglottids develop
Common Name Beef Tapeworm
Square in Shape and contain Mature
Mature
Male and Female Reproductive
Proglottids
System (Hermaphrodite)
• Features:
1. 2 Large Lobes of Ovaries
Female 2. Median Club-Shaped Uterus
3. Vagina is marginally located
with Sphincteric Muscle
• 300 to 400 Follicular Testes
Male
throughout the Proglottid

Gross image of Ischemic Colon containing a pile of T.

saginata proglottid
DIAGNOSIS

• 97,000-124,000 Ova
• Longer and wide (16-20 mm x 5-7
mm)
• Formalin Concentration Techniques → demonstrate
Gravid • Distal in location from the neck
eggs
Proglottid • Uterus is distended with 15-20
TREATMENT
lateral branches
• Praziquantel – 5 mg to 10 mg per kg/weight
• Genital Pore – alternate irregular
C. TAENIA SOLIUM
arrangement on the lateral sides
Pass-Out in • Effects of Taenia solium in the Human Host
• 594,000,000 Ova
Stool 1. Taeniasis – intestinal infection with an adult
tapeworm follows ingestion of contaminated
• Gravid Proglottids is separated
CYSTICERCI from Taenia solium
and passed out in the stool
2. Cysticercosis – this is a parasitic tissue infection
Apolysis • Eggs are RELEASED in the
caused by larval cyst of the tapeworm, T. solium,
EXTERNAL ENVIRONMENT for
by ingesting contaminated egg
weeks
CYSTICERCOSIS
• Ingestion by CATTLE → ONCOSPHERE is released
• 1 Tapeworm per
Intestine
• 12 weeks to become
MATURE FORM

• Parasitic disease that is caused by Cysticercus or

LARVAL STAGE of Cestode Tapeworm
• They can be able to survive in host tissues for a longer
period of time even with immune response
• There are numerous “CALCAREOUS CORPUSCLES” or
mineral concretions within the tissue of the Cestode
• People living with the same household of the infected
patient with Taeniasis has high risk for infection
• You will not get infected by Cysticercosis if you only
ate uncooked pork alone → you need to ingest
contaminated larval cyst
• Cysticercus/Cysticercus Cellulosae → bladder worm,
is a translucent fluid filled oval sac containing a single
inverted scolex → 5 mm in diameter
CYSTICERCUS RACEMOSE
• Large lobulated cysts with predilection for basal
cisterns
• Causes CYSTICERCOTIC ARACHROIDITIS and presents
as MENINGITIS
• Causes obstruction of 4th Ventricle and resultant
raised ICP and Hydrocephalus
• Can cause occlusion of vessels and vasculitis
resulting in STROKE
• Causes intense inflammatory reaction and seizures
• MOST AGGRESSIVE NEUROCYSTICERCOSIS
DIAGNOSIS

• Species infect human in its LARVAL STAGES

• Biopsy specimens the LARVAL and ADULT Stages
may have BASOPHILIC Staining Laminated Bodies
“Calcareous corpuscles” seen in Cysticercosis.
• “CALCAREOUS CORPUSCLES” → may function is to
protect the parasite against calcification formation.
• Caused by
unintentional • Identifying the characteristics of the proglottids
ingestion of eggs via • Characteristics of Eggs
CONTAMINATED • Neck Area (Scolex)
FECES, FOOD, or
• Specimen
WATER and hatches
o Usually Gravid Proglottid in Single or Chains
within the GI Tract
• Seizure in Endemic Area
• Embryo penetrate the
o Neurocysticercosis
intestinal mucosa and
• CSF
disseminate in the
o Elevated protein, reduced glucose, mononuclear
bloodstream into the
infiltrates seen
distant sites
• CAT Scans and MRI → DIAGNOSTIC
• NOTE: THEY DO NOT
• SUBCUTANEOUS NODULES → also presumptive
GROW OR MIGRATE
clinical finding
FURTHER
A. Skeletal Muscles RADIOGRAPHIC • To see the presence of calcified
SCANS cysts
B. Heart
INFECTED SITES • Serologic Test
C. Brain
D. Eye • More SENSITIVE and SPECIFIC
• Common sign and symptom Glycoprotein • Screening only but not
Seizures Immunoblot recommended for distinguishing
especially in endemic areas
• The patients can infect active and inactive infection for
Autoinfection themselves due to poor hygienic response to treatment
practice TAENIASIS
Common Name Pork Tape Worm • You can get exposed or get infected through:
Definitive and HUMAN (Intestinal and Tissue 1. AUTOINFECTION – improper hygiene with a
Intermediate Infections occur) patient with TAENIASIS (acquired through
Host unintentional ingestion of feces with egg)
Upper Small Intestines → derives its 2. EXTERNAL AUTOINFECTION – contaminated water
Habitat nourishment from intestinal or food with egg to a susceptible host
contents • Mature Cysticercus – oval and capsulated
Life Span 25 Years
Shorter and less number of
Adult Form Proglottids (2-4 m)
Length – 800-1000 Proglottids
A. Smaller Acetabula (1 mm)
B. 4 Prominent Spherical Acetabula
Scolex C. It has cushion-like Rostellum
with DOUBLE CROWN (25-30 large
hooks)
The human host is the only definitive
Taeniasis
host of all types of Taenia sp. TAENIA SPP.
EGGS

• Measly Pork → if ingested, it can develop into Adult

Tapeworm within a span of 2 months • Figure A. Scolex of T.
CHARACTERISTICS solium. Note the four
large suckers and
rostellum containing two
rows of hooks.
• Figure B. Scolex of T.
saginata. Note the four
large suckers and lack of
rostellum and rostellar
hooks.
• Figure C. Scolex of T.
solium. Note the four
large suckers and
rostellum containing two
rows of hooks.

• ABSENT Vaginal Sphincter

• PRESENT Accessory Ovary • Cross-section of a
• Follicular Testes → Smaller Follicles and numerous proglottid of Taenia sp.,
• Gravid Proglottid → Has 7–15 Branches and contain stained with H&E. Note
30,000 to 50,000 OVA the thick outer tegument
• Mature & Gravid Proglottid → Undergo APOLYSIS and the loose
• PASSING OUT Active and Passive Proglottids → May parenchyma filling the
cause severe anxiety body.
• Taenia saginata –1,000-2,000 Proglottids • Calcareous corpuscles
o Can pass out 100,000 eggs (red arrows),
• Taenia solium –1,000 Proglottids characteristic of the
o Can pass out 50,000 eggs cestodes, can be seen in
MORPHOLOGY the parenchyma.
EGGS • Cross-section of a
• Eggs → very RESISTANT – can proglottid of Taenia sp.,
survive in months in the stained with H&E. Note
environment – and when the thick outer tegument
ingested can become and the loose
CYSTICERCI like in pigs and parenchyma filling the
thereby travel in ALL TISSUES body.
• SHAPE: oval and peripherally • Calcareous corpuscles
radially-striated (red arrows),
• MEASURES: 30-35 um in characteristic of the
diameter cestodes, can be seen in
• NB: the egg is the parenchyma. Eggs
indistinguishable to other (blue arrows) can also be
Taenia sp. seen
• Higher magnification of • In the animal’s intestine, the oncospheres hatch ,
the image in Figure B, invade the intestinal wall, and migrate to the striated
showing a close-up of the muscles, where they develop into cysticerci.
eggs. • A cysticercus can survive for several years in the
• Note the characteristic animal.
striations, typical for the • Humans become infected by ingesting raw or
taeniids. undercooked infected meat
• Not visible in these • In the human intestine, the cysticercus develops over
images are the hooks 2 months into an adult tapeworm, which can survive
commonly seen in for years.
cestode eggs. • The adult tapeworms attach to the small intestine by
• Hooks do not stain with their scolex and reside in the small intestine
H&E but are refractile and • Length of adult worms is usually 5 m or less for T.
are visible with fine saginata (however it may reach up to 25 m) and 2 to 7
focusing of the m for T. solium.
microscope • The adults produce proglottids which mature, become
• Close-up of a cross- gravid, detach from the tapeworm, and migrate to the
section of a Taenia sp. anus or are passed in the stool (approximately 6 per
proglottid stained with day).
H&E, showing numerous • T. saginata adults usually have 1,000 to 2,000
calcareous corpuscles proglottids, while T. solium adults have an average of
(yellow arrows). 1,000 proglottids.
• The eggs contained in the gravid proglottids are
released after the proglottids are passed with the
feces.
• T. saginata may produce up to 100,000 and T.
• Close-up of a cross- solium may produce 50,000 eggs per proglottid
section of a Taenia sp. respectively.
proglottid stained with MINOR CESTODES
H&E, showing numerous A. ECHINOCOCCUS GRANULOSUS
calcareous corpuscles.

Echinococcosis, Hydatid Disease,

Disease
Hydatid Cyst
LIFE CYCLE: TAENIA SP. • SMALLEST tapeworm of medical importance
• SCOLEX
o Bears a prominent Rostellum with a DOUBLE
CROWN of HOOKS
• 3 Proglottids
Intermediate Herbivores (Sheep, Cattle)
Host
Habitat Small Intestine of Dogs, Wolves, etc.
Life Span 5 months
LIFE CYCLE: E. GRANULOSUS

• Taeniasis is the infection of humans with the adult

tapeworm of Taenia saginata, T. solium or T. asiatica.
• Humans are the only definitive hosts for these three
species.
• Eggs or gravid proglottids are passed with feces ;
the eggs can survive for days to months in the
environment.
• Cattle (T. saginata) and pigs (T. solium and T. asiatica)
become infected by ingesting vegetation • The adult Echinococcus granulosus (sensu lato) (2—7
contaminated with eggs or gravid proglottids 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 release six-hooked
oncospheres that penetrate the intestinal wall and
migrate through the circulatory system into various
organs, especially the liver and lungs. In these organs,
the oncosphere develops into a thick-walled hydatid
cyst that enlarges gradually, producing
protoscolices and daughter cysts that fill the cyst
interior.
• 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
hydatid cysts develop in a variety of organs
• If cysts rupture, the liberated protoscolices may
create secondary cysts in other sites within the body
(Secondary Echinococcosis).
• When ingested by carnivores, they
develop into adult tapeworms B. HYMENOLEPIS NANA
Protoscolices • If the cyst ruptures within the host, Dwarf Tapeworm (20x0.7 mm; 200
Common Name
the prostoscolices develop into Proglottids)
daughter cysts Natural Humans, Mice, and Rats
• Depends upon the location of the Definitive Host
cyst Habitat Ileum
• Liver (66%), lung, kidneys, brain With short retractile Rostellum with
Scolex
• Enlarging unilocular cyst evokes an a singly ring of small hooks
Pathology inflammatory reaction of the Mature Single Genital Pore on the left
surrounding tissues and produces a Proglottid
fibrous capsule → pressure → Oval or Globular
impairment of the organ Encloses a hexacanth embryo
• Cyst ruptures → Secondary Cysts Egg Inner membrane has 2 POLAR
• Clinical diagnosis → slowly growing THICKENINGS with filaments
cystic hepatic tumor and association Susceptible to heat and dessication
with dogs
• Ultrasound
Diagnosis • Laboratory Diagnosis → finding the
protoscolices, brood capsules or
daughter cysts in the cyst after
surgical removal
• Serologic Tests (ELISA, IHA)
Differential • Malignancies, Amebic Abscesses,
Diagnosis Congenital Cysts
• Surgery – removal of cyst fluid
Treatment • Epinephrine or Antihistamine
• Chemotherapy with Albendazole
MORPHOLOGY No material damage to the intestinal
mucosa but Enteritis may be produced
by heavy infections
Pathogenicity
In heavy infections, children may show
lack of appetite, abdominal pain,
anorexia, vomiting
Diagnosis Finding EGGS in the feces
Praziquantel 25 mg/kg single dose
Treatment
Niclosamide 5-7 days
MORPHOLOGY
EGG
• Egg of H. nana in an
unstained formalin
ethyl acetate (FEA)
wet mount.
• In this image, four of
the hooks in the
oncosphere are
clearly visible.
• Egg of H. nana in an • Eggs of Hymenolepis nana are immediately infective
unstained wet when passed with the stool and cannot survive more
mount. than 10 days in the external environment
• Note the presence of • When eggs are ingested by an arthropod intermediate
hooks in the host (various species of beetles and fleas may
oncosphere and serve as intermediate hosts), they develop into
polar filaments cysticercoids, which can infect humans or rodents
within the space upon ingestion and develop into adults in the small
between the intestine.
oncosphere and • A morphologically identical variant, H.
outer shell. nana var. fraterna, infects rodents and uses
• =Cross-sections of arthropods as intermediate hosts. When eggs are
mature proglottids
ingested (in contaminated food or water or from
of H. nana stained
hands contaminated with feces), the oncospheres
with hematoxylin
contained in the eggs are released.
and eosin (H&E),
• The oncospheres (hexacanth larvae) penetrate the
taken at 100x.
intestinal villus and develop into cysticercoid
• Note the craspedote
larvae
(overlapping)
• Upon rupture of the villus, the cysticercoids return to
proglottids.
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 proglottids
• Eggs are passed in the stool when released from
proglottids through its genital atrium or when
proglottids disintegrate in the small intestine
• An alternate mode of infection consists of internal
autoinfection, where the eggs release their hexacanth
embryo, which penetrates the villus continuing the
infective cycle without passage through the external
environment
• The life span of adult worms is 4 to 6 weeks, but
• 3 adult specimens of internal autoinfection allows the infection to persist
H. nana for years.
C. HYMENOLEPIS DIMINUTA
10-60 cm x 3-5 mm (800-1000
Measures
Proglottids)
Has a rudimentary apical unarmed
Scolex
Rostellum
Gravid Contains a saccular uterus filled with egg
Proglottid masses
Egg Has no POLAR FILAMENTS
Infective Cysticercoid
Stage
Intermediate Larval Fleas and Adult Beetles
Host
Definitive Rats and Mice
Host
Accidental Humans
Host
Life Span 5-7 Weeks
Diagnosis Finding eggs in the stool

LIFE CYCLE: HYMENOLEPIS NANA

 LIFE CYCLE: HYMENOLEPIS DIMINUTA • Higher magnification
(400x) of one of the
eggs

D. DIPHYLIDIUM CANINUM
Disease Dipylidiasis, Dog Tapeworm Infection
Measures 15-70 cm in length (60-175 proglottids)
Intermediate Larval Fleas of the dog, cat, and human
Hosts being and the dog louse
Definitive Dogs, Cats, and Wild Carnivora
Hosts Humans, occasionally
Packed with membranous egg capsules
containing 15-25 eggs
Gravid Separate from the Strobila singly or in
• Eggs of Hymenolepis diminuta are passed out in the Proglottid groups of 2 or 3
feces of the infected definitive host (rodents, man) Creep out of the Anus or are passed in
the feces
• The mature eggs are ingested by an intermediate host
Contains an oncosphere with six
(various arthropod adults or larvae) , and hooklets
oncospheres are released from the eggs and Expelled by the contractions of the
penetrate the intestinal wall of the host , which proglottid or by its disintegration
develop into cysticercoid larvae. Egg
When ingested by a flea, the
• Species from the genus Tribolium are common oncosphere escapes, penetrates the
intermediate hosts for H. diminuta. wall of the gut, and develops into an
• The cysticercoid larvae persist through the infective cysticercoid larva
arthropod’s morphogenesis to adulthood. Clinical Usually asymptomatic
• H. diminuta infection is acquired by the mammalian Presentation
host after ingestion of an intermediate host carrying Finding the proglottids or eggs in the
Diagnosis
the cysticercoid larvae feces
• Humans can be accidentally infected through the
ingestion of insects in precooked cereals, or other
food items, and directly from the environment (e.g.,
oral exploration of the environment by children)
• After ingestion, the tissue of the infected arthropod is
digested releasing the cysticercoid larvae in the
stomach and small intestine.
• Eversion of the scoleces occurs shortly after the
cysticercoid larvae are released.
• Using the four suckers on the scolex, the parasite
attaches to the small intestine wall.
• Maturation of the parasites occurs within 20 days and
LIFE CYCLE: DIPYLIDIUM CANINUM
the adult worms can reach an average of 30 cm in
length
• Eggs are released in the small intestine from gravid
proglottids that disintegrate after breaking off
from the adult worms.
• The eggs are expelled to the environment in the
mammalian host’s feces
MORPHOLOGY
• Egg of H. diminuta in a
wet mount stained with
iodine.
• Four of the hooks are
visible at this level of
focus
• Egg of H. diminuta in a
wet mount stained with • Gravid proglottids are passed intact in the feces or
iodine.
emerge from the perianal region of the host
• Four of the hooks are
• In the environment, the proglottids disintegrate and
visible at this level of
release egg packets, which are also occasionally
focus
found free in the feces
• The intermediate host (most often larval stages of the
dog or cat flea Ctenocephalides spp.) ingests egg
• Eggs of H. diminuta in packets, and the oncosphere within is released into
an unstained wet the larval flea’s intestine.
mount of concentrated • The oncosphere penetrates the intestinal wall,
stool. invades the insect’s hemocoel (body cavity), and
• Image taken at 200x develops into a cysticercoid
magnification. • The cysticercoid remains in the flea as it matures
from a larva into an adult
• The vertebrate host becomes infected by ingesting 1. Ingestion of infected Cyclops
the adult flea containing the cysticercoid containing Procercoid in
drinking water
• In the small intestine of the vertebrate host, the
2. By consuming frogs, snakes, or
cysticercoid develops into the adult tapeworm after
Transmission rodents harboring the
about one month.
Plerocercoid
• The adult tapeworms (measuring up to 60 cm in length
3. By the penetration of
and 3 mm in width) reside in the small intestine of the
cutaneous tissue by
host, where they each attach by their scolex Plerocercoids from poultices
• Gravid, double-pored proglottids detach from the • Plerocercoid Larvae may be
strobila (body) and are shed in the feces. found in any part of the body
• Humans also acquire infection by ingesting the Pathogenicity
• Spargana may migrate through
cysticercoid contaminated flea. the tissues
• Children are most frequently infected, possibly due to Diagnosis • Finding the larvae in the lesions
close contact with flea-infested pets
• Surgical removal of the Larval
MORPHOLOGY Treatment
Plerocercoid
LIFE CYCLE: SPIROMETRA SPP.

• Adult members of the genus Spirometra live in the

intestines of dogs and cats
• Eggs are shed in feces and embryonate in the
environment
• Eggs hatch in water and release coracidia , which are
ingested by copepods.
• D. caninum scolex • The coracidia develop into procercoid larvae in the
copepod intermediate host
• Second intermediate hosts, including fish, reptiles
and amphibians, ingest infected copepods and
acquire procercoid larvae.
• The procercoid larvae develop into plerocercoid larvae
in the second intermediate host
• The cycle is completed when a predator (dog or cat)
eats an infected second intermediate host
• Humans cannot serve as definitive hosts
• D. caninum proglottid. for Spirometra spp., but serve as paratenic or second
• The genital pores are intermediate hosts and develop sparganosis.
clearly visible in the • Humans acquire sparganosis by either drinking water
carmine-stained contaminated with infected copepods or consuming
proglottid. the flesh of an under-cooked second intermediate or
paratenic host.
• Spargana can live up to 20 years in the human host.

• Adult tapeworm of D.
caninum.
• The scolex of the worm is
very narrow and the
proglottids, as they
mature, get larger.
E. SPIROMETRA SPP
• Causes SPARGANOSIS
• Resembles D. latum but smaller
• Found in East and Southeast Asia, Japan, Indochina
Primary Cyclops
Intermediate Host
Secondary Small Rodents, Snakes, and Frogs
Intermediate Host
Definitive Hosts Dogs, Cats, and Wild Carnivora