PARASITOLOGY LECTURE 7 – Taenia + Echinococcus - Dr.

Ng Notes from Lecture USTMED ’07 Sec C – AsM
TAENIA SOLIUM (pork tapeworm)

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half as many testes as T.saginata Genital pores on consecutive segments

the pork tapeworm producing taeniasis solium or pork tapeworm infection

DISTRIBUTION

Cosmopolitan distribution o Countries:  Mexico  Pakistan  Latin America  India  North China  USA (rare)  Manchuria o Associated with eating raw or insufficient cooked pork

iii. -

DISEASES

• • • •

Taeniasis solium - refers to infection of humans with adult pork tapeworm Human cysticercosis - refers to infection of humans with larval stage of parasites Diseases produced by infection with larval taenia solium is not uncommon in regions where Taenia solium adult infection exist In human cysticercosis: Man becomes the intermediate host.

Gravid proglottid longer than broader consists: o common genital pore with muscular sphincter o gravid uterus with 5 to 13 lateral uterine branches arranged in a Dendritic or finger like fashion

2. • •

Egg Shape – spherical Color – pale buff to walnut brown Measurement – 5 to 10 um in diameter 2 radially-striated shells a. Outer shell – thin and rarely seen b. Inner shell – brown, thick and striated – embryo or oncosphere with six hooklets Eggs escape from the uterus through the ruptured wall at the anterior end after the ripe proglottids become free Larval stage or bladder worm also called Cysticercus cellulosae measurement – 5 to 10 mm in length and 5 mm in diameter Consists – dense milky white spot at one where the invaginated scolex with hooks and suckers are located


MORPHOLOGY 1. • • Adult worm Measurement – 2-3 meters (exceptionally 8 meters in length) Composition o Head

3. • • • Head or scolex

LIFE CYCLE: TAENIA SOLIUM

 

globular in shaped with 4 cupshaped suckers provided with conspicuous, rounded rostellum armed with double rows of large and small hooks numbering 22 to 36 and measuring 140 to 200 um and 100 to 150 um in length.

o

Neck (cervical region)  short measuring 5 to 10 mm in length (only about one-half as thick as scolex) Proglottids  Numbers : 800 to 1,000 proglottids  Composed i. ii. Immature proglottid - broader than long Mature proglottid nearly square containing full set of functioning male and female reproductive organs 150 to 200 follicles distributed throughout the dorsal plane uterus – rises from the anterior face of ootype trilobed ovary – situated in the posterior of the proglottid with the presence of accessory ovarian lobe

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serious, because it may lodge in vital organs like brain, spinal cord, heart, liver and the eyes Symptoms: a. cellular reactions b. blood cell infiltration c. fibrosis d. necrosis cysticercosis in the brain may cause: a. epilepsy b. behavioral changes c. intermittent obstructive hydrocephalus d. disequilibrium e. meningoencephalitis f. failing vision

Cysticercosis Cysticercus cyst in Human muscle

Cross section of Single cysticercus of T. solium of Brain (left cerebral cortex)

Life Cycle of Human Cysticercosis

Section of eye with a single Cysticercus of Taenia solium DIAGNOSIS

1.
Human Being Harbor Cysticercus Cellulosae:

1. 2.

3.

Hetero Infection – eggs liberated from disintegrating gravid proglottides passed by one individual get into the mouth of another and are swallowed External autoinfection – eggs maybe transferred from anus to mouth or unclean fingertips of an individual who has an intestinal infection with Taeniasis solium Internal autoinfections – gravid proglottids in an individual harboring the adult Taenia solium may become detached from the main strobila or regurgitated into the stomach and then return to duodenal canal where they disintegrate and liberate ripened eggs

Demonstration of eggs in stool a. Direct fecal smear b. Scotch tape swab • Taenia spp. Differentiation is not possible through eggs examination

2. 3.

Demonstration of gravid proglottids in the stool Recovery of scolex after antihelminthic therapy

SPECIES DIFFERENTIATION

T. solium and T. saginata can be made possible thru: 1. • • 2. scolex: T. solium – has rostellum armed with spines or hooklets T. saginata – no well defined rostellum nor spine Segment differentiation a. Segments: o T. solium – 800-1000 segments o T. saginata – 1000-2000 segments b. Lateral branches: o T. solium have less than 13 lateral uterine branches o T. saginata have more than 15 lateral uterine

PATHOLOGY AND CLINICAL MANIFESTATIONS

1.

2.

Pathology brought about by adult taenia solium in lumen of the small intestines maybe negligible a. Mild transitory intestinal obstruction b. Vague abdominal pain similar to hunger pain which is due to heavy cysticercosis resulting to regurgitation of gravid segments in to the stomach of patients suffering from taeniasis solium pathology brought about by larval stage (cysticercus cellulosae)

branches
EPIDEMIOLOGY

1.

T. solium infection prevalence of infection is directly related to eating habit of people (raw or insufficient cooked pork) Man is the only known definitive host and the pig appears to be the only intermediate host a. Man become the intermediate host b. Can be caused by: o ingestion of eggs from contaminated food or water o contamination from dirty fingers o by internal autoinfection when the eggs are carried by reverse peristalsis back to the duodenum or stomach Treatment a. Praziquantel Dosage: 10 to 20 mg per kg single dose Effect: expel worm in toto b. c. Niclosamide Paramomycin
Disadvantage – causes the proglottids to rupture and releases innumerable eggs into the bowel lumen and increase risk of cysticercosis

Head or Scolex

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TREATMENT, PREVENTION AND CONTROL

Neck Proglottids  Usual numbers between 1,000 to 2,000 proglottids  Extending the small intestine, sometimes reaching the jejunum  Composed: i. ii. Immature proglottids

1.

2.

Prevention and control o Taeniasis solium avoid eating raw or insufficiently cooked pork proper excreta disposal o Human cysticercosis good personal hygiene avoidance of drugs which causes disintegration of gravid segments

Mature proglottids broader than longer contain both male and female reproductive organ genital organs same with T. solium contains twice as many testes as T. solium Bilobed ovary with absence of an accessory ovarian lobe

TAENIA SAGINATA (Adult Beef Tapeworm)

• • •

infection of man with the adult beef tapeworm Mode of transmission: eating raw or insufficiently cooked beef containing the cysticercus] Longest human parasite capable of growing to 7.5 m therefore most individuals harbor only one adult worm

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Gravid or Ripe proglottids narrower and longer uterus containing more than 15 to 20 mm arranged in lateral uterine branches arranged in a tree-like or dichotomose pattern

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cosmopolitan in distribution o Africa o Mexico o Argentina o Middle Europe o USA o Asian-Pacific region  Korea  Indonesia  Philippines  Thailand man serve only as definitive host and never as intermediate host therefore cysticercosis due to Taenia saginata does not occur It thrives in the upper half of the small intestine

2. • • • • • • 3. •

Eggs are indistinguishable between species of T. solium and T. saginata Shape: rount to slightly oval Measurement: 31 to 43 um Have thick, striated shell and contain the six-hooked embryo (oncosphere) Can remain viable in soil for days to weeks Eggs of T. saginata by man do not result in infection Larva (cysticercus bovis) Hexacant (six-hooked) larva hatched from egg, actively penetrates the small intestine and migrates by hematogenous route to all organ system Mostly they lodge in the skeletal muscles, where they encyst in the fascial tissues and develop into cysticercus, the stage infective to man

MORPHOLOGY

1. • • •

Adult worm Color: Whitish opaque in color Measurement: 5 to 10 meters but may extend up to 25 meters or more Composition o Scolex  Similar to T. solium except that the rostellum is not well defined and has no spines or hooklets  Serve as an organ of attachment in the mucosa of small intestines

LIFE CYCLE: TAENIA SAGINATA SPECIES DIFFERENTIATION

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DIAGNOSIS

Each proglottid may contain about 80,000 eggs More segments in T. saginata than T. solium (1000 to 2000 segments in T. saginata) More lateral uterine branches (15 or more) in T. saginata

1.

demonstration or identification of the proglottids passed by patients a. Method: fixing in 10% formaldehyde solution and the uterine branches injected with India ink b. Twelve or more uterine branches are characteristic of gravid proglottid of Taenia saginata Demonstration of Eggs in the Perianal skin o Scotch tape swab  eggs in the stool can be identified only as Taenia species because the eggs of all tapeworms look alike

2.

PATHOGENESIS

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It would appear that it is more dangerous to be infected with Taenia solium than Taenia saginata because there seems to be no cysticercosis in man due to T. Saginata Is mainly due to its large size which is frequently responsible for the disturbances in the normal function of digestive tract Absorbed by-product of the worm may also cause systemic intoxication Does not cause obstruction although the large tapeworm occupies a substantial proportion of the lumen of the small intestine flexibility and relatively fragile There are no host responses against the worm and therefore no tissue reaction Proglottids usually pass from the patient during the period of sleep and are found in the bedding or clothing, the following morning Patient may pass a large segment of the worm either during defecation or spontaneously

TREATMENT, PREVENTION AND CONTROL

A. • •

Treatment Drug of Choice – Niclosamide action: damage to the point of dissolution Prevention and Control 1. protection of cattle from coming in contact with human excreta 2. Thorough cooking of beef

B.

SUMMARY: COMPARATIVE ANALYSIS OF T. SOLIUM AND T. SAGINATA

ECHINOCOCCUS GRANULOSUS

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DISEASE

Parasite of dog Smallest tapeworm (5 mm in length) Only the larval form of infection is found in the human host and causes space occupying lesions known as hydatid cysts Infection is considered serious and might result to fatalities World wide distribution Man becomes an accidental intermediate host

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Hydatid disease Unilocular echinococcosis Echinococcus disease

MORPHOLOGY

1. • • •

Adult Tapeworm smallest tapeworm parasitizing man measurement: 2.5 mm to 9 mm in length consisting: o scolex  has prominent rostellum with a double row of 20 to 40 large and small hooklets and “cup-like” suckers

o o

neck 3 segments i. one immature proglottid ii. one elongated mature proglottid  narrowest

consists • • • • • • • •

genital pore ootype ovary uterus seminal receptacle testes vagina vas deferens

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• vitellaria • vitelline duct one long gravid proglottid (terminal) broades and longest consists of hundreds of infective eggs breaks off and disintegrates in the large bowel releasing hundreds of infective eggs that pass out with the feces

2. • • 3. • •

Eggs has brown radially striated oncosphere or embryosphere cannot be differentiated from Taenia spp. Larval Stage (oncoshpere) Measurement: 20 cm in diameter Consisting of an enveloping membrane with 2 layers a. Outer laminated milky opaque non-nucleated layer b. Inner nucleated germinal layer which will give rise to protoscolex or protoscoleces from this inner membrane arises buds or broad capsule which i. may remain attached to the inner membrane by stalks ii. may be set free into the fluid of the cystic cavity the free broad capsules or free scolices are referred to as “hydatid sand”

LIFE CYCLE: ECHINOCOCCUS GRANULOSUS

PATHOGENESIS AND CLINCIAL MANIFESTATIONS

• A.

The pathology produced by the hydatid cyst in the human body is both mechanical and toxic Mechanical 1. Growing hydatid cyst lodged in the vital organs like liver, lungs, brain, heart interferes with the functions of the organs 2. Infection may become fatal due to growing cyst which can cause obstruction to the organ o A unilocular cyst located in the bone cells is called osseous hydatid cyst Toxic 1. Rupture of the cyst may produce allergic or anaphylactic shock

B.

DIAGNOSIS

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Unilocular cysts are diagnosed only after they grown to a tremendous size Hydatid disease can be diagnosed by: o X-ray o Exploratory cyst puncture o Immunologic tests 1. intradermal test 2. Precipitin test 3. Complement fixation test 4. Hemagglutination test 5. Bentonite latex slide agglutination test 6. Fluorescent antibody test

EPIDEMIOLOGY

Echinococcus infection is very rare in the Philippines 2 cases reported o Hydatid cyst in the kidney o Hydatid cyst in the lung

Prevalence in countries (sheep and cattle raising regions) o Europe o China o Japan o Vietnam o Canada o Alaska o USA

TREATMENT, PREVENTION AND CONTROL

A.

B.

Treatment 1. Surgery o Precaustion – prevent the spilage of the cyst fluid or hydatid sand into the operative cavity lead to the development of secondary cyst 2. Albendazole o Dosage – 400 mg twice daily for 4 weeks Prevention and Control 1. Personal hygiene 2. Prevent dogs from eating carcasses of sheep, cattle and hogs

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