HYMENOLEPIS NANA

GROUP 5
Shaddrack Ogubi- P292/1374/2022

Teresa Mundia-P29s/11900/2022

Susan Gachukia-P292/1367/2022

Ayaga Stephen-P29s/11865/2022

Farhan Muhammed- P29S/11944/2022

INTRODUCTION

-Also known as dwarf tapeworm.

-It was also once known as Vampirolepis nana and Taenia nana.
-It is the only cestode that completes its life cycle in one host,humans(it doesn't need an
intermediate host to develop into its infective stage)

HISTORY
-It was first discovered by Bilharz in 1857.
-Its called so since Hymenolepis refers to the thin membrane covering the egg and nana
meaning it's of small size.

SCIENTIFIC CLASSIFICATION

Domain - Eukaryota
Kingdom -Animalia
Phylum -Platyhelminthes
Class- Cestoda
Order -Cyclophyllidea
Family -Hymenolepididae
Genus-Hymenolepis
Species-H.nana

EPIDEMIOLOGY
-It is cosmopolitan in distribution but found in warm areas than cold areas.
-It's found in temperate than tropical countries.
It's highly prevalent in South Africa, South Europe, Central America and Middle East Asia.
-Infection is most common in school children,persons living in institutional settings, crowded
environments and in people who live in areas where sanitation and personal hygiene is
inadequate.

MODE OF TRANSMISSION
-Ingesting dwarf tapeworm eggs
-Ingesting fecally contaminated foods or water
-Touching mouth with contaminated fingers
-Ingesting contaminated soil
-Ingesting an infected arthropod.

MORPHOLOGY
EGGS
-Colourless, oval,30-50mm in size
-It has two membranes; outer membrane that's thin and colourless, inner membrane that
encloses oncosphere.
- On the inner membrane are two poles from which 4-8 polar filaments spread out between the
two membranes, the space also has yolk granules.
-The oncosphere has three pairs of hooks.
-They are non- bile stained and float in saturated solution of salt.
-They are immediately infective when shed in faeces and can only survive for not more than 10
days in external environment.

ADULT WORM
-It is 5-45mm in length and less than 1mm thick.
-It has three parts;Scolex( head), long slender neck,Strobilla(trunk).
-The scolex has 4 suckers and a retractable rostellum with a single row of 20-30 hooks.
-The rostellum always remain invaginated at the apex.
-The neck is long and slender.
-The strobili consists of nearly 200 proglottids, they are much broader than long and they are
craspedote ie overlap
-The proglottids near neck are small, short, narrow and immature while those far are mature and
gravid.-Genital spore are marginal and unilateral.
-Uterus is a transverse sac with lobulated walls and there are 3 testes.
-New proglottids are continuously differentiated near the anterior end in a process called
strobilation.
-Each segment moves toward the posterior end as a new one takes it place and during the
process becomes sexually mature.
-Segment reaches end(distal end -gravid proglottids- which contains embryonated eggs.
- The segment at the end disintegrates releasing eggs in a process called apolysis.

LIFE CYCLE:-

Two Life Cycles;

1). DIRECT LIFE CYCLE
• Host: Man
• Infective form: Eggs
• Mode of transmission: -Feaco-Oral Route. -Autoinfection

2). INDIRECT LIFE CYCLE

HOSTS
–Definitive host : Rat and mice
-Intermediate host: Rat fleas- Xenopsylla cheopis - Pulex irritans.

Mode of transmission: Men acquire the infection rarely by accidental ingestion of insects
containing cysticercoid larvae.

Eggs of Hymenolepis nana are immediately infective when passed with the stool and cannot
survive more than 10 days in the external environment.
When eggs are ingested by an arthropod intermediate host (various species of beetles and
fleas may serve as intermediate hosts), they develop into cysticercoids, which can infect
humans or rodents upon ingestion and develop into adults in the small intestine.
After ingestion of eggs (in contaminated food or water or from hands contaminated with feces),
the oncospheres contained in the eggs are released.

The oncospheres (hexacanth larvae) penetrate the intestinal villus and develop into cysticercoid
larvae .
Upon rupture of the villus, the cysticercoids return to the intestinal lumen, evaginate their
scoleces.
They can then 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 internal autoinfection allows the infection to
persist for years.
PATHOGENESIS

Infection occurs by ingestion of food and water contaminated with eggs released along with the
feces of an infected man or rodent.
Internal autoinfection may also occur when the eggs released in the intestine hatch there itself.
External autoinfection occurs when a person ingests their own eggs by fecal-oral route.
Light infections are asymptomatic.

In heavy infections [where there are many worms present] the symptoms are; anorexia, nausea,
abdominal pain, diarrhea, weight loss and irritability.

Infection can be deadly in children or immunocompromised people.

The larva burrows into the walls of the intestine and absorbs all the nutrition.
Dehydration can result from prolonged diarrhea.
Other symptoms are; convulsions and sometimes anal and nasal pruritus [itchiness and
swelling] that occurs due to the allergic response to the released toxic metabolites.
Main pathological changes are due to mechanical irritation of the intestinal mucosa due to the
presence of adult and cysticercoid larvae.

SYMPTOMS

The symptoms of infection with H. nana vary depending on the severity of the infection.
In mild cases, there may be no symptoms at all.
In more severe cases, there may be abdominal pain, diarrhea, nausea, and vomiting.
In some cases, the infection may cause cysticerci, which are small, round cysts in the organs or
tissues of the body.
These cysts can cause tissue damage and may need to be surgically removed.

The most serious complication of H. nana infection is cysticercosis, which is a condition in which
cysts form in the organs or tissues of the body.
This can lead to tissue damage and may require surgery to remove the cysts.In rare cases, H.
nana infection can also lead to anaphylactic shock, which is a potentially life-threatening allergic
reaction.
It is important to seek medical treatment if any of these symptoms occur.

LABORATORY DIAGNOSIS
SPECIMEN

Stool sample
Rectal swab
serum

MICROSCOPY

The eggs can readily be concentrated by the salt flotation and formalin ether sedimentation
technique
Microscopic examination reveals eggs with polar filaments between the shell membranes that
emanate from little knobs at either end of the embryophore (distinguishing feature from
H.diminuta)
The outer membrane is thin and colorless while the inner embryophore encloses an oncosphere
with three pairs of lancet shaped hooklets
It is the only cestode egg that is not stained by bile when passed through intestinesa.

HEMATOLOGY
• Eosinophila of more than 5% is seen in 1/3rd of the infected children

• ENDOSCOPY
Adult worm can be identified during endoscopic examination in the intestines

ELISA TEST
Used to detect antibodies directed against H.nana in serum It has 80% sensitivity.

(https://www.sciencedirect.com/topics/medicine-and-dentistry/hymenolepis-nana)

TREATMENT.
Treatment for H. nana infection typically involves the use of anti-parasitic medications, such as

• Praziquantel (drug of choice)-

as a single dose is currently the treatment of choice.-

It causes paralysis and death of the tapeworm.-
Use 25 mg/kg for one dose only. Expect a full recovery following treatment.

Niclosamide -

causes death to the tapeworm by interfering with oxidative phosphorylation.- use40 mg/kg
for one dose only in children

These medications can be taken orally or injected, depending on the severity of the infection.
In cases where cysticerci are present, surgery may be necessary to remove them.
In some cases, the cysts may be treated with anti-parasitic medications as well.

PREVENTION AND CONTROL.

The best way to prevent infection with H. nana is to practice good hygiene and food safety. This
includes washing hands thoroughly after handling rodents, avoiding contaminated food and
water, cooking food thoroughly, keep grains cereals, and flour stored properly in household
kitchens.It is also important to practice good rodent control, such as trapping and removing
rodents from homes and other areas where they may be found. This can help reduce the risk of
infection.

CASE REPORT:

Three children, aged 9, 12, and 13 years, living in a marginal urban area of Guayaquil, Guayas
province, Ecuador, presented symptoms of diarrhea, low body weight, abdominal discomfort,
anorexia, paleness, and anal itching. Subsequently, their fecal samples were analyzed by direct
coproparasitic methods, flotation and sedimentation with centrifugation using saline solution; the
presence of H. nana eggs was determined. Blood biometry was performed. Further, 10 rodents
were captured and necropsied to obtain intestinal contents. The powdered milk consumed by
the children was analyzed, the same powder that contained rodent feces. Subsequently, these
were studied with the above-mentioned coproparasitic methods. H. nana eggs were identified in
the 6 trapped rodents, the powdered milk, and the feces of rodents found in the milk powder.

CONCLUSIONS:

Hymenolepiasis can affect populations of endemic areas. In this case, the disease was
identified in 3 children, who were diagnosed with eosinophilia and anemia. Additionally, the
presence of H. nana eggs in captured rodents and in powdered milk was determined, indicating
that the community was exposed to this zoonotic disease.

(Hymenolepiasis: DPDx – Laboratory Identification of Parasites of Public Health Concern.,

2022)