Life cycle in human trematodes

Intestinal Cestodes

Dr Mohiedden M Abdul-Fattah

1-Adult in intestine of man

Pseudophyllidea: Diphyllobothrium latum

1-Adult in intestine of Man

4-

larva in fish

2nd

2-Egg in water

3- 1st Larva in cyclops 1-Adult in intestine of Man

Cyclophyllidea: H. Nana Direct LC

Cyclophyllidea: 1.Taenia saginata 2.T. solium 3.Hymenolepis nana. 4.H. diminuta 5.Dipylidium caninum

2-Egg in soil

3-Larva in tissue of IH 2-Egg in soil

3- Larvae in tissue of intestinal villi of Man

Intestinal cestodes

Man is usually infected by intestinal cestodes when ingests the larvae except H.nana, infection occurs by eggs. All Cyclophyllidea must need one intermediate host in their life cycle except H. nana The IH in Taenia is vertebrate host (cattle or pigs). In Hymenolepis and Dipylidium it is invertebrate insect (fleas, beetles or cockroach) Pseudophyllidea (D. latum) needs two intermediate hosts in their life cycles: (Cyclops as 1st IH and Salmon fish as 2nd IH.

OUTLINE OF LLIFE CYCLE IN INTESTINAL CESTODES

1.

Biology: Final host: human. Habitat: small intestine. Exit stage: mature egg or
gravid segments.

Taenia saginata

Diagnostic morphology of adult:

segmented 4-7 meter long with globular scolex without rostellum or hooks. 4 circular suckers. Each mature segment has central tube shaped uterus.

1.
2.

3.
4.

Taenia Life Cycle

4. Lab Diagnosis: Detection of either of the following in stool:

the non hooked scolex of the adult after treatment, The gravid segment (15 20 branches on each side) . The egg: 30-40 m, spherical, with outer thick and inner thin shell and embryo.

2. Epidemiology Distribution: cosmopolitan. Intermediate host: cattle. Infective stage: Cysticercus bovis larva in meat. Mode of infection: ingestion of under cooked meat containing the infective stage. Reservoir host: None. 3. Host parasite relationship: Light infections remain asymptomatic, but Heavier infections may produce abdominal discomfort, epigastric pain, vomiting and diarrhea.

5. Treatment: Praziquantel is the drug of choice,(1020mg/kg PO for single dose), or Niclosamide (1-2 g children and 4 g for adults; for single dose). Expulsion of scolex must be assured to assume a satisfactory treatment. 6. Control:

Thorough inspections of beef and pork, Adequate cooking or freezing of meat. cysticerci do not survive temperatures below -10o C and above 50o C.

1. 2. 3. 4.

Biology: Man is the only final host but can act as blind end intermediate host also. Habitat: small intestine Exit stage from the final host: scolex, gravid segments and/or mature egg. Diagnostic morphology segmented 3-5 meter long with quadrate scolex with 4 circular suckers. It has rostellum with double rows of hooks. Each mature segment has central tube shaped uterus

Taenia solium

Taenia solium Life Cycle

2. Epidemiology
Distribution: where pork is eaten. Transmission Intermediate hosts: pigs (mainly) and man (if swallowed the eggs). No reservoir hosts. Infective stages: Intestinal adult: - C. cellulosae larva larval infection (cysticercosis): T. solium eggs. Mode of infection: 1. Adult taeniasis solium: ingestion of infected pork. 2. Larva taeniasis solium (cysticercosis): If man ingests T. solium egg, cysticercus cellulosae develops in human tissues.

3. Host parasite relationship:

Disease due to adult: mild enteritis with indigestion.

Disease due to larva: cysticercosis .

4. Lab diagnosis:

Adult: - Detection of the following in stool samples: Gravid segment with 12 lateral branches.

scolex with rostellum having double rows of hooks

Eggs similar to that of T. saginata.

Cysticercosis: Imaging (sonar, CT) and serology

5. Treatment:
Intestinal: A. Praziquantel is the drug of choice,(10-20mg/kg PO for single dose), or B. Niclosamide (1-2g for children and 4 g for adults; (single dose).

Neurocysticercosis: A. albendazole (15mg/kg/day PO for 30 days) B. Corticosteroids are used to control the inflammation due to death of the larva. Symptomatic cysticercosis outside CNS: Surgery is the management of choice. 6. Control: like Taenia saginata.

Intestinal Cestodes (Tapeworms): Cyclophyllidea

worm
Man Reservoir Habitat Exit stage

Taenia saginata

Tenia solium
Final host None Small intestine

Egg: mature, round, striated shell, yellow brown, 30-40 m, Gravid Segments with branched uterus singly in saginata, in chains (solium) Cattle Cysticercus bovis in beef Ingestion of C. bovis in beef 1. Enteritis 2. obstruction Pigs Cysticercus cellulosae in pork Ingestion of C. cellulosae in pork 1.Enteritis 2. obstruction Cysticercosis: induced by antipaeristalsis or by external autoinfection

Intermediate H. Infective stage Mode of infection Disease

diagnosis

1. Detection of eggs or segments passed iin stool

Treatment
Control
16

Oral Praziquantel or by Albendazole

1. Thorough freezing or cooking of pork and beef. 2. Sanitary disposal of human sewage
2/28/2013

Hymenolepis nana
1. Biology:

Final hosts: Humans and rodents. Habitat: small intestines. Exit stage (diagnostic): mature egg. Life cycle and Diagnostic morphology: segmented, 0.5 1 cm long with retractile armed scolex.

H.nana Life Cycle

2. Epidemiology:

Distribution: cosmopolitan. Children more than adults. Intermediate hosts: Fleas act as intermediate host when its larva ingests the egg and cysticercoids develops within its body cavity. Reservoir hosts: rodents. Infective stage: egg.

Mode of infection: 1-Ingestion of foods and drinks contaminated with egg. 2- Autoinfection.
Disease: mild enteritis and allergy to the worm excretion. Heavy infection may cause diarrhea

3. Host parasite relationship:

4. Diagnosis: By detection of eggs in stool sample. Characteristics of egg: - 30-40 m, round, colorless, with hexacanth embryo and polar filaments. 5. Treatment: 6. Praziquantel is the drug of choice,(25mg/kg PO for single dose), or 7. Niclosamide (1g - 2g for children and 4 g for adults; for 7 days). There is relative resistance of cysticercoids to drug therapy. 6. Control: Health education and personal hygiene.

Hymenolepis diminuta
1. Biology: Final Hosts: mainly rats; occasionally man. Habitat: small intestine Exit stage (diagnostic): the egg; Diagnostic morphology: segmented, 90 cm long with unarmed scolex. Life cycle

2. Epidemiology:
Distribution:
Common parasite of rats allover the world. Human is occasionally infected. Resevoir hosts: rats Intermediate hosts: grain beetles and cockroaches. Infective stage: The cystic larva (cysticercoid). Mode of infection: Ingestion of cereals, dried fruits

contaminated with insects containing the cysticercoid.

3. Host- parasite relationship: Disease: affects mainly children and may suffer abdominal pain, diarrhea, insomnia and convulsions.

4. Lab. Diagnosis: Detection of the characteristic eggs in stool samples. Egg characteristics: 60- 80 m, round, yellow brown, with hexacanth embryo and polar knobs. 5. Treatment: Niclosamide (2g first day+ 1g daily for 6 days). 6. Control: health education and personal hygiene.

Dipylidium caninum
1. Biology:

Final Hosts: mainly dogs and cats; occasionally man. Habitat: small intestine. Exit stage: eggs in feces within egg capsules Life cycle and Diagnostic morphology: scolex with retractile rostellum armed with 4-6 rows of hooks, with cucumber like segments and length of 30 cm.

Life Cycle of D. caninum

2. Epidemiology:

1.

2.

Distribution: Common parasite of dogs, cats. Accidental in humans specially children.. Intermediate hosts: fleas (pulex) and dog louse. Their larvae ingest the eggs passed in the faeces. The eggs release onchospheres that develop into cysticercoids in the haemocele of the adults. Reservoir host: dog Infective stage: The cystic larva (cysticercoid). Mode of infection: Ingestion of cereals, contaminated with insects containing the cysticercoid. Accidental swallowing of the infected fleas.

3. Host - parasite relationship: The worms affect mainly children that may suffer abdominal pain. 4. Lab. Diagnosis: - Detection of egg capsules; each containing 8 25 eggs. Or the segments in stool samples. 5. Treatment: Niclosamide (2g first day+ 1g daily for 6 days. 6. Control: health education and personal hygiene.

Intestinal Cestodes (Tapeworms): Cyclophyllidea

worm
Man Reservoir Habitat Exit stage

Hymenolepis nana
Final host None

H. diminuta
Occasional final host rodents Small intestine

Dipylidium
Occasional final host dogs

Mature, Spheroid egg, thin Mature ovoid 70-80m egg capsules with shelled, 30-45 m with with polar knobs cluster of eggs each polar filaments 20-30 m Beetles or fleas Cysticercoid in insects Imgestion of cysticercoid in fleas Enteritis Detection of egg in stool Flea control Rat control Fleas, dog lice Cysticercoid Ingestion of cysticercoid in flea enteritis Detection of eggs or segments in stool Avoid playing with & treta pet animals
2/28/2013

Intermediate host None or fleas Infective stage Egg or cysticercoid in fleas

Mode of infection Ingestion of egg in food or cysticercoid in insect Disease diagnosis Treatment Control
28

1. Enteritis 2.Insomnia Detection of egg in stool

Oral niclosamide or Praziquantel Health education. Personal hygiene

Diphyllobothrium latum
A.

Biology: Final host: Fish eating animal including human. Habitat: Attach to mucosa of ileum or sometimes jejunum. Exit stage: Immature egg or chains of mature segments. Diagnostic morphology of adult: segmented 3-10 meter long with scolex that has no hooks, but with 2 elongated sucking grooves. Each mature segment has central rosette shaped uterus.

Life cycle of D. Latum

B.

C.

1.

Epidemiology: Intermediate hosts: cyclops (1st I.H.) and fresh water fish; salmon (2nd I.H ). Reservoir host: fish eating animals Infective Stage: pleurocercoid larva in muscle fish. Mode of infection: ingestion of undercooked fish containing plerocercoid Host parasite relationship: Macrocytic anemia and neurological problems of vitamin B12 deficiency are seen in heavily infected individuals.

D.

Lab diagnosis: Detection of eggs in faeces (many).Yellowish brown ovoid 70x40 m with anterior operculum and posterior knob long chains of segments with rosette shaped uterus.

E.
1. 2.

Treatment: Praziquantel is the drug of choice, (1020mg/kg PO for single dose), or Niclosamide (1g -2g for children and 4 g for adults; single dose).

Control: 1. Freezing for 24 hours. 2. Thorough cooking or pickling of fish kills the larvae. 3. Fish reservoirs should be kept free of raw sewage.
F.

Intestinal Cestodes (Tapeworms): Pseudophyllidea

worm
Man Reservoir Habitat

Dipyllobothrium latum
Final host Fish eating animals: cats, dog, birds Small intestine

Exit stage

Egg: Immature, operculate, abopercular knob, yellowish brown, 75 X50 m. Segments with rosette shaped uterus passed in chains.
1st : cyclops in fresh water 2nd : Salmon fish Plerocercoid in fish Ingestion of plerocercoid in salmon fish 1. Enteritis & abdominal colic 2. megaloblastic anemia due to vitmin B12 consumption

Intermediate host Infective stage Mode of infection Disease

diagnosis
Treatment Control 33

1. Detection of eggs or segments passed in chains in stool

Oral Praziquantel 1. Thorough freezing or cooking of fish
2/28/2013

Summary
Man

is usually infected by intestinal cestodes when ingests the larvae except H.nana, infection occurs by eggs. Psuedophyllidea (D. latum) needs two intermediate hosts in their life cycles (Cyclops as 1st IH and Salmon fish as 2nd IH. All Cyclophyllidea must need one intermediate host in their life cycle except H. nana. 1.The IH in Taenia is vertebrate host (cattle or pigs). 2.In Hymenolepis and Dipyllidium it is invertebrate insects (fleas, beetle, cockroach)

OUTLINE OF LLIFE CYCLE IN INTESTINAL CESTODES