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Tape worms

Fish Tape worm – Diphylobothrium latum
Dog Tape worm – Echinococcus granulosus
Beef Tape worm – Taenia saginata
Pork Tape worm – Taenia solium
Dwarf Tape worm – Hymenolepis nana

Dr. Sudheer Kher

1/3/2015

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Include all tapeworms.
They have suckers and teeth that grasp the host.
Behind a short neck are repeated parts of the
worm, each containing reproductive structures with
eggs and sperm, which can be released with the
host's feces.
The pieces give the worm a ribbon-like structure,
beneficial for absorbing nutrients from the
intestine.

Dr. Sudheer Kher

1/3/2015

http://www.ndpteachers.org/
perit/biology_image_gallery1
.htm
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HOSTS
• INTERMEDIATE: harbors the
immature forms of the parasite.
• DEFINITIVE: Harbors the mature
forms of the parasite

Man is an intermediate host in Dog
tape worm infection.
Man can occasionally be intermediate
host in pork tape worm infection

Tapeworms scolex neck strobila .

The reproductive system .

Pseudophyllidean Cestodes Slit like grooves ( bothria ) Diphyllobothrium latum ( Fish tape worm ) Cyclophyllidean Cestodes Cup like & round suckers ( acetabula ) Taenia saginata ( Beef tape worm ) Adult worm in intestine Taenia solium ( Pork tape worm ) Hymenolepis nana ( Dwarf tape worm ) Echinococcus granulosus ( Dog tape worm ) Larval stage in man Dr. Sudheer Kher 1/3/2015 6 .

(Fish Tape Worm) Definitive host Man 1st Intermediate host Cyclopes 2nd Intermediate host Fish Infective form Pleurocercoid larva Mode of transmission Ingestion Site of localization Small intestine Dr. Sudheer Kher 1/3/2015 7 .

Sudheer Kher .cdc. eel. etc. white fish. perch. Salmon. pike.    1/3/2015 8 Common in fish eating carnivores with little host specificity.gov/DPDx/HTML/Diphyllobothri asis. Adults get quite long (10 m) and shed up to a million eggs per day Eggs must reach water for embryonation After several days a coracidium hatches through the operculum and is eaten by a copepod http://www. trout.htm Dr.dpd.

Sudheer Kher 1/3/2015 9 .Disease Digestive disturbances Vit B 12 deficiency Diagnosis Operculated eggs/ segments in stool Treatment Niclosamide / Praziquantel Dr.

(Dog Tape Worm) Definitive host Dogs / wolves Intermediate host Pigs. Sudheer Kher 1/3/2015 10 . grazing animals Man occasional Infective form Eggs Mode of transmission Ingestion Site of localization Liver. lung / any organ Dr.

Sudheer Kher 1/3/2015 11 . Produces cystic lesions Dr.  Echinococcus granulosus: cystic echinococcosis. Echinococcus multilocularis: alveolar echinococcosis. Invasive solid lesions of firm consistency. full of connective tissue and a jellylike material.

drkoop. caused by echinococcus. right epigastric pain. nausea. http://www. Note the large circular cyst (seen on the left side of the screen) and multiple smaller cysts throughout the liver. vomiting Obstruction of bile ducts and blood vessels can cause cholangitis.com/ency/93/ImagePages/1177.  Liver cysts cause liver swelling. Sudheer Kher . cirrhosis and portal hypertension This upper abdominal CT scan shows multiple cysts in the liver. jaundice.html 1/3/2015 1 2 Dr.

red fox. (E) Infection of humans. Arctic fox) as principal definitive hosts. Sudheer Kher . right. (H) single metacestode cyst with protoscoleces. (D) Egg with oncosphere. Dr. (G) Rodent liver with metacestodes. other canids. (F) Rodent infected with metacestodes. (B) Foxes (left. dogs. (C) Proglottid with eggs.1/3/2015 1 3 • Sylvatic zoonosis in Europe and northern America • Humans get infected by eating contaminated berries and mushrooms collected in forests populated by foxes • Life Cycle: (A) Adult parasite. and cats can be involved in the cycle.

Sudheer Kher . Dr.The Hydatid Cyst      1/3/2015 1 4 The cyst is lined by a multilayer parasite tissue with the innermost layer being the germinal layer This layer is a undifferentiated “stem cell” layer that can spawn the formation of “brood capsules” which are themselves lined by GL The daughter cysts (the encircled body) "bud" into the center of the fluid-filled cyst. This is a very small portion of the cyst which may become quite large. Each of the smaller bodies will develop into diminutive tapeworms should this be eaten by a definitive or final host such as a canine.

Hydatid Cyst (Intermediate Host) Liver / Lung / Any organ Eaten by definitive host Embryos penetrate intestine Larva escapes Embryo released from egg Adult worm in Intestine Eggs eaten by intermediate host Eggs discharged Dr. Sudheer Kher 1/3/2015 15 .

Sudheer Kher 1/3/2015 16 . allergic reaction Cyst can rupture leading to broncho biliary fistula Diagnosis Aspiration is contraindicated X ray / US / CT / MRI Casoni’s intradermal test IHA / ELISA Dr.Disease Hydatid cyst or disease Clinical presentation Nonspecific or asymptomatic 60% right hypochondriac pain 15% jaundice Others like skin rashes. pruritus.

mebendazole Surgical removal of the cyst Dr. albendazole. Sudheer Kher 1/3/2015 17 .Drugs are not curative Act as adjunct to kill spilled scolices Praziquantel.

• The adults produce proglottids passed with stool •The eggs are released after the proglottids are passed with the feces 1/3/2015 Dr. Sudheer Kher 18 .Taenia life cycle • Humans are the only DHs • The eggs can survive for days to months in the environment • The adult worm attaches by their scolex to the human small intestine.

(Beef Tape Worm) Definitive host Man Intermediate host Cattle Lenghth 5 meters Max reported 25 meters Infective form Cysticercus bovis (larva) Mode of transmission Ingestion Site of localization Small intestine Dr. Sudheer Kher 1/3/2015 19 .

TAENIA SAGINATA • Beef tapeworm • Ranges in length from 6-30 ft • Geographic distribution: cosmopolitan. Sudheer Kher Taenia saginata adult worm. Taenia saginata. Scolex (Mit freundlicher Genehmigung Roche AG) 20 . In third-world nations could be up to 10% • No symptoms or some abdominal discomfort • Diagnosis: finding eggs or proglottids in feces 1/3/2015 Dr. Most common where poor sanitation and no inspection of meat combine • Africa and South America • Transmission: Ingestion of larval form in undercooked beef • In N. America 1 in 100 is infected.

a narrow neck. and a large strobila (2-4 m) (B) consisting of several hundred proglottids.TAENIA SOLIUM The armed scolex of T. solium has a scolex (A) with four suckers and a double crown of hooks.000 fertile eggs. CDC • T. proglottids begin to detach from the distal end and are excreted in the feces. 1/3/2015 Dr. • Each segment contains 50-60. Sudheer Kher The Lancet (2003) 361: 547 21 . • About 2 months after ingestion. solium (note hooks on top of scolex).

sub-saharan Africa. saginata. and parts of Oceania. • Infection with the adult forms of the parasite produces similar symptoms to infection with T. Sudheer Kher 22 . Latin America. most of Asia.TAENIA SOLIUM • Endemic in less developed countries where pigs are raised as food source. 1/3/2015 Dr.

Sudheer Kher MRI of multiple cysts.Human cysticercosis When humans plays the role of the Intermediate Host • Larval stages develop in the human host • Humans acquire cysticercosis through faecal-oral contamination with T. . solium • • • • • eggs The oncosphere in the eggs is released by the action of gastric acid and intestinal fluids Cross the gut wall and enter the bloodstream They are carried to the muscles and other tissues They encyst as cysticerci at small terminal vessels (1 cm) (A) and (B) Neurocysticercosis and ophtalmic cysticercosis serious 1/3/2015 Racemose Cysticercosis-MRI Dr. Image courtesy of the Centers for Disease Control and 23 Prevention.

• Occasionally a cyst may grow larger (giant cyst) • Geographical variation in clinical manifestations 1/3/2015 Dr. The Lancet (2003) 361: 547 • The parasite infects the CNS • Epileptic seizures (58-80% when parenchymal brain cysts). or both. This syndrome is related to the location of parasites in the cerebral ventricles or vasal cisterns. hydrocephalus. • Intracranial hypertension.Neurocysticercosis Neuroimaging: MRI of viable (A) and degenerating (B) cysts and CT of calcified cysticerci. Sudheer Kher From: NEJM (2001) 345:879 24 .

Sudheer Kher 25 . Calcification starts in the cephalic portion and leaves a whitish calcified nodule 1/3/2015 Dr. Viable cysts have a translucent membrane through which the scolex is visible. Cysts degenerate: the fluid becomes opaque and dense and edges irregular and shrink. basal cisterns. mainly at the junction of grey and white matter. and spine. ventricles. brainstem.Cysticercosis pathology • • • • • • Cysts are rounded or oval vesicles from a few mm to 1-2 cm Most common location is in the cerebral hemispheres. Cysts can be found in the cerebellum.

Ongoing viable infection.Cysticercosis diagnosis • Serologic diagnosis: • Antibody assays for cysticercosis: •Antigen-detection assays: circulating antigens means live parasites. 1/3/2015 MRI showing parenchymal (A) and extraparenchymal (basal ccs) (B) viable NCC. patient serum samples. Monoclonal antibodies seem to detect AGs in CSF. Dr. Also their viability and the severity of the host inflammatory reaction. Sudheer Kher MRI showing calcified cyst with surrounding edema 26 . • Antibody assays for taeniasis: TSE33 and TSE38 were recognized by a panel of taeniasis but not cysticercocis. • Neuroimaging diagnosis: CT and MRI provide objective evidence on number and location of cysticerci.

surgical resection of lesions and placement of ventricular shunts • Parenchymal cysticercosis with viable cysts: Albendazole 15 (mg/kg/day) with dexamethasone (0. level of inflammation and clinical presentation • Therapy should include analgesics.1 mg/kg/day). Sudheer Kher 27 .Cysticercosis treatment Treatment should be individualized based on cyst location. • Surgical therapy: ventricular shunting to resolve hydrocephalus. Praziquantel. cysticidal drugs. • Subarachnoid ccs: antiparasitic therapy • No reason to use antiparasitic drugs to treat dead calcified cysts. antiepileptic drugs. Symptomatic therapy. Also excision of giant cysts or intraventricular cysts • 1/3/2015 Dr.

• Infected pork contains only the larval cysts that develop into adult worms in the human intestine • What is that transmits CCS? • The eggs • Most common source of infective eggs? • A symptom-free tapeworm carrier in the household 1/3/2015 Dr. Sudheer Kher 28 .Transmission • You do not get NCC by eating pork • Ingestion of infected pork only causes adult tapeworm infestation: taeniasis.

Adult worms (intestine) Scolex release in intestine Eggs (stool) Man eats undercooked beef Cattle ingest Cysticercus (bladder) Onchosphere release Blood to muscles Intestine penetration Dr. Sudheer Kher 1/3/2015 29 .

Disease Digestive disturbances Diagnosis Eggs / segments in stool Treatment Niclosamide / Praziquantel Dr. Sudheer Kher 1/3/2015 30 .

(Pork Tape Worm) Definitive host Man Intermediate host Pig Infective form Cysticercus cellulosae (larva) Eggs Mode of transmission Ingestion Site of localization Small intestine Dr. Sudheer Kher 1/3/2015 31 .

Sudheer Kher 1/3/2015 32 .Adult worms (intestine) Scolex release in intestine Eggs (stool) Man eats undercooked pork Pigs ingest Cysticercus (bladder larva) Onchosphere release Blood to muscles Intestine penetration Dr.

T solium lateral branches of uterus 7-13 T saginata lateral branches of uterus 15-20 Dr. Sudheer Kher 1/3/2015 33 .

(Dwarf Tape Worm) Definitive host Man Intermediate host No Infective form Eggs Internal autoinfection Mode of transmission Ingestion Site of localization Small intestine Dr. Sudheer Kher 1/3/2015 34 .

Sudheer Kher 1/3/2015 35 .Adult worms (intestine) Scolex release in intestine eggs (stool) Cysticercoid larva ingestion Onchosphere release Dr.

Sudheer Kher 36 .Hymenolepis nana the dwarf tape worm • Hymenolepis nana occurs relatively frequently world wide and is usually an infection of children • An intermediate host is not required and autoinfections occur frequently • Cysicercoids develop in the lymphatics of villi • Alternatively infection through cysticercoids in insects that contaminate grains or cereal 1/3/2015 Dr.

Disease Digestive disturbances Diagnosis Eggs / segments in stool Treatment Niclosamide / Praziquantel Dr. Sudheer Kher 1/3/2015 37 .

an unsuspecting gentleman Gorged on a succulent pork steak with élan Never realized he acquired an elite companion A slithering tapeworm in his intestine And never did he live happily ever in his lifespan The ribbon-like flatworm hijacked his gut Hooked onto the wall with its ‘armed head’ As it feasted on his meals with delight Sprouted segments to grow a healthy three metres in height ‘Taenia solium’ is the exotic name of this notso-pretty sight! While our gentleman was oblivious to the fact He passed some segments teeming with eggs From…. Department of Neuromicrobiology. National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore.A Tale of a Tapeworm Once upon a time. Sudheer Kher 38 . you-know-where! Not a stickler for regular hand-washing He swallowed some eggs at breakfast one morning! The eggs hatched into curious baby larvae Which set out on an adventure trail Through coursing blood vessels like a metrorail 1/3/2015 And decided to relax at destination BRAIN But alas! Could not find their way back again Some years later the victim had seizures one night As Doctors peeked and prodded the verdict was out ‘Neurocysticercosis’ the radiologist pronounced There was a worm in his brain. save me from the tapeworm everyday! Dr Reeta Mani Senior Resident.com Dr. while you pray God. INDIA • drreeta@gmail. Err……………. Dead and Mummified Like a tomb-stone with an epitaph that read "Catch me if you can!” Vegetarians need not sneer at pork-eaters And assume they can escape the sly tapeworm A delicious salad or a sandwich tainted with eggs Is all that it takes for the tapeworm to make you its prey So keep your hands crossed.

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