CESTODES

Prepared by:
CHARRIZ A. AMOYAN
General Properties of Cestodes
• Classified under the subkingdom Metazoa, phylum
Platyhelminthes.
• Considered as primitive worms.
• Do not possess a digestive system nor a nervous system.
• Absorb nutrients and eliminate waste products through their
outer surface called the tegument.
• Commonly known as tapeworms, flat and consist of three
distinct regions – the head, neck, and body (proglottids).
General Properties of Cestodes
• Head contains an organ of attachment called the scolex, may
consist either hooks, suckers, or sucking grooves.
• In some species, scolex has a fleshy extension called rostellum
to which hooks my attached.
• Body is divided into multiple segments (tapeworm) called
proglottids.
• Series of proglottids is called strobili.
• All cestodes are hermaphroditic (self-fertilizing) with each
proglottid containing both male and female reproductive organs.
General Properties of Cestodes
• Each proglottid is capable of laying eggs (now called a pregnant
proglottid or gravid segment.
• Neck serves as the region of growth and connects the head to
the body of the worm.
• Worm grows by adding new proglottids from the neck.
• Oldest proglottids are found at the most distal part of the body
of the parasite.
• Typical cestode life cycle is divided into three stages – egg,
larva, and adult worm
Intestinal Cestodes
1. Taenia saginata (Beef Tapeworm)
• Properties and Life Cycle
• Intermediate host is cattle where the eggs enter the blood vessels
within the cattle’s intestines.
• Eggs are transported to the skeletal muscles of the cattle where they
develop into cysticerci (larvae).
• Infection with beef tapeworm is acquired by ingestion of improperly
cooked or raw beef containing the infective larva.
• Larvae matured into adult worms (pathogenic stage) in small intestines
within a period of ~3 months.
Intestinal Cestodes
1. Taenia saginata (Beef Tapeworm)
• Properties and Life Cycle
• Scolex does not contain rostellum.
• Proglottid is rectangular and contains more uterine branches (about 15-
30)
• Epidemiology and Pathogenesis
• Common in areas of the world where beef is routinely eaten, especially
undercooked beef.
• Found to be endemic in Eastern Europe, Russia, Eastern Africa, and
Latin America.
• Adult worms do not produce significant damage in the small intestines.
Scolex Gravid proglottid
T. saginata Life Cycle
Intestinal Cestodes
1. Taenia saginata (Beef Tapeworm)
• Disease: Taeniasis
• Majority of patients are asymptomatic.
• Those with high worm burden may complain of diarrhea, abdominal
pain, loss of appetite with resultant weight loss, and body malaise.
• Gravid proglottids may reach the anus where egg-laying may occur
resulting in itchiness in the anal region (pruritus ani).
• Laboratory Diagnosis
• Examination of fecal specimen from infected patients.
Intestinal Cestodes
2. Taenia solium (Pork Tapeworm)
• Properties and Life Cycle
• Acquired through ingestion of improperly cooked or raw pork meat
which contains the infective larva (cysticercus cellulosae).
• Infection can also occur following the ingestion of food or water
contaminated with human feces that contain the egg of the parasite.
• Two infective stages – egg and larvae.
• Autoinfection may also occur.
• Pig serve as the intermediate host while humans serve as both
intermediate and definitive hosts.
Intestinal Cestodes
Comparison of scolex and gravid segments of Taenia saginata and Taenia solium
Characteristic Taenia saginata Taenia solium

Scolex
Four Four
Number of suckers
Absent Present
Rostellum
Absent Present; double crown
Hooks

Gravid Proglottid
Rectangular Somewhat square
Appearance, shape
15-30 7-15
Number of uterine branches on
each side of uterus
Scolex Gravid proglottid
Intestinal Cestodes
2. Taenia solium (Pork Tapeworm)
• Epidemiology and Pathogenesis
• More prevalent in underdeveloped communities with poor sanitation
and where people eat raw or undercooked pork.
• Higher rate of illness have been seen in people in Latin America,
Eastern Europe, sub-Saharan Africa, India, and Asia.
• Adult worms produce little damage in the intestines.
• Encysted larvae may produce damage in the tissues where they
disseminate.
Intestinal Cestodes
2. Taenia solium (Pork Tapeworm)
• Disease
• Taeniasis
• Disease produced by the adult worm.
• Most cases are asymptomatic but in the presence of high worm burden,
manifestations may be similar to beef tapeworm infection.
• Cysticercosis
• The result of larval encystation in various tissues of the body. The most common
involvement is that of the skeletal muscles where patients may complain of
muscle pain.
• Cysticercosis of the brain (neurocysticercosis) is the most feared and most
severe.
Intestinal Cestodes
2. Taenia solium (Pork Tapeworm)
• Disease
• Cysticercosis
• Symptoms of neurocysticercosis associated with increased intracranial pressure
such as seizures, headache, and vomiting.
• Ocular cysticercosis may lead to visual disturbances due to development of
inflammation of the uvea (uveitis) and retina (retinitis).
Intestinal Cestodes
2. Taenia solium (Pork Tapeworm)
• Laboratory Diagnosis
• Microscopic examination of stool specimen from infected persons.
• Demonstration of ova or proglottids may help establish the diagnosis.
• The demonstration of the typical morphology of the scolex can
differentiate pork tapeworm from beef tapeworm.
• For cysticercosis, diagnostic procedure depends on demonstration of
the cyst in tissue, through biopsy or CT scan.
Intestinal Cestodes
2. Taenia solium (Pork Tapeworm)
• Treatment
• Drug of choice for treatment of intestinal infection is praziquantel.
• For cysticercosis, praziquantel is not recommended for ocular and CNS
involvement.
• Alternative drugs include albendazole, paromomycin, and quinacrine
hydrochloride.
• Surgical removal of the larvae may be necessary.
• Anti-convulsants may be given in cases of neurocysticercosis.
Intestinal Cestodes
2. Taenia solium (Pork Tapeworm)
• Prevention and Control
• Proper waste disposal and sanitary measures.
• Thorough cooking of pork meat.
• Prompt treatment of infected persons to prevent the spread of the
parasite.
Intestinal Cestodes
3. Diphyllobotrium latum (Broad Fish Tapeworm)
• Properties and Life Cycle
• Longest of the tapeworms, can reach a length of about 13 meters.
• Eggs consist of ciliated larvae called coracidia (coracidium).
• One end of the egg is occupied by a lid structure called an operculum.
• Scolex contains a pair of long sucking grooves.
• Gravid segments contain a uterine structure that s centrally located and
assumes a rosette formation.
• Human infection is through ingestion of improperly cooked or raw fish
containing the plerocercoid (infective stage), the precursor larval stage.
Egg Scolex Gravid proglottid
Intestinal Cestodes
3. Diphyllobotrium latum (Broad Fish Tapeworm)
• Epidemiology and Pathogenesis
• Occurs in countries where raw freshwater fish is consumed.
• Little damage is produced in the small intestines of the human hosts.
• Parasite may compete with the host for vitamin B12, leading to
deficiency.
• Disease
• Asymptomatic disease
• Most common presentation among most individuals infected with the parasite.
Intestinal Cestodes
3. Diphyllobotrium latum (Broad Fish Tapeworm)
• Disease
• Diphyllobothriasis
• May manifest with symptoms of gastrointestinal involvement, may include diarrhea
and abdominal discomfort.
• When adult worm attaches to the jejunum and ileum, patient may develop
deficiency of vitamin B12, leading to anemia similar to pernicious anemia and is
characterized as megaloblastic anemia resulting from lack of maturation of red
blood cells.
• Laboratory Diagnosis
• Finding of the characteristic eggs and/or the proglottids (less frequent)
in a stool specimen.
Intestinal Cestodes
3. Diphyllobotrium latum (Broad Fish Tapeworm)
• Treatment
• Drug of choice is praziquantel.
• Alternative drug is niclosamide.
• Prevention and Control
• Thorough cooking of fish prior to consumption.
• Prompt treatment of infected individuals to prevent spread of the
parasite.
• Freezing of the fish for 24-48 hours at -18°C can kill all larvae.
Intestinal Cestodes
4. Hymenolepis nana (Dwarf Tapeworm)
• Properties and Life Cycle
• It does not require an obligatory intermediate animal host.
• Eggs are directly infectious and humans get the infection after the
accidental ingestion of the eggs of the parasite from fecally-contaminated
food or water.
• Accidental ingestion of rice and flour beetles containing the infective larvae
and that may have gotten into food.
• Rodents serve as additional source of infection.
• Autoinfection occurs when eggs of the parasite remain inside the human
host hatch into the larvae and mature into adults worms, thereby starting a
new cycle within the human host.
Egg Scolex Gravid proglottid
Life Cycle of H. nana
Intestinal Cestodes
4. Hymenolepis nana (Dwarf Tapeworm)
• Epidemiology and Pathogenesis
• Most common tapeworm recovered in the US.
• Has worldwide distribution and is also found in East Asia and the
Philippines.
• Common in areas with inadequate sanitation and hygiene.
• Children and persons living in crowded areas are at risk of developing
infection.
• Parasite produces little damage in the small intestine.
Intestinal Cestodes
4. Hymenolepis nana (Dwarf Tapeworm)
• Disease
• Hymenolepiasis
• Most patients are asymptomatic.
• In cases of high worm burden, patients may complain of nausea, weakness, loss
of appetite, diarrhea, and abdominal pain.
• In young children, anal itchiness (pruritus ani), may occur leading to headaches
due to difficulty sleeping.
• It can be confused with a pinworm infection.
• Autoinfection may lead to hyper-infection syndrome which can result in
secondary bacterial infection and spread of the worm to other tissues of the body.
Intestinal Cestodes
4. Hymenolepis nana (Dwarf Tapeworm)
• Laboratory Diagnosis
• Finding of the characteristic eggs in stool specimen.
• Treatment
• Praziquantel is the drug of choice.
• Niclosamide can be an alternative drug.
• Prevention and Control
• Proper hygiene and waste disposal.
• Control of transport host population and rodent control.
• Proper storage of grains and flour to prevent infestation with flour and grain beetles.
• Prompt treatment of infected individuals to prevent the spread of the parasite.
Extra-intestinal Cestodes
1. Echinococcus granulosus (Dog Taperworm or Hyatid Tapeworm)
• Properties and Life Cycle
• Primarily a zoonotic type of infection.
• Dogs are the definitive hosts while sheep are the intermediate hosts.
• Humans are considered as accidental or dead-end hosts.
• Eggs are identical to those of Taenia spp. and are thus not diagnostic.
• Diagnostic stage is its larval form, which is encased in a cyst wall and is
called the hydatid cyst.
Extra-intestinal Cestodes
1. Echinococcus granulosus (Dog Taperworm or Hyatid Tapeworm)
• Epidemiology and Pathogenesis
• Common in Africa, Europe, Asia, the Middle East, Central and South
America, and in rare cases, North America.
• Embryos develop into large, fluid-filled hydatid cysts, which act as space-
occupying lesions.
• Cyst fluid contains antigens that can sensitize the host.
• Rupture of the cyst, either spontaneously or during trauma or surgical
removal, may lead to the release of these antigens leading to anaphylaxis
and widespread dissemination of the parasite.
Extra-intestinal Cestodes
1. Echinococcus granulosus (Dog Taperworm or Hyatid Tapeworm)
• Disease: Echinococcosis, Hydatid Cyst Disease, Hydatid Disease,
Hydatidosis
• Most patients are asymptomatic during the early stages of the disease.
• As the cysts enlarge, necrosis of the infected tissues occur.
• Involvement of the liver may result in obstructive jaundice.
• Patients with lung involvement may manifest with cough, chest pain, and
shortness of breath.
• Other organs that may be infected include the spleen, kidneys, heart, bone,
and CNS, including the brain and eyes.
• Cyst rupture may lead to anaphylactic shock leading to death of the patient.
Extra-intestinal Cestodes
1. Echinococcus granulosus (Dog Taperworm or Hyatid Tapeworm)
• Laboratory Diagnosis
• Examination of biopsy specimen.
• Serologic tests (e.g. ELISA or indirect hemagglutination test).
• Radiography to demonstrate the hydatid cysts (e.g. CT scan or ultrasound).
• Care should be exercised when doing biopsy to prevent rupture of the cyst.
• Treatment
• Removal of the cyst through surgery.
• Mebendazole, albendazole, and praziquantel
Extra-intestinal Cestodes
1. Echinococcus granulosus (Dog Taperworm or Hyatid Tapeworm)
• Prevention and Control
• Improvement of personal hygiene and practices.
• Prevention of contamination of food and water with dog feces.
• Avoidance of feeding pet dogs with contaminated viscera.
• Prompt treatment of infected canines and humans to prevent the spread of
the parasite.
• Chemoprophylaxis should be given to dogs in endemic areas.
• Health education is essential.