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Intestinal Cestodes
1
Objectives (1 of 2)
Describe the distinguishing morphologic
characteristics, clinical disease, basic lifecycle
(vectors, hosts, and stages of infectivity), and
laboratory diagnosis for the intestinal cestodes
Define and identify (where appropriate) the
following parasitic structures: scolex, proglottids,
rostellum, hermaphroditic, oncosphere,
hexacanth embryo, strobila, bothria, and
coracidium
2
Objectives (2 of 2)
Compare and contrast autoinfection and
hyperinfection
List several methods of control and prevention of
tapeworm infection
Correlate the lifecycles with the specific
diagnostic stage(s) for each organism
3
General Characteristics
Intestinal Cestodes
Commonly referred to as tapeworms
Dorsoventrally flattened
Mature cestodes contain male and female
organs (hermaphroditic)
Food is absorbed through the integument
Organisms typically inhabit the small intestine
Fresh or preserved stools are the specimens of
choice for ova and parasites (O&P) examination
4
Intestinal Cestodes (1 of 2)
Three Regions
Head (Anterior
• Scolex—Specialized attachment structure; anterior
• Rostellum-Crown or scolex (smooth or hooked)
Neck Region- may or may not be evident
Body
• Proglottids—Body segments (immature, mature or gravid);
vary in geometric charateristics
• Strobila—Adult worm body made of segments
5
Intestinal Cestodes (2 of 2)
Proglottids
Immature
• Male and female organs not evident, anterior end of strobila
Mature
• Male and female organs evident, middle of the strobila
Gravid
• Uteri evident and filled with eggs
Integument
Outer covering or the skin of the worm
Oncosphere
A six hooked (Hexacanth embryo) inside the egg
6
Diphyllobothrium spp.
Worldwide distribution
Cool lakes contaminated with sewage
North America, Canada, Midwest, Great Lakes
14 species all capable of infecting humans
Commonly referred to as the freshwater broad
fish tapeworm
The largest human tapeworm
Humans and animals are definitive hosts
Two intermediate hosts; copepods and fish
7
Diphyllobothrium spp.
Epidemiology
Transmitted by eating fish contaminated with the parasite
Freshwater and marine
• Burbot, pike, perch, ruff, and salmon
D. latum
• Most common species identified
D. nihonkaiense
• Endemic in Japan, spreading throughout Europe
D. pacificum
• Southern Pacific coast of South America
D. cordatum, D. ursi, D. dendriticum
• New Guinea and Australia
8
Diphyllobothrium spp. Life Cycle
9
Diphyllobothrium spp. Spectrum of
Disease
Infection occurs through the digestion of the infection of
fish containing the plerocercoid larvae
The larvae mature into the adult worms in the human
intestine
Disease depends on the worm burden and immune
status of the host
Infection is usually asymptomatic
Mild gastrointestinal symptoms may occur
Diarrhea, abdominal pain, fatigue, vomiting, or dizziness.
Vitamin B12 level may be decreased (pernicious
anemia)
10
Diphyllobothrium spp. Laboratory
Diagnosis
Speciation within the genus is nearly impossible based
on morphological characteristics
Scolex
Elongated, bothria containing 2 lateral sucking grooves
Eggs and proglottids are transmitted in feces
Eggs are ovoid, operculated, and yellow-brown
• Abopercular knob
• 58-75 μm × 40-50 μm
Proglottids are wider than they are long with a rosette-shaped
central uterus
Maybe passed in chains
11
Diphyllobothrium spp. Identification
12
Diphyllobothrium spp. Other
Methods
Nucleic acid detection
Can be used to speciate for epidemiological reasons
RFLP using ribosomal DNA sequences
No serological methods are available
13
Diphyllobothrium spp. Treatment
and Prevention
Praziquantel or Niclosamide is effective and
nontoxic
Vitamin B12 supplement
Prevention
Avoid consumption of raw fish
Thoroughly cooked at 55°C for 5 minutes or frozen at
-20°C for 7 days or flash freezing to -35°C for 15
hours, if the flesh is less than 15 cm thick
Good hygiene and proper sanitation
Treatment of sewage before it enters lakes
14
Dipylidium caninum
Worldwide Distribution
Commonly referred to as the cat or dog
tapeworm
Scolex has armed rostellum and four suckers
Characteristic egg packets are found in feces
Double-pored with many proglottids
Resembles a “cucumber seed” (wet)
Resembles a grain of rice (dry)
15
Dipylidium caninum Epidemiology
Humans acquire the tapeworm through the
accidental ingestion of fleas.
Intermediate host
Flea
Reservoir hosts
Dogs, cats both wild and domestic
Accidental host
Humans
16
Dipylidium caninum Life Cycle
17
Dipylidium caninum Spectrum of
Disease
Humans demonstrate mild symptoms upon
infection
Indigestion, appetite loss, weight loss, perianal
itching, persistent diarrhea, and vague abdominal
pain
Severity is dependent on worm burden
Infections are generally self-limiting
18
Dipylidium caninum Laboratory
Diagnosis
First sign of infection may be the appearance of
seed-like proglottids in the stool
Groups of egg packets are recognized
Scolex has four suckers and a rostellum with four to seven
rows of hooklets
Wet prep or permanent stain
Patients may develop a moderate eosinophilia
Serologic tests typically performed
Nucleic Acid Detection
Utilized primarily for genotyping
Not currently used for clinical diagnosis
19
Dipylidium caninum Egg Packet
20
Dipylidium caninum Scolex
21
Dipylidium caninum Therapy and
Prevention
Therapy
Praziquantel and Niclosamide
Household pets should be treated simultaneously
Prevention
Flea control of household pets
22
Hymenolepis nana
Worldwide Distribution
Wide spread in the Southern United States
Commonly referred to as the dwarf tapeworm
Intermediate host is not required
Person-to-person transmission is possible
Autoinfection or hyperinfection may occur
Generally found in children
Common in poor socioeconomic conditions,
poverty, poor hygiene, and institutional
settings
23
Hymenolepis nana Spectrum of
Disease
Direct fecal-oral transmission or accidental
ingestion
Symptoms
Similar to pinworm
Diarrhea
Abdominal discomfort
Itchy bottom
Most patients are asymptomatic even with a
heavy worm burden
24
Hymenolepis nana Laboratory
Diagnosis
Wet mount or permanent stain
Eggs in stool
• Spheroidal, pale and thin shelled
• Oncosphere with six hooklets and polar filaments enclosed
within a double membrane
• 30-47 μm in diameter
Adult worm or proglottids are rarely found
Eggs are infectious, and therefore unpreserved
specimens should be handled carefully
Patients may present with a low-grade eosinophilia
25
Hymenolepis nana Other Methods
Nucleic acid testing
Serologic testing
Under development
Not currently available in the clinical diagnostic
laboratory
26
Hymenolepis nana Treatment and
Prevention
Therapy
Praziquantel remains the therapy of choice
Niclosamide is also effective
Prevention
Good hygiene
General sanitation measures
Rodent control that controls the flea populations
27
Hymenolepis diminuta
Worldwide Distribution
Commonly referred to as the rat tapeworm
Infection is rare in humans
More common in childre
Humans acquire infection from contaminated
grains with rodent feces
Lifecycle is similar to H. nana
28
Hymenolepis diminuta Spectrum of
Disease
Rarely infects humans
Humans accidentally ingest an arthropod or feces
contaminated
Multiple adult worms will mature in the human intestine
Because of the small size of the organism, the infection
is tolerated well
Symptoms include
Diarrhea, anorexia, nausea, headache, and dizziness
Small children may present with
Mild diarrhea, remittent fever, and abdominal pain.
29
Hymenolepis diminuta Laboratory
Diagnosis
Wet mount and permanent stained smear
Recovery of eggs in stool
Proglottids usually disintegrate in the gut
Eggs are large, ovoid, yellowish, and moderately thick
Eggs contain six hooked oncospheres (no polar
filaments)
70-85 μm × 60-80 μm
Nucleic acid detection and serologic testing are
under development, not currently available
clinically
30
Hymenolepis diminuta Treatment
and Prevention
Therapy
Praziquantel
Disease is self-limiting and treatment is often not
necessary
Prevention
Controlling populations of infected mice and rats
Good hygiene and sanitation
31
Taenia spp.
Two species:
T. saginata
T. solium
Humans are the definitive host for both species
Two different intermediate hosts:
T. saginata: cattle, beef tapeworm
T. solium: pigs and humans, pork tapeworm
Two distinct diseases:
Taeniasis: both species
Cysticercosis: T. solium only
32
Taenia spp. Life Cycle
33
Taenia solium
Worldwide Distribution
Higher rates in Latin America, Asia and sub-Saharan
Africa
Found in the United States
More prevalent in under developed countries
Commonly referred to as the pork tapeworm
Transmitted in undercooked pork
34
Taenia solium Spectrum of Disease
Consumption of raw or undercooked pork
containing embedded larvae
Cysticercus larvae are released where they attach to
the mucosa of the small intestine
Intestinal infection—Abdominal pain, diarrhea,
indigestion and loss of apetitie
Extraintestinal (cysticercosis)—Larvae in tissue
Eyes, brain, muscle, or bone
Invades the CNS and can cause
neurocysticercosis
35
Taenia soliumLaboratory Diagnosis
Tapeworm proglottids in stool
7-13 lateral uterine branches
Eggs—Round and oval with thickly striated shell
and six oncospheres
Unable to speciate
Scolex
4 large suckers
Armed rostellum
36
Taenia solium Other Methods
Serologic testing
Developed for the diagnosis of neurocysticercosis
Anti-cysticercal antibodies detected in serum, CSF
and saliva
Not commercially available
37
Taenia solium Treatment and
Prevention
Therapy
Praziquantel or niclosamide followed by use of a
laxative
Expulsion of the scolex must be verified
Prevention
Good hygiene, immediate treatment, and cooking
pork thoroughly
38
Taenia saginata
Worldwide Distribution
More common than T. solium
Commonly referred to as the beef tapeworm
Has a lifecycle similar to T. solium
Cattle—Is the intermediate host
Humans are infected through the ingestion of
cysticerci
39
Taenia saginata Spectrum of
Disease
Human infections are typically asymptomatic
May demonstrate very mild indigestion, loss of
appetite, vomiting, and abdominal discomfort.
Rare severe infections that may result in
intestinal obstruction and appendicitis.
Slight eosinophilia may develop
40
Taenia saginata Laboratory
Diagnosis
Wet mount and permanent stained smear
Eggs indistinguishable from other Taenia spp.
Proglottids in stool
15-18 lateral uterine branches
Scolex
Four large suckers
Unarmed rostellum
41
Taenia saginata Treatment and
Prevention
Therapy
Praziquantel or Niclosamide
Prevention
Inspect beef for cystercerci and cook thoroughly
42
Taenia asiatica
Georgraphic Distribution
Gound primarily in remote area of the East and
South East Asian countries
Commonly referred to as the Asian tapeworm
Gravid proglottids and adult worm is difficult to
indistinguish from that of T. saginata
Similar life cycle to that of T. solium
Pigs, cattle and goats are the intermediate hosts
Humans are infected through the ingestion of
cysticerci in raw or undercooked liver from cattle or
pork
43
Taenia asiatica Spectrum of
Disease
Human infections are typically asymptomatic
May experience abdominal pain, nausea,
weakness, weight loss, headache and changes
in appetite
Eosinophilia may be present
44
Taenia asiatica Laboratory
Diagnosis
Proglottids in stool
12-26 lateral uterine branches
Scolex has two rows of rudimentary hooklets
Eggs in stool
• Eggs cannot be distinguished from other Taenia spp.
45
Taenia asiatica Treatment and
Prevention
Therapy
Praziquantel or Niclosamide; followed by a laxative
Prevention
Inspect beef and pork liver for cystercerci and cook
thoroughly
46
Taenia crassiceps
Geographically distributed in the Northern Hemispher
U.S. and Canada
Infects intestine of carnivores
Causes human cysticercosis
Intermediate hosts - small rodents and moles
Humans serve as intermediate hosts
Frequently immunocompromised
Accumulate in skeletal muscle and subcutaneous
tissue
Occasional ocular larva migrans (OLM)
47
Taenia crassiceps Spectrum of
Disease
Generally infects immunosuppressed individuals
Often asymptomatic
Symptoms when present may include
headaches, nausea, and vomiting
Parasites may migrate to subcutaneous tissues
including skeletal muscle
May cause intraocular infections (OLM)
48
Taenia crassiceps Laboratory
Diagnosis
Observation of cysticerci in biopsy or autopsy
specimens
Patient may present with eosinophilia
Serologic testing
ELISA for Anti-cysticercal antibodies help confirm
the diagnosis
Negative test results do not exclude cysticercosis
49
Taenia crassiceps Treatment and
Prevention
Therapy
Surgical removal is mandatory for individuals with
intraocular cysts
Albendazole or Praziquantel
Oral corticosteroids for inflammation
Prevention
Avoid contaminated food and water
Inspect animal products for cysticerci
50
Taenia crassiceps Nucleic Acid
Detection
All species of Taenia and two genotypes of T.
solium can be differentiated
PCR amplification
Taenia solium – cytochrome oxidase subunit cox1
51