Chapter 53

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

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 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

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 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

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 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

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 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

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 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

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Diphyllobothrium spp. Life Cycle

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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)

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 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

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Diphyllobothrium spp. Identification

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 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

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 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

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 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)

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 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

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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

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 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

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Dipylidium caninum Egg Packet

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Dipylidium caninum Scolex

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 Dipylidium caninum Therapy and
Prevention
 Therapy
 Praziquantel and Niclosamide
 Household pets should be treated simultaneously
 Prevention
 Flea control of household pets

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 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

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 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

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 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

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Hymenolepis nana Other Methods
 Nucleic acid testing
 Serologic testing
 Under development
 Not currently available in the clinical diagnostic
laboratory

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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

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 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

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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.

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 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

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 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

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 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

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Taenia spp. Life Cycle

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 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

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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
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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

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 Taenia solium Other Methods
 Serologic testing
 Developed for the diagnosis of neurocysticercosis
 Anti-cysticercal antibodies detected in serum, CSF
and saliva
 Not commercially available

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 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

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 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

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 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

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 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

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 Taenia saginata Treatment and
Prevention
 Therapy
 Praziquantel or Niclosamide
 Prevention
 Inspect beef for cystercerci and cook thoroughly

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 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

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 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

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 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.

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 Taenia asiatica Treatment and
Prevention
 Therapy
 Praziquantel or Niclosamide; followed by a laxative
 Prevention
 Inspect beef and pork liver for cystercerci and cook
thoroughly

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 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)

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 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)

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 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

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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

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 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

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