Chapter 54

Tissue Cestodes
 Objectives (1 of 2)
 Describe and compare the lifecycles of the tissue
cestodes, including the reservoir and intermediate hosts
 Describe the clinical manifestations and complications of
cysticerciin in the human host
 List the various methods used to diagnose cystericercus
infection
 Define and describe the morphologic characteristics of
the following: oncosphere, brood capsule, hydatid cyst,
and hydatid sand
 Objectives (2 of 2)
 Describe hydatid disease, including laboratory diagnosis
and the best course of treatment
 Compare and contrast the pathogenesis and spectrum of
disease associated with direct tissue damage versus the
immune response to Echinococcus spp.
 Describe the tapeworm that causes coenurosis,
including hosts and symptoms that humans may
experience
 Describe the preventative measures recommended to
avoid infection with tissue cestodes
 Tissue Cestodes
 Larvae do not reach adult stage in humans
 Eggs are accidentally acquired by ingestion from
an intermediate host
 Capable of causing serious illness and death
 Larvae deposit in various organs and tissue
 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
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
 Larval infection may invade the central nervous
system (CNS), eye, or other tissues
 Most severe infection occurs in the CNS
(neurocysticercosis)
 Cysticerci in the eye must be removed to prevent
blindness
 Taenia solium Laboratory
Diagnosis (1 of 2)
 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
 Taenia solium Laboratory
Diagnosis (2 of 2)
 Diagnosis of cysticercosis
 Cysticercus is recognized in tissue via biopsy,
computed tomographic (CT) scan, or magnetic
resonance imaging (MRI)
• cysticercus is round to oval, translucent, and about 5 mm or
more in diameter
 Taenia solium Other Methods
 Serologic Testing
 ELISA using serum or CSF
• Antibodies are produced and offer the patient secondary
immunity
• does not distinguish between active or inactive
 Nucleic Acid Testing
 PCR not widely used clinically
 Taenia solium Treatment and
Prevention
 Therapy
 Not all patients respond to treatment and not all
patients must be treated
• inflammatory response may be more serious than the
disease
 Albendazole is the drug of choice; with
corticosteroids, anticonvulsants, and surgery if
deemed appropriate
 Prevention
 Education, meat inspection, and improvement of
sanitation measures
Echinococcus granulosus Complex
 Geographical Distribution
 Southern South America, Russia, East Africa, and the
western United States.
 Cool, damp areas where mammalian hosts are
prevalent
 Echinococcus granulosus sensu lato can be
used as a general term for all of the species and
strains.
 Dog or sheep strain is the most common
 It is the smallest of all tapeworms
E. granulosus Complex Life Cycle
 E. granulosus Complex
 Adult worms present in the animal’s intestine
 Proglottids and eggs passed in animal stool
 Eggs ingested by intermediate host (humans,
sheep, moose, cattle, dogs)
 Hatch in duodenum, oncospheres penetrate
intestine and moves into bloodstream
 Various organs (esp. liver), develop cysts
 E. granulosus Complex Spectrum
of Disease
 May cause hydatid disease
 Oncospheres hatch in the intestine, and are distributed through
the blood stream
 Unilocular cysts (hydatid cysts) develop in tissue (usually the
liver)
• Large fluid filled sacs
 Brood capsules are the daughter cysts
 Hydatid sand are the scolices in hydatid fluid
 Infection of the common bile duct (chonlangitis)
 Interference with flow of bile from the liver (cholestasis)
 Rupture and release of the fluid of a hydatid cyst may cause
anaphylactic shock
E. granulosus Complex Laboratory
Diagnosis
 Abdominal tumor with or without eosinophilia is slow
growing
 Cysts are identified in the organ
 Fluid-filled cysts may be observed on an MRI or a CT
scan
 Serologic test
 ELISA and Western Blot is positive
 Indirect hemagglutination (IHA), indirect fluorescent antibody
(IFA) tests, and enzyme immunoassays (EIA) available
 Negative test results do not rule out echinococcosis
Echinococcus spp.
Echinococcus spp. Treatment and
Prevention
 Therapy
 Surgical removal of cyst
 PAIR Technique
• puncture, aspiration, infection, and reinjection
 used for the inactivation of hydatid sand if surgical removal is
not feasible
 Albendazole or albendazole plus praziquantel have
been used effectively
 Prevention
 Avoid contact with infected dogs and deworm animals
regularly
 Echinococcus multilocularis
 Geographical Distribution
 Asia, Europe, and northern North America
 Rare; most lethal of all helmintic diseases
 Causes alveolar hydatid disease (fatal)
 Cyst lacks a laminated membrane and develops
connected chambers with little or no fluid
 Rarely contains a scolex
 Very resistant to cold temperatures
 Echinococcus multilocularis
Epidemiology
 Definitive host—Foxes, coyotes, and dogs
 Intermediate host—Rodents
 Humans are an accidental intermediate host
 Fur trappers and veterinarians at highest risk
 Ingestion of contaminated food or water, or handling
of animals
 Echinococcus multilocularis
Spectrum of Disease
 Highly lethal and destructive disease
 Commonly asymptomatic –discovered with surgery,
imaging scan or autopsy
 Cysts form primarily in the liver and metastasize to the
lungs or brain
 Multilocular (multiple chambered) hydatid cysts
 Often mistaken for hepatic sarcoma
 Diagnosed by CT scans and MRI
 Serologic Testing
 ELISA is sensitive and specific
 Available in Europe, but not currently in the U.S.
 Echinococcus multilocularis
Treatment and Prevention
 Therapy
 Remove the parasite surgically
• Pre-surgical treatment with albendazole
• Inoperable cases -- life-long treatment with mebendazole
and albendazole

 Prevention
 Control rodents and educate public
 Good hygiene and periodically deworming household
pets
 E. oligarthrus and E. vogeli
 Geographical Distribution
 Found only in Central and South America
 Referred to as polycystic echinococcosis (or
neotropical polycystic echinococcosis)
 In humans, this disease has also been called
unicystic echinococcosis
 E. oligarthrus and E. vogeli
Epidemiology
 E. vogeli
 Definitive host – bush dogs or domestic dogs
 Intermediate hosts – South American Rodents
 Proliferation occurs in accidental hosts such as
primates
 E. oligarthrus
 Definitive host – wild felids
 Intermediate hosts – rodents
 Proliferation occurs in non-human primates
 E. oligarthrus and E. vogeli
Spectrum of Disease
 Metacestode is found primarily in the liver, but
can also occur in the lungs and other organs
 Cysts are often interconnected and can have
multiple chambers
 Has not been documented in domesticated
intermediate mammalian hosts
 E. oligarthrus and E. vogeli
Laboratory Diagnosis
 Eggs are morphologically indistinguishable from
Taenia spp.
 Tiny proglottids are rarely noticed in feces
 Serologic Testing
 ELISA to screen definitive host
 Nucleic Acid Detection
 PCR used to confirm infection
 Speciation accomplished using sequencing
technology
 E. oligarthrus and E. vogeli
Treatment and Prevention
 Therapy
 Anthelminthic drugs -- Praziquantel, is effective
against both juvenile and adult parasites
 Intermediate hosts -- surgery is often the treatment of
choice
 Prevention
 Avoiding contact with infected dogs and deworming
animals regularly
 Taenia multiceps
 Geographical Distribution
 Mostly found in Africa
 South America, the United States, and Canada.
 Causes coenurosis (larval form)
 May cause destructive damage and death
 Adult worms are found in dogs and other canids
 Humans may serve as an intermediate host
 Accidental ingestion from contamination by dog feces
 Extremely rare
 Taenia multiceps Spectrum of
Disease
 Oncosphere hatches, penetrates the intestine and is
carried to other tissues through the blood stream
 Brain, eyes and CNS
 Coenurus produces multiple daughter cysts
 Infected sheep lose their balance and rotate in circles
until they fall (screw disease)
 The human clinical condition is known as gid, sturdy, or
staggers.
 Symptoms include headache, vomiting, paralysis, and blindness
 Taenia multiceps Laboratory
Diagnosis
 Diagnosis is similar to that for Echinococcus infection
 Adult worm is 5 to 6 cm long with 200 to 250
segments and has multiple scolices
 Scolex has four suckers and a proboscis (tubular
appendage) or rostellum with 22 to 32 hooks
arranged in two rows
 CT and MRI may be useful for detecting the cysts
 Serologic Testing
 ELISA and IHA methods exist, but are not produced
commercially
 Indirect ELISA and Nucleic acid methods have been
used for diagnosis
 Taenia multiceps Treatment and
Prevention
 Therapy
 Similar to that for Echinococcus
 Most common treatment is surgical removal
 Prevention
 Not feeding brain or spinal cord to animals
 Good hygiene
 Taenia serialis
 Worldwide Distribution
 North America, South America, Europe and Africa
 Referred to as the canid tapeworm
 Definitive hosts - dogs
 Intermediate hosts – Rabbits
 Humans are accidental hosts through the
ingestion of contaminated food or water
 Taenia serialis Spectrum of
Disease
 Oncospheres hatch in the intestine, invade the
intestinal wall and are carried throughout the
body in the bloodstream.
 Coenuri can occur in humans within their
muscles, brain, eye, or subcutaneous
connective tis-sue.
 May mimic lymphomas, lipomas, pseudotumors,
or neurofibromas.
 Taenia serialis Diagnosis,
Treatment and Prevention
 Diagnosis
 Observation of cysticerci or coenuri in tissue biopsy or
autopsy specimens
 Therapy
 Oral epsiprantel, praziquantel or fenbendazolel
 Corticosteroids for inflammation
 In many cases surgical removal is a safer option
 Prevention
 Similar to that for T. multiceps
 Spirometra mansonoides
 Characteristics
 Larvae (spargana)—Are white, wrinkled, and ribbon-
shaped
 Sparganum has bothria (grooves) instead of suckers
 Does not contain a scolex
 Disease
 Humans acquire plerocercoid larvae from water or
undercooked fish
 Spargana migrate and lodge anywhere in the human
body
 Painful nodules may develop in tissues
 Spirometra mansonoides
Laboratory Diagnosis
 Removal and identification of sparganum from
tissue confirms the diagnosis
 Serology Testing
 ELISA to target anti-sparganum IgG antibodies within
the blood
 Clinical history, ELISA, MRI, and CT can all be
used together to presumptively diagnose
sparganosis
 Spirometra mansonoides
Treatment and Prevention
 Therapy
 Limited success with Praziquantel
 Preferred method -- Injection of ethanol into the
nodule along with surgical removal of the complete
sparganum
 Prevention
 Safe drinking water practices and awareness of
dangers of consuming raw fish and amphibians
 Consume boiled water from contaminated areas