CESTODES

Helminthes

1. Nemahelminthes

 Roundworm

2. Platyhelminthes

 Flatworm

TREMATODE (THE FUCK!!!) CESTODE

- FLUKE - TAPEWORM
- Flat, unsegmented - Flat, segmented

NEMATODES CESTODES TREMATODES

CHARACTERISTICS OF CESTODES

- Flat dorsoventrally resembling a tape (tapeworm)

- Bilaterally symmetrical bodies
- Segmented, with ribbon-like appearance

Hermaphrodite

- Both male and female reproductive organs in the same organism

Nervous system

- Pair of lateral and longitudinal nerves

NOTE!!! No digestive tract and circulatory system

 Habitat of adult worm Intermediate
- Intestine of the definitive - Larval stage encysted in the tissue
host

THREE DISTINCT PARTS OF CESTODES

Head Scolex Strobila

- Anterior structure - Region of growth and - Long, segmented body
- Main organ of actively dividing composed of
attachment of the - Segmentation or proglottids
worm to the definitive strobilization
host originates from the
ROSTELLUM neck
- Retractable, muscular,
protruding part used
for attachment
- Armed with hooks

No rostellum, no hooks
- Unarmed

Suckers
- Used for attachment

THREE TYPE OF PROGLOTTID

Immature Mature Gravid

- Male and female - Testes and ovaries are - Uterus with lateral
reproductive differentiated and prominent branches is filled
organs are not yet with eggs
associated
TWO MEDICALLY SIGNIFICANT CESTODES

Pseudophyllidea Cyclophyllidea
Examples Diphyllobothrium latum Taenia spp., Echinococcus
spp., Hymenolepis spp.,
Dipylidium spp.
Scolex Spatulate with 2 slit-like sucking Globular with 4 muscular cup-
grooves (bothria) shaped suckers with or
without rostellum with hooks

Intermediate host Two One or none

Genital Pores Midline Lateral
Uterus Midline, non-branching, rosette-like With lateral branches
With uterine pore Without uterine pore

Proglottids Anapolytic Apolytic

Ova Immature, operculated ova found in Proglottids in the feces
the feces Non-operculated ova with
hexacanth embryo
TYPES OF LARVA

BLADDER LARVA SOLID LARVA

1. Cysticercoid 1. Coracidium
- Taena solium, Taenia Saginata - Diphyllobothrium latum (1st stage larva)

2. Cysticercoid 2. Procercoid
- Hymenolepis spp. - Diphyllobothrium latum (2nd stage larva)

3. Hydatid cyst 3. Plerocercoid (Sparganum)

- Echinococcus spp. - Diphyllobothrium latum (3rd stage larva)

4. Coenurus
- Taenia multiceps
THE PLATYHELMINTHES (FLATWORMS) TAPEWORMS

Development of Proglottids

- New proglottids bud from behind the scolex.

- Pushed back, mature eggs are produced.
- “Gravid” proglottids filled with eggs

Taenia spp.
 Taenia saginata (Beef tapeworm) Taenia solium (Pork tapeworm)
Definitive Man Man (IH)
host
MOT Ingestion of cysticercus in flesh of cow Ingestion of raw or undercooked infected
meat or eggs
Infective stage Cysticercus bovis Cysticercus cellulosae/egg
Size Up to 10 meters in length
Pathogenesis - Most common complaint is - Cysticersosis due to the ingestion of
passage of proglottids eggs from feces
- Irritation at site of attachment - Racemose form of infection may
- Taeniasis causing non-specific develop in the brain
symptoms like weight loss, loss of Intestinal infection
appetite and pruritis ani - Non-specific abdominal pains
- Intestinal Obstruction Cysticercosis
Cysticercosis
- Cysticerci are found in straited
muscle, brain, eye, heart and other
organs
- NCC or neurocysticercosis is the most
serious manifestation
- convulsion is the most common
manifestation in cerebral cysticercosis
- Patient with subcutaneous cysticerci
concomitant with neurologic
symptoms is a presumptive evidence
for neurocysticercosis
Intestinal is same with T. saginata
Morphology Scolex Scolex
- With 4 prominent acetabula, - Scolex - armed, with 4 acetabula
unarmed - Has rostellum with double crown of
- Mature proglottids are square in 25 to 35 large and small hooks
shape Proglottids
- Genital pores are irregularly - Same morphology with T. saginata
alternate except that it has accessory ovarian
lobe, no vaginal sphincter
- fewer follicular testes and lateral
branches
- Eggs are indistinguishable
- If Taenia solium eggs are ingested, the
oncosphere hatches in the duodenum
Gravid Proglottids and spread in different organs via the
- Longer than wide bloodstream
- Uterus contains 15 to 20 primary - Human infection with cysticercus
branches cellulosae can be acquired in fecal oral
- Uterine pore is located in a lateral route by ingesting Taenia solium eggs
position from contaminated food or drink.
- Autoinfection is possible
- Eggs are identical to T. solium,
measuring about 40 microns in
diameter.
 Diagnosis Intestinal is same with T. saginata
Cysticercosis
-Patient with subcutaneous cysticerci
concomitant with neurologic symptoms is a
presumptive evidence for neurocysticercosis
-Serologic testing includes: ELIZA EITB
Western blot
- Dot ELIZA is good for screening test for
cysticercosis

Taenia saginata

Mature segment: nearly Gravid segment longer than Egg of Taenia spp. Circular,
square, bilobed ovary, broad branched uterus filled radiating double wall (H.P).
scattered testis, uterus: with eggs (magnifier)
median tube (magnifier)

DIAGNOSIS: BEEF VS. PORK TAPEWORM

- the scolex or proglottid can be speciated;

- eggs cannot be speciated
- Anal swabs (cellophane tape preparations) are often helpful due to squeezing of segments
(causing release of eggs) on the outside of the stool as it passes through the anus

Diagnosis for T. solium and T. saginata

- Specific diagnosis rests on identifying the characteristic proglottids, eggs or scolex

- gravid proglottids are passed or flattened in between two slides and examined against the
light in order to count the lateral branches
CASE STUDY!!!!!

- A 26-year-old female college student had undergone a homeopathic regimen advertised to

eliminate parasites from the body. The only travel reported was to Maine a year ago to live
with relatives on a farm between semesters. After experiencing recent mild to moderate
abdominal discomfort, she sought medical attention to confirm that her home remedy was
effective. A stool specimen was collected and tested for ova-and-parasites (O&P) by her
primary health care provider. Figures A–C show examples of what was observed in low
numbers in a formalin-ethyl acetate (FEA) concentration of the stool. Figure A is at 200x
magnification; Figures B and C show the two objects of interest individually at 400x
magnification.

Echinococcus granulosus (Hydatid tapeworm)

- Extraintestinal cestode
- Adults are only found in caninces. Eggs are shed in the feces.
- Humans accidentally ingest eggs from canine feces.
- Hexacanth embryo migrates to tissues.
- The hexacanth develops into the larval stage (hydatid cyst) in the tissue (liver, lung or brain,
most often).

Morphology:

- Adult worm - Small, consists of only 3 segments

- The scolex has 4 acetabula with 30 to 36 hook

- Hydatid cyst - a thin walled larva containing many thousands of invaginated scoleces.
- The protoscolices and brood capsules lie free in the cyst which are referred the Hydatid sand

- Protoscolices liberated from a hydatid cyst. The two protoscolices on the right side of the
image are evaginated.
 - Echinococcosis infection with tiny tapeworms of the genus Echinocococcus.

Cystic echinococcosis (hydatid disease) Alveolar echinococcosis

- caused by larval stage of - caused by larval stage of
Echinococcus granulosus, a ~2-7 Echinococcus multilocularis, a ~1-4
millimeter long tapeworm found in millimeter long tapeworm found in
dogs (DH) and sheep, cattle, goats, foxes, coyotes, and dogs (DH).
and pigs (IH). - Small rodents are intermediate
- Usually asymptomatic but causes hosts.
harmful, slowly enlarging cysts in - AE poses a much greater health
the liver, lungs, and other threat to people than CE
Prevention and Control Prevention and Control
- Cystic echinococcosis is controlled - Alveolar echinococcosis can be
by preventing transmission of the prevented by avoiding contact with
parasite. Prevention measures wild animals such as foxes, coyotes,
include limiting the areas where and dogs and their fecal matter and
dogs are allowed and preventing by limiting the interactions
animals from consuming meat between dogs and rodent
infected with cysts. populations.

Note:

- New World species, E. vogeli and E. oligarthrus, are associated with “Neotropical
echinococcosis”;
- E. vogeli causes a polycystic
- E. oligarthrus causes the extremely rare unicystic form.

Major Pathology

- hydatid cysts in the brain.

- Can grow to size of a coconut
- Pressure necrosis of tissue can result from larger cysts.
Echinococcus multilocularis vs. Echinococcus granulosus

- Both produce hydatid disease in many mammals, including rodents and humans.
- Unlike E. granulosus and E. multilocularis produces many small cysts that spread throughout
the infected animal.
- E. granulosus infections often remain asymptomatic for years
- Hepatic and pulmonary S/S are the most common clinical manifestations
- Rupture of the cysts can produce a host reaction manifesting as fever, urticaria, eosinophilia,
and potentially anaphylactic shock;
Clinical Presentation

- E. multilocularis affects the liver as a slow growing, destructive tumor, often with abdominal
pain and biliary obstruction. This may be misdiagnosed as liver cancer.
- Echinococcus vogeli affects mainly the liver, where it acts as a slow growing tumor;
secondary cystic development is common.

Treatment

- Chemotherapy, cyst puncture, and PAIR (percutaneous aspiration, injection of chemicals and
reaspiration) have been used to replace surgery as effective treatments for cystic
echinococcosis.
- Surgery remains the most effective treatment
- The treatment of alveolar echinococcosis is more difficult than cystic echinococcosis
Dipylidium caninum (Double pored tapeworm/cucumber tapeworm)

- Rare in humans, occurring primarily in infants and small children closely associated with
pets

Intermediate host Dogs, cats, flear

Definitive host Dog, cat, human (The worm develops in the
small intestine of the definitive host.)
Diagnosis Usually based on identification of gravid
proglottids since free eggs not usually found.
Cyclophylid cestode an important order that infects mammals
afflicted with fleas, including dogs, cats, and the
owners of pets, especially children.
Proglottids
Pumpkin shaped
Eggs characteristic “egg clusters” or “egg balls” of 15
to 25 eggs that are passed in the host’s feces
and ingested by fleas
Prevent human infection control of flea populations on pets is the best
way
Morphology Adult
- the adult is up to 70 cm in length.

Scolex
- armed rostellum;4 sucking disks.

Gravid proglottids
- are the size of rice grains, and exhibit a
genital pore on each side.

Eggs
- contained within packets (up to 12
eggs/packet)

Clinical Manifestations - some individuals with a heavy worm

infection will experience mild
symptoms of gastrointestinal distress
- most are asymptomatic.
Transmission of the infection - hand-to-mouth ingestion of fleas from
infected domestic animals in which the
developing cysticercoid larvae are
found.
- ingestion of beetles and other
arthropods that may be in contact with
domestic animals.
Treatment and prevention - niclosamide is the drug of choice.
- good veterinary care of cats and dogs
by keeping the animals free of parasites
and fleas (ectoparasites) is essential.
- Control of other insects such as beetles
may aid greatly in the prevention of
infections by D. caninum.
- Personal hygiene is also paramount in
preventing hand-to-mouth ingestion of
infected fleas.
Ctenocephalides canis dogs
C. felis cat
- may both be implicated in transmitting D. caninum to humans and other animals
- control of flea populations on pets is the best way to prevent human infection
- common tapeworm of dogs and cats
Hymenolepis

Hymenolepis nana Dwarf tapeworm

Intermediate host None
Disease Transmission - ingesting fecally contaminated food or
water w/ dwarf tapeworm eggs
- by touching your mouth with
contaminated fingers, or by ingesting
contaminated soil.
- Ingestion of infected arthropod that
has gotten into food.
- The adult dwarf tapeworm is made up
of many small segments, called
proglottids
- As it matures inside the intestine, these
segments break off and pass into the
stool.
- An adult dwarf tapeworm can live for 4-
6 weeks. However, once you are
infected, the dwarf tapeworm may
reproduce inside the body
(autoinfection- where the eggs “hatch”
in the intestine) and continue the
infection
- parasitic for both birds and mammals
such as mice and rats.
- Rodents are also capable of
transmitting the disease
- Can be misdiagnosed for pinworm
infection.
Clinical Manifestations - Most are asymptomatic
- symptoms may experience nausea,
weakness, loss of appetite, diarrhea,
and abdominal pain.
- Young children, especially those with a
heavy infection, may develop a
headache, itchy bottom, or have
difficulty sleeping.
Morphology Adult worm
- 10-45 mm long and 0.5-1 mm wide

Neck
- Long and slender
 Scolex
- small, 0.3 mm in diameter, globular
(rounded), cup-like.
- Scolex situated at the anterior end, has
four suckers and retractile rostellum
with a single row of 20-30 hooks.
Genital pores
- unilateral (side of the segment)
- Each mature segment contains three
- Testes

- They have 100-200 segments that are

wider then they are long
- Gravid (mature, full of eggs) proglottids
are 0.2-0.3 mm long and 0.8-0.9 mm
wide.
- Proglottid is filled with eggs,
- Each proglottid has both male and
female reproductive organs making
Hymenolepis nana hermaphroditic.
- A proglottid copulates with itself or
with other segments of the same
individual or nearby H.nana.
- Proglottids usually disintegrate in the
gastrointestinal tract and are rarely
present in the feces.

Egg - colourless, almost transparent, round

to oval, 30-50 m in diameter, has polar
filaments.
- When shed in stool they are
immediately infective and survive up to
10 days in the external environment,
- they are embryonated pund have a 6-
hooked
- oncospheres inside the shells.
- Shell consists of two distinct
membranes. On inner membrane there
are two small "knobs" or poles from
 which 4-8 filaments arise and spread
out between the two membranes.

Hymenolepis diminuta (Rat tapeworm)

- resembles that of H. nana.

- Hymenolepis worms are often found in rat intestines.
- The secondary host is the beetle, particularly those who consume rat feces.
- Mild gastrointestinal distress may be encountered but the infected individuals are most
often asymptomatic.
- Symptoms are generally mild with occasional bouts of nausea.
- Minimal abdominal cramps and pain may be experienced by some.

Treatment and prevention:

- Treatment for H. diminuta infections is usually the administration of niclosamide, but

praziquantel is also a drug of choice.
- Prevention entails cleaning areas of food storage, rodent control, and sanitary practices in
food handling and personal hygiene. These practices, however, are greatly curtailed in low
socioeconomic settings and in poor countries.
Diphyllobothrium latum (The Broadfish Tapeworm) or Dibothriocephalus latus

Intermediate host 1. Copepods (water flea)

2. Fish
Definitive host Bears, cats, dogs, and humans (several fish
eating mammals)
Infective stage for mammal plerocercoid larva, which is ingested in raw or
undercooked fish.
- Larvae attach to the mucosa lining of
the small intestine and develop to
adults.
Diagnostic stage eggs or proglottids in feces.
Morphology - largest tapeworms that can infect
people Adult worms are up to 15
meters in length.
Scolex
- almond shaped with a pair of suctorial
grooves, known as bothria.
Proglottids
- rosette shaped uterus; the uterine pore
is centrally located, not lateral as with
Taenia spp.
Eggs
- measure 30 x 60 microns, and exhibit
an operculum (this is the only cestode
with an operculated egg).
- the largest tapeworms that can infect
people
- Complications include intestinal
obstruction and gall bladder disease
caused by migration of proglottids.
- Diagnosis is made by identification of
eggs or segments of the tapeworm in a
stool sample with a microscope.
- Safe and effective medications are
available to treat Diphyllobothrium
- Infections are acquired by eating raw or
undercooked fish,
- Fish infected with Diphyllobothrium
larvae may be transported to and
consumed in any area of the world.
- Adequately freezing or cooking fish will
kill the parasite.
Clinical Manifestations - Most infections are asymptomatic.
However, symptoms can include
abdominal discomfort, diarrhea,
vomiting, and weight loss.
- Vitamin B12 deficiency leading to
pernicious anemia may occur.
 - Complications include intestinal
obstruction and gall bladder disease
caused by migration of proglottids.
Biology Causal agents - These pseudophyllidean cestodes have
a scolex bearing bothria (grooves),
instead of suckers as in the
cyclophyllidean cestodes (the group
including nearly all human-infecting
species).
- All species associated with human
diphyllobothriid infections have marine
or aquatic life cycles and transmission
occurs via ingestion of undercooked
fish.
Major Pathology - Intestinal obstruction.
- Many people exhibit vague diagnostic
symptoms such as weight loss and
weakness.
- May cause a macrocytic anemia and
eventual nervous system disturbances
due to vitamin B12 deficiency. The
worm has affinity for vitamin B-12, and
can selectively absorb it.

PREVENTION

- Do not eat raw or undercooked fish. The FDA recommends the following for fish preparation or
storage to kill parasites.

Cooking -Cook fish adequately (to an internal temperature of at least 145° F [~63° C]).

Freezing At -4°F (-20°C) or below for 7 days (total time), or At - 31°F (-35°C) or below until solid, and
storing at -31°F (-35°C) or below for 15 hours, or At -31°F (-35°C) or below until solid and storing at -4°F (-
20°C) or below for 24 hours.