 Genus Echinococcus
filled cyst
Belong to family Taeniidae
Contains 3 species for which humans are host to
the larval stage (hydatids)
o E. granulosus
o E. multilocularis
o E. vogeli
Share the same Life cycle, Diagnosis, Treatment
and Prevention & Control
Epidemiology:
o primarily involves parasitized
members of the canine family
o most important specie producing
human disease
o infection of this parasite is very rare
in the Phil
 Hydatids or hydatid cysts
o larval stage / Infective stage
o are large, roughly spherical, fluid
filled
hollow bladders
o cyst wall consists of:
 outer laminate hyaline wall,
supporting the whole
cyst
 Inner germinal layer studded
with
developing brood
capsules
o the protoscolices are formed within
the brood capsules, which may
rupture to give off free
protoscolices in the fluid filled cyst
o Thousands of protoscolices can fill
the hydatid
o Hydatid cyst usually grow slowly
but steadily (1-5 cm per year)
producing protoscolices and
daughter cysts that fill the cyst
interior, they are usually well
tolerated until their size becomes a
problem or they rupture
o Cyst rupture or leakage can result
in allergic reactions and
metastasis
 Hydatid sand
o From the inside surface of the fluid
grow hundred of protoscolices
which bud off
and fall to the bottom of the cysts,
forming
hydatid sand
o a granular material, consisting of
free
 protoscolices, daughter
cysts, and amorphous
materials which is found in
older cysts
o sometimes aspirated for diagnostic
purposes
 3 forms hydatid cyst :
o Unilocular hydatid cyst
 Unilocular hydatid disease
( E. granulosus)
o Multilocular/alveolar hydatid cyst
 Multilocular/alveolar hydatid
disease (E. multilocularis)
o Polycystic hydatid cyst
 Polycystic hydatid disease (E.
vogeli)
 Echinococcus granulosus
Syn: Dog tapeworm, Hydatid worm
Disease: Unilocular Echinococcosis,
Unilocular Hydatid Disease
 Intermediate host: sheep, goat, ,ox
 Definite host: dog
Humans: accidental intermediate host
 Hydatid disease in man is caused
principally by infection with the larval
stage
Geog. Dist:
o Worldwide
o Chiefly Russia, Siberia, Bavaria,
Tyrol
o heavy infection occurs in sheep
raising areas of the world, South
America, Iceland, Tasmania, Africa,
Asia
 Adult
measures 0.25cm – o.9cm (ave 0.6cm)
o Only 3 proglottods: 1 immature, 1
mature and 1 gravid proglottids
Scolex
 o globular shape with 4 prominent
cup-shaped suckers
o rostellum - armed with 2 circular
rows of 28-50 large and small
hooklets
Mature proglottids
-more elongated, and contains fully
developed reproductive organs w/c consist of
pyriform testes, 45-65 in number, and located
anterior to cirrous sac
-Bilobed ovary at the posterior portion
o Club –shaped uterus
 Gravid proglottids
• longer than wide; Biggest segment
of the strobila
• Uterus at median, gives rise to 12-
15 lateral uterine pouches filled with
eggs
 Egg
• spherical shaped, with radially
striated embryophore
• Cannot be distinguished from those
of Taenia spp.
• This genus compensate their very
minute size by producing thousands
of eggs
 MOT:
o Accidental ingestion of tapeworm
eggs excreted in the feces of
infected dogs
o Intimate association with dogs
o Contaminated fingers and food
o 2° seeding from ruptured cyst
 Pathogenesis:
o disease will vary in their
seriousness depending on where in
the body the hydatid develops, and
how large it grows
Sometimes the infection is asymptomatic, the
only evidence of infection being the presence of
calcified cysts on autopsy after death due to an
unrelated cause:
o the major pathology is due to the
size
of the cyst, giving rise to pressure
related injury by expanding
o of hydatid cyst
 cysts can grow to be the size
of a
o softball or basketball, and may
o contain several smaller "balloons"
o inside the main cyst
 Pressure effects can cause
local
tissue damage and
obstruction
-Leakage of hydatid fluid synsitizes the patient
and elicit eosinophilia
-a complication may arise if the cyst is ruptured,
possibly due to blows to the body, muscular
strain, or during operation
-the hydatid cyst fluid is highly allergenic and
cyst rupture may
-result in severe allergic manifestations,
anaphylactic shock and rapid death
o deadliest tapeworm parasitizing
humans
 Diagnosis:
o Stool exam – charac. Ova & gravid
segments
o X-ray, CT scan, Ultrasound –
demonstate hydatid cyst
o serological – Indirect HAI, ELISA, CF
o Liver puncture
o Blood smear – eosinophilia
 Therapeutic Modalities:
o Surgery: leaking cysts, infected
cysts, multiple daughter cysts
o Chemotherapy: Albendazole -
inoperable, in-aspiratable
 Praziquantel – active protoscolicidal agent
o Ivermectin – injected directly into
cysts was found to kill
protoscolices in experimental
animals
o Observation: extreme age, much
calcification, well padded small
cysts
o Percutaneous aspiration & drainage
of hydatid cyst of the liver & lungs
 Prevention & Control:
o Avoid fondling of infected dogs
o Strict personal hygiene
o Avoid eating contaminated foods
 o Dogs should be dewormed growth through the infected organ
periodically with Praziquantel every replacing that organ tissues
6 wks
-minor morphologic difference between hydatid
cyst and alveolar cyst
Echinococcus multilocularis
Syn: Dog tapeworm, Hydatid worm
Disease: Multilocular Echinococcosis Multilocular / Alveolar Hydatid Disease
 Multilocular / alveolar hydatid  Adults
disease o As with E. granulolsus the adult
recognized as distinct specie from E. tapeworm is usually
granulosus o non-pathogenic to its canine hosts
definitive hosts: primarily foxes and to a lesser  Larvae
extent dogs, cats, coyotes and wolves o MOT
intermediate host: rodents, mice  eating foods contaminated
 Man is an accidental host by the ingestion with feces of the hosts
of eggs  hunters can be infected while
more adaptations for colder climates handling foxes & wolves
 Adults o common site of development: liver
o very similar to E. granulosus, with next lung and other organ
a maximum length of -Growth in the vena cava or portal vein may lead
approximately 4mm, and consisting to metastases, usually to the lungs or brain and
of 4-5 proglottids other body organs
 Larvae -Prognosis is poor and depends on extend of
o the 'cyst' grows invasively by organ involvement
external budding, to proliferate in  the multilocular cyst is highly pathogenic
any direction, forming a diffuse due to its fast growth rate and invasive
nature, in extreme cases completely
replacing liver tissue thus simulating
E. E. granulosus hepatocellular carcinoma with local
multilocularis pressure effects and allergy
limiting thin Thick &
membran laminated
e Echinococcus vogeli
Syn: Dog tapeworm, Hydatid worm
germinal Grows Grows to the Disease: Polycystic Echinococcosis,
epitheliu externally, to internal cavity Polycystic hydatid disease
m proliferate in of the cyst -found in Central and Northern South America
any direction definitive hosts: bush dogs
and act like a Intermediate host: large rodents (pacas and
neoplasm with spiny rats)
local  Larvae - Similar to that of E. granulosus
infiltration or
 Adults - Similar to E. granulosus, but
even to
rather smaller; non-pathogenic
metastasize
-The germinal membrane of the hydatids
appearan Alveolar or Unilocular proliferates both inward, in the original cyst,
ce Multilocula cyst forming septa that divide it in many sections
r cyst and outwards to form new multi-chambered
Amount less more
of fluid
cysts – resulting in multiple vesicles (polycystic
hydatid cyst)
 The vesicles forming a polycystic hydatid
are relatively large and fluid filled
 In humans, hydatids are found in the liver,
but also the lungs, pleura, pericardium,
heart, intercostal muscles & diaphragm,
stomach, omentum and mesenteries
 Genus Hymenolepis
Belong to family Hymenolepidae
2 species:
Hymenolepis nana
Geog. Dist:
o cosmopolitan with highest infection in
tropics
o common in warm than cold region
o endemic in Central Europe, India, Latin
America and some Asian countries
Hymenolepis diminuta
Geog. Dist:
o cosmopolitan endemic in Japan, China,
Africa,Argentina, Russia, Latin America, &
USA
Hymenolepis nana
Syn: Dwarf tapeworm
Disease: Hymenolepiasis, Dwarf Tapeworm
Infection
Definitive host: house mouse, human
intermediate host: grain beetles
 infection is more common in children than
in adults
 It requires only one host but can also
cycle through two hosts
o has the unusual characteristic of
being able to complete its life-
cycle without the aid of the
intermediate host
o this makes H. nana the only
tapeworm in which an adult will
grow after the definitive host
ingests the eggs
 Adult
o measures 25-40mm length x 1 mm
width
o Smallest cestode infecting humans
 Scolex
o rhomboidal-shaped with 4 cup-
shaped suckers
o rostellum armed with 1 circle of 20
to 30 hooks
 Immature proglottids
o wider than long and trapezoidal-
shaped
 Mature proglottids
o wider than long
o 1 set of male & 1 set of female
reproductive organs
o 3 ovoidal testes arranged in
straight line with a bilobed ovary in
between
o penis - the elongate body near the
pore
o a compact vitelline gland and a
large uterus opening to a lateral
genital pore (as does the cirrus) on
the side of the segment
 Gravid proglottids
o wider than long
o saclike uterus completely filled with
80-180 eggs
o Also contains cirrous pouch,
seminal receptacle
 Egg
o thin and smooth outer shell
o Broadly ovoidal, hyaline & colorless,
30-47μm
o Usually liberated from the gravid
segments before they become
detached
o contain oncospere within a rigid
membrane with 2 polar thickenings
, from which 4-8 long and thin
filaments (polar filaments) spread
out between the two memb.
o These filaments are visible in the
space between the embryo and the
outer shell
 Infective stage: cysticercoid larva
o A small larva that develop from the
hexacanth larva of Hymenolepis
characterized by possession of a
single invaginated scolex but
 without the bladder characteristic o Drug of choice: Praziquantel
cycticercus 25mg/k single oral dose
alternative: Niclosamide daily for 5 days
life cycle:  Prevention & Control:
Adult worm develop following ingestion of o Proper personal hygiene
the egg by definitive hosts o Protect food from being
↓ contaminated with mice, grain
eggs hatch in the duodenum, releasing beetles
oncospheres
and lie in the lymph channels of the Hymenolepis diminuta
villi Syn: Rat tapeworm
↓ Disease: Hymenolepiasis, Rat tapeworm
oncospheres develops into a cysticercoid, infection
which attaches to  Larger than H. nana
↓
 primary zoonotic
the small intestine and matures into an
Definitive host: rats
adult
-Completion of the life cycle require an
↓
arthropod intermediate hosts: flour beetle, flour
gravid proglottids then release and pass
moths
out through feces along with eggs
 human is an incidental host, occasionally
↓
infected thru accidental ingestion of
A. MOT: an oral-anal cycle in which eggs
infected intermediate host that carry the
are passed from one human to another or
parasite in their body cavities
recycle externally in a single host or eggs
Infective stage: cysticercoid larva
can hatch and infect original host and
Morphology:
start cycle over
 Adult
↓
o H. diminuta is slightly larger,
B. MOT: internal autoinfection, whereby
eggs hatch within the gut and initiate a measures 20-50 cm long x 4mm
2nd generation infection without ever wide
exiting the host  Scolex
o small, club-shaped with 4 cup-
Hymenolepiasis / Dwarf Tapeworm shaped suckers and small
Infection rudimentary apical unarmed
rostellum
-Pathogenesis:  Mature proglottids
o Light infections are usually o same with H. nana
asymptomatic  Gravid proglottids
o When large number of worms are o sacculate-like uterus filled with
present: eggs
-Clin. Manifestations: abdominal pain, diarrhea, o Same with H. nana
headache, dizziness, anorexia, and various  Egg
nonspecific symptoms o Round or slightly oval, yellow-brown
color
o the shell is relatively thick, 60-80μ
 Diagnosis: in diameter
o Stool exam – characteristic egg o fine concentric striations in the
 Treatment: outer shell
 o space between the membranes is
smooth or faintly granular, inside is
the oncosphere enclosed in 2
membrane with 2 polar thickening
but no polar filaments

Life cycle:
The adult tapeworm is found in the host’s
small intestine
↓
Eggs are passed in the host’s feces
↓
Eggs are eaten by intermediate host
(flour beetle, flour moth)
↓
Oncosphere hatch and penetrate the
intestinal wall of intermediate host
↓
larva develops into ‘cysticercoid larva’ in
the body cavity
↓
of insects ingested by rodents or
accidentally by humans

Hymenolepiasis / Rat tapeworm infection

Pathogenesis:
o most asymptomatic but occasional
patients may have mild GI
complaints: nausea, anorexia,
diarrhea and abdominal discomfort
o no autoinfection
o Eosinophilia, anemia may also be
present
 Diagnosis: Stool exam – characteristic
egg
 Treatment: drug of choice:
 Niclosamide
 Praziquantel – equally
effective
 Prevention & Control:
o Proper rodent control measures
o Destruction of intermediate hosts
o Proper disposal of stools of infected
person