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Cestodes

Learning Objectives
At the end of this lecture, the students must be
able to apply to concepts of cestode parasitism
1. Identify the medically important Cestodes based on
Epidemiology
Morphology

2. Correlate the life cycle with respective clinical features


Mode of transmission
Pathogenesis
Symptomatology, Diagnosis and management

Lecture Outline
I.

Introduction to Cestode Biology

II. Cestode Classification


III. Medically-important Cestodes

Cestodes (Tapeworms)
General Characteristics
Two Main Features
1. Tapeworms

Segmented and Dorsoventrally flattened


Size varies from a few
mm to several meters

2. Lacks alimentary
canal

Cestodes (Tapeworms)
Habitat Preference
Adult worms inhabit
alimentary canal of
their hosts

Larvae show wide


range of habitat
preferences
Found in almost any organ
of both vertebrate and
invertebrate hosts

Cestodes (Tapeworms)
Three Main Morphologic Regions

1. Head or scolex

Suckers (sometimes with


hooks) serve as organs of
attachment

Cestodes (Tapeworms)
Three Main Morphologic Regions
2. Neck

Small narrow
undifferentiated part
behind the scolex

Hinder end (Area of


segmentation) adds new
segment to strobila or the
main body and the event
is strobilization

Cestodes (Tapeworms)
Three Main Morphologic Regions
3. Strobila

body or trunk consists of


series of segments (8001,000) called proglottids

Last gravid segments


usually detach one by
one from the body and
pass out with the feces of
the host (phenomenon is
known as Apolysis)

Cestodes (Tapeworms)
Cestoidean Biology
Alimentary canal is entirely absent
Lack digestive system differentiates tapeworms from
nematodes & trematodes
Once anchored to hosts intestinal wall, adult worms
absorb food from hosts intestine
habitat associated with high nutritional levels ensuring
high growth rate

Cestodes (Tapeworms)
Cestoidean Biology
Alimentary canal is entirely absent
Outer tegument of body serve not only as protective
coating but also as metabolically active layer
nutritive material can be absorbed, along with secretions and
waste material to be transported out of body
each segment contains independent absorption system

Cestodes (Tapeworms)
Cestoidean Biology
Nerve Center
Cerebral ganglion in its scolex
Motor and sensory innervation

Smaller nerves emanate from commissures to supply


general body muscular and sensory ending
cirrus and vagina are innervated, and sensory endings around
genital pore are more plentiful than other areas
Sensory function includes both tactoreception and
chemoreception.
Some nerves are only temporary

Cestodes (Tapeworms)
Cestoidean Biology
Body cavity is absent
Excretory organs
Flame cells (protonephridia) located in proglottids

Sexes are not separate


Reproductive system present and complete in each
segment

Cestodes (Tapeworms)
Cestoidean Biology
According to maturity of reproductive organs,
three types of segments of the strobila can be
recognized from the front backwards
1. Immature:
= first 200 segments
male and female organs are not differentiated

Cestodes (Tapeworms)
Cestoidean Biology
2. Mature:

male and female organs have become differentiated


male organs appear first at around 200th proglottid
=250th - 600th proglottid

3. Gravid:
. Tail proglottids
. all organs including sex organs are atrophied or have
disappeared due to distended uteri filled with eggs
. Gravid proglottids are oldest and are longer than broad and
have fertilized eggs only within branched uterus

Cestodes (Tapeworms)
Cestoidean Biology
Reproductive organs
Hermaphrodites: male and female reproductive
systems present in their bodies
Mature hermaphroditic segments can reproduce
independently

Cestodes (Tapeworms)
Cestoidean Biology
Reproductive organs
Each segment contains reproductive tract
Male: one or many testes, cirrus, vas deferens and seminal
vesicle
Female: single lobed or unlobed ovary with the connecting
oviduct and uterus
Genital pore: There is a common external opening for both
male and female reproductive systems

Cestodes (Tapeworms)
Cestoidean Biology
Reproductive organs
Older segments are pushed toward tip of the tail as new
segments are produced by neckpiece
Even though they are sexually hermaphroditic, selffertilization is a rare phenomenon
To permit hybridization, cross-fertilization between two
individuals is often practiced for reproduction.
During copulation, cirrus of one individual connects with that
of other through genital pore, and then exchange their
spermatozoa

Cestodes (Tapeworms)
Cestoidean Biology

Cestodes (Tapeworms)
Life Cycle
No asexual phases
Two-phase life cycle with two types of host
1. Adult lives in digestive tract of a definitive
(vertebrate) host
2. Juveniles live in bodies of (at least one) intermediate
host
Except for Hymenolepis nana, which can develop directly in
same host
Juveniles cause more damage to intermediate host than
adults do to definitive host

Cestodes (Tapeworms)
Classification

Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order
Amphilinidea, Gyrocotylidea, Eucestoda,
Aporidea, Caryophyllidea, Cyclophyllidea,
Diphyllidea, Lecanicephalidea, Litobothridea,
Nippotaeniidea, Proteocephalidea,
Pseudophyllidea, Spathebothriidea, Tetraphyllidea,
Trypanorhyncha

Cestodes (Tapeworms)
Medically-Important Cestodes
Egg / Ova

Pseudophyllidae

Cyclophyllidae

Operculated

YES

NO

Gives rise to ciliated larvae

YES

NO

Water

Intermediate host

Immature when
oviposited

Fully emryonated
when released
from gravid
segment

TWO

ONE

ONLY Place of Development


Maturity

Larval development: # of host

Cestodes (Tapeworms)
Medically-Important Cestodes
Pseudophyllidae

Cyclophyllidae

Scolex

2 slit-like grooves

4cup-like suckers

Uterus

No branching
Convoluted uterine tubes
assume the form of rosettes

Branching
May or may not be present

Uterine
Pore

Present

Absent

Common
Genital
Pore

Ventral; in the midline

Lateral

Cestodes (Tapeworms)
Egg / Ova
Pseudophyllidae

thin shell wall and operculum


which on hatching opens to
release the free swimming larvae

Eggs are operculated


Develop only in water
immature when oviposited
oncosphere gives rise to
ciliated embryo

Larval development
proceeds in two
intermediate hosts:

closely resembles that of trematodes

First larval stage is called


procercoid
Second larval stage is called
plerocercoid

Cestodes (Tapeworms)
Head / Scolex

Pseudophyllidae
Possess false or slitlike grooves called
bothria

Bothria

Cestodes (Tapeworms)
Pseudophyllidea
Adult worms in Intestine
Diphyllobothrium latum

Larval stages: Plerocercoid in Man


Sparganum mansoni
Sparganum proliferum

Cestodes (Tapeworms)
Pseudophyllidean Larval Morphology
CORACIDIUM
Ciliated aquatic embryo of
pseudophyllid and other cestodes
with aquatic cycles
w/in ciliated embryophore is
hooked larva (hexacanth)
develops in first intermediate
host or IH (usually an aquatic
crustacean like copepod water
flea) into next larval stage
(procercoid)

Cestodes (Tapeworms)
Pseudophyllidean Larval Morphology
PROCERCOID

First larval stage

tailed larva develops in body


cavity of crustacean first IH
When procercoid and its host
are ingested by second IH
(usually fish), procercoid
enters new host's tissues
Develops to become
plerocercoid.

Cestodes (Tapeworms)
Pseudophyllidean Larval Morphology
PLEROCERCOID

Second larval stage

Infects a wide range of


vertebrate hosts including fish,
amphibia, reptiles, mammals,
birds
Develops in 2nd IH into
elongated solid body with adult
scolex
Infectious stage: eating tissues
of second intermediate host
infects definitive host (man)

Cestodes (Tapeworms)
Egg / Ova
Cyclophyllidae

Eggs are not operculated


Develop only in the
intermediate host
fully embryonated when
escape from the rupture or
disintegration of ripe segments
Oncosphere is never a ciliated
embryo

In contrast have a very thick,


resistant egg shell, with no
operculum

Larval development
proceeds in one
intermediate host

Lets Review!
Egg / Ova

Pseudophyllidae

Cyclophyllidae

Operculated

YES

NO

Gives rise to ciliated larvae

YES

NO

Water

Intermediate host

Immature when
oviposited

Fully emryonated
when released from
gravid segment

TWO

ONE

ONLY Place of Development


Maturity

Larval development: # of host

Cestodes (Tapeworms)
Head / Scolex
organs for attachment:
Rostellum , hooks & 4 suckers

Cyclophyllidae
Possess cup-like and
round suckers called
acetabula

No role for catching food

Cestodes (Tapeworms)
Cyclophyllidea
Adult Worms in the Intestine

Taenia saginata
Taenia solium
Hymenolepis nana
Hymenolepis diminuta
Dipylidium caninum

Larval Stages in Man


Hydatid cyst of Echinococcus granulosus and Echinococcus
multilocularis
Cysticercus cellulosa of Taenia solium
Coenurus cerebralis of Multiceps multiceps
Coenurus glomeratus of Multiceps glomeratus

Diphyllobothrium latum
Classification
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda Subclass: Eucestoda
Order: Pseudophyllidea
Family: Diphyllobothriidae
Genus: Diphyllobothrium
Species D. latum
D. pacificum, D. cordatum, D. ursi, D. dendriticum,
D. lanceolatum, D. dalliae, D. yonagoensis;
D. Nihonkaiense, D. klebanovskii

Diphyllobothrium latum
Classification
tapeworm which can cause Diphyllobothriasis in (high
risk) humans through consumption of raw or
undercooked fish (sushi, sashimi, carpaccio di persico,
tartare maison, ceviche, marinated herring , KILAWIN)
with plerocercoid larvae
A.k.a broad or fish tapeworm, or broad fish tapeworm
D. latum: Scandinavia, western Russia, Baltics, North America,
D. klebanovskii: Far East Russia (Pacific salmon as second
intermediate host)
D. dendriticum (the salmon tapeworm), D. pacificum, D.
cordatum, D. ursi, D. lanceolatum, D. dalliae, D. yonagoensis (all
infect humans only infrequently)
D. nihonkaiense = D. klebanovskii: Japan

Diphyllobothrium latum
Ova
knob
Inconspicuous
operculum

Oval Bile stained


Contains abundant
granules and
unsegmented

Passed out in the


hosts feces in large
numbers
Does not
float in saturated
solutions of common
salt

40-50um
A single egg gives
rise to a single larva
Not infective to man

60-75um

Diphyllobothrium latum
Larval Satges

Plerocercoid

Coracidium

Procercoid

Diphyllobothrium latum
Morphology: Adult Scolex and Neck
Neck is thin and unsegmented
and is much longer than the head

Neck: proliferative region

Scolex is spoon-shaped or spatulate

Scolex has no rostellum


and no hooklets

Each side (dorsal & ventral) has a slitlike groove (bothrium or tentacle)
for attachment to the small intestine

Diphyllobothrium latum
Morphology: Adult proglottid
Uterine glands are
widely scattered in the
parenchyma and is
composed of many acini
Midventral
genital
pore

Uterus opens to the


exterior through which
eggs come out

reproductive organs of the


worm
(In adults, proglottids are
wider than they are long

Diphyllobothrium latum
Morphology: Whole worm
Longest tapeworm in humans
(ave=10m long)
Adult worm is yellowish grey in
color
Adults can shed up to a million
eggs a day
Dark central markings in the
strobila are due to the egg-filled
uterus
Life-span is for a period of 5 to 15
years

Paratenic host
2nd I.H.
Fresh water fish:
pike, trout,
salmon, perch

Final Host:
Man, dog, cat

3 weeks

1st I.H.
Cyclops
or Diaptomus

> 1 week

3 weeks

Diphyllobothrium latum
Clinical Fetaures
Diphyllobothriasis: generally mild, includes diarrhea,
abdominal pain, vomiting, weight loss, fatigue,
constipation and discomfort
Incubation period: 46 weeks (2 weeks to 2 years) tapeworm
can live up to 20 years
80% asymptomatic; may go many years without being detected
Few lead to severe vitamin B12 deficiency due to parasite
absorbing 80% or more of the hosts B12 intake, and a
megaloblastic anemia indistinguishable from pernicious
anemia
Chronic infestation depletes vit. B12 resulting in anemia
which lead to subtle demyelinating neurological symptoms
(subacute combined degeneration of spinal cord)

Diphyllobothrium latum
Diagnosis & Management

Diagnosis
Fecalysis: proglottid segments, operculated eggs
PCR: for speciation

Treatment
Praziquantel: 510 mg/kg PO once (S/E: malaise, headache,
dizziness, abdominal discomfort, nausea, rise in temperature and
occasionally allergic skin reactions)
Niclosamide (alternative): 2 g PO once for adults or 50 mg/kg PO
once (both adults & children)

Diphyllobothrium latum
Prevention
1. Prevention of water contamination

Stop defecating in recreational bodies of water


Implementation of basic sanitation measures

2. Screening & successful treatment of people infected


with the parasite
3. Prevention of infection of humans via consumption of
raw, infected fish.

Proper preparation of fish (Fish thoroughly cooked,


brined, or frozen at -10C for 2448 hours)

Taenia
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Taeniidae
Genus: Taenia
Species: T. saginata , T. solium
Binomial name Taenia saginata (Goeze, 1782)
Taenia solium (Linnaeus, 1758)

Taenia
Epidemiology
T. saginata

Tapeworm of both cattle and


humans, causing taeniasis in
infected humans when they
eat undercooked beef

A.k.a. Taeniarhynchus
saginata or the beef
tapeworm
Africa, some parts of Eastern
Europe, Southeast Asia, and
Latin America where beef is
widely eaten

T. solium

tapeworm which in its larval


stage causes cysticercosis
which is a major cause of
seizures in humans

A.k.a pork tapeworm


It infects pigs and humans in
Asia, Africa, South America,
parts of Southern Europe and
pockets of North America; rare
in Muslim countries

Taenia
Morphology: Ova

Thick embryophore
with numerous tiny
pores

Morphologically same
for both Taenia
species; therefore is
not useful for
speciation

Taenia
Morphology: Scolex
T. saginata

T. solium

NO rostellum or scolex armature

(+) nonretractable
rostellum with 2
rows of 22-32
hooks

Four suckers

Cuboidal shape

Spheroidal shape

Taenia
Morphology: Proglottid
Mature proglottid
1,000-2,000
contains the uterus (unbranched), ovary, genital pore, testes, and
vitelline gland.
does not have a digestive system, mouth, anus, or digestive tract.
Acoelomate: does not have a body cavity.

Gravid proglottid
uterus is branched and filled with 97,000to 124,000 eggs
The gravid segments detach and are passed in the feces. Each of
these segments can act as a worm. When they dry up, the
proglottid ruptures, and the eggs are released.

Taenia
Morphology: Proglottid
T. saginata

T. solium

Taenia
T. Saginata vs T. solium
Characteristic

Taenia saginata

Taenia solium

Intermediate Host

Cattle, reindeer

Pig, wild boar

Site of Development

Muscle, viscera

Brain, skin, muscle

Scolex: adult worm

No hooks

Hooks

Scolex: cysticercus

No rostellum

Rostellum & hooks

Proglottid: uterine
branches

23 (14 32)

9 (7-11)

Passing of proglottids

Single, spontaneous

In groups, passively

Ovary

2 lobes

3 lobes

Vagina: sphincter
muscle

Present

Absent

Taenia
Morphology Adult
Normally 4 m to 10 m in
length, (up to 12 m)
1000 to 2000 proglottids
each with approximately
50,000 eggs
lifespan of 25 years in a
host's intestine

Cysticercus bovis

Final Host: Man

Cysticercus cellulosae

T. solium

Taenia
Clinical Features
T. saginata
Taeniasis usually
asymptomatic
Heavy infection:
weight loss, dizziness,
abdominal pain, diarrhea,
headaches, nausea,
constipation, or chronic
indigestion, and loss of
appetite.

Intestinal obstruction
Allergic reaction due to
some antigens

T. solium

Cysticercosis
Subcutaneous tissue >
eyes > brain > muscles >
heart > liver > lungs >
coelom

Neurocysticercosis

Taenia
Clinical Features
Cysticercosis
Ingestion of eggs or
proglottid rupture within
the host intestine can
cause larvae (cysticerci or
baldder worms) to migrate
into host
Severe inflammation when
cysticercus dies may be
fatal if brain is involved
3 types: ordinary fluidfilled bladder cellulose,
intermediate with
scolex, and large
racemose without scolex

Taenia
Clinical Features
Neurocystercosis
Cysticercosis in CNS causing
epilepsy, seizures, lesions in
brain, blindness, tumor-like
growths, and low eosinophil
levels, hydrocephalus,
paraplegy, meningitis,
convulsions and even death
Other S/Sx: headaches,
dizziness, sensory deficits,
involuntary movements,
ocular cystation, brain system
dysfunction, occasional
seizures, dementia or
hypertension

Severity depends on location,


size, number of parasite larvae
in tissues, and host immune
response

Taenia
Diagnosis
T. saginata

T. solium

Fecalysis

Biopsy of the infected tissue


Fecalysis.

Eggs (Family level)


Scolex or the gravid proglottids
can help identify species level
uterine branches enables some
identification (Taenia saginata uteri
have 15 to 20 branches on each
side, while other species such as
Taenia solium only have 7 to 13);
in addition, the ovaries are bilobed
and testes are twice as many

PCR

eggs (family level) and proglottids


(species level) found in feces diagnoses
taeniasis and not cysticercosis
Cysticercosis is diagnosed primarily on
confirming the presence of hooks on
the scolex of T. solium

Adjunctive radiological imaging


tests
X-ray, CT scans demonstrate calcified
larvae in subcutaneous, muscle tissues
and "ring-enhancing brain lesions
MRI detect cranial cysticercosis

Taenia
Management
Treatment
Praziquantel 5-10mg/kg single dose
Criteria for cure: Recovery of the scolex & Negative stool examination 3 months after
treatment

Niclosamide
Albendazole combined with steroids reduces the inflammation in
cysticercosis
Surgical intervention may be necessary to treat CNS lesions

Prevention
1. Adequate cooking of meat (>56C)
2. Freezing the meat at 5C for 7 days
3. High level of personal hygiene
4. Prevention of fecal contamination of pig foods

Echinococcus granulosus
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Taeniidae
Genus: Echinococcus
Species: E. granulosus
Binomial name Echinococcus granulosus (Batsch, 1786)

Echinococcus granulosus
Epidemiology
Tapeworm which parasitizes small intestine of canids as
an adult, but causes hydatid disease in intermediate
hosts such as livestock and humans through accidental
ingestion of food or other substances contaminated with
dog feces
A.k.a. Hydatid worm, Hyper Tape-worm, Dog Tapeworm

Echinococcus granulosus
Morphology: Ovum

Embryophore with
Double layer & striated
Outer layer

Hexacanth
oncosphere

Ovoid-round
Without
operculum

30-40 um

Note: ovum
morphologically
similar to Taenias

Echinococcus granulosus
Morphology: Scolez
4

29-50

30 mm

Echinococcus granulosus
Morphology: Adult Worm
Single, lateral
Equatorial genital
pore

0.5 mm

Uterus: irregular
lateral sac
2-7 mm
2 oval ovaries
46-60 minute
Spherical testes

2 months

Echinococcus granulosus
Clinical Features
Hydatid disease:
liver enlargement, hooklets
in sputum and possible
anaphylactic shock when
immune system reacts to
ruptured cysts

Echinococcus granulosus
Diagnosis and Management
Diagnosis
Cyst seen with ultrasound,
MRI, or
immunoelectrophoresis
Microscopy cannot
differentiate from Taenia and
Echinococcus eggs
Detection of antigens in feces
(coporoantigen) by ELISA is
currently the best available
technique.
Newer techniques like PCR is
also used to identify the
parasite from DNA isolated
from eggs or feces

Echinococcus granulosus
Management
Management
Treatment: Surgical
removal of the hydatid
cysts, taking special care
to leave the cyst intact so
new cysts do not form, and
mebendazole /
albendazole over a long
period of time at low
dosages
Prevention: Avoid ingesting
food or other substances
contaminated with dog
feces

Hymenolepis nana
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Hymenolepididae
Genus: Hymenolepis
Species: H. nana
Binomial name Hymenolepis nana
Hymenolepis diminuta (Rudolphi,
1819)

Hymenolepis
Epidemiology
H. nana

smallest cestodes of humans,


especially children causing
hymenolepiasis

A.k.a. Dwarf tapeworm and


previously known as
Vampirolepis nana,
Hymenolepis fraterna, and
Taenia nana

H. diminuta
tapeworm that infects mammals
using insects as intermediate
hosts and causes hymenolepiasis
A.k.a rat tapeworm
H. diminuta is prevalent
worldwide, but only a few
hundred human cases have been
reported.
Australia, United States, Spain, Italy,
Malaysia, Thailand, Jamaica,
Indonesia

Hymenolepis
Morphology: Ova
H. nana

H. diminuta

30 - 47 m
thin, hyaline, outer
30 - 47 m
Membrane hyaline
shell

6 hooks

No striated
embryphores
70-85mm
inner, thick membrane with
polar thickenings that bear
several filaments

no polar filaments extending


into the space between the
oncosphere and the outer
shell

Hymenolepis
Morphology: Scolex
H. nana
single circle of
5 rostellar
hooklets are
shaped like
tuning fork

Retractable
rostellum remains
invaginated in
apex of the organ

H. diminuta
Rostellum has NO hooks

Neck is long
and slender,
the region of
growth

Hymenolepis
Morphology: Proglottid
H. nana

H. diminuta

segments are wider than long; Genital pores are


unilateral, and each mature segment contains
three testes and 1 ovary

40 mm long and 1 mm wide

Up to 90 cm

4 weeks

H. nana

Hymenolepis
Clinical Features
Light infections are usually symptomless
Heavy infection due to autoinfection results in deprivation of
nutrient absorption in immunocompromised children
>2000 worms can cause enteritis, abdominal pain, diarrhea, loss of
appetite, restlessness, irritability, restless sleep, anal and nasal
pruritus. Rare symptoms include anorexia, increased appetite,
vomiting, nausea, bloody diarrhea, hives, extremity pain, headache,
dizziness and behavioral disturbances. Occasionally epileptic seizures
occur in infected children

Allergic responses or systematic toxemia caused by waste


products of the tapeworm

Hymenolepis
Morphology: Diagnosis, Treatment & Prevention
Diagnosis

Fecalysis identify eggs

Treatment

Praziquantel
both adult worms and larvae

Niclosamide

Prevention

Preventing fecal contamination of food and water in institutions and


crowded areas
General sanitation and rodent and insect control (especially control
of fleas and grain insects)

Dipylidium caninum
Scientific classification
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Cestoda
Order: Cyclophyllidea
Family: Dipylidiidae
Genus: Dipylidium
Species: D. caninum
Binomial name Dipylidium caninum

Dipylidium caninum
Epidemiology
Tapeworm that infects organisms afflicted with
fleas, including canids, felids, and pet-owners,
especially children. Adult worms are about 18
inches long.
A.k.a. cucumber tapeworm or the double-pore
tapeworm

Dipylidium caninum
Morphology: Ova
Eggs hatch and
form oncospheres
With 6 hooks
Egg packet
contain
8-15 eggs

Dipylidium caninum
Morphology: Scolex

Four suckers

Retractable
pointed
rostellum with
four rows of
hooks

Dipylidium caninum
Epidemiology

genital pores on both sides


(Each side has a set of male
and female reproductive organs

Dipylidium caninum
Clinical Features, Diagnostics, Treatment & Prevention
Clinical Features

Similar to Hymenolepis

Diagnosis

Fecalysis: Identification of proglottids

Treatment

Niclosamide or praziquantel

Prevention

treat infected animals and to kill dog fleas & lice

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