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Cestode Cysticercus cellulosae

 They are Hermaphrodite  Develop in multiple organs (most common tissue: striated muscle and brain)
Phylum: Platyhelminthes  5 years (reason below the statement)
Class:Cestoda  Upon death, Cystic fluid increases and causes increase tissue response and the
Intestinal larvae is calcified (calcification)
 Taenia solium (pork tapeworm) LIFE CYCLE
 Taenia saginata (beef tapeworm)
 Taenia asiatica (Tawian tapeworm)
 Hymenolepis nana (dwarf tapeworm)
 Hymenolepis diminuta (rat tapeworm)
 Diphyllobothrium caninum (dog or cat tapeworm or pumpkin seed tapeworm)
 Raillietina garrisoni
 Diphyllobothrium latum (fish or broad tapeworm)
Intestinal & Extra-intestinal
 Taenia solium (can be)
 Echinococcus granulosus
 Echinococcus multiocularis
 Sparganosis
Taenia solium (Pork Tapeworm).
Disease: Pork tape worm infection (Taeniasis)
Man may serve as both definitive and infective host
Intestinal and Tissue infection may occur
Does lead to cysticercosis.
Adult
 2 - 4 (7) meters long
 800 - 1,000 proglottids
Scolex (Head part)
 four suckers / acetabula
 Cushion-like rostellum armed with double crown of 25 - 30 large end small hooks
Strobia/Proglottids/Segments (Segment part of the body of the tapeworm; immature,
Diagnostic stage: Eggs or gravid proglottids in feces or undergarments
mature, gravid segments; has mature male and female reproductive organs; square)
Infective stage: Ingestion of raw or undercooked meat containing Cysticercus cellulosae
 similar to that of T. saginata but with accessory ovarian lobe (3 lobes of ovary);
Intermediate host: Pigs & Humans (could be if they ingest the eggs)
 NO vaginal sphincter; 3 lobes of ovary Definitive host: Humans
 FEWER follicular testes (scattered; 100 - 200)
Pathogenesis and Clinical Manifestation
 less active than T. saginata
Human Cysticercosis
 median club-shaped uterus
 Accidental ingestion of eggs (fecal – oral route)
 Genital Atrium/ Genital pore/ Genital Primordium alternate
 Eggs go to the tissue
Gravid Uterus
 Can be attained 10 weeks after infection
 7-15 lateral branches
Adult
 30,000 - 50,000 ova
 Capsulated; 5mm diameters
 undergo apolysis (disintegration) Intestinal infection
Eggs
 Ingestion of Cysticercus Cellulosae
 Eggs are passed in feces when gravid segements become apolysis (disentrigate)
 Mild to non-specific abdominal complaints
 confused with that of T. saginata (so we can say Taeina specie egg)
 Obstructions are rare (Proglottids are not that active)
 30-45 um; spherical or sub-spherical; oncospheres Neurocysticercosis (recovered in the brain tissue)
 thick brown striated embryophore and hexacanth embryo with 3 pairs of hooklets  Most serious manifestation
 ingested by hogs; released in the intestines
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 2 Types: Parenchymal and Extra-parenchymal  SEA, China

 Extra-parenchyma  India
o Sub-arachnoid  Cosmopolitan distribution
 Wright's most cysticercosis (most aggressive) Taenia asiatica (Taiwan Tapeworm)
Cyst located at the base of the brain
 Resembles T. saginata by morphology but close to T. solium appearance in
o Intraventricular aspinal (located in the 3rd and 4th ventricles )
cysticercus form (unique)
 Leads to obstruction and hydrocephalus
Adult
o Spinal
 Unarmed scolex
 Rare case
Gravid segment
Recovered other than the brain tissue
 11-32 branches arising from the main uterus
 Ophthalmic cysticercosis
Intermediate host: pigs, cattle, goats, wild boards & monkeys
 Muscular & subcutaneous cysticercosis
Definitive host: Humans
Symptoms depend on the number (how many) and size of the cysticercae and the
location of the infection Taenia saginata (beef tapeworm)
Common manifestations Disease: Beef tapeworm infection (Taeniasis)
 Convulsion with visual and other defects (common in cerebral cysticercosis) Man may serve ONLY as a definitive host
 Head ache and vomiting Only Intestinal Infection
CSF tap results Does NOT lead to cysticercosis.
 Increase opening pressure Adult
 Elevated protein  Habitat: Jejunum
 Decreased glucose  25 years
 Increase mononuclear cells  4 – 10 meters
 Increase Eosinophil (some cases)  1,000 – 4,000 proglottids
Scolex
Diagnosis
 Cubiodal without hooks and rostellum
 Specific diagnosis for the characteristic proglottids, eggs or the scolex
 4 promintent suckers
 Serological Test ( 75 – 100% sensitivity)
Mature segment
o Enzyme Linked Immunosorbent Assay (ELISA; serum and CSF)
 Square; Bilobed ovary
o Electro Immuno transfer dot (EITD)
o Western blot (detection of IgG & IgM anti cysticercus antibodies)  median club-shaped uterus
o Dot ELISA test (screening for cysticercosis)  high number of follicular testes (scattered; 300 to 400)
For Cysticercosis Gravid segment
 CSF examination  15-20 lateral branches
 CAT (computerized axial tomography) scans (definitive method) Note: Segments are pressed between 2 slides then add at the Genital Pore (to count the
lateral branches to differentiate T. solium and T. Saginata)
 MRI (Magnetic resonance imaging) scans
 97,000 to 124,000 ova
 Opthalmoscopy (ophthalmic cystecercosis)
 Annually worm may pass out 1,000,000 worms
 Tissue Biopsy
 More Active
Treatment
Eggs
 Praziquantel (DOC)
 Viable for weeks in the soil
 Niclosamide (not available in the PH)
Cysticercus bovis
For Cysticercosis
 will develop in 2 months
 Management depend on time, location, and the size of the cyst
 Ovoidal in shape; milky white
For Multiple parenchymal cystic lesions
 10mm in diameter
 Praziquantel & Albendazole
Note: This parasite is irritated by alcohol and passed out in feces
For Parenchymal forms
Same life cycle with T. solium except for possibility that the humans can acquire the
 Corticosteroid therapy
infection through accidental ingestion of egg
Epidemiology Infective stage: Ingestion of raw or undercooked meat containing Cysticercus bovis
 Latin America Diagnostic stage: Eggs or gravid proglottids in feces or undergarments
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Intermediate host: cow, cattle  retractable rostellum armed with 20-30 Y-shaped hooklets
Definitive host: Humans  175 to 220 segments
Pathogenesis and Clinical Manifestation  Prominent neck (long and slender)
Taeniasis Proglottids
 Usually 1 adult tapeworm  Mature forms 3 ovoid testes & 1 ovary arrange in a straight pattern across the
 Primarily located in small intestine segment
Common chief complaint  0.15-0.3 mm long x 0.8-1.0 mm wide
 Recovery of proglottids in the stool specimen Egg
 Mild irritation at the site of attachment  spherical or subspherical; colorless embryophore
 Very non-specific symptoms  30-47 um in diameter
 Obstruction (T. saginata is actively motile compared to T. Solium)  oncosphere has thin outer membrane & thick inner membrane w/ conspicuous
o Due to tangled proglottids in the intestine bipolar thickenings
o Bile & Pancreatic ducts  4-8 hairlike polar filaments
Diagnosis for Taeniasis  Significance: Hexicant embryo with 3 pairs of hooklets, polar thickenings with
 DFS pollar filaments embedded in the inner membrane of the polar thickening
 Injection of india ink through the genital pore Adult
 Concentration Techniques  4.0 cm long; lodge in the ileum
o FECT – useful for increasing the chance of demonstrating the eggs Life cycle
 Perianal swab – usually left in the perianal region when gravid segments are Direct Cycle
apolysed  Humans ingest the embryonated eggs from contaminated food and water
Treatment for Taeniasis Indirect Cycle
 Praziquantel  Eggs are ingested by the insect arthropods (rice (grain) beetles); accidental
Criteria for cure for Taeniasis ingestion of cysticercoid from the insect
 Recovery of Scolex
 Negative stool exam, 3 months after treatment
Epidemiology
 Cosmopolitan distribution
 Endemic in Ethiopia and East Africa
 Japan
 SEA
 Europe
 Australia
 Canada
 US
 More common in the Philippines
Prevention for Taeniasis
 Thorough cooking of meat
 Freezing at -20oc for 10 days (kills the cysticerci)
 Sanitary inspection of all slaughtered pigs, cows and cattle
Hymenolepis nana (dwarf tapeworm)
 Smallest tapeworm infecting humans
 Only human tapeworm that can complete its life cycle on a single host
 Infects mainly children; Doesn’t need an intermediate host to acquire the infection
 common parasite in mice; worldwide distribution
Scolex Infective stage: Ingestion of contaminated food, water, or accidental ingestion of insect
 Sub-globular; 4 suckers arthropods containing Embryonated egg
Diagnostic stage: Embryonated egg in feces
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Intermediate host: Rice (grain) beetles (Insect arthropods) LIFE CYCLE

Definitive host: Humans
Pathogenesis and Clinical Manifestation
Hymenolepiasis
 From patient’s immunological response to the presence of parasite
 Regulatory immunity may limit or clear the parasitic population spontaneously
Diagnosis for hymenolepiasis
 DFS
 Demonstration of characteristic eggs
 Concentration Techniques
Note: There are no proglottids in the diagnostic stage because proglottids are not recovered
due to degeneration prior to passage to stool
Treatment for hymenolepiasis
 Praziquantel (Follow up treatment after 2 weeks ; stool examination)
Epidemiology
 Southern USA, Latin America
 Mediterranean
 East Asia
 Philippines
 among children and young adults Infective stage: Ingestion of contaminated food, water, or insect arthropods containing
 Can also be found on mice and less frequently among rats. Cysticerci
Prevention for hymenolepiasis Diagnostic stage: Detection of eggs, scolex, proglottids
 Personal hygiene and environmental sanitation Intermediate host: Beetle, earwig
 Rodent control Definitive host: Humans
 Proper storage of food Pathogenesis and Clinical Manifestation
 Thorough treatment Hymenolepiasis
Hymenolepis diminuta (rat tapeworm)  Worm burden is relatively low
 Requires an intermediate host to acquire the infection  19 worms – highest number recorded in man
Adult  Clinical manifestations are minimal & nonspecific
 Larger than H. nana; 60 cm long Diagnosis for hymenolepiasis
 ADULT tapeworms develop in the small intestine  Identification of eggs in stool
 Rudimentary armed rostellum  Distinguished from H.nana by their circular shape, larger, size & lack of bipolar
Scolex filaments
 Hooklets are fan-like arrangement  Scolex morphology may aid in diagnosis
Proglottids Treatment for hymenolepiasis
 Mature forms 3 ovoid testes & 1 ovary arrange in a straight pattern across the  Praziquantel
segment Epidemiology
 Genital pores are unilateral; larger  Worldwide but more common among children than adults in poor communities
 GRAVID PROGLOTTIDS contain sac-like uterus filled with eggs. with rat infestation.
Egg  Can also be transmitted by accidental ingestion of grain beetles infesting dried
 Significance is similar to H. nana but with the absence of bipolar fillaments grains, dried fruits, flours & cereals
Prevention and Control for hymenolepiasis
 Rodent control Elimination of insect intermediate host
 Protection of food ( especially precooked cereals from such insects)
 Sanitary disposal of human waste
 Treatment of human cases
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Diphyllobothrium caninum Infective stage: Ingestion of flea containing Cysticerci (usually) or animals that contain the
Other Name infected fleas
 dog or cat tapeworm Diagnostic stage: Detection of gravid proglottids in single or in chain (usually) or egg packets
(sometimes); egg capsules (rarely found in stool); eggs (not so much)
 flea tapeworm
Intermediate host: Human flea (Pulex irritans), Cat flea, Dog Flea
 double-pore tapeworm
Definitive host: Humans, Dogs, Cats
 cucumber tapeworm
Pathogenesis and Clinical Manifestation
 pumpkin seed tapeworm
Adult Diphyllobothriasis
 Pale-reddish  Infection is rarely multiple
Scolex  symptoms are minimal
 4 suckers; small  Slight intestinal discomfort
 smaller and globular with four deeply cupped suckers  Epigastric pain
 protrusible rostellum, armed with 1-7 rows of rosethorn shapes hooklets  Diarrhea
 attaches in the intestines  Anal pruritus
Proglottids  Allergic reactions
 2 sets of male and female reproductive organs  Some are asymptomatic
 Bilateral genital pore (unique) Diagnosis for diphyllobothriasis
 Gravid form have a size and shape of a pumpkin seed  Recovery of characteristic gravid proglottids passed out singly or in chain.
 Gravid segments contain contain 8 – 50 eggs that are enclosed in embryonic  Gravid proglottids may crawl out of the anus.
membrane o They do not disintegrate in the intestines, thus making egg capsule
 Gravid form Remains intact when passed out in feces recovery rare.
Egg  Stool examination for the presence of egg capsules is not recommended
 spherical, thin-shelled Treatment for diphyllobothriasis
 six-hooked /hexacanth embryo/ oncosphere (24-40 um in diameter)  Praziquantel
 occur singly or in packets Epidemiology
 released by contraction of the proglottid or by its disintegration outside the host  European countries
Life Cycle  USA, Argentina
 Rhodesia
 China
 Philippines
 Infants &very young children usually infected (close contact with their pets)
 Adults are not commonly infected because of age tolerance against the parasite
Prevention and Control for diphyllobothriasis
 Periodic deworming of dogs & cats
 Insecticide dusting of dogs & cats are effective against fleas
 Health education on children
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Raillietina garrisoni Life Cycle

 appear in rice grains when passed out in feces
 associated with insect arthropods
 Direct infection doesn’t occur in humans as eggs are ingested by the intermediate
host
 Rarely seen in the Philippines
Adult
 60 cm long
Scolex
 2 alternating circular rows of 90 to 140 hammer-shaped hooks with an armed
rostellum
Proglottids
 White in color
 Gravid form contains bilobed ovary surround with 36 – 50 ovoid testes
 200 – 400 egg capsules with 1 – 4 spindle-shaped eggs
 Gravid segments may be ingested by the insect
Eggs
 Spindle-shaped Intermediate Host: trout, salmon, pike
Intermediate Host: flour beetle (Tribolium confusum) Definitive Host: Humans
Definitive Host: Humans Infective Stage: Ingestion of raw or undercooked fish containing the plerocercoid
Infective Stage: Accidental Ingestion of arthropod insects containing the cysticerci Diagnostic stage: Unembryonated eggs in stool
Diagnostic stage: Proglottids or ova in stools Note: Freshwater fish ingests the crustaceans containing the procercoid larvae developing
Pathogenesis and Clinical Manifestation into plerocercoid larva/sparganum
 Asymptomatic Pathogenesis and Clinical Manifestation
Treatment  Anemia that is similar to Vitanim B12 Deficiency
 Praziquantel Hematologic finding: hyperchromic, megaloblastic anemia, thromboctypenia, &
Note: Worms may be expelled spontaneously leukonpenia
Diphyllobothrium latum (fish or broad tapeworm) Diagnosis for diphyllobothriasis
 DFS finding the operculated egg
Disease: Diphyllobothriasis, fish tapeworm infection, broad tapeworm infection
Adult  Kato technique
 3 – 10 meters in length; 4000 proglottids  Examination of gastric juice for the presence of free Hydrochloric Acid
Scolex o Use to differentiate pernicious anemia from infection, D. latum
 Spatulate due to its out of shape sucking grooves Treatment for diphyllobothriasis
 2-3mm in length by 1mm in diameter  Praziquantel
Criteria for cure
 2 suckers/bothria (dorsally and ventrally located)
 Recovery of scolex in stool after treatment
Proglottids
 Repeat stool exam after 3 months
 Mature form has longer
Prevention and Control for diphyllobothriasis
 Gravid form has Dark, rosette-like, coiled uterus located in the middle stained with
carmine stain  Avoid ingestion of raw or improperly cooked fish
 Ovary is symmetrical & bilobed  Thorough cooking of fresh water fish
 Proglottids only disintegrate when segment has completed its reproductive function  Freezing for 24-48 hours at -18oc
Egg o kills the plerocercoids (Controlling source of infection)
 Operculum; Think shelled; Yellowish-brown color  Proper disposal of sewage & marketing fish
 Terminal knob opposite to the operculum
 1,000,000 ova daily
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Echinococcus granulosus (hydatid worm) Clinical specimen: Hydatid sand (is a mixture of protoscoleces that is released from the
Disease: Echinoccocosis, Hydatid disease, Hydatidosis hydatid cyst)
 Unilocular hydatids develops as single cysts in the liver and lungs Pathogenesis and Clinical Manifestation
Note: only have 3 segments (unique)  When there is rupture in the hepatic cyst in the biliary duct
Scolex – neck – Immature segment – Mature segment – Gravid segment (largest and longest) o Intermittent Jaundice
Adult o Fever and Eosinophilia
 3 – 6 mm in length o Sometimes Cyst may rapture upon coughing
Scolex o Peribronchial cysts may discharge into a bronchus and result in sudden
 prominent rostellum with a double crown of 28-40 large & small hooklets + 4 coughing accompanied by allergic symptoms
prominent cup-like oval suckers  Sputum sample may contain frothy bloody, mucus, hydatid fluid
 globular, 0.3 mm in diameter  Involvment in the brain
 narrows posteriorly to form a slender neck o Increased intracranial pressure
Eggs o Jacksonian epilepsy
 Similar with Taenia species  Renal Involvment
Hydatid Cyst o Intermittent pain
 Can be found in Lung, Liver, Cardiac, Spleen, Bone, & Brain (worse) Tissue o Hematuria
Note: Humans can acquire the infection when we eat the meat containing the hydatid cyst o Kidney Dysfunction and hydatid material in urine
Developing larval cyst in tissue  Secondary infection when bacteria enter the cyst that leads to pyogenic abscess
 70% cases in liver formation
 22% - 30% cases in lung Unilocular hydatid cyst
 10% brain, etc.  Infection of E. granulosus
Alveolar cyst
Life Cycle
 Echinococcus multilocularis
Diagnosis
 Radiographic imaging studies (primarily)
 Ultrasonography
 Positive Serological test ( 60 – 90% sensitivity)
Treatment
 Surgical resection (treatment of choice)
Sparganosis
Genus: Spirometra
Larval infection with a plerocercoid larva also known as spargana of pseudophyliidean
tapeworms
Commonly involved in human sparganosis
 Spirometra mansoni
 Spirometra erinacei
 Spirometra ranarum
Humans can acquire infection via 4 routes
 Drinking water containing Cyclops or copepods infected with procercoid larvae
 Eating infected second intermediate hosts like fish, frogs, toads or snales containing
the plerocercoid larvae
 Applying plerocercoid infected flesh of frogs and snakes as poultices in sores in the
eyes, vagina and skin resulting in subsequent penetration into cutaneous tissues
Intermediate Host: trout, salmon, pike
 Consumption of infected flesh of paratenic hosts like wild pigs
Definitive Host: Humans
Infective Stage: Accidental Ingestion of feces containing the Embryonated egg
Diagnostic stage: Hydatid cyst in liver, lungs, etc
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Life Cycle Reincarnated by: MEMEKING2k17

“Don’t feel bad in failing, at least you succeed in failing.
What I’m trying to say is that at least you gave it your all
and I’m sure the experience of failing will surely lead
you to the heights of experience that you will never
experience it until you fail continuously in life”
–MEMEKING2k17
Good luck may the Gods Bless you~ 

Intermediate Host: Crustaceans

Second Intermediate Host: Dogs, Cats, Frogs, Snails, or Toads
Definitive Host: Humans
Infective Stage: Ingestion of Plerocercoid larva from second intermediate hosts or
Ingestion of Procercoid larvae from crustaceans
Diagnostic stage: Unembryonated eggs in feces