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Helminths
Trematoda Heterophyes heterophyes (intestinal fluke) Diphylobothrium latum (broad/ fish tapeworm) Lake area of central Europe, central Africa, North America, Far East *not in Egypt D.F : small intestine of man Reservoir : fish eating mammals(cat, dogs, bears 10 meters /> *3000-4000 segments Elongate (length: 1mm) spoon shape, 2 longitudinal bothria/groove + Broader than long Mid ventral genital pore 4mm (L) X 12 mm (B) Testis : multiple, dorsolateral Vas deferens>seminal vesicle Cirrus, ootype, vagina: open in common genital pore Bilobed ovary (posterior) Tenia saginata (beef tapeworm) Cosmopolitan Ethiopia, Mexico, South America, East & West Africa D.F : small intestine of man (the only) *scolex attached to mucosa, the rest folded 4-10 meters (usually 5)
Cestoda Tenia Solium (pork tapeworm) Cosmopolitan *rare in Islamic country Hymenolypis nana (dwarf tapeworm) Cosmopolitan *more in warm climates
Geograpgical distribution
Habitat
Size
D.F : small intestine of man reservoir : cats, dogs, fish eating birds Length : 1.5-3 mm Breadth : 0.5 mm -
3-8 meters *1000 segments Globular Rostellum armed Double row of hooks 4 suckers(cikgu ckp) +
Scolex
*1000-2000 proglottids Quadrate (diameter: 2mm Unarmed 4 strong hemispherical suckers + (thin neck) Broader than long
Length : 20-60 mm Breadth : 1 mm *100 segments Rhomboidal Short rostellum armed 20-30 spines in single row 4 suckers + (long & slender)
300-400 testis
150 testis
Vagina with terminal sphinter Bilobed ovary Trilobed ovary One small lobe ovary
Gravid segments
Vitelline glands (ventrolateral) Uterus: coiled rossete shape Open in uterine pore below common genital pore Same as mature segment *egg continuously discharged from uterine pore Uterus : darker, more coiled, rossete shape, pack with egg
Elongate & rectangular 2X7mm (L X B) Lateral side branch of uterus : 15-20 Lateral side branch of uterus : 7-13
Sac like uterus with 80100 eggs *segment usually rupture liberating egg in intestine
Eggs
Pass in faeces Immature, ovoid, operculated Yellowish brown 65x45mic Must reach fresh water to mature
Intermediate host
1st : Pirenella conica (Rt. Handed snail 2nd : Mugil cephalus (Boury) & Tilapia nilotica (Bolty) Encysted metacercariae Eating imperfectly cooked fish/ undersalted fish(sweet fessikh-salted <7days)
1st : Cyclops / diaptomus (crustacean copepod) 2nd : fresh water fish (perch, salmon, trout) Plerocercoid larvae Eating raw / insufficiently cooked flesh / fish
Usually detached singly from parent worm> very active-creep out of anus even without defecate Cannot differ from other Indistinguishable from tenia T.saginata Mature, spherical 30-42mic *Thin hyaline capsule shed after leave proglottid *Thick brown striated embryophore surround hexacanth embryo/oncosphere Pigs Man causing cysticercosis
Oval/spherical Colorless 40mic diameter 2 thin shell Inner shell:embryophore has 2 knob at opp. Sidearise 4-8 filaments Inside embryophore: hexacanth embryo
-Mild catarrhal inflammation -Superficial ulcer -necrosis Mild : asymptomatic Heavy : -abdominal colic, -chr. Intermittent diarrhea -blood in stool -Myocarditis, heart Failure -encephalitis
Clinical pictures
Depends on no of worm *competition for nutrients B12 & metabolic by products absorbed by host Usually assyptomatic -diarrhea, abdominal pain, -pernicious anemia (small in genetically predisposed) Multiple worm : intestinal obs.
Complication
Diagnosis
Eggs in stool
Treatment
Praziquantel orally
Niclosamide (Yomesen) -morning, empty stomach, well chewed -strobila often evacuated -if not use purgative Praziquantel -thorough cooking of fish -freez 24-48h at -18C to kill plerocercoid -dewormed periodically RESEVOIR HOST (dogs,cat)
Often cause change in motility & secretion of GIT than pathological *reduce gastric secretion (70%) -vague abdominal pain -nausea -</> appetite,body weight -weakness -insomnia -irritability -abdominal discomfort(due to active crawling of proglottid from anus) -allergy(rare) -intestinal obstruction -sporadically straying : acute/ subacute appendicitis / cholangitis Gravid proglottid in faeces Eggs (rarely finding) *teniasis : most difficult to diagnose in 1st 3 months of infection (x egg, x proglottids discharged) Niclosamide (Yomesen) Praziquantel
Slight irritation at their site of attachment to mucosa Rarely intestinal obstruction -vague abdominal discomfort -hunger pain -diarrhea -diarrhea alternating with constipation -loss of appetite
Well tolerated even in large no. *Symptoms > allergic Usully asymptomatic -headache -dizziness -anorexia -periodic diarrhea -abdominal pain
Gravid segment in stool Rarely egg *egg xblh diff. dgn T.saginata (except kira lateral branch)
Egg in stool
Niclosamide -5-7 days :kill adult Praziquantel -systemically abs. -act on: cysticercoid in villi Adult in lumen
-X eat RAW / imperfect cooked Light infection : consumed after freezing at -18C for 5days -early detection & treat. Of human teniasis (helpful) -condemn/boil carcasses with intensive cysticerci