Intestinal Cestodes

Dr Mohiedden M Abdul-Fattah
Intestinal cestodes
 Pseudophyllidea:
1. Diphyllobothrium latum
 Cyclophyllidea:
1. Taenia saginata,
2. T. solium ,,
3. Hymenolepis nana.
4. H. diminuta,
5. Dipylidium caninum
 Diphyllobothrium latum
A. Biology:
 Final host: Fish eating animal including
human.
 Habitat: Attach to mucosa of ilium or
sometimes jejunum.
 Diagnostic stage: Immature egg or chains of
mature segments.
Life cycle of D. Latum
B. Epidemiology:
 Intermediate hosts: cyclops (1st I.H.) and
fresh water fish; salmon (2nd I.H ).
 Reservoir host: fish eating animals
 Infective Stage: pleurocercoid larva in
muscle fish.
 Mode of infection: ingestion of
undercooked fish containing the infective
stage.
C. Clinical picture:
1. Macrocytic anemia and neurological
problems of vitamin B12 deficiency are
seen in heavily infected individuals.
D. Lab diagnosis:
 Detection of eggs in faeces (many).Yellowish
brown ovoid 70x40 µm with anterior operculum
and posterior knob
 long chains of segments with rosette shaped
uterus.
E. Treatment:
1. Praziquantel is the drug of choice, (10-
20mg/kg PO for single dose), or
2. Niclosamide (1g for 11-34 kg, 2g for> 34kg
children and 4 g for adults; for single dose).
F. Control: Freezing for 24 hours. Thorough
cooking or pickling of fish kills the larvae. Fish
reservoirs should be kept free of raw sewage.
 Taenia saginata
1. Biology:
 Final host: human.
 Habitat: small intestine.
 Diagnostic stage: mature egg or gravid
segments.
Taenia Life Cycle
2. Epidemiology
 Distribution: cosmopolitan.

 Intermediate host: cattle.

 Infective stage: Cysticercus bovis larva in meat.

 Mode of infection: ingestion of under cooked

meat containing the infective stage.
 Reservoir host: No.

3. Clinical picture:
 Light infections remain asymptomatic, but heavier
infections may produce abdominal discomfort,
epigastric pain, vomiting and diarrhea.
4. Lab Diagnosis:
 Detection of either of the following in
stool:
 the non hooked scolex of the adult after
treatment,
 The gravid segment (15 – 20 branches on
each side) .
 The egg: 30x40 µm, spherical, with outer
thick and inner thin shell and embryo.
5. Treatment:
 Praziquantel is the drug of choice,(10-
20mg/kg PO for single dose), or
Niclosamide (1g for 11-34 kg, 2g for> 34kg
children and 4 g for adults; for single dose).
. Expulsion of scolex must be assured to
assume a satisfactory treatment.
6. Control:
 Thorough inspections of beef and pork,
 Adequate cooking or freezing of meat are
effective precautions, since cysticerci do not
survive temperatures below -10o C and above
50o C.
 Taenia solium

 Biology:
 Man is the only final host but can act as blind
end intermediate host also.
 Habitat: small intestine
 Diagnostic stage from the final host: scolex,
gravid segments and/or mature egg.
Taenia solium Life Cycle
 2. Epidemiology
 Distribution: where pork meat is eaten.
 Transmission
 Intermediate hosts: pigs (mainly) and man (if swallowed
the eggs).
 No reservoir hosts.
 Infective stages:
 Intestinal adult: - Cysticercus cellulosae larva adult.
 Tissue larval infection (cysticercosis): T. solium eggs.
 Mode of infection:
1. Adult taeniasis solium: ingestion of infected pork.
2. Larva taeniasis solium (cysticercosis): T. solium eggs can
also infect humans and cysticercus cellulosae develops in
tissues of human by.
A. Ingestion T. solium eggs in contaminated foods or by
external autoinfection.
B. Internal auto infection (by antiperistalsis during vomiting).
3. Clinical picture:
 Disease due to adult: mild enteritis with indigestion.
 Host- larva relationship: cysticercosis is caused by
ingestion of egg. The larval cysts exist in the lung, liver.
In the eye and brain (neurocysticercosis), they result in
blindness and neurological disorders (epilepsy).
4. Lab diagnosis:
 Adult: - Detection of the following in stool samples:

 Gravid segment with 12 lateral branches.

 scolex with rostellum having double rows of hooks

 Eggs similar to that of T. saginata.

 Cysticercosis: Imaging (sonar, CT) and serology

5. Treatment:
 Intestinal:
A. Praziquantel is the drug of choice,(10-20mg/kg PO
for single dose), or
B. Niclosamide (1-2g for children and 4 g for adults; for
single dose).
 Neurocysticercosis):
A. albendazole (15mg/kg/day PO for 30 days) for
parenchymatous lesions.
B. Patients with arachnoiditis or with interventricular
cysts need surgery.
C. Corticosteroids are used to control the inflammation
due to death of the larva.
 Syptomatic cysticercosis outside CNS: Surgery is
the management of choice.
6. Control: like Taenia saginata.
Hymenolepis nana
1. Biology:
 Final hosts: Humans and rodents.
 Habitat: small intestines.
 Diagnostic stage (diagnostic): mature
egg.
H.nana Life Cycle
2. Epidemiology:
 Distribution: cosmopolitan. Children more than
adults.
 Intermediate hosts: Man acts as an intermediate
host because the larva (cysticercoid) develops in the
villi of the intestines. Fleas act as intermediate host
when its larva ingests the egg and cysticercoids
develops within its body cavity.
 Reservoir hosts: rodents.

 Infective stage: egg.

 Mode of infection: 1-Ingestion of foods and drinks

contaminated with egg. 2- Autoinfection.
3. c/p:
 Disease: mild enteritis and allergy to the worm
excretion. Heavy infection may cause diarrhea
4. Diagnosis:
 By detection of eggs in stool sample.

 Characteristics of egg: - 30-40 µm, round,

colorless, with hexacanth embryo and polar
filaments.
5. Treatment: Praziquantel is the drug of choice,
(25mg/kg PO for single dose), or Niclosamide (1g
for 11-34 kg, 2g for> 34kg children and 4 g for
adults; for 7 days). There is relative resistance of
cysticecoids to drug therapy.
6. Control: Health education and personal hygiene.
 Hymenolepis diminuta
1. Biology:
 Final Hosts: mainly rats; occasionally man.
 Habitat: small intestine
 Diagnostic stage (diagnostic): the egg;
 Life cycle of H. diminuta
2. Epidemiology:
 Distribution:
 Common parasite of rats allover the world.
 Human is occasionally infected.

 Resevoir hosts: rats

 Intermediate hosts: grain beetles and cockroaches.
 Infective stage: The cystic larva (cysticercoid).
 Mode of infection: Ingestion of cereals, dried fruits
contaminated with insects containing the cysticercoid.
3. c/p:
 Disease: affects mainly children and may
suffer abdominal pain, diarrhea, insomnia
and convulsions.
4. Lab. Diagnosis:
 Detection of the characteristic eggs in stool
samples.
 Egg characteristics: 60- 80 µm, round, yellow
brown, with hexacanth embryo and polar knobs.
5. Treatment:
Niclosamide (2g first day+ 1g daily for 6 days).
6. Control: health education and personal hygiene.
 Dipylidium caninum
1. Biology:
 Final Hosts: mainly dogs and cats;
occasionally man.
 Habitat: small intestine.
 Diagnostic stage: eggs in feces within egg
capsules
Life Cycle of D. caninum
2. Epidemiology:
 Distribution: Common parasite of dogs, cats.
Accidental in humans specially children..
 Intermediate hosts: fleas (pulex) and dog
louse. Their larvae ingest the eggs passed in
the faeces. The eggs release onchospheres
that develop into cysticercoids in the haemocele
of the adults.
 Reservoir host: dog
 Infective stage: The cystic larva (cysticercoid).
 Mode of infection:
1. Ingestion of cereals, contaminated with insects
containing the cysticercoid.
2. Accidental swallowing of the infected fleas.
3. c/p:
 The worms affect mainly children that may
suffer abdominal pain.
4. Lab. Diagnosis: - Detection of egg capsules; each
containing 8 – 25 eggs. Or the segments in stool
samples.
5. Treatment: Niclosamide (2g first day+ 1g daily for 6
days.
6. Control: health education and personal hygiene.