CESTODES

Classification of the flat worms medically

important groups and species

Phylum Platyhelminthes
Class Cestodes (tapeworms)
Subclass Cestoda
Order Pseudophyllidea scolex spatulate
with bothria
1. Diplyllobothrium latum
Order Cyclophyllidea scolex globular with
4 cup-like suckers

 Order Cylophyllidea
A. Species which require vertebrate intermediate host
1. Taenia solium
2. Taenia saginata
B. Species which require intervertebrate intermediate
hosts
1. Dipylidium caninum
2. Hymennolepis diminuta
C. Species which may or may not require intermediate
host
1. Hymenolepis nana
D. Species which infect man in their larval stage
1. Echinococcus Multilocularis
2. Echinococcus granulosus
3. Taenia solium

General characteristics
Majority are long, segmented, and tape-like are called
tapeworms
Dorso-ventrally flattened
Size varies from a few mm to several meters
Adult worms found in the intestinal canal of man and
animal
head or scolex is provides with suckers and sometimes
with hooks that serve as organs of attachment
There are 3 regions in an adult worm:
Head: scolex
Neck
Strobilia (body and trunk)

Consists of series of segment called proglottids

General characteristics

Sexes are not separate

Body cavity is absent
Alimentary canal is entirely absent
Excretatory and nervous systems are present
Reproductive system is present and complete in each
segment
According to maturity of reproductive organs, three types
of segment of the strobilia can be recognized from the front
backward

Immature: male and female organs are not

differentiated
Mature: male and female organs have become
differentiated (male organs appear first)
Gravid: uteri are filled with eggs (Other organs
are atrophied or have disappeared )

Classification of cestodes infecting

man
I. Pseudophylledean cestodes
.Posses false or slit-like grooves
called bothria
.Adult worms in intestine
. Diphyllobothrium latum: fish
tapeworm
. Larval stages: Plerocercoid in man

Classification of cestodes infecting

man
II. Cyclophyllidean cestodes

Posses cup-like and round suckers called

acetabula
Adult worms in intestine
o Taenia saginata
o Taenia solium
o Hymenolepis nana
o Dipylidium caninum

Classification of cestodes infecting

man
According to habitat
Cyclophyllidean cestodes
Larval stages in man

Hydatid cyst of Echinococcus granulosus

and Echinococcus multilocularis
Cysticercus cellulosa of taenia solium
Coenurus cerebralis of Multiceps
muliceps
Coenurus glomeratus of multiceps
glomeratus

Differences between a Paseudophyllidean

and a Cyclophyllidean Cestodes

Head and scolex

Uterus

Uterine pore
Common genital

Pseudophyllidea
n
Spoon-shaped
with slit-like
sucking grooves
called bothria
No branching,
Convoluted
uterine tubes
assume the form
of rosettes
Present
Ventral; in the

Cyclophyllidean
Bears 4 cup-like
suckers

Branching
May or May not be
present

Absent
Lateral

Differences between a Pseudophyllidean and a Cyclophyllidean

Cestodes

Example
Strobila

Larval stage

Pseudophylli
dea
False
tapeworm
D. latum

Cyclophyllid
ea
True
tapeworm
All except D.
latum
Apolytic (shed
segments)

Anapolytic
(dont shed
segments)
1st coracidium 1st cysticercus
2nd procercoid 2nd
3rd
cysticercoid
rd

Order Pseudophyllidea
Characteristics
Large worms consists of a long chain of segments
head has two slit-like sucking grooves called Bothria instead of
suckers
Uterine glands scattered in the parenchyma, composed of many
acini
Genital pores on the ventral surface of the segment, not marginal
Uterus opens to the exterior through which eggs come out

Order Pseudophyllidea
Characteristics
Eggs are operculated and can
develop only in water; immature wh
en oviposited and oncoshere gives ris
e to ciliated embryo
Larval development proceeds into
two intermediate hosts:

First larval stage called Procercoid

Second larval stage called
Plerocercoid

Diphyllobothrium latum

Common name: Fish tapeworm, Broad tapeworm

Final host/ definitive host

Man, dog, cat small intestine

1st I.H. a procercoid develop inside

Freshwater Copepods of the genera Cyclops or Diaptomus

2nd I.H. containing the plerocercoid or sparganum

Freshwater fish, pike, trout, salmon, perch

Mode of infection

Ingestion of imperfectly cooked infected fish or roe containing

plerocercoid larvae

Infection

Diphyllobothriasis

G.I. disturbances and anemia

Diagnosis

Microscopic examination of feces for the characteristic operculated

eggs

Diphyllobothrium latum

Nec
k

Bothrium

Bothrium

Scolex spoon-shaped or
spatulate
Scolex bear 2 slit-like grooves
called bothria (1 on dorsal surf
ace the other on ventral)
Scolex has no rosetellum and
no hooklets
Neck thin and unsegmented,
much longer than the head,
followed by immature proglott
ids, mature and gravid proglot
tid
Scolex spatulate

Diphyllobothrium latum
Adult worm yellowish
grey in color
Dark central markings in
the strobia the egg-filled
uterus
Measure 3 to 10 meters in
length
Life-span 5 to 15 years
Encysts in fish muscle
Larvae develop on
intestinal wall

Diphyllobothrium
latum
A mature segment is filled with male
and female reproductive organs
Terminal segments shrink and
becomes empty as eggs are
constantly discharged
Dried up segments break off from
the body in chains, passed out in th
e hosts feces
Uterus at the center of the segment
appears in the form of a rosette

Diphyllobothrium latum
Oval, light brown, thick shell
Bile stained
Contains abundant granules
and unsegmented ovum
Inconspicuous operculum at
one end, small knob at the
other end
Does not float in saturated
solutions of common salt
A single egg gives rise to a
single larva
Eggs unembryonated when
passed in feces
Not infective to man

Kno
b

Diphyllobothrium latum

Larvae
o Passed first in water and then in the respective
intermediate hosts
3 stages
First stage larva
Coracidium
Ciliated oncoshere develop from egg in water

Second stage larva

Procercoid
Spindle-like solid body with cephalic invagination
Found inside the cyclops (the first intermediate host)

Third stage larva

Plercocercoid
Heads is invaginated in the neck
Found in the freshwater fish, the second intermediate host

Life Cycle

Pathogenesis and clinical

manifestations

Infection limited to one worm, although there have been

reported obstruction due to a number of worms
Infected individuals may show no signs
Some may experience nervous disturbances, digestive
disorders, abdominal discomfort, weight loss, weakness, an
emia
Symptoms due to absorbed proglottids or due to mucosal
irritation
D. latum infection hyperchromic, leukemia megaloblastic,
anemia with thrombocytopenia could be mistaken for
pernicious anemia(Vit. B12 def.)
Worms in jejunum compete with the host for vit. B12, if
pushed down further to the intestines, with treatment,
anemia is relieved.

Diagnosis
Definitive diagnosis finding the
characteristic operculated eggs or on occasio
n, proglottids in stool, may be vomited.
DFS usually suffice due to a number of eggs.
TO differentiate anemia due to
diphyllobothriasis from pernicious anemia, ex
amination of gastric juice for the presence of
free HCL pernicious anemia is associated wit
h ACHLORHYDRIA

Treatment
Praziquantel 5 to 10 mg/kg single dose
If the scolex is not recovered, a repeat stool exam
is done after 3 months to be certain for no longer
infection.
Prevention and control

All freshwater fishes should be cooked.

Freezing for 24 to 48 hrs at a temp. of -18 C kills all
plerocercoids
Endemic area, prevention should focus on controlling
the source of infection, proper disposal for sewage and
marketing of fish.

Order Cyclophyllidea
Characteristics

Large or small worms consisting of chains of segment

Scolex quadrate with four cup-like round suckers
An apical rosettum with hooklets may be present
Vitelline glands concentrated in a single mass
Common genital pore is marginal (on lateral side of
segment)
No uterine opening for the exit of eggs from the gravid
uterus
Eggs only escape from the rupture or disintegration of
ripe segments
Eggs not operculated, develop only in the intermediate
host, fully embryonated
Oncosphere never a ciliated embryo
Larval development proceeds in one intermediate host

INTESTINAL CESTODES

Taenia saginata- known as beef

worm of human
Humans only definitive
host so, human
cysticercosis due to this
species does not occur.
Inhabit upper jejunum,
may live up to 25 years
Adult measure 4 to 10 m
in length, have 1,000 to
4,000 proglottids
Adult worms are white
and semi-transparent

 Mature proglottids
almost square,
contain mature
male and female
Gravid proglottids
are longer than T.
solium

Taenia saginata

Final host: Man

Intermediate host: cattle, cow, buffalo
Mode of infection: eating beef containing
Cysticercus bovis
Pathogenesis
Taeniasis
Passage of proglottids in stool
Mild irritation at site of attachment, Epigastric
pain
Hunger fangs
Weakness, weight loss,Loss of appetite
Pruritis
Obstruction in intestine but also in bile and
pancreatic ducts and appendix because of prog

Taenia saginata

Diagnosis
Identify characteristics eggs, proglottids or scolex
Usual specimen gravid proglottids (lateral
branches 15-20)
Concentration techniques for eggs (eggs rarely
passed out in stool)
Perianal swabs
Treatment
Praziquantel 5-10 mg/kg single dose
Criteria for cure
Recovery scolex
Negative stool examination 3 months after
treatment

Taenia Life Cycle

Cysticercus

Intestinal cestodes
Common name
Intermediate host
Scolex
Length
#of uterine
branches
# of proglottids
Gravid proglottid
Eggs
Larva
Infective stage

Taenia saginata
Beef tapeworm
Cattle
No rostellum
<25m
15 or more

Taenia solium
Pork tapeworm
Pig
Armed rostellum
<7m
13 or less

1000 to 2000
<1000
Tree-like
Finger(dichomotous)
like(dendritic)
Spherical and striated, inside is an
embryo or oncosphere with 6 hooklets
Cycticercus bovis Cysticercus
cellulosae
Cysticercus bovis Cysticercus

 The eggs of Taenia saginata and Taenia solium are

indistinguishable morphologically (morphologic

species identification will have to rely on the progl
ottids or scolices)
dark-yellowwith a thick shell wall and radially

striated, giving it a PRISMATIC appearance and c

ontain a six-hooked embryo called an onchosphere

 The eggs are rounded, diameter 31 to 43 m, with a

thick radially striated brown shell. Inside each shell
is an embryonated oncosphere with 6 hooks.
The egg in FigureBstill has the primary
membrane that surrounds eggs in the proglottids.

T. Solium
eggs

 T. saginata has 15 to 20 branches on

each side (FigureDandE)

Taenia solium has 7 to 13

(FiguresFandG). Note the genital pores
in mid-lateral position.

Characteristic

intermediate
host

Taenia
Saginata
cattle, reindeer

Taenia solium
pig, wild boar

Site of Development

Muscle, viscera

Brain, skin, muscle

Scolex: adult worm

No hooks

Hooks

Scolex: cysticercus

No rostellum

Rostellum & hooks

Proglottis:uterine
branches
Passing of proglottids

23 (14 - 32) *

8 (7 -11) *

Single,
spontaneous
2 lobes

In groups, passively

Present

Absent

Ovary
Vagina:sphincter
muscle

3 lobes

 Calcified cysts
of Cysticercus
bovis in muscle
tissue.
(Cysticercus
bovis, larval for

Numerous cysticerci
(Cysticercus cellulosae,
larval form of Taenia
solium)
Each cyst contains a
single inverted scolex

Taenia solium
Pork tapeworm
Armed tapeworm of
man
Taeniasis is common
among those eating
raw or insufficiently c
ooked (measly pork)
Uncommon among
non-pork eaters

T. Solium
scolex

T. solium

Taenia solium
Scolex globular in
outline with 4
circular suckers
Scolex has a
rostellum armed with
double row of
alternating large and
small hooklets
Rostellar hooklets
shaped like daggers
or Arabian poniards

Taenia solium
800-900 proglottids
Common genital pore marginal and
thick lipped
Vaginal opening not guarded by a
muscular sphincter
Gravid segments expelled passively in
chains of 5-6 at a time and not singly
Gravid proglottids contains approx.
30,000 to 50,000 eggs

Taenia solium
Ova
Same as those of
Taenia saginata
Infective to man as
well as pigs
Thick brown striated
embryophore
surrounding a
hexacanth embryo

Taenia solium
Final host: Man
Intermediate host: Pig
Mode of infection: eating measly
pork containing Cysticercus cellulosa
e
Diagnosis: stool examination for
proglottids/ eggs

Taenia solium
Pathogenesis
Mild, non-specific abdominal complaints
Proglottids are not as motile as T. saginata, so
organ obstruction is less likely.
Cysticercosis
Multiple
Develop in any organ or tissue
Neurocysticercosis (most serious zoonotic
disease)
Chorioretinitis
Vasculitis

Taenia solium

Diagnosis
Intestinal
Identifying the characteristic proglottids, eggs or scolex
Cysticercosis
Computed Axial Tomography
Magnetic Resonance Imaging
Treatment
Praziquantel 5-10 mg/kg single dose for children and
adults
Noclosamide not available locally
Criteria for cure
Recovery of scolex
Negative stool exam 3 months after treatment

Cysticercus
cellulosae, T
solium

Life cycle

EXTRAINTESTINAL
CESTODES

Echinococcus sp.

Belong to the Family Taeniidae, Order

Cyclophyllidea

Echinococcus granulosus

Cause cystic echinococcosis

Echinococcus multilocularis
Cause alveolar ecinococcosis

Echinococcus granulosus
Definitive host
Dog and other canines
Intermediate host
Goats, horses, cattle,
camels and sheep
Larval stage: hydatid cyst
Numerous (1M)
protoscolices may be found
within the cyst
Cyst has outer laminated
layer and inner nucleated
germinal layer

Protoscolices and
broad capsules lie
free in the cyst,
referred to as
hydatid sand

Echinococcus
granulosus
Adult worms are small (3-6
mm in length)
It is composed of a
Armed Scolex
Short Neck
Strobia
3 proglottids (occasionally
4)
Immature
Mature
Gravid

Echinococcus granulosus
Scolex bears 4 suckers and protrusible
rostellum with 2 circular rows of hooks
Resemble Taenia ova
Hexacanth embryo with 3 pairs of hooks
Infective to:
Man
Cattle
Sheep and other herbivorous animals

Echinococcus granulosus
Larva

Found within the hydatid cyst developing inside the

intermediate host
Represents the structure of the scolex of the future
adult worm

Young larva transformed into a hollow bladder

(hydatis, drop of water)
Brood capsules develop within the cysts and
may contain thousands of scolies
On entering the final host, the scolex armed with
a rostellum and 4 suckers become adult worm

Pathogenesis and clinical manifestation

Liver (right lobe) the most common and most
important site involvement
Unilocular hydatid cyst cyst of E. granulosus
Alveolar cysts cyst of E. multiocularis
Osseous hydatid cyst unilocular cyst when located in
the bone
Rupture of cyst in the lungs may present coughing
accompanied by allergic reactions
Regulation inflammatory cytokines leading to a local
immunosuppression
Hepatic cyst mostly found in the inferior right lobe
and may cause obstructive jaundice
Abdominal cyst may cause discomfort when the cyst
are large enough

Pathogenesis and clinical

manifestation
Jacksonian seizures are partial
seizures that begin in one part of the
body such as the side of the face, the
toes on one foot, or the fingers on on
e hand. The jerking movements then
spread to other muscles on the same
side of the body. This type of seizure
is associated with a lesion or defect i
n the area of the cerebral cortex that
controls voluntary movement

Life cycle

Echinococcus granulosus
Diagnosis

Radiographic findings: calcification of the cysts

Ultrasound: identify hydatid sand and
calcification
Immunodiagnosis
Antibody detection

IHA (Indirect hemagglutination test)

IFA
ELIZA (enzyme-linked immunosorbent)
EIA

Antigen detection

Diagnosis
1. Roentgenogram
2. Exploratory cyst puncture
3. Immunologic tests (intradermal, precipitin,
complement fixation, hemagglutination, and ben
tonite flocculation latex slide agglutination and fl
uorescent antibody tests)
. Positive cases will have to undergo a gel
diffusion assay that would demonstrate the echi
nococcal Arc 5 for confirmation.

Echinococcus granulosus
Treatment

Surgical resection: not 100% effective

Solicidal agent
Hibitane
95% ethanol
Hypertonic 30% Normal Saline Solution

PAIR technique for inoperable cyst

Puncture, aspiration, injection,
reaspiration intervention
Albendazole

Sparganosis
Refers to the larval infection with the
plerocercoid larvae also known as
spargana of pseudophyllidean
tapeowrms falling under the Genus S
pirometra.
Common in man: Spirometra
mansoni
Spirometra erinacei
Spirometra ranarum

Hymenolopis species
Genus derived from the membranous character of the
egg shell hymen
3 testes in each mature segment
Uterus sac-like and transverse
Eggs posses two membranes outer membrane is thin and
transparent
Larval stage is called cysticercoid
Small bladder containing the invaginated head proximally
and a solid, elongated portion as a caudal appendage
There are 2 species:
Hymenolopis nana
Hymenolopis diminuta

Hymenolepis
Hymenolepis nana

Hymenolepis
diminuta

Common name

Dwarf tapeworm
(smallest
tapeworm)

Rat tapeworm

Scolex

Armed rostellum

Unarmed rostellum

eggs

With 4 to 8 polar
filaments

Without filaments

Infective stage

Eggs (direct)
Cysticercoid larvae
(indirect)

Cysticercoid larvae

Intermediate host

Fleas
(Ctenocephalides
canis, Xenopsylla
cheopis, Pulex
iritans)
Flour beetles

Insects

H. Diminuta cysticercoid
larva
The larvae used to infect rats
should have longer tails to
insure they are mature
enough to be infectious to
rats.

Hymenolepis diminuta
Rat tapeworm
Common parasite of rats and mice
Accidental human infection
Differ from Hymenolepis nana in morphology and
life cycle because it requires an intermediate host
2 host
Larval stage: cysticercoid is passed in fleas
Adult stage: in rats and mice and accidentally in
humans especially children who accidentally
ingest infected fleas

Hymenolepis diminuta
Adult
Larger than Hymenolepis nana

Measures 60 cm in length
Scolex
Unarmed rostellum
4 suckers lacking hooklets

Hymenolepis diminuta
Ova
Larger than H.
nana
Outer shell
yellowish in color
Inner
embryophore 2
knob-like
thickenings
No polar filaments

Hymenolepis
diminuta
Cysticercoid of Hymenolepis diminuta
Like a cysticercus but this larva has no
bladder but has a tail instead
The dark body within the spherical
portion is the scolex
The longer the tail, the more mature
the cysticercoid
This stage found inside an insect as
the mealworm

H. diminuta
Pathogenesis
Hymenolepiasis
Worm burden in rodents relatively
low
In man, highest worm burden is 19
Clinical manifestations minimal and
non-specific

Life cycle

Hymenolepis nana
Common name: Dwarf tapeworm
Smallest tapeworm infecting man
Found worldwide
Mainly among children
Only human tapeworm that can complete its
life cycle in a single host
Man can harbor both the adult and larval
stages of the parasite
Exception to the general rule that

Heliminths do not multiply inside the body of the

definitive host

Hymenolepis nana

Adult
Found in the ileum
Delicate strobia
Short life span,
about 2 weeks
Up to 200
proglottids
Transverse uterus
3 testes

Hymenolepis nana
Scolex

Subglobular
4 suckers
Provided with a short retractile rostellum
armed with a single row of 20-30
hooklets
Rostellar hooklets are shaped like tuning
forks

Cysticercoid larva of H.
nana

Hymenolepis
nana
Ova

Sphereical or oval
Floats in saturated solution of common salt

2 distinct membranes

Outer membrane thin transparent and colorless

Inner embryophore encloses an oncosphere with
3 pairs of lancet shaped hooklets

Intermembranous space is filled with yolk

granules and 4-8 polar filaments emating fro
m little knobs at either end of the embryophor
e

Hymenolepis nana
Mode of transmission is thru
Direct
Host ingests eggs that hatches in the
duodenum
Indirect pathway
Accidental ingestion of infected
arthropod intermediate host like rice and
flour beetles in which cysticercoid larvae
are released and develop into adult wor
ms in the small intestine of the host

Life cycle

Dipylidium caninum
Double Pored Dog tapeworm
Presence of bilateral genital pores in each segment
(di:2; pylis: gate): 2 entrance
Common intestinal parasite of dogs
Scolex
Small and globular
4 deeply cupped elliptical suckers
Protrusible/ retractile rostellum
Rostellum has 1-7 rows of rose thorn shaped
hooklets

Dipylidium caninum
Strobia
200 proglottids
Narrow
Mature proglottids
2 sets of male and
female reproductive
organs
Bilateral genital pores

Dipylidium caninum
Gravid proglottids
Have size and shape of
pumpkin seeds
Filled with capsules or
packets of 8-15 eggs
enclosed in an embryo
nic membrane

D. caninum
Ova
Passed out in the feces
along with the proglottids
Released by contraction of
proglottids or disintegration
outside the host
Spherical
Thin shelled
With a hexacanth embryo

Dipylidium caninum
Intermediate host
Ctenocephalides canis: dog flea
Ctenocephalides felis: cat flea
Pulex irritans: human flea
Trichoedectes canis: dog flea

Dipylidium caninum
Pathogenesis
Dipylidiasis
Rarely multiple
Symptoms are minimal
Slight intestinal discomfort
Epigastric pain
Diarrhea
Anal pruritus
Allergic reactions

Life cycle