CLASS CESTOIDEA

• The Tape Worms

By: Mihreteab A.(MSc)

 Objectives
At the end of this unit the student will be able to:
➢ Explain the general feature of cestode
➢ Explain the general morphology of Adult larvae and ova
➢ Describe the classification of cestode
➢ List the major differences between order Cyclophyllidea and
Pseudophyllidea
➢ Explain the geographical distribution Morphology, differential
characteristics, life Cycles of each species
➢ Apply the necessary laboratory procedures for detection and
identification of cestode parasites
 Outline
➢ General feature of cestodes
➢ General morphology of cestodes
➢Adult , Larva and Ova
➢ Clarification of cestode
➢ Major differences between order Cyclophyllidea and
Pseudophyllidea
➢ Geographical distribution, Morphology, differential characteristics,
life Cycles of each species
➢ Laboratory diagnosis, Treatment, control & prevention methods for
each species
 General characteristics
➢ Segmented long tape-like worms
➢ Vary from few mm to several meters
➢ Flattened dorsoventrally
➢ Has no body cavity/alimentary canal, circulatory system &
respiratory system
➢ Obtains its nutrient by absorption through body surface
Bilaterally symmetrical
➢ Hermaphrodites ( well developed reproductive system)
➢ Sexual-Oviporous
➢ Excretory system: flame cells and collecting tubules drain into
ventral and dorsal longitudinal excretory canals
 Morphology
❖The body is divided in to three main body regions
1. Scolex (head): attachment region and carry organs of fixation
– Two basic types of scolex:
➢ Acetabulum – suckers
➢ Bothria – slit – like grooves
– The scolex may carry rostellum
➢ A rostellum with hooks = armed
➢ A rostellum without hooks = unarmed
2. Neck (growing region): actively dividing part forming the
strobila

3. Strobila (segments or proglottids): entire chain of proglotids

5
Morphology…
Scolex (head)

Neck

Strobila made up of
proglottids
 Proglottids
➢ Set of reproductive organs

➢ Includes male & female organs & genital pore

➢ Segments/ Body divisions

➢ Segments may have one or more proglottids

➢ More mature as gets farther from neck

➢ Size & shape of segment along with number of proglottids &

location of genital pore key to identification of the tapeworms
– The strobila has three portions:
a. Immature segements the anterior most segments in which
the reproductive organs are not fully developed

b. Mature segments in which the organs are fully developed

and functioning, and

c. Gravid segments having a uterus full of eggs. It has

reduced or atrophied primary genital organs.

8
9
Major organs and external structures

10
Cestode scolex

11
 Cestode eggs
• Two type
– Operculated, immature when voided to the
external environment.
operculum
 Eggs…
– Non-operculated ,fully embryonated when voided
to the external environment
Cestode - Eggs

14
 Larvae
• Generally two types
1.Solid :
eg. Procercoid, Plerocercoid, cysticercoid
2.Cystic ( true bladder) can be with:
– Single scolex
eg. Cysticercus;
– Many scolexes and/or with daughter cyst
eg. hydatid cyst, coenurus cyst, etc
 Life cycle
➢ Complete in two host (exception H.nana)

➢ Habitat: Adult live in small intestine

➢ Human:
➢The only or main definitive host for T. Saginata, T.
solium, H. nana and D. latum
➢Intermediate host for E. granulosus & E.
multilocularis
➢Both as definitive & intermediate host for H. nana
& T. solium
 Definitive
Adult Host
Pseudohyllidea Cyclophyllidea
Egg
Operculated Non-operculated
Intermediate
Coracidium Oncosphere Host

Solid larval form

Cystic larval form
procercoid larva
Cysticercus Cysticercoide coenuruses Hydatid Cysts
Plerocercoid larva
• Subclass cestoda is divided into two orders:
– Order pseudophullidea
– Order cyclophyllidea

18
 Pseudophyllidea Cyclophyllidea
Scolex Elongated , spoonshaped, Globular
Organs of grooves Suckers and hooks
attachment Bothria
Rostellum Abscent Present

Proglottids Broader than long Longer than broad

Mature segment:
Genital pore Ventral Lateral/marginal
Uterine pore Present (ventral) Abscent
Uterus Coiled Sacular, tubular or branched
Vitellaria Scattered Single mass
Gravid segment Abscent Present
Eggs Operculated Non operculated
Immature Mature
Need water for development Do not need water
Onchosphere Ciliated Non ciliated
19
 Pseudophyllidea Cyclophyllidea

Intermediate hosts Two hosts One host

Larval stages Solid larvae: Cystic (true bladder) larvae:
Procercoid Cysticercus
Plerocercoid Cysticercoid
Hydatid
Coenurus

Members Diphylobothrium latum Taenia saginata/solium

Diphylobothrium mansoni Hymenolepis nana/diminuta
Dipylidium caninum
Echinococus granulosus
Multiceps multiceps

20
Life cycle patterns

21
Life cycle patterns

22
Generalized life cycle

23
• Man may be infected with the adult tapeworms or their larval stages:

1. Human infection with adult cestodes (intestinal cestodes):

a. D. Latum (Broad fish tapeworm)

b. T. Saginata (Beef tapeworm)

c. T. Solium (Pork tapeworm)

d. H. Nana (Dwarf tapeworm)

e. H. Diminuta

f. D. Caninum (Dog tapeworm)

24
1. Human infection with larval cestodes (extra - intestinal
cestodes):

a. Sparganosis

b. Cysticercosis

c. Hydatid disease

d. Coenurosis
Teania species
Habitat

➢Adult : in the small intesine of man

➢Larvae: in muscular tissues of cattle, pigs

➢Eggs: in faeces of man or in gravid segments

➢ Geographical Distribution:-

➢T. saginata
➢World wide distribution where cattle are raised & beef is
eaten raw or under cooked.

➢Very common in Ethiopia

 Geographic…
➢T. solium
➢Not widely distributed as T saginata.
➢Common in all areas where raw or partially cooked pork is
eaten.
➢Common throughout Mexico, South America and southern
Africa & southern Europe.
➢ Not reported from Ethiopia
 T. saginata T. solium
• Adult: • Adult
➢Size: 4-10 m long (can – Size: 2-3m
reach up to 20 m) – Colour: pale blue
➢Colour: ivory white – Strobila: 800-1000
➢Strobila : 1000-2000 Proglottides
proglottides – Mature segment :0.5-
➢Mature segment: 1-2cm 1.5 cm
long
 Taenia saginata
➢ Scolex (head):
➢ Quadrate, with 4suckers, no hooks, no rostellum
➢ Size-2mm across
 Taenia solium
Scolex has
• Four suckers
• two rows of hooks on a prominent rostellum
• Size-1mm
 Taenia species larvae
• Larval stage is cysticercus

– Invaginated scolex in fluid filled body

– Cysticercus bovis-T saginata

– Cysticercus cellulosae-T solium

 Eggs
• Eggs are very round with very thick walls.
• Morphologically eggs of T.saginata & T. solium are
indistinguishable unless stained by AFB
 Eggs..
➢ Size: 33-40 m

➢ Shape: Round

➢ Colour: Shell-dark yellowish-brown,

➢ Content: light yellowish gray.

➢ Shell: Thick, Smooth, brown, radially straited (embryophore)

➢ Content: A round granular mass enclosed by a fine membrane

with six hooklets
 Gravid proglotides
Taenia saginata
➢ Detach when fully develop & pass through the anus
independently.
➢ Color- white & opaque
➢ Size- 20mmX6mm
➢ Uterus- > 13 main (15-30)
➢ lateral uterine branches.
 Gravid…
Taenia solium
➢ Grey-blue and translucent
➢ Size-13mmX8m
➢ 7 to 12 on average 10 lateral
compound uterine branches
➢ Small chains of 3-4
➢ rectangular segments
➢ found in the faeces
 Transmission and lifecycle
➢ Transmission

➢Humans become infected by ingesting raw or

undercooked meat infected with infective cysticercus
larvae:
➢Beef- T.saginata*

➢pork meat –T.solium

➢T. solium can also be transmitted by :

➢Ingesting ova in food or water

➢Internal autoinfection
 Clinical manifestation
• T. saginata
– Taeniasis
• Usually asymptomatic but may cause dizziness, abdominal
pain, diarrhea, headache and nausea

– Proglottids obvious in feces

– Proglottids have a strong tendency to crawl from the
anus during the day when its host is active Pruritis ani
 Clinical….
• Taenia solium taeniasis
• Major symptoms are as a result of the adult worm and its
location
• Include abdominal pain, loss of appetite

– Cysticercosis
• when infected by eggs
• larval cysts in lung, liver, eye and brain resulting in
blindness and neurological disorders
 Laboratory diagnosis
➢ Detecting eggs in faeces

➢ Macroscopic Identification of gravid segments/proglotids in

underclothing/beding/ in faeces

➢ scolex recovered from clothing or passed in faeces;

➢ T.saginata ova on perianal skin (cellotape slide)

➢ T.solium (cysticercosis): Finding calcified larvae in histological

or X-rays examination
 Treatment
• Praziquqntel in adults 2.5-10mg/kg given in a single dose

• Albendazole: adults 6.6mg/kg or two doses each of 200mg/day

on 3consecutive days.(this drug should not be used in
children<2years old or during pregnancy.
 Prevention and control
➢ Avoid eating raw or or insufficiently cooked meat

➢ Inspecting meat for larvae

➢ Provide latrine for proper waste disposal

➢ Not using untreated human faeces as fertilizers

➢ Protection of cattle from grazing on faeces or sewage polluted

grass

➢ Treating infected persons & providing health education

 T. Saginata T. Solium

Disease Taeniasis saginata Taeniasis solium

Distrubution Cosmopolitan Cosmopolitan (in pig meat

eating areas)
Adult

✓Size 4 – 6m 2 - 4m

✓Scolex 2mm in diameter 1mm in diameter

No rostellum or hooks Rostellum with double
crown large & small hooks
✓Mature Testes more numerous (400) Testes fewer (200)
segment Ovary bilobed Ovary trilobed
Vaginal opening with sphinicter Vaginal opening without
sphinicter

✓Gravid segment 20 x 7mm 12 x 6 mm

Uterus with 15 – 30 lateral 7 – 12 lateral branches
branches Segments detach in groups
45
Segments detach singly of about 5
 T. Saginata T. Solium

Egg Similar (not infective to man) Similar (infective to man =

cysticercosis)

Definitive host Man Man

Intermediate host Cattle (not man) Pig (and man)

Larval stage Cysticercus bovis Cysticercus cellulosae

(scolex without hooks) (scolex with hooks)

Human infection Ingestion of undercooked beef Ingestion of undercooked

= Taeniasis pork = Taeniasis
Ingestion of eggs =
cysticercosis
46
Hymenolepsis nana (Dwarf Tape
worm)
 H.nana
➢ Disease: Hymenolepiasis
➢ Distribution: cosmopolitan (more common in children)
➢ Morphology:
➢Adult : the smallest tapeworm of man (1 – 3cm)
➢ Scolex: globular, 4 suckers, a retractile rostellum with a single
crown of hooks
➢ Mature segments: broader than long

48
 H. Nana Eggs

➢ Oval & smaller than those of H. diminuta

➢ Size being 40 to 60 µm by 30 to 50 µm

➢ On the inner membrane are two poles, from which 4 to 8

polar filaments spread out between the two membranes.

➢ The oncosphere has six hooks (seen as dark lines)

➢ Cysticercoid:

➢ A bladder like structure similar to cysticercus but the head is

withdrawn in upright position and not invaginated

➢ It has a tail like appendage

49
 Transmission and life cycle
➢ Mode of Transmisssion: -

➢Ingestion of egg with contaminated food, drink or

finger

➢Autoinfection (internal and external)

➢ Life Cycle:

➢ Has a direct life cycle with a human host serving as both

definitive and intermediate host
 Clinical manifestations
➢ Majority of infections are asymptomatic and are probably
associated with low no. of parasites.

➢ Symptoms are vague abdominal discomfort, nausea, vomiting,

weight loss, diarrhea & irritability in light infections.

➢ In heavy infections, ulcerations of the mucosa lead to enteritis

➢ Some patients especially children suffer from dizziness and there

may be convulsion, attributed to a neurotoxic product of the
worms
 Laboratory Diagnosis
➢ Finding eggs in feces and sometimes the adult

➢ Size: 35-50m

➢ Shape: oval, almost round

➢ Shell: double; thin external membrane and internal membrane

often thicker at the poles

➢ Thread like polar filaments coming from both poles

➢ Colour: colour less or very pale gray

➢ Content: Rounded mass (embryo) with six refractile hooklets

arranged in fan shaped.
53
Diagnosis…
 Treatment
➢ Niclosamide (Yomesan): dose of 2gdaily for 5consequetive days

➢ Praziquantel at a dose of 25mg/kg

Prevention and control

➢ Personal cleanliness (to avoid autoinfection)
➢Wash hands before eating & after defecation
➢ Sanitary disposal of feces in to latrines
➢ Avoiding eating uncooked food
➢ Health education
➢ Treatment of infected persons
➢ Rodent control
Hymenolepis diminuta (Rat tape worm
 Morphology
➢ Disease: Hymenolepiasis

➢ Distribution: cosmopolitan, fairly common in Ethiopia

➢ Morphology:

➢Adult : 20 – 80cm
➢Scolex with 4 suckers and retractile rostellum without
hooklets

➢Strobila: 800 – 1000 segments

➢Slightly larger than H. nana but still very small

➢Proglottid same as H. nana but larger

 Eggs…
➢ Bigger than H. nana
➢ size 70 to 86 µm by 60 to 80 µm, with a striated outer membrane
and a thin inner membrane.
➢ Round or slightly oval

➢ Oncosphere has six hooks

➢ No polar filament

➢ Eggs not infective when passed

➢ Yellowish brown or bile pigmented

with double shell & with out thread

like polar filaments

Life cycle of H. diminuta

60
 H. Nana H. Diminuta

Distrubution Cosmopolitan Cosmopolitan

Adult

✓Size 1 – 3 cm 30 – 60 cm

✓Scolex Rostellum with hooks Rostellum without hooks

✓Mature Similar but smaller (0.5 x Similar but bigger (4 x 0.8mm)

segment 0.15 mm)

✓Gravid Testes and ovary close Two aporal testes and one poral testis
segment together in the middle of with the ovary in between
the mature segment
61
 H. Nana H. Diminuta

Egg

✓Size 30 – 50  in diameter 60 – 70 in diameter

✓Shape Polar filament Absent

✓Color Transparent Yellowish

✓Content onchosphere Onchosphere
Definitive host Man (rat, mice) Rats, mice (rarely man)

Intermediate host Optional Obligatory (rat flea and other

insects as beetles and
cockroaches)
Larval stage Cysticercoid Cysticercoid
(infective stage)
Human infection 1. Direct (ingestion of eggs, Ingestion of fleas and insects
autoinfection) containing cysticercoid
2. Indirect (ingestion of fleas and
62
insects containing cysticercoid)
 Dipylidium caninum (dog tapeworm)
➢ Disease: Dipylidiasis
➢ Distribution: cosmopolitan
➢ Dogs or cats (humans rarely)- definitive host
➢ Fleas or lice are the intermediate host.
Morphology:
1. Adult: 20 – 60 cm (strobilla appear beaded)
– Scolex: 0.5mm in diameter, 4 suckers
▪ A retractile rostellum with several rows of hooks (1-7)
▪ Hooks are rose – thorn shaped

63
 D.caninum…
➢ Mature segment: longer than broad (12 x 4mm)

➢ Gravid segments: similar to mature segments

➢The uterus divided into packets (egg capsules) each

containing 5 – 15 eggs
2. Eggs:
• Size : about 40  in diameter
• Shape: spheroid with 2 envelopes separated by a hyaline
layer
• Color : yellowish brown
• Content : onchosphere containing 6-hooklets
 D.caninum….
3. Larva: cysticercoid, similar to that of H.nana or diminuta but
without a tail appendage cryptocystic cysticercoid)

– Has several rows of hooklets

Habitat:
➢ Adult: mucus membrane of small intestine of carnivores (dog,
cat) & human

➢ Cysticercoid larvae: In the body cavity of insects

➢ Egg: in the faeces of dog, cat, man

 D. Caninum proglotid
➢ Such proglottids (average mature size 12 mm by 3 mm) have two
genital pores
➢ Proglottids may be passed singly or in chains, and occasionally
may be seen dangling from the anus

68
Adult tapeworm of D. caninum

69
Life Cycle of D. caninum

70
 Diagnosis
• Finding gravid segments and eggs in the feces

71
Echinococcus granulosus
(Hydatid worm)
 E. granulosus (Hydatid worm)
➢ Also called sheep tape worm

➢ Distribution: cosmopolitan, especially in sheep & cattle raising

countries

➢ Also found in South & South East Ethiopia

Morphology:
➢ Smallest of all tapeworms
➢Scolex, neck, 3 segments
➢Segments look like Taenia sp.
➢ Largest larval stage of all tapeworms
➢Hydatid cyst
 E.granulosus

➢ Adult: 3 – 6mm

• Scolex with 4 suckers, rostellum with two rows of hooklets

• Strobila: 3 proglottids (1immature, 1 mature, 1 gravid)

➢ Egg: morphologically indistinguishable from eggs of Taenia spp

➢ Larvae (hydatid cyst) contains:

➢Brood capsules with many scolices, Free broad capsules,

Hydatid sand, Cystic fluid (containing salt, enzymes &
toxins)
75
 E. granulosus….
➢ Definitive Host: Carnivores such as dogs, wolves
➢ Intermediate Host: Herbivores such as sheep
➢ Occasionally infect humans
➢ The hyatid cysts grow in humans very slowly & can overcrowd
organs
• "Hydatid sand“:
– Fluid aspirated from a hydatid cyst
– shows multiple protoscolices, each of which has not fully
developed hooklets
– The protoscolices are normally invaginated (left), and evaginate
(middle, then right) when put in saline

77
 Life Cycle of E. granulosus
➢ The adult E. granulosus resides in the small bowel of the definitive
hosts, dogs or other canids

➢ Gravid proglottids release eggs that are passed in the feces

➢ Eggs ingested by a suitable intermediate host (under natural

conditions: sheep, goat, swine, cattle, horses, camel),

➢ the egg hatches in the small bowel and releases an oncosphere

➢ Oncosphere penetrates the intestinal wall and migrates through the

circulatory system into various organs, especially the liver and
lungs

78
 Life Cycle of E. granulosus
➢ The oncosphere develops into a cyst that enlarges gradually,
producing protoscolices and daughter cysts that fill the cyst
interior.

➢ Definitive host becomes infected by ingesting the cyst-containing

organs of the infected intermediate host

➢ Protoscolices evaginate, attach to the intestinal mucosa , and

develop into adult stages

79
Life Cycle of E. granulosus

80
 Clinical features and Pathology:
➢ The symptoms, depend upon the location of the cyst

➢ Large abdominal cysts produce increasing discomfort

➢ Liver cysts cause obstructive jaundice

➢ Peribronchial cysts may produce pulmonary abscesses

➢ Brain cysts produce intracranial pressure and epilepsy

➢ Kidney cysts cause renal dysfunction.

➢ The contents of a cyst may produce anaphylactic responses

 Laboratory diagnosis
➢ Histological examination to find larvae
➢ X – ray examination to find larvae
➢ Examination of cystic fluid for brood capsules and protoscolice

Treatment
➢ Surgical removal of intact cysts
➢ Albendazole given for 1-2wks before surgery & for several
weeks afterwards
➢ PAIR( puncture of cysts Aspiration of cyst fluid Introduction of
Protoscolicide & reaspiration with the use of Ultrasound
guidance

82
Prevention and control
➢ Personal hygiene: washing of hands before eating
➢ Avoid handling dogs

➢ Avoid eating uncooked food

➢ Protection of food and drinks from contamination with feces

➢ Treatment and health education

83
 Echinococcos multilocularis
➢ Same life cycle occurs with E. granulosus with the following
differences:
➢ The definitive hosts are foxes, & to a lesser extent dogs, cats &
wolves;

➢ The intermediate host are small rodents;

➢ Larval growth (in the liver) remains indefinitely in the

proliferative stage, resulting in invasion of the surrounding
tissues
 Diphlobothrium latum (fish tapeworm)
Distribution:
➢ lake areas of Europe, Asia, America, Central Africa
Morphology:

➢Adult: the largest tapeworm (10m or more)

➢Scolex: elongated, spoon shaped, longitudinal structural
groove/bothria/ with no rostellum and hooklets

85
 D. latium
➢Strobila: 3000 – 4000 proglotids

➢Broader than long

➢Genital & uterine pores open on the ventral surface

➢Has coiled uterus

➢Gravid segments are retained by the worm

➢Eggs are discharged periodically, but as they stop to function

they gradually disintegrate
 D. latum

➢ Eggs:

➢Oval or ellipsoidal, with at one end an operculum that

can be rarely visible

➢At the opposite (abopercular) end is a small knob that

can be barely visible

➢Eggs are passed in the stool unembryonated

➢Size range: 58 to 76 µm by 40 to 51 µm

87
 D. latum eggs

Inconspicuous operculum Small knob that can be discernible 88

Proglottids of D. latum

90
 Life Cycle of D. latum
➢ Immature eggs passed in feces .

➢ Eggs mature in which develops a coracidia

➢ Coracidia ingested by a suitable freshwater crustacean (copepod

1st IH), develop into procercoid larvae .

➢ Ingestion of the copepod by 2nd IH (small freshwater fish), the

procercoid larvae are released from the crustacean and migrate
into the fish flesh, develop into a plerocercoid larvae
(sparganum).

91
 Life Cycle of D. latum
➢ Ingestion of the infected fish, the plerocercoid develop into adults
which will reside in the small intestine

➢ The adults of D. latum attach to the intestinal mucosa by means of

the two bilateral groves (bothria) of their scolex

➢ In addition to humans, many other mammals can also serve as

definitive hosts for D. latum

92
Life Cycle of D. latum

93
 Pathogenesis and clinical features
➢ Clinical symptoms may be mild, depending on the no. of worms
➢ Competes for vitamin B12 and cause megaloblastic anaemia

➢Major symptoms:
➢Abdominal pain
➢Diarrhoea, constipation
➢Loss of weight, intestinal obstruction
➢Eosinophilia

94
 Laboratory diagnosis
➢ Eggs in the faeces

➢ Scolex in the faeces

➢ Adult worms in the faeces

Treatment
➢ Adminstration of 5-10mg/kg praziquantel in a single dose.

Prevention and control

➢ Avoid eating raw or undercooked fish
➢ Proper disposal of faeces
➢ Fish inspection for larvae
➢ Treatment of individuals and health education

95
BASIC INFORMATION ON CESTODE BIOLOGY

96
 References
1. Guerrant RL, Walker, DH, Weller PF (2006). Tropical
Infectious Diseases. Principles, pathogens & practices. 2nd
Edition.
2. Gillespie SH & Pearson RD (2001). Principles & practices of
clinical parasitology.
3. Cheesbrough M (2005). District laboratory practice in
Tropical Countries. 2nd edition updated. Part one.Cambridge.
4. CDC. Note
5. Awole M & Cheneke W(2006). Medical parasitology for
medical laboratory technology students. Upgraded lecture
notes series.