Cestodes and

Trematodes
parasites
Shirley O.Solitario,RMT
 The Platyhelminthes (Flatworms):
Tapeworms & Flukes
General Characteristics:
• Multicellular animals characterized by a
flat, bilaterally symmetric body. It is
dorsoventrally flattened and is solid (no
body cavity).
• Most are hermaphroditic, having both
male and female reproductive organs in
the same individual.
• Overall size varies greatly, some
members are as small as 1mm, and
others may be 20 meters or longer.
• The classes Cestoda (tapeworms) and
Trematoda (flukes) contain species
parasitic in humans.
 The
Platyhelminthes
(Flatworms):
Tapeworms
The Cestodes (tapeworms):
◻ Adult worms - Flat & ribbon-like; body
consists of an anterior attachment organ
(scolex) and a body (strobila) consisting
of a chain of segments called
proglottids.
◻ Scolex (head) - Characterized by the
presence of sucking disks or lateral
grooves. Some have hooks (armed).
◻ Rostellum - A small button-like
structure on the scolex of “armed”
tapeworms from which the hooks
protrude. It may be retractable.
 The Platyhelminthes
(Flatworms): Tapeworms
The Cestodes (tapeworms):
◻ Dioecious - each proglottid has both
male & female reproductive organs; can
fertilize itself.
◻ Reproductive organs - male: testes are
spread throughout the segment; sperm
is collected in the seminal vesical;
delivered to female organ via
copulatory spicules. Female: ovaries
produce eggs, which are stored in the
uterus.
 The Platyhelminthes (Flatworms):
Tapeworms
The Cestodes (tapeworms):
Development of proglottids -
• New proglottids bud from behind the
scolex.
• As they are pushed back, they mature &
eggs are produced.
• When filled with eggs, they are “gravid”
proglottids. Eggs are sometime released
in feces, but often are retained within the
segment. Hexacanth embryos
(onchospheres) develop within the eggs.
• Proglottids - a few are usually shed every
2-3 days.
 The Platyhelminthes (Flatworms):
Tapeworms
The Cestodes (tapeworms):
Diagnosis - the scolex or proglottid can
be speciated; eggs of some tapeworms
can be speciated, but not the Taenia
spp. eggs. Anal swabs (cellophane tape
preparations such as used for pinworm
diagnosis) are often helpful due to
squeezing of segments (causing
release of eggs) on the outside of the
stool as it passes through the anus.
 The Platyhelminthes (Flatworms):
Tapeworms

Hymenolepis nana – The Dwarf Tapeworm

• Frequency - most common tapeworm
infection in humans.
• Requires no intermediate host - can use
insects such as fleas or beetles, but these
are not required.
• Definitive hosts - man, rodents.
• Autoinfection - infected humans can
ingest eggs from their own feces.
• Mode of Infection - Ingestion of eggs or
insects containing larvae.
• Diagnosis - most often by finding eggs in
a feces specimen.
The Platyhelminthes (Flatworms):
Tapeworms
Hymenolepis nana - The Dwarf Tapeworm
• Morphology - small, 2 to 4 cm in length.
• Scolex - 4 sucking disks & short rostellum
with hooks.
• Proglottid - are broader than long; rarely
seen in feces specimens (usually
disintegrate in intestine).
• Eggs - most often seen stage in specimens,
measuring 45 to 50 microns in diameter and
exhibiting polar filaments lying between the
egg shell and the hexacanth embryo.
 The Platyhelminthes (Flatworms):
Tapeworms
Hymenolepsis diminuta – The Rat
Tapeworm
• Must be able to differentiate from H. nana.
• A common parasite of rats, mice and other
rodents.
• Mode of infection - ingestion of intermediate
host containing larval stage(s). Grain weevils
are the most important intermediate host
(other intermediate hosts include earwigs,
larval fleas, various beetles). Infection is often
due to ingesting bugs in precooked cereals.
 The Platyhelminthes (Flatworms):
Tapeworms
Hymenolepsis diminuta – The Rat Tapeworm
• Morphology - considerably larger than H. nana (adult as
well as egg).
• Size - adults measure 20 to 60 cm in length.
• Scolex - exhibits no hooks; is larger than that of H.
nana.
• Eggs - measure 60 to 80 microns in diameter and do not
exhibit polar filaments.
 The Platyhelminthes (Flatworms):
Tapeworms
Taenia spp. - two species that infect humans.

Life cycle:
◻ Infective eggs (from human feces) are ingested by
the intermediate host (cow or pig).
◻ The onchosphere hatches and penetrates the
intestinal mucosa of the intermediate host. It is
delivered to various parts of body via the circulatory
or lymphatic systems. Most localize & encyst in
muscle.
◻ Infective stage - the encysted larva, called a
cysticercus develops within 2 months.
◻ Human infections take place when uncooked or
undercooked meat containing larvae is ingested.
 The Platyhelminthes (Flatworms):
Tapeworms
Taenia spp. (continued)
General:
• Scolex - attaches to human intestine.
• Larva - cysticercus, a fluid filled bladder with
an invaginated scolex.
• Eggs of both species are identical.
• Cysticercosis – results when humans
become the intermediate host. More serious
than infections with the adult stage alone.
This condition only occurs with the pork
tapeworm, Taenia solium.
 The Platyhelminthes (Flatworms):
Tapeworms
Taenia saginata – The Beef Tapeworm
General:
• Man is the only definitive host.
• Infection - ingestion of cysticercus
in flesh of cow.
• Size - up to 10 meters in length
(although 70' worms have been
reported).
• life expectancy - 25 years or more.
 The Platyhelminthes (Flatworms):
Tapeworms
Taenia saginata – The Beef Tapeworm
Morphology:
• Scolex - unarmed (no hooks); 4 sucking disks.
• Gravid proglottids - one inch or slightly longer;
uterus contains 15 to 20 primary branches. The
uterine pore is located in a lateral position.
• Eggs are identical to T. solium, measuring
about 40 microns in diameter.
 The Platyhelminthes
(Flatworms): Tapeworms
Taenia solium – The Pork Tapeworm
General:
• Man is the only definitive host.
• Infection - ingestion of cysticercus in flesh
of swine.
• Size - up to 7 meters in length.
• Life expectancy - 25 years or more.
• Autoinfection – called cysticercosis, due to
ingestion of eggs from feces if infected with
adult worm.
• Racemose form of infection may develop in
the brain. A Racemose is a larva which is
branching, spreading throughout tissue.
 The Platyhelminthes
(Flatworms): Tapeworms

Taenia solium - The Pork Tapeworm

Morphology:
• Scolex - armed, with 4 sucking disks.
• Gravid proglottid has 7-13 primary uterine
branches.
• Eggs are identical to T. saginata, measuring
about 40 microns in diameter.
 The Platyhelminthes (Flatworms):
Tapeworms
Diphyllobothrium latum – The Broad Fish
Tapeworm
General:
◻ Two intermediate hosts are required, copepods
(water flea) and fish.
◻ Several fish-eating mammals serve as definitive
hosts: bears, cats, dogs and humans.
◻ The infective stage for mammals is the
plerocercoid larva, which is ingested in raw or
undercooked fish.
◻ Larvae attach to the mucosa lining of the small
intestine and develop to adults.
◻ Diagnostic stage - eggs or proglottids in feces.
The Platyhelminthes (Flatworms):
Tapeworms
Diphyllobothrium latum - The Broad Fish
Tapeworm

Morphology:
• Adult worms are up to 15 meters in
length.
• Scolex - almond shaped with a pair of
suctorial grooves, known as bothria.
• Proglottids – rosette shaped uterus; the
uterine pore is centrally located, not
lateral as with Taenia spp.
• Eggs - measure 30 x 60 microns, and
exhibit an operculum (this is the only
cestode with an operculated egg).
The Platyhelminthes (Flatworms): Tapeworms

Diphyllobothrium latum - The Broad Fish

Tapeworm
Major pathology:
• Intestinal obstruction.
• Many people exhibit vague diagnostic
symptoms such as weight loss and
weakness.
• May cause a macrocytic anemia and
eventual nervous system disturbances
due to vitamin B12 deficiency. The
worm has affinity for vitamin B-12, and
can selectively absorb it.
 The Platyhelminthes
(Flatworms): Tapeworms
Echinococcus granulosis – The Hydatid
Tapeworm
General:
◻ Adults are only in canines. Eggs are shed in
the feces of infected animals.
◻ Humans accidentally ingest eggs from close
contact with an infected animal or from
canine feces.
◻ Hexacanth embryo penetrates the intestinal
mucosa and migrates to tissues.
◻ The hexacanth develops into the larval stage
(hydatid cyst) in the tissue (liver, lung or
brain, most often).
◻ Viscera containing hydatid cysts are eaten by
canines. Adult worms develop.
The Platyhelminthes (Flatworms):
Tapeworms
Echinococcus granulosis -
The Hydatid Tapeworm
Morphology:
• Adult worm - Small, consists of
only 3 segments.
• Hydatid cyst - a thin walled larva
containing many thousands of
invaginated scoleces.
The Platyhelminthes (Flatworms):
Tapeworms
Echinococcus granulosis -
The Hydatid Tapeworm
• Major pathology - hydatid cysts
in the brain. Can grow to size of
a coconut and contain as much
as two liters of fluid. Pressure
necrosis of tissue can result
from larger cysts. Most
commonly found in liver, but can
develop anywhere, including in
bone.
 The Platyhelminthes (Flatworms):
Tapeworms
Dipylidium caninum - The Double-Pored
Tapeworm
General:
• Rare in humans, occurring primarily in infants
and small children closely associated with pets.
• Eggs are ingested by fleas (dog or cat fleas are
intermediate hosts); larvae develop within fleas.
• The definitive host (dog, cat, human) is infected
by ingestion of larvae within fleas. The worm
develops in the small intestine of the definitive
host.
• Diagnosis - Usually based on identification of
gravid proglottids since free eggs not usually
found.
The Platyhelminthes (Flatworms):
Tapeworms
Dipylidium caninum -
The Double-Pored Tapeworm
Morphology:
• Adult - the adult is up to 70
centimeters in length.
• Scolex - armed rostellum;4 sucking
disks.
• Gravid proglottids - are the size of
rice grains, and exhibit a genital pore
on each side.
• Eggs - contained within packets (up
to 12 eggs/packet).
 Trematodes
• multicellular
eukaryotic
helminths
• unsegmented
leaf-shaped worms
• MONECIOUS
except for
schistosomes
(DIECIOUS)
 TREMATODES
• blood flukes
Schistosoma mansoni
S. japonicum
S. hematobium.
• intestinal fluke
Fasciolopsis buski
• liver fluke
Clonorchis sinensis
• lung fluke
Paragonimus westermani.
 Trematodes
• MOT:
1. cercariae
- FREE SWIMMING LARVAE
- given off by infected snail
- penetrate the skin of the human definitive
host
2. metacercariae
- encysted form of the cercariae
- edible plants or animals
water plants
fishs
crustaceans
• Praziquantel
-paralysis of musculature
-attachment of phagocytes to
parasite and death.
 Schistosomiasis
(Bilharziasis)

• S. hematobium: Africa
• S. mansoni : Africa and America
• S. japonicum: Far East.

• 250 million people are infected

Morphology
Adult worms
are 10 to 20
mm long
•Male:
lamelliform
shape with
marginal folds
“The sweetest parasites on
earth”
 SCHISTOSOMES
MOT: skin penetration by cercariae
 FAVORITE SITES
• S. japonicum :VEINS OF GIT
• S. mansoni : VEINS OF GIT
• S. haematobium : VEINS OF
BLADDER
 Schistosomiasis
• type I and type IV hypersensitivity

• collagenase: damage to the

vascular endothelium.
 Three major disease syndromes occur in
schistosomiasis

• 1. schistosome dermatitis

• 2. acute schistosomias (Katayama

fever)

• 3. chronic schistosomiasis.
dermatitis (swimmers' itch): penetration of
cercariae
Acute schistosomiasis
(Katayama fever)

-4 to 8 weeks after primary

exposure
-cough, hepatosplenomegaly

-lymphadenopathy,and eosinophilia
 Chronic disease
• may appear many years later
• japonica and mansoni
hepatomegaly
splenomegaly
portal hypertension
esophageal varices
• schistosomiasis haematobium
inflammation and fibrosis
obstruction
hydronephrosis
uremia
Schistosoma eggs in the
intestinal mucosa
S. Haematobium and bladder
cancer
Schistosomiasis
 Characteristic eggs: diagnosis

Apical spine: S.
haematobium

Lateral
spine:
S.
mansoni

Vestigial spine: S.
japonicum
Treatment and control
• Praziquantel is effective against all
species.
• Contaminated water should be
avoided.
• Control measures include sanitary
disposal of sewage and destruction
of snails.
• No vaccine is available.
Fasciolopsis buski (Giant
intestinal fluke)
• central and
southeast Asia.
• elongate oval
fluke
• 2 to 7 cm long
• small intestine
 Fasciolopsis buski:
MOT: INGESTION OF CYSTS
 Pathology
• attaches itself
to the
intestinal
mucosa
• inflammation,
ulceration,
abscesses
WATERCRESS
 Fasciolopsiasis
• Diagnosis
Eggs in feces

• Treatment
and control
Praziquantel
• Water
chestnuts
• Sewage
treatment
 Clonorchis sinensis
(Chinese Liver Fluke)

• parasite of man, dogs and cats in

the southeast of Asia
• extraordinarily common: China,
Korea and Japan
 Clonorchiasis
• Morphology
• spindloid
flukes
MOT: INGESTION OF
METACERCARIAE
Clonochis adult worms in
the liver
 CLONORCHIASIS
• irritation of the bile ducts 🡪 dilated
• Liver:
enlarged
necrotic
tender
elevated liver enzymes
 CLONORCHIASIS
• Diagnosis
eggs in the feces
or bile
• Treatment and
control
Praziquantel
• Fish should be
cooked well
before
consumption.
• Sewage must be
treated before
disposal.
 Paragonimus westermani
(Lung Fluke)

• most commonly encountered in parts

of Asia, Africa and South America.
• plump reddish brown oval worm
• 10 by 4 mm
MOT: INGESTION OF
METACERCARIAE
 Paragonoimus
• migrate by penetrating through the
intestinal wall 🡪 peritoneal cavity🡪
abdominal wall 🡪 diaphragm 🡪
lungs.
• immature worms settle close to the
bronchi 🡪 grow 🡪 sexually mature
hermaphrodite worms 🡪 eggs
Paragonimus westermani:
lung tissue
 Paragonimus

• dry cough
• blood stained rusty brown sputum
• pulmonary pain and pleurisy
• Brain: granulomatous abscess 🡪
epilepsy
Paragonimus
• Diagnosis
Eggs are found in
rust colored sputum
• Treatment and
control
Praziquantel
• Adequate cooking of
crustaceans
• Improved sanitary
conditions