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CESTODES
1. Intestinal
Diphyllobothrium latum
Dipylidium caninum
Hymenolepis nana
Hymenolepis diminuta
Taenia saginata
Taenia solium
2. Tissue
Echinococcus granulosus
Echinococcus multilocularis
Spirometria mansonoides
GENERAL CHARACTERISTICS AND
CLASSIFICATION
Adult
• White and yellowish in color
• Long, tape-like multi-segmented worms flattened dorsoventrally (flat
and ribbon like in appearance)
• Found in the small intestine of man
• No circulatory system and is usually divided into segments or proglottids
• No digestive system
• Nervous system is confined primarily in the scolex
• Excretory system consists of flame cells, capillaries and collecting tubules
• Reproductive system consists of both male and female which are both
present in each segment (monoecious)
GENERAL CHARACTERISTICS

multicellular flatworms or “tapeworms”

hermaphroditic” and can initiate a new life cycle with the ingestion of a single egg
Life Cycle
1. The Egg
The egg with a hexacanth embryo or oncosphere

2. The Larval Stage

Coracidium, Procercoid, Plerocercoid, Cysticercoid, and Cysticercus larvae

3. Adult Stage
GENERAL CHARACTERISTICS AND CLASSIFICATION

Three parts/regions of adult tapeworm

• Scolex
• Head
• For attachment (holdfast organ)
• Accessory structures present that will help in the attachment
• 2 sucking grooves/sulci
• 4 cup-like suckers (in some species)
• Rostellum
• Hooklets
• Neck
• Region of growth
• Strobila
• Chain of proglottids or segments
GENERAL CHARACTERISTICS AND CLASSIFICATION
Three types of segments
• Immature segment
• Present near the neck. The male and female sex
organs are still immature and are not differentiated
• Mature segment
• Large segment. Male and female sex organs are
differentiated
• Each segment contains single, sometime two sets of
male and female genital organs
• Gravid segment
• Situated farthest away from the scolex
• Uterus is completely filled up with eggs
 The Larval Stage
Larval stages
• Solid type
• Plerocercus/procercoid/procercus
• Present in the 1st IH
• Relatively globular with the scolex invaginated into the body
• Plerocercoid/sparganum larva
• Present in the 2nd IH
• Elongated with head free or invaginated only in the neck
• Cystic type
• Cysticercoid
• Larva is provided with a slightly developed bladder anteriorly, into which the head is invaginated and
with an elongated solid posterior portion
• 2. Cysticercus (true bladder worm)
• In this type of larva, head is invaginated into the proximal portion of the bladder
• Simple, Coenurus, Echinococcus/Hydatid
CLASS CESTOIDEA
• Order Pseudophillidea
• Scolex typically unarmed, with a dorsal and ventral grooves (bothria)
• All representatives in man belong to Superfamily Bothriocephaloidea
• Order Cyclophillidea
• Scolex with 4 suckers and usually a centrally placed apical rostellum,
frequently armed with hooks
• All species found in man belong to Superfamily Taeniodea
 Medically important species of tapeworms
Order Pseudophillidea C. Species which may or may not
Diphyllobothrium latum require IH
Order Cyclophillidea Hymenolepis nana
A. Species which require vertebrate IH D. Species which may infect man in
Taenia solium their larval stage
Taenia saginata
Echinococcus granulosus
B. Species which require invertebrate
IH Echinococcus multilocularis
Dipylidium caninum Taenia solium
Hymenolepis diminuta
Raillietina garisoni Spirometra mansoni
Laboratory diagnosis: involves examining
stool samples for eggs or proglottids.

Symptoms of cestode infections vary but

can include gastrointestinal discomfort,
diarrhea, abdominal pain, nausea, weight
loss, anemia, and organ involvement.

Some infections can lead to allergic

responses or anaphylactic shock
Taenia saginata
Taenia solium
• Cysticercus: survive
for several years in the
host
• Human intestine:
cysticercus develops
over 2 months into
adult tapeworm
Taenia saginata
Common name: Beef tapeworm.
Common associated disease and condition names: Taeniasis,
beef tapeworm infection
Recently, a third human tapeworm was shown to be distributed
in the Asian-Pacific region: Korea, Indonesia, Philippines, and
Thailand.
It is now generally referred to as the Asian Taenia.
• DNA studies showed that the Asian
Taenia is closely related to T.
saginata.
• The Asian Taenia infects cattle,
goats, monkeys and wild boars, but
pigs are the dominant
intermediate hosts.
• Habitat: Small intestine particularly
the upper jejunum. They remain
attached to the intestinal mucosa
with their suckers
 Taenia saginata
MORPHOLOGY
Adult:
• Whitish opaque in color
• The scolex is similar to that of T. solium
except for the absence of rostellum,
spines or hooklets.
• There are more segments in T. saginata
than in T. solium, there being 1,000 to
2,000 segments in T. saginata.
• The lateral uterine branches of the
uterus in the gravid segments number
15 or more.
 Taenia saginata
• Eggs:
• Each proglottid may contain about
80,000 eggs.
• T. saginata eggs are indistinguishable
from T. solium eggs.

• Larval Stage:
• Cysticercus bovis or the larval stage of T.
saginata is similar to cysticercus
cellulosae except that the scolex is
unarmed.
• Cysticercus larvae may remain viable in
the tissue of cattle for about 8 months.
Disease

•Taeniasis
Majority of patients are asymptomatic.
Those with high worm burden may complain of diarrhea,
abdominal pain, loss of appetite with result weight loss, and
body malaise.
The gravid proglottids may reach the anus where egg laying
may occur resulting in itchiness in the anal region (pruritus
ani).
Reservoir, source and transmission of
infection
• Man is the only reservoir of infection
• Contamination of the environment by
human feces is the most crucial in
maintaining the infection in the community
• Raw or undercooked beef containing
Cysticercus bovis is the source of infection
for human

Man acquires infection by:

• Eating raw or undercooked beef harboring
the cysticerci
• Tasting meat dishes during cooking
 Taenia solium
Common name: Pork tapeworm. Common
associated disease and condition names:
Taeniasis, pork tapeworm infection.
• T. solium infection underdeveloped
communities with poor sanitation
and where people eat raw or
undercooked pork. Higher rates of
illness have been seen in people in
Latin America,Eastern Europe,sub
Saharan Africa, India, and Asia
(CDC).
• Adult worms produce little damage
in the intestines
Disease
1. Taeniasis– the disease produced by the adult worm.
Most cases are asymptomatic but in the presence of
high worm burden, manifestations may be similar to
beef tapeworm infection.

1. Cysticercosis– the result of larval encystation in various

tissues of the body. The most common involvement is
that of the skeletal muscles where patients may
Disease

Cyticercosis of the brain (neurocysticercosis) is the most

feared and most severe involvement.

It may present with symptoms associated with increased

intracranial pressure such as seizures, headache, and
vomiting. Ocular cysticercosis may lead to visual
disturbancesdue to developmentof inflammationof the
uvea (uveitis) and retina (retinitis).
 Morphological Differences Taenia solium Taenia saginata

Adult – Length 2-7 meters 5-10 meters

Adult - # of segments 800-1,000 1,000-2,000

Scolex – shape Globular Quadrte

Scolex - # of suckers 4 4

Scolex - Rostellum Present Absent

Scolex – Hooklets Present, double row of 20-25 Absent

Mature segment - Tubular uterus - 1 ovary with 2 large ovarian lobes

- 1 ovary with 2 large ovarian - wider than long
lobes and 1 accessory
- wider than long

Gravid segment - 150-200 testicular follicle - 330-400 testicular follicle

- 5-14 uterine branches - 15-20 uterine branches
- Longer than broad - Longer than broad
 Morphological Taenia solium Taenia saginata
Differences

Infective stage Cysticercus cellulosae Cysticercus bovis

Intermediate hosts Hogs, pigs Cattle cow

Eggs Spherical, non-operculated, mature with 3 Same as T. solium

pairs of hooklet and shell striation. Walnut
brown
Laboratory Diagnosis
• Stool is the specimen of choice for the recovery of Taenia eggs
and gravid proglottids.
• The scolex may be seen only after the patient has been treated
with anti-parasitic medication.

• Furthermore, there is evidence to suggest that specimens

collected around the perianal area using the cellophane tape
prep procedure result in a very high recovery rate of Taenia eggs.
 Treatment
• The drug of choice for treatment of intestinal infection
is praziquantel.
• For cysticercosis, praziquantel may also be effective
but it is usually not recommended for ocular and CNS
involvement.
• Alternative drugs: albendazole, paromomycin,and
quinacrine hydrochloride.
• Surgical removal of the larvae may be necessary. Anti
convulsants may be given in cases of
neurocysticercosis..
 Prevention and Control
• Proper waste disposal and sanitation practices as well
as the adequate cooking of beef or pork are the main
preventive measures for taeniasis.

• Freezzing of beef meat for approximately 10 days may

kill the encysted larvae.
• Prompt treatment of infected persons help prevent
spread of the disease.
 Hymenolepis diminuta
Common name: Rat tapeworm.
Common associated disease and condition
names: Hymenolepiasis, rat tapeworm disease

*worldwide
Laboratory Diagnosis
•recovery of the characteristic eggs in stool
specimens.
•proglottids are typically not found in stool they
disintegrate in the human gut.

• Similarly, the scolex is rarely seen in these

samples.
Clinical Symptoms
•Asymptomatic.
•Hymenolepiasis: Rat Tapeworm
Disease. Persons infected with H.
diminuta usually present with mild
symptoms such as diarrhea, nausea,
abdominal pains, and anorexia.
•The treatment of choice against H. diminuta is
praziquantel.

•Niclosamide is an effective alternative therapy;

however, it is not yet readily available in the
United States.
Prevention and Control
•First, administering effective rodent control thus
preventing rats from contaminating foodstuffs
such as grains and cereals.
Prevention and Control
•Second, protection of these foods from both rat
droppings and from intermediate host insects is
critical to prevent consumption of contaminated
food.
Hymenolepis nana
(Common name: Dwarf
tapeworm. Common
associated disease and
condition names:
Hymenolepiasis, dwarf
tapeworm disease.
✓ H. nana does not require an obligatory
intermediate animal host. The eggs are directly
infectious and humans get the infection after
the accidental ingestion of the eggs of the
parasite

MOT:. Fecal-oral ,touching one’s mouth with

contaminated fingers or through ingestion of
contaminated soil,Accidental ingestion of rice
or flour beetles containing the infective larvae
Hymenolepis nana
Three phases in the Life Cycle of H. nana
1. Direct phase
Does not require intermediate host, only definitive host
2. Indirect phase
Ex. H. nana var. fraterna
Ova in beatles and fleas which may serve as IH. Ova becomes cysticercoid
3. Internal and external autoinfection
Internal – eggs hatch out in the lumen of SI and liberate embryo which directly invade the intestinal villi. Responsible in the increase of worm
load in the SI
External – person ingests one’s own eggs by fecal-oral route due to bad personal hygiene. Responsible for persistence of infection in the host

Intermediate Hosts:
Ctenocephalides canis
Pulex irritans
Xenopsylla cheopis
Tenebrio molitor
Tenebrio confusum
Hymenolepis nana
Pathogenesis And Pathology
Development of cycticercoid larvae in the intestine of man causes little or no pathology
In heavy infections, large number of worms may cause:
Mechanical irritation of the intestine
Various allergic manifestation such as anal and nasal pruritus by releasing toxic metabolites

Reservoir, source and transmission of infection

Infected human are the chief source of infection
Man is the main reservoir
Hexacanth eggs are infective to human
Transmission of infection in man occurs:
1. Fecal-oral route
2. Contamination of foods and water
3. Ingestion of foods contaminated with fleas

Diagnosis
Stool examination reveals the characteristic eggs with its six hooklets embryo and polar filaments
Treatment :
Praziquantel is considered to be the
treatment of choice for infections with H.
nana
Prevention and Control
•Proper personal hygiene and sanitation
practices are crucial to preventing the
spread of H. nana. Controlling transport
host populations and avoidance of
contact with potentially infected rodent
feces are also prevention and control
measures aimed at halting the spread of
the parasite.
 Dipylidium caninum ˇ
Common names: Dog or cat tapeworm, pumpkin
seed tapeworm.
Common associated disease and condition names:
Dipylidiasis, dog or cat tapeworm disease.
Laboratory Diagnosis
•D. caninum diagnosis is based on the
recovery of the characteristic egg packets or
gravid proglottids in stool samples. The
presence of a single egg in a stool sample
may occur, but is extremely rare.
Clinical symptoms:
•Usually asymptomatic, but heavy
infections can cause appetite loss,
diarrhea, abdominal discomfort,
indigestion, and anal pruritus.
Treatment:
•Praziquantel is the preferred drug, with
niclosamide and paromomycin as alternatives.
Prevention and control
•Regular veterinary examinations,
deworming of infected pets, flea prevention
for pets, and teaching children not to let
pets lick them near their mouths.
 Diphyllobothrium latum
Common name: Broad fish tapeworm.
Common associated disease and condition names:
Diphyllobothriasis, fish tapeworm infection, broad
fish tapeworm infection
Laboratory diagnosis
• : Examination of stool samples for eggs, proglottids, or
scolex.
• Life cycle: Requires two intermediate hosts (copepods
and freshwater fish) to complete the cycle.

• MOT:Ingestion of contaminated raw or undercooked

fish by humans initiates infection.
Clinical symptoms:
•Most infected individuals are
asymptomatic. Symptoms may include
digestive discomfort, weakness, weight
loss, abdominal pain, and vitamin B12
deficiency.
•Treatment: Praziquantel and
niclosamide are effective drugs.
Prevention and control:
•Proper human fecal disposal, avoiding
raw or undercooked fish, and thorough
cooking of all fish before consumption.
 Echinococcus granulosus
Common names: Dog tapeworm, hydatid
tapeworm.
Common associated disease and
condition names: Echinococcosis, hyatid
cyst, hyatid disease, hyatidosis.
Morphology
• Hyadatid cyst.
 Disease
• : Echinococcosis,Hydatid Cyst Disease, Hydatid Disease, Hydatidosis

• Most patients are asymptomatic during the early stages of the

disease.
• cysts enlarge, necrosis of the infected tissues occur.
• liver : obstructive jaundice.
• lung involvement :with cough, chest pain, and shortness of breath.
Other organs that may be infected in clude the spleen, kidneys,
heart, bone, and central nervoussystem, including the brain and eyes
 TREATMENT
• Care should be exercised when doing
biopsy to prevent rupture of the cyst.
Treatment In cases when surgery is
possible, removal of the cyst has been
considered as the treatment of choice.
• Drugs that have been proven effective
include mebendazole, albendazole, and
praziquantel.
Prevention and Control
• . Improvement of personal hygiene practices prevention of
contamination of food and water with dog feces
• avoidance of feeding pet dogs with contaminated viscera,
• prompt treatment of infected canines and humans are some
measures to prevent the spread of the parasite.
• Chemoprophylaxis should be given to dogs in endemic areas.
• Health education