Cestodes- Tapeworms

• Cestodes belong to Phylum Platyhelminthes and class

Cestoidea.
• The class Cestoidea includes 2 orders:
- Pseudophyllidea
- Cyclophyllidea
• Tapeworms: General Characteristics
• Adult Worms
• The adult worm consists of 3 parts:
• €Head (scolex)
• €Neck
• €Trunk (strobila)
• Head (Scolex)
• It is the organ of attachment to the intestinal mucosa
of the definitive host, human or animal.
• In parasites of the order cyclophyllidea, the scolex
possesses 4 suckers (or acetabula).
• In some cyclophyllidea like Taenia solium, scolex has
an apical protrusion called as the rostellum.
• The rostellum may or may not be armed with hooks.
• Neck
• It is the part, immediately behind the head and is the
region of growth from where the segments of the
body (proglottids) are being generated continuously.
• Trunk (strobila)
• The trunk also called as strobila is composed of a chain of
proglottids or segments.
• The proglottids near the neck, are the young immature
segments, behind them are the mature segments, and at
the hind end, are the gravid segments.
• Tapeworms are hermaphrodites (monoecious) and every
mature segment contains both male and female sex
organs.
• In the immature segments, the reproductive organs are
not well-developed. They are well-developed in the
mature segments.
• The gravid segments are completely occupied by the
uterus filled with eggs.
• Tapeworms do not have a body cavity or alimentary
canal.
• Rudimentary excretory and nervous systems are
present.
• CYCLOPHYLLIDEAN TAPEWORMS
• Taenia Saginata and Taenia Solium
• Common name
• Taenia saginata - Beef tapeworm
• Taenia solium - Pork tapeworm
• T. saginata
• The adult worms live in the human small intestine,
commonly in the jejunum.
• Morphology
• Adult Worm of T. saginata
• The adult T. saginata worm is opalescent white in color,
ribbon-like, dorsoventrally flattended, and segmented.
• The adult worm consists of head (scolex), neck, and strobila
(body).
• Scolex bears 4 hemispherical suckers situated at its
four angles. They may be pigmented.
• The scolex has no rostellum or hooklets.
• T. saginata is, therefore called the unarmed tape
worm.
• The suckers serve as the sole organ for attachment.
• The neck is long and narrow.
• The strobila (trunk) consists of 1000 to 2000
proglottides or segments—immature, mature and
gravid.
• The segment contains male and female reproductive
structures.
• As there is no uterine opening, the eggs escape from
the uterus through its ruptured wall.
• Eggs
• Eggs of both species are indistinguishable.
• The egg is spherical.
• It has a thin hyaline embryonic membrane around it,
which soon disappears after release.
• The inner embryophore is radially striated and is
yellow-brown due to bile staining.
• In the center is a fully-developed embryo
(oncosphere) with 3 pairs of hooklets (hexacanth
embryo).
• The eggs do not float in saturated salt solution.
• The eggs are infective only to cattle and not
• to humans.
• Larva
• The larval stage of Taenia is called as cysticercus.
• Cysticercus bovis is the larva of T. saginata
• Cysticercus bovis
• € It is the larval form of T. saginata.
• €The name cysticercus in derived from the Greek, kystis—
bladder and kerkos—tail.
• €The larva (cysticercus bovis) is infective stage for humans.
• €The cysticercus is an ovoid, milky-white opalescent fluid-filled
vesicle.
• Contains a single invaginated scolex (bladder worm).
• The cysticerci are found in the muscles of mastication, cardiac
muscles, diaphragm and tongue of infected cattle.
• They can be seen on visual inspection as shiny white dots in
the infected beef (measly beef).
• Life Cycle of Taenia Saginata
• T. saginata passes its life cycle in 2 hosts.
• Definitive host: Humans are the definitive hosts and harbor the adult
worm.
• Intermediate host: Cattle (cow or buffalo) are the intermediate host
and harbor the larval stage of the worm.
• Infective stage: Cysticercus bovis (larval stage) is the infective stage
to man, while eggs are infective to cattle.
• The adult worm lives in the small intestine of man.
• The gravid segments from the adult worm breakaway and are
expelled singly. They actively force their wayout through the anal
sphincter.
• The eggs or gravid segments are passed out with feces on the ground.
• The eggs deposited in soil remain viable for several weeks.
• They are infective to cattle, which ingest the eggs while
• grazing.
• Development in Cattle
• When ingested by cattle (cow or buffalo), the eggshell
ruptures releasing onchosphere in the duodenum.
• The onchospheres, with their hooklets penetrate the
intestinal wall, reach the mesenteric venules or
lymphatics and enter the systemic circulation.
• They get filtered out in the striated muscles, particularly
in muscles of the tongue, neck, shoulder, ham, and in the
myocardium.
• In these sites, the onchosheres lose their hooks and in
about 60–70 days develop in the mature larva, cysticercus
bovis.
• The cysticerci can live in flesh of cattle for about 8
months, but can develop further only when ingested by
man, its definitive host.
• Development in Man
• Man acquires infection by ingesting raw or
undercooked beef containing cysticerci.
• The cysticerci are digested out of the meat in the
stomach.
• In the upper part of the small intestine, the head
(scolex) evaginates out of the cysticercus, becomes
attached to the mucosa, and by gradual strobilization
develops into the adult worm in about 2–3 months.
• The adult worm has a life span of 10 years or more.
• Infection in usually with a single worm, but sometimes
multiple infection is seen and 25 or more worms have
been reported in patients.
• In man it have a dead end.
• T. solium
• The adult worm is usually 2-3 meters long.
• The scolex of T. solium is small and globular, with 4 large
cup-like suckers and a conspicuous rounded rostellum,
armed with a double row of alternating round and small
dagger-shaped hooks, 20–50 in number.
• The neck is short and half as thick as the head.
• The proglottides number less than a thousand. They
resemble those of T. saginata in general.
• The gravid segments are twice as long as broad.
• The testes are composed of 150 to 200 follicles.
• There is an accessory lobe for the ovary.
• The vaginal sphincter is absent.
• The uterus has only 5 to 10 (under 13) thick lateral
branches. A lateral thick-lipped genital pore is present,
alternating between the right and left sides of adjacent
segments.
• The gravid segments are not expelled singly, but pass
passively out as short chains.
• The eggs escape from the ruptured wall of the uterus.
• Larva
• Cysticercus cellulosae
• €It is the larval form of T. solium and also the infective
form of the parasite.
• €It can develop in various organs of pig as well as in man.
• The cysticercus cellulosae or ‘bladder worm’ is ovoid opalescent
milky-white.
• The scolex of the larva, with its suckers, lies invaginated within
the bladder and can be seen as a thick white spot. It remains
viable for several months.
• Life Cycle of Taenia Solium
• Definitive host: Man
• Intermediate host: Pig
• Infective stage: Cysticercus cellulosae (larva)
• Humans are infected by consuming inadequately cooked pork
containing cysticercus cellulosae (measly pork).
• Man harboring adult worms may autoinfect oneself either by
unhygenic personal habits or by reverse peristaltic movements
of the intestine.
• Infective stage: Eggs of T. solium and larva also
• Humans may develop intestinal infection with adult
worms after ingestion of contaminated pork or may
develop cysticercosis after ingestion of eggs (making
humans intermediate hosts).
• 1. Humans ingest raw or undercooked pork containing
cysticerci (larvae).
• 2. After ingestion, cysts evaginate, attach to the small
intestine by their scolex, and mature into adult worms in
about 2 months.
• 3. Adult tapeworms produce proglottids, which become
gravid; they detach from the tapeworm and migrate to
the anus.
• 4. Detached proglottids, eggs, or both are passed from
the definitive host (human) in feces.
• 5. Pigs or humans become infected by ingesting
embryonated eggs or gravid proglottids (eg, in
fecally contaminated food). Autoinfection may
occur in humans if proglottids pass from the
intestine to the stomach via reverse peristalsis.
• 6. After eggs are ingested, they hatch in the
intestine and release oncospheres, which
penetrate the intestinal wall.
• 7. Oncospheres travel through the bloodstream
to striated muscles and to the brain, liver, and
other organs, where they develop into cysticerci.
Cysticercosis can result.
• Pathogenicity and Clinical Features
• Intestinal Taeniasis
• It can be caused by both T. saginata and T. solium.
• The adult worm, inspite of its large size, causes
surprisingly little inconvenience to the patient.
• When the infection is symptomatic, vague
abdominal discomfort, indigestion, nausea,
diarrhea, and weight loss may be present.
• Occasional cases of acute intestinal obstruction,
acute appendicitis, and pancreatitis have also
been reported.
• Cysticercosis
• It is caused by larval stage (cysticecus cellulosae) of T. solium.
• Any organ or tissue may be involved, the most common
being subcutaneous tissues and muscles.
• It may also affect the eyes, brain, and less often the heart,
liver, lungs, abdominal cavity, and spinal cord.
• The cysticercus is surrounded by a fibrous capsule except in
the eye and ventricles of the brain.
• The larvae evoke a cellular reaction starting with infiltration
of neutrophils, eosinophils, lymphocytes, plasma cells, and
at times, giant cells.
• This is followed by fibrosis and death of the larva with
eventual calcification.
• The clinical features depend on the site affected.
• Subcutaneous nodules are mostly asymptomatic
• Muscular cysticerosis may cause acute myositis
• €Neurocysticerosis (cysticercosis of brain) is the most common
and most serious form of cysticercosis.
• About 70% of adult-onset epilepsy is due to neurocysticercosis.
Other clinical features of neurocysticercosis are increased
intracranial tension, hydrocephalus, psychiatric disturbances,
meningoencephalitis, transient paresis, behavioral disorders
aphasia, and visual disturbances.
• It is considered as the second most common cause of intracranial
space occupying lesion (ICSOL) after tuberculosis in India.
• €In ocular cysticercosis, cysts are found in vitreous humor,
subretinal space and conjunctiva.
• The condition may present as blurred vision or loss of vision,
iritis, uveitis, and palpebral conjunctivitis.
 Echinococcus Granulosus
• Common name: Dog tape worm
• Habitat
• The adult worm lives in the jejunum and duodenum of dogs
and other canine carnivora (wolf and fox).
• The larval stage (hydatid cyst) is found in humans and
herbivorus animals (sheep, goat, cattle and horse).
Morphology
• Adult Worm
• It is a small tapeworm.
• It consists of a scolex, a short neck, and strobila.
• The scolex is pyriform, with 4 suckers and a prominent
rostellum bearing 2 circular rows of hooklets (25–30).
• The neck is short than the rest of the worm.
• The strobila is composed of only 3 proglottids, the
anterior immature, the middle mature, and the
posterior gravid segment.
• The terminal proglottid is longer and wider than the
rest of the worm and contains a branched uterus
filled with eggs.
• The adult worm lives for 6–30 months.
• Egg
• The eggs of Echinococcus are indistinguishable from
those of Taenia species.
• It is ovoid in shape and brown in color.
• It contains an embryo with 3 pairs of hooklets.
• Larval Form
• The larval form is found within the hydatid cyst
developing inside various organs of the intermediate
host.
• It represents the structure of the scolex of adult worm
and remains invaginated within a vesicular body.
• After entering the definitive host, the scolex with
suckers and rostellar hooklets, becomes exvaginated
and develops into adult worm.
• Life Cycle
• The worm completes its life cycle in 2 hosts.
• Definitive hosts: Dog (optimal host), wolf, jackal, and
fox.
• Intermediate host: Sheep and Cattle. Sheep is the ideal
intermediate host.
• €Man acts as an accidental intermediate host (dead end).
• €The larval stage of the parasite is passed in intermediate
hosts, including man, giving rise to hydatid cyst.
• The adult worm lives in the small intestine of dogs and
other canine animals. These animals discharge numerous
eggs in the feces.
• Intermediate hosts (sheep and cattle) ingest them while
grazing.
• Human infection follows ingestion of the eggs due to
intimate handling of infected dogs or by eating raw
vegetables or other food items contaminated with dog
feces.
• The ova ingested by man or by sheep and cattle are liberated
from the chitinous wall by gastric juice liberating the hexacanth
embryos which penetrate the intestinal wall and enter the portal
venules, to be carried to the liver along the portal circulation.
• These are trapped in hepatic sinusoids, where they eventually
develop into hydatid cyst. About 75% ofmhydatid cyst develop in
liver, which acts as the first filter for embryo.
• Some embryo which pass through the liver, enter the right side of
heart and are caught in pulmonary capillaries (forming
pulmonary hydatid cysts), so that the lung acts as the second
filter.
• A few enter the systemic circulation and get lodged in various
other organs and tissues such as the spleen, kidneys, eyes, brain,
or bones.
• When sheep or cattle harboring hydatid cysts die or are
slaughtered, dogs may feed on the carcass or offal.
• Inside the intestine of dogs, the scolices develop into the
adult worms that mature in about 6–7 weeks and produce
eggs to repeat the life cycle.
• When infection occurs in humans accidentaly, the cycle
comes to a dead end because the human hydatid cysts are
unlikely to be eaten by dogs.
• Pathogenesis
• Evolution of Hydatid Cyst
• At the site of deposition, the embryo slowly develops into a
hollow bladder or cyst filled with fluid.
• This becomes the hydatid cyst (Greek hydatis: a drop of
water).
• It enlarges slowly in about 6 months.
• The growing cyst evokes host tissue reaction leading to the
deposition of fibrous capsule around it.
• The cyst wall secreted by the embryo consists of 3
indistinguishable layers.
• € Pericyst is the outer host inflammatory reaction consisting
of fibroblastic proliferation, mononuclear cells, eosinophils,
and giants cells, eventually developing into dense fibrous
capsule which may even calcify.
• €Ectocyst is the intermediate layer composed of
characteristic acellular, chitinous, laminated hyaline material.
It has the appearance of the white of a hard boiled egg.
• € Endocyst is the inner germinal layer which is cellular and
consists of number of nuclei embedded in a protoplasmic
mass and is extremly thin (22–25 mm).
• The germinal layer is the vital layer of the cyst and is the site
of asexual reproduction giving rise to brood capsules with
scolices. It also secretes hydatid fluid, which fills the cyst.
• Hydatid fluid: The interior of the cyst is filled with a
clear colorless or pale yellow fluid called as hydatid
fluid. €pH of the fluid is 6.7 (acidic).
• Composition: It contains salts (sodium chloride 0.5%,
sodium sulphate, sodium phosphate, and salts of
succinic acid) and proteins.
• €It is antigenic and highly toxic so that its liberation into
circulation gives rise to pronounced eosinophilia or may
even cause anaphylaxis.
• €The fluid was used as the antigen for Casoni’s
intradermal test.
• A granular deposit or hydatid sand is found at the
bottom of the cyst, consisting of free brood capsules
and protoscolices and loose hooklets.
• Brood capsules
• From the germinal layer, small knob-like excrescences or
gemmules protrude into the lumen of the cyst. These
enlarge, become vacuolated, and are filled with fluid. These
are called as brood capsules.
• They are initially attached to the germinal layer by a stalk,
but later escape free into the fluid-filled cyst cavity.
• From the inner wall of the brood capsules, protoscolices
(new larvae) develop, which represent the head of the
potential worm, complete with invaginated scolex, bearing
suckers and hooklets.
• Several thousands of protoscolices develop into a mature
hydatid cyst, so that this represents an asexual
reproduction.
• Inside mature hydatid cysts, further generation of cyst,
daughter cysts and grand-daughter cysts may develop.
• The cyst grows slowly often taking 20 years or more to
become big enough to cause clinical illness and is
therefore, particularly seen in man.
• Acephalocysts
• Some cysts are sterile and may never produce brood
capsules, while some brood capsule may not produce
scolices. These are called acephalocysts.
• Fate of hydatid cysts
• The cyst may get calcified or spontaneously evacuated
following inflammatory reaction. Hydatid cyst of liver
may rupture into lung or other body cavity producing
disseminated hydatid lesions.
• Clinical Features
• Most of the times infection is asymptomatic and accidentally
discovered.
• Clinical disease develops only when the hydatid cyst has grown big
enough to cause obstructive symptoms.
• Disease results mainly from pressure effects caused by the enlarging
cysts.
• In about half the cases, the primary hydatid cyst occurs in liver
(63%) , mostly in the right lobe.
• Hepatomegaly, pain, and obstructive jaundice are the usual
mainfestations.
• The next common site is the lung (25%) (most common being the
lower lobe of the right lung). Cough, hemoptysis, chest pain,
pneumothorax, and dyspnea constitute the clinical picture.
• In the kidney (2%), hydatid cyst causes pain and hematuria.
• Other sites affected include spleen (1%), brain (1%), pelvic organs,
orbit, and bones (3%).
• Apart from pressure effects, another pathogenic
mechanism in hydatid disease is hypersensitivity to
the echinococcal antigen.
• The host is sensitized to the antigen by minute
amounts of hydatid fluid seeping through the
capsule.
• Hypersensitivity may cause urticaria. But if a hydatid
cyst ruptures spontaneously or during surgical
interference, massive release of hydatid fluid may
cause severe, even fatal anaphylaxis.