PARASITOLOGY

Topic: Introduction to Cestodes & Minor Cestodes

References: Old Trans + Belizario

Outline: MINOR CESTODES

I. Introduction to Cestodes Dipylidium caninum
II. Minor Cestodes:  Dog tapeworm
 Dipylidium caninum  Dipylidiasis in humans is accidental and is observed to be more
 Railetina garrisoni common in children than in adults
 Hymenolepis nana  D. caninum is a very common intestinal parasite of dogs and cats
 Hymenolepis dimunata worldwide, especially in dog populations where ectoparasitism is
 Echinococcus granulosus high
 Multiceps multiceps
Parasite Biology
INTRODUCTION TO CESTODES
Morphology
Cestodes:
 Adult worm:
 Long, segmented and flat
o Pale reddish
 “Tapeworms” o 10 to 70 cm in length
 Phylum: Platyhelminthes o The scolex is small and globular with four deeply cupped
 Class: Cestoda suckers and a protrusible rostellum, which is armed with
 Habitat: Intestine one to seven rows of rose thorn-shaped hooklets
 Hermaphrodite: Monoecious o The proglottids are narrow with two sets of male and
 Absent: female reproductive organs and bilateral genital pores,
o Body cavity earning for this parasite the common name double-
o Alimentary canal pored tapeworm
 Present: The gravid proglottids have the size and shape of a
o Excretory system pumpkin seed and are filled with capsules or packets
o Nervous system of about 8 to 15 eggs enclosed in an embryonic
o Reproductive system membrane
 General Characteristic of Cestodes:
o Three regions in an adult worm: o When the gravid segments are detached, they either
1. Head (scolex) with hooks (rostella) – for migrate out of the anus or are passed out with the feces
attachment o The ova are released by contraction of the proglottid or
2. Neck (region of growth) by its disintegration outside the host
3. Strobila (body or trunk) – series of segment
(proglottids)
 Reproductive organs
o Immature
 Male and female organs are not developed
o Mature
 Male and female organs are developed
o Gravid
 Uteri filled with eggs
 Classification of Cestodes infecting man:
o Pseudophyllidean Cestodes – Possessing false slit-like
grooves (bothria)
 Adult worm in intestine
 Diphyllobothrium latum (fish
worm) – Major cestode  Eggs
 Larval stages (Plerocercoid) in Man o Spherical
 Sparganum mansoni o Thin-shelled with hooklets enclosed in an embryonic
 Sparganum proliferum membrane (egg packets)
o Cyclophyllidean Cestodes – Possessing cup-like and
round suckers
Life Cycle
 Adult worm in intestine
Based on Belizario:
 Taenia solium (pork tapeworm)
 Larval fleas ingest the ova as they feed on epidermal debris
 Taenia saginata (beef tapeworm)
 Among the intermediate hosts are the larval stages of:
 Dipylidium caninum (Double-pored
o Ctenocephalides canis (dog flea)
Dog tapeworm)
o Ctenocephalides felis (cat flea)
o Pulex irritans (human flea)
Comparison between Pseudophyllidean and Cyclophyllidean
o Trichodectes canis (dog louse)
Pseudophyllidean Cyclophyllidean
Head Bears 2 slit-like grooves Bears 4 cup-like suckers  In the body cavity of the arthropod, the hexacanth embryo develops
No branching, rosette shaped Branching may or may not into the cysticercoid larvae, which is able to survive the flea’s
Uterus development
convoluted tubule be present
Uterine pore Present Absent  When the insect is ingested by mammalian hosts (dogs, cats,
Common genital pore Ventral, in the midline Lateral humans), the cysticercoid is liberated and becomes an adult in 3 to 4
Operculated giving rise to Not operculated, do not weeks
Eggs
ciliated larvae give rise to ciliated larvae

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 PARASITOLOGY
Topic: Introduction to Cestodes & Minor Cestodes
References: Old Trans + Belizario

Dipylidium caninum:
 Intermediate host: Dog/Cat fleas
 Definitive host: Dogs
 Accidental host: Humans
 Infective stage to humans & dogs/cats: Cysticercoid larva in insects
 Diagnostic stage: Proglottids which are double-pored

Raillietina garrisoni
 Family: Davaineidae
 Raillietina madagascariensis was first reported by Garrison to be
present in an adult Filipino in 1911
 R. garrisoni was later documented in three children
 It is generally believed that the species are identical
 Tubangui further showed that this was a common tapeworm of rats
 Almost all human infections in the Philippines have involved children

Parasite Biology
Morphology:
Gravid proglottids are passed intact in the feces or emerge from the perianal region of the
 The tapeworm is about 60 cm in length
host (1) . In the environment, the proglottids disintegrate and release egg packets, which
are also occasionally found free in the feces (2) . The intermediate host (most often larval  With a minute, subglobular scolex with four acetabula
stages of the dog or cat flea Ctenocephalides spp.) ingests egg packets, and the oncosphere  The rostellum is armed with two alternating circular rows of 90 to 140
within is released into the larval flea’s intestine. The oncosphere penetrates the intestinal hammer-shaped hooks
wall, invades the insect’s hemocoel (body cavity), and develops into a cysticercoid (3). The  Several rows of spines also surround the rostellum
cysticercoid remains in the flea as it matures from a larva into an adult (4) . The vertebrate
 The mature proglottid has a bilobed ovary surrounded by 36 to 50
host becomes infected by ingesting the adult flea containing the cysticercoid (5) . In the
small intestine of the vertebrate host, the cysticercoid develops into the adult tapeworm
ovoid testes
after about one month. The adult tapeworms (measuring up to 60 cm in length and 3 mm  The genital pore opens on the side near the anterior lateral border of
in width) reside in the small intestine of the host, where they each attach by their scolex (6) . the segment
Gravid, double-pored proglottids detach from the strobila (body) and are shed in the feces.  The fully gravid proglottids are about 2 mm in length containing 200
to 400 egg capsules with one to four spindle-shaped eggs
Humans also acquire infection by ingesting the cysticercoid contaminated flea. Children are
 The oncosphere is enclosed in two thin membranes: an outer
most frequently infected, possibly due to close contact with flea-infested pets (7) .
elongated membrane and an inner spherical membrane
 The gravid segments detach from the rest of the strobili by apolysis
Pathogenesis & Clinical Manifestations
and may be passed out in the feces
 Infection is rarely heavy and symptoms are minimal
 The segments are motile, white, and appear like grains of rice when
 Slight intestinal discomfort, epigastric pain, diarrhea, anal pruritus,
passed out with the feces
and allergic reactions have been reported
 While most patients are asymptomatic, moderate eosinophilia has
Life Cycle
been reported

Diagnosis
 Diagnosis is established upon recovery of the characteristic gravid
proglottids passed out singly or in chain
Gravid proglottids may crawl out of the anus, and may be passed
out involuntarily. Proglottids should be pressed or flattened
between two glass slides for examination

 Stool examination for the presence of the egg capsules is NOT

recommended, since the gravid proglottids do not disintegrate in the
intestines but in the environment
Egg capsules are RARELY recovered from the stool

Treatment
 Praziquantel – 5 to 10 mg/kg as a single dose

Epidemiology
 Human infection is rare but has been reported in European countries,
USA, Argentina, Rhodesia, China, and the Philippines Motile proglottids containing numerous egg capsules are shed in the definitive host’s
 Infants and very young children are usually infected because of their feces (1) . Arthropod intermediate hosts ingest proglottids or free egg capsules released as
close contact with their pet cats and dogs the proglottid breaks down in the environment (2) . Within the intermediate host,
oncospheres are released from the eggs and develop into cysticercoids (3) . The definitive
 Likely, transmission could have occurred through hand to mouth
host becomes infected after ingesting intermediate hosts containing cysticercoids (4) . The
contamination or accidentally swallowing the arthropod hosts when
scolex, armed with two rows of hammer-shaped hooks, everts and anchors to the small
hugging and kissing the animal intestinal wall, where maturation to the adult stage occurs (5) . Aberrant human infections
may occur when infected arthropod intermediate hosts are ingested (6)

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 PARASITOLOGY
Topic: Introduction to Cestodes & Minor Cestodes
References: Old Trans + Belizario

Based on Belizario: o The proglottids measure 0.15 to 0.3 mm in length and 0.8
 Gravid segments may be ingested by the insect intermediate host, to 1.0 mm in width
the flour beetle Tribolium confusum o The genital pores are found along the same side of the
 The development from egg to the cysticercoid larval stage takes segments
about two weeks o Mature proglottids contain three ovoid testes and one
 Infected insects are accidentally ingested and the cysticercoid larva ovary in a more or less straight pattern across the
attaches to the intestinal villi to develop into an adult in about 8 segment
weeks o When segments become gravid, the testes and the ovary
 Direct infection does not occur if eggs are ingested by the mammalian disappear while the uterus hollows out and becomes
host; therefore, there is no autoinfection in R. garrisoni infection filled with eggs
Gravid segments are separated from the strobila and
Pathogenesis & Clinical Manifestations disintegrate as they pass out of the intestines,
 Patients are usually asymptomatic releasing eggs in the stool
 Children are brought for medical consultation when proglottids are  Eggs:
passed out with their feces o Spherical or subspherical
o Colorless or clay-colored
Diagnosis o 30 to 47 µm in diameter
 Diagnosis is made by finding the characteristic proglottids or ova in o The oncosphere has a thin outer membrane and a thick
stools inner membrane with conspicuous bipolar thickenings,
from each of which arise four to eight hair-like polar
Treatment filaments embedded in the inner membrane
o These eggs, however, die immediately once passed out
 Sometimes, long strobila or the complete tapeworm may be expelled
into the environment
by the child spontaneously without treatment
 Praziquantel may be given to expel the worm
Life Cycle
Epidemiology
 Raillietina garrisoni is a common intestinal cestode of rodents in the
Philippines
 More than 20 human infections have been reported in Philippine
scientific journals
 Almost all infections occurred in children who were below three
years of age

Raillietina garrisoni:
 Intermediate host: Flour beetles
 Definitive host: Rats
 Accidental host: Human
 Infective stage: Cysticercoid larva

Hymenolepis nana
 Dwarf tapeworm
 Is a cyclophyllidean tapeworm
 Smallest tapeworm infecting humans
 It is found worldwide, mainly among children
 The parasite is the ONLY human tapeworm, which can complete its
entire life cycle in a SINGLE HOST, indicating that it does not require Eggs of Hymenolepis nana are immediately infective when passed with the stool and cannot
survive more than 10 days in the external environment (1). When eggs are ingested by an
an obligatory intermediate host
arthropod intermediate host (2) (various species of beetles and fleas may serve as
 Man can harbor both the adult and the larval stages of the parasite intermediate hosts), they develop into cysticercoids, which can infect humans or rodents
upon ingestion (3) and develop into adults in the small intestine. A morphologically identical
Parasite Biology variant, H. nana var. fraterna, infects rodents and uses arthropods as intermediate hosts.
Morphology When eggs are ingested (4) (in contaminated food or water or from hands contaminated
with feces), the oncospheres contained in the eggs are released. The oncospheres
 Adult worm:
(hexacanth larvae) penetrate the intestinal villus and develop into cysticercoid larvae (5).
o Delicate strobila
Upon rupture of the villus, the cysticercoids return to the intestinal lumen, evaginate their
o 25 to 45 mm in length and 1 mm in width scoleces (6), attach to the intestinal mucosa and develop into adults that reside in the ileal
o Reside in the ileum portion of the small intestine producing gravid proglottids (7). Eggs are passed in the stool
o The scolex is subglobular with four cup-shaped suckers when released from proglottids through its genital atrium or when proglottids disintegrate
o There is a retractable rostellum armed with a single row in the small intestine (8). An alternate mode of infection consists of internal autoinfection,
of 20 to 30 Y-shaped hooklets where the eggs release their hexacanth embryo, which penetrates the villus continuing the
infective cycle without passage through the external environment (9). The life span of adult
o The neck is long and slender
worms is 4 to 6 weeks, but internal autoinfection allows the infection to persist for years
o The anterior proglottids are short and the posterior ones
are broader than long
o No more than 175 to 220 segments compose the entire
length of the strobili

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 PARASITOLOGY
Topic: Introduction to Cestodes & Minor Cestodes
References: Old Trans + Belizario

Based on Belizario:  This human tapeworm is also found among the mice and less
 The life cycle has a dual pathway: frequently among the rats
o Direct development The species in mice and rats is considered to be a distinct
o Indirect development subspecies called H. nana var. fraternal
 In the direct cycle, the host ingests eggs, which hatch in the
duodenum Hymenolepis nana:
 The liberated embryos penetrate the mucosal villi and develop into  Intermediate host: Arthropods
the infective cysticercoid larvae  Definitive host: Humans or Rodents
 After 4 to 5 days, the larvae break out of the villi and attach to the  Infective stage to humans or rodents: Embryonated eggs or
intestinal mucosa to develop into adults Cysticercoid in insects
 Infection through the indirect cycle is usually via the accidental  Diagnostic stage: Eggs in feces
ingestion of infected arthropod intermediate hosts like the rice and
flour beetles(Tenebrio sp.) and sometimes through fomites, water, or Hymenolepis dimunata
food contaminated with the larvae  Rat tapeworm
 The cysticercoid larvae are released and will eventually develop into  Cosmopolitan parasite primarily of rats
the adult tapeworms in the intestines of the host  Accidental human infections do occur resulting in hymenolepiasis
 It takes 20 to 30 days from the time of ingestion for the eggs to  H. diminuta differs from H. nana in that it requires an intermediate
appear in the feces host
 Eggs are optimally viable immediately after discharge from the bowel
 Autoinfection can occur through the fecal-oral route or within the Parasite Biology
small bowel Morphology:
 Oncospheres from the eggs are released and they invade the host villi  Adult worm:
to start a new generation o Larger than H. nana.
o The worm measures about 60 cm in length
Pathogenesis & Clinical Manifestations o The scolex differs from that of the H. nana by having a
 Symptoms are generally produced because of the patient’s rudimentary unarmed rostellum
immunological response to the parasite o As in H. nana, mature proglottids are broader than they
 Light worm burden is generally asymptomatic are long, and the arrangement and number of sexual
 Clinical manifestations include: organs are similar: three ovoid testes and one ovary in a
o Headache, dizziness, anorexia, pruritus of nose and anus, more or less straight pattern across the segment
diarrhea, vomiting, abdominal pain, pallor, and weight o The proglottids are larger and may reach 0.75 mm in
loss length and 3.5 mm in width
 Some infected children are restless, irritable, and exhibit sleep o The genital pores are unilateral
disturbances o Each gravid proglottid contains a sac-like uterus filled with
 Rarely, convulsions occur eggs
 Heavy infections may result in enteritis due to necrosis and  Eggs:
desquamation of the intestinal epithelial cells o Circular
 With time, regulatory immunity may limit or eventually clear the H. o 60 to 80 µm in diameter
nana population spontaneously o Bile-stained
 Infections in children resolve spontaneously in adolescence o The oncosphere is enclosed in an inner membrane, which
has bipolar thickenings but lacks the bipolar filaments
Diagnosis o The hooklets usually have a fan-like arrangement
 Specific diagnosis is made by demonstration of the characteristic
eggs in the patient’s stool
Life Cycle
 In light infections, concentration of the stool specimens on alternate
Based on Belizario:
days is useful
 The gravid proglottids separate from the main body of the worm,
 Generally, proglottids are NOT recovered because they undergo
disintegrate, and release eggs into the feces
degeneration prior to passage with stools
 Eggs, when ingested by a wide range of adult and larval insects like
fleas, beetles, cockroaches, mealworms, and earwigs, develop into
Treatment
the infective cysticercoid larvae
 Praziquantel – DOC  25 mg/kg single dose
 When these infected insects are ingested by the rat or accidentally
 Nitazoxanide (500 mg orally for 3 days) – alternative drug
ingested by man, the larva is released and develops into the adult
worm in about three weeks
Epidemiology
 Hymenolepis nana is found in areas with warm climate like Southern
USA, Latin America, the Mediterranean, East Asia, and the Philippines
 Transmission generally occurs where there is poor sanitation,
overcrowding, and poor personal hygiene practices
 Direct contact plays an important role because the eggs cannot
survive long outside the host
 Prevalence varies from 5 to 20% among children and young adults in
communities where direct transfer of embryonated eggs from hand
to mouth is likely to occur

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 PARASITOLOGY
Topic: Introduction to Cestodes & Minor Cestodes
References: Old Trans + Belizario

Hymenolepis dimunata:
 Intermediate host: Cockroaches, fleas, beetles
 Definitive host: Human or Rodents
 Infective stage to humans or rodents: Cysticercoid larva in insects
 Diagnostic stage: Eggs in feces

Echinococcus granulosus
 Human echinococcosis is regarded as an emerging/re-emerging
zoonotic disease
 The disease is caused by the larval stage of Echinococcus spp., which
is acquired when the eggs of this parasite are ingested
 Family: Taeniidae
 Order: Cyclophyllidea
 E. granulosus  cause cystic echinococcosis
 E. multilocularis  cause alveolar echinococcosis
 E. vogeli and E. oligarthrus  cause polycystic echinococcosis
E. multilocularis, E. vogeli, and E. oligarthrus are less common
because their life cycles are sylvatic

Eggs of Hymenolepis diminuta are passed out in the feces of the infected definitive host Parasite Biology
(rodents, man) (1). The mature eggs are ingested by an intermediate host (various
Morphology
arthropod adults or larvae) (2), and oncospheres are released from the eggs and penetrate
the intestinal wall of the host (3), which develop into cysticercoid larvae. Species from the  Adult worm:
genus Tribolium are common intermediate hosts for H. diminuta. The cysticercoid larvae o Inhabits the small intestines of canines
persist through the arthropod’s morphogenesis to adulthood. H. diminuta infection is o 3 to 6 mm in length
acquired by the mammalian host after ingestion of an intermediate host carrying the o Possesses a pyriform scolex, a short neck, and three
cysticercoid larvae (4). Humans can be accidentally infected through the ingestion of insects proglottids: one immature, one mature, and one gravid
in precooked cereals, or other food items, and directly from the environment (e.g., oral
o The scolex is typically taeniid in that it has four acetabula
exploration of the environment by children). After ingestion, the tissue of the infected
arthropod is digested releasing the cysticercoid larvae in the stomach and small intestine.
o It is armed with 30 to 36 hooks
Eversion of the scoleces (5) occurs shortly after the cysticercoid larvae are released. Using o The gravid proglottid is usually the widest and the longest
the four suckers on the scolex, the parasite attaches to the small intestine wall. Maturation proglottid
of the parasites occurs within 20 days and the adult worms can reach an average of 30 cm o The uterus is midline, with lateral evaginations, and is
in length (6). Eggs are released in the small intestine from gravid proglottids (7) that filled with eggs
disintegrate after breaking off from the adult worms. The eggs are expelled to the  Eggs:
environment in the mammalian host’s feces (1).
o Resemble those of other taeniid worms
o May be released inside or outside the host
Pathogenesis & Clinical Manifestations
 The worm burden in rodents is relatively low  Hydatid cyst:
 In man, the highest number recorded is 19 worms o 1 to 7 cm in diameter
 Clinical manifestations are minimal and non-specific o The cyst has an outer laminated hyaline layer and an inner
 The life span of H. diminuta in humans is short, which possibly nucleated germinal layer
explains why human infections are usually light o Protoscolices may be found in brood capsules, which
contain only the germinal layer, and daughter cysts which
Diagnosis are replicas of the mother cysts
 Diagnosis is based on the identification of eggs from the stool o The brood capsule may rupture and release protoscolices
H. diminuta eggs are distinguished from H. nana eggs by their o Protoscolices and brood capsules that lie free in the cyst
MORE circular shape, larger size, and LACK of bipolar filaments are referred to as hydatid sand
o Up to 2 million protoscolices may be found in an average
 At times, the whole worm is expelled and the morphology of the cyst
scolex may be used as an aid in diagnosis
Life Cycle
Treatment Based on Belizario:
 Praziquantel – 25 mg/kg single dose  The eggs are swallowed by suitable intermediate hosts, such as goats,
horses, camels, and sheep
Epidemiology  Man may also accidentally ingest the eggs
 Human infection occurs worldwide but is more common among  The eggs hatch in the duodenum and release oncospheres that
children than adults in poor communities with rat infestation penetrate the intestinal wall of the intermediate host
 It probably occurs by accidental ingestion of grain beetles infesting  The oncospheres then migrate into the mesenteric venules which
dried grains, dried fruits, flour, and cereals lead them to various organs and tissues where they eventually lodge
 In a nationwide survey of rats in the Philippines, prevalence of H. and develop into cysts
diminuta was found to be about 8%  The larval stage, called hydatid cyst, is formed through central
vesiculation
 Cysts may grow at rates ranging from 1 to 5 cm in diameter per year
 Numerous protoscolices may be found within the cyst

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 PARASITOLOGY
Topic: Introduction to Cestodes & Minor Cestodes
References: Old Trans + Belizario

Life Cycle continued……  Although echinococcal infection may be acquired during childhood,
 Development is completed when the cysts in tissues are ingested by infections involving the liver and the lungs are often diagnosed in
carnivores or omnivores adults due to the cysts’ slow growing nature
 Once inside the definitive host, the protoscolices evaginate and  Simple or uncomplicated cysts may not produce any symptoms, and
attach to the intestinal wall where they develop into adults patients may harbor the cysts for years
 They reside in the small bowel of the host where they start to release  In some cases, the presence of the cyst is only an incidental finding in
eggs that are then passed out in the stool routine radiographic examination
 Once symptoms start to occur, they typically reflect the site of
involvement
 Hepatic cysts are mostly found in the inferior right lobe, and may
present as hepatic enlargement, right epigastric pain or jaundice
 Abdominal cysts may cause discomfort when the cysts are large
enough
 Cysts may rupture from coughing, muscle strain, trauma, aspiration,
and operative procedures
When this happens, the protoscolices, brood capsules, and
daughter cysts may metastasize and reach other tissues to
develop into secondary cysts after 2 to 8 years
Cysts may also become intrathoracic if they are located in the
superior lobe of the liver and rupture into the thoracic region

 The rupture of a hepatic cyst into the biliary duct produces a

characteristic triad of findings:
o Intermittent jaundice
o Fever
o Eosinophilia
 Peribronchial cysts may discharge into a bronchus and result in
The adult Echinococcus granulosus (sensu lato) (2—7 mm long) (1) resides in the small sudden coughing accompanied by allergic symptoms
intestine of the definitive host. Gravid proglottids release eggs (2) that are passed in the
Sputum may contain frothy blood, mucus, hydatid fluid, and bits
feces, and are immediately infectious. After ingestion by a suitable intermediate host, eggs
hatch in the small intestine and release six-hooked oncospheres (3) that penetrate the of membrane
intestinal wall and migrate through the circulatory system into various organs, especially the
liver and lungs. In these organs, the oncosphere develops into a thick-walled hydatid  Involvement of the brain may cause increased intracranial pressure
cyst (4) that enlarges gradually, producing protoscolices and daughter cysts that fill the cyst and Jacksonian epilepsy
interior. The definitive host becomes infected by ingesting the cyst-containing organs of the
 Renal involvement may cause intermittent pain, hematuria, kidney
infected intermediate host. After ingestion, the protoscolices (5) evaginate, attach to the
dysfunction, and hydatid material in the urine
intestinal mucosa (6) , and develop into adult stages (1) in 32 to 80 days.
 Secondary infection of the cyst may also occur
Humans are aberrant intermediate hosts, and become infected by ingesting eggs (2) .
Oncospheres are released in the intestine (3) , and hydatid cysts develop in a variety of Bacteria may enter the cyst and lead to pyogenic abscess
organs (4) . If cysts rupture, the liberated protoscolices may create secondary cysts in other formation
sites within the body (secondary echinococcosis) A patient with this condition usually presents with chills and high
fever
Pathogenesis & Clinical Manifestations
 Pathology of human cystic echinococcosis is caused by the Old Trans Info:
developing larval cyst in the tissues of the intermediate host  Hydatid disease – Right lobe of liver, heart, lung
 The most common and most important site of involvement is the  Unilocular – Echinococcus granulosus
liver, which is seen in 70% of the cases, 85% of which is located in the  Alveolar Cysts – Echinococcus multiocularis
right lobe  Downregulation of immune system
 The lungs are involved in 20 to 30% of cases, while other organ  Cyst rapture – Anaphylaxis  spread
involvement, such as the brain and the orbit, make up 10% of cases
 Cysts are LESS commonly seen in the spleen, kidneys, heart, bone, Three layers of Hydatid Cyst:
and central nervous system  Pericysts or Adventitia
 The cysts of E. granulosus are called unilocular hydatid cysts, while  Outer cuticular or external membrane (Ectocysts)
those of E. multilocularis are considered alveolar cysts
 Inner germinal layer (Endocyst)
 As the unilocular cyst develops, inflammatory reactions may occur in
surrounding tissues Hydatid Fluid
 Recent studies in mice have shown that infection with E. granulosus  Clear, colorless (may be pale yellow)
leads to down-regulation of inflammatory cytokines, resulting in
 Low specific gravity (1.005-1.010)
local immunosuppression
 Slightly acidic pH 6.7
This may be the mechanism by which the parasite is able to
 Contains NaCl, Na2SO4 , NaPO4, Na and Ca salts of succinate
escape host cell-mediated response
 Antigenic (Immunological test)
 Highly toxic – Anaphylaxis
 Mass effect brought about by the enlarging cyst results in organ
impairment as the neighboring tissues undergo atrophy and tissue
Hydatid Sand:
necrosis
 Granular deposits, Brood capsule, Free scolices, Loose hooklets

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 PARASITOLOGY
Topic: Introduction to Cestodes & Minor Cestodes
References: Old Trans + Belizario

Diagnosis Prevention & Control

 Radiographic findings and/or ultrasonography, combined with a  Dog deworming
history of residence in an endemic area, and close association with  Prophylaxis
dogs are important in the diagnosis of echinococcosis
 The World Health Organization (WHO) has developed a standardized Echinococcus granulosus:
classification system for hepatic cysts detected by ultrasonography:  Intermediate host: Goats, Camels, Sheep
 Definitive host: Dogs
 Accidental host: Human
 Infective stage: Embryonated egg
 Diagnostic stage: Hydatid cysts

Additional Minor Cestodes: (Based on Course Outline)

Multiceps multiceps
 Common name: Coenurus tapeworm
 Also known as Taenia multiceps
 Taenia multiceps or T. serialis, a rare cause of human infection, is
acquired by accidental ingestion of eggs from dog feces
 Definitive host: Canines
 Intermediate host: Sheep and other herbivorous animals
 The larvae invade and for a cyst (coenurus) in human tissue, usually
in the CNS

Causal Agents
 Coenurosis is infection with the metacestode larval stage (coenurus;
 Adjuncts to Radiologic diagnosis:
plural coenuri) of coenurus-forming Taenia species, including
o Indirect hemagglutination (IHA)
o Taenia (=Multiceps) multiceps
o Indirect fluorescent antibody (IFA) test
o T. serialis
o Enzyme immunoassays (EIA)
o T. brauni
 Serology:
o T. glomeratus
o ELISA or immunoblot  current gold standard serology
Of these, T. multiceps is the most commonly implicated
for human cystic echinococcosis
species
Old Trans Info:
 Cansoni’s test – Immediate hypersensitivity test  Unlike the other prevalent human-infecting Taenia species, humans
 Blood examination – eosinophilia do not support the maturation of these cestodes (tapeworms) in the
 Serology: CFT, Precipitin Test, ELISA, IHAT, HA, Flocculation tests, intestine and only experience tissue infections with coenuri
Latex tests, IFA, IEE  These species are sometimes called “bladder worms” due to the
 Molecular methods: DNA probe, PCR shape of the coenurus
 Exploratory cysts puncture
 Radiologic modalities Life Cycle

Treatment
 Surgical resection is still considered the preferred treatment for
echinococcosis presenting with a LARGE (>10 cm in diameter) liver
cyst, secondary infection, or cysts in extrahepatic sites
 SMALL (<7 mm in diameter), isolated cysts, uncomplicated cysts, and
patients with negative serology respond best to chemotherapy with
benzimidazole compounds
 Albendazole (10-15 mg/kg/day)
 Mebendazole (40-50 mg/kg/day)
 Percutaneous aspiration, injection, re-aspiration (PAIR) technique
may be indicated for patients with single or multiple cysts

Epidemiology
 Cystic echinococcosis is the most common presentation of
echinococcal infection in humans, accounting for >95% of global
cases, with a burden of disease of about one million disability-
adjusted life years (DALYs)
 Cystic echinococcosis is most prevalent in countries in the temperate
zones, such as southern South America, the Mediterranean, southern
and central parts of Russia, Central Asia, China, Australia, and parts
of Africa

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 PARASITOLOGY
Topic: Introduction to Cestodes & Minor Cestodes
References: Old Trans + Belizario

Life Cycle continued…..

Eggs and gravid proglottids are shed in feces of the infected definitive host (canids) into the
environment (1) , where they are immediately infectious and may be ingested by an
intermediate host (2) . Eggs hatch in the intestine of the intermediate host and oncospheres
are released (3) that circulate in blood until they lodge in suitable organs (including skeletal
muscle, eyes, brain and subcutaneous tissue). After about three months, oncospheres
develop into coenuri, which contain numerous protoscolices. The definitive host becomes
infected by ingesting the tissue of an infected intermediate host containing a coenurus (4) .
The protoscolices evert, attach to the small intestinal wall (5) , and develop into adult
cestodes in the definitive canid host (6)

Humans become infected after the accidental ingestion of eggs on fomites or in food and
water contaminated by feces of the infected definitive host (7) . Eggs hatch in the intestine,
and oncospheres are released (8) that circulate in blood until they lodge in suitable organs
and after about three months develop into coenuri (9) . Coenuri of T. multiceps are usually
found in the eyes and brain; those of T. serialis are usually found in subcutaneous tissue.

Clinical Presentation
 There is not a well-defined clinical syndrome for coenurosis;
presentation will depend on the location and extent of the coenuri
 Coenuri in the skin or subcutaneous tissue usually present as painless
nodules, which may be fluctuant and tender
Most subcutaneous nodules manifest on the torso, sclera,
subconjuctiva, neck, shoulders, head, and limbs

 Coenuri in the neck may affect neck movement and swallowing, and
central nervous system-associated coenuri may present with variable
neurologic signs/symptoms similar to cysticercosis
 Coenuri in the eye cause both intraocular and orbital infections with
varying degrees of visual impairment
 Obstructive jaundice has been observed in some cases where
coenuri are found intraperitoneally
 Clinically, coenuri may mimic lymphomas, lipomas, neurofibromas,
or pseudotumors
 Coenurosis should be distinguished from other tissue cestodiases
including cysticercosis, hydatid disease/echinococcosis, and
sparganosis

Diagnosis
 Diagnosis is made by the observation of coenuri in biopsy or autopsy
specimens
 Coenuri are usually readily distinguished from cysticerci by the
presence of multiple protoscoleces, and it is 2-5 cm

Treatment
 Removal of coenurus effectively treats intracranial coenurosis in
most cases
 There have also been reports of successful removal of coenuri from
patient’s eyes, resulting in a recovery of sight
 Coenuri are susceptible to Praziquantel, but caution should be used
especially in cases of intraocular coenurosis

References:
 Medical Parasitology in the Philippines by
Belizario & de Leon (3rd Ed.)
 Lecture Notes

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