MICRO PARA

LABORATORY 11
JEANNETTE R. ABELLA MD DFPAFP
• 1. compare the different cestode infections based on
• a. source of infection,
• b. mode of transmission
• c. characteristic manifestation;
• 2.discuss the infective stage and intermediate hosts of
common Cestodes
• 3. discuss cysticercosis and its management; and
• 4. describe hydatid cyst disease and its complications.
Infection
• Cestodes are worms that belong to the Phylum
platyhelminthes or flatworms
• They are commonly called tapeworms because their
bodies are divided into segments which are called
proglottids
• These are hermaphroditic worms, with each progrottid
containing both male and female reproductive organs
• Hence, each proglottid is capable of laying eggs
• These worms also have an organ of attachment called a
scolex, which helps differentiate one from the other.
• The tapeworms can be divided into two major groups-
intestinal and extraintestinal
• Intestinal tapeworms are characterized by having an animal intermediate
host (cattle, pig, fish, beetle).
• Humans serve as the definitive host.
• On the other hand, the definitive host for the extraintestinal tapeworm
Echinococcus granulosus is an animal (dog) while humans serve as
accidental or dead-end hosts.
Helminth – Greek word for worms
• Morphology
1. The integument maybe hardened, tough & elastic &
some relatively delicate.
• It is resistant to digestion while the organism is alive
2. Integument provide spines, hooks, stylets & other
armature for attachment & penetration to host tissues
3. Trematodes & Cestodes have muscular acetabula or
suckers used for attachment to host tissue & for
locomotion
 4. Helminths are provided with secretory glands that
usually open near the mouth which serve to digest host
tissue for food & enable them to migrate through site
where it will mature
5. Both male & female organs developed
• The sexes separate in the majority of roundworms &
thorny headed worms & in few trematodes , but in the
remainder of trematodes and all cestodes
hermaproditism is the rule
6. Egg is produced in considerable numbers (as many as
200,000 or more per female system /24 hours
• Platyhelminthes (Flatworms)
1. Cestodes -Tapeworms
Adult Morphology
• Long segmented bodies
• Total absence of digestive system & hermaproditism
• It is composed of 3 distinct regions
a. Scolex- head provided with suckers & either knob-like
or spatulate
b. Neck- immediately posterior to the scolex also called
region of growth
c.Chain- proglottids or segments
 Egg / Ova Morphology
• Eggs are fully embryonated when discharged with 6
hooklets (hexacath)
• Eggs are not operculated
Cestodes
Platyhelminthes -Cestodes
Taenia saginata or Beef tapeworm
• Intestinal Cestodes
• Cattle- intermediate host where eggs enter the blood vessels within the
intestine
• Eggs→ transported to the skeletal muscle of the cattle to develop into
cystecerci or infective larvae
• Beef tapeworm infection- is acquired by ingestion of improperly cooked or
raw beef with cystecerci
• Larva then mature to adult worms or pathogenic stage in the SI within 3
months→ known to achieve great length as much as 10 meters
• Humans – serve as definitive host
• Eggs of T.saginata are indinstinguishable from T.solium
• Differentiated by their scolex and proglottids
• Scolex- no rostellum
• Proglottids –rectangular & contain more uterine branches
about 15-30
• Disease : Taeniasis
• Majority –asymptomatic
• With high worm burden- complain of diarrhea,
abdominal pain, loss of appetite with resultant weight
loss & body malaise
• Gravid proglottids- may reach the anus, where agg laying
occurs resulting in pruritus ani or itchiness in the anal
region
Taenia Saginata –beef tapeworm
Cysticercosis T. saginata
Taenia solium
• Pork tapeworm/ Armed tapeworm
• Important human parasite wherever raw or insufficiently
cooked pork is eaten (cysticercus cellulosae or infectvive
stage)
Morphological characteristic
1. Adult worm
• Lives in the small intestine with it’s scolex attached to the
mucosa & it’s body folded back & forth in the lumen
• Length 2 to 7 meters
• Scolex is roughly quadrate, with diameter of about 1mm, has
4 large deeply cupped suckers & a conspicuous rostellum,
armed with double row of large & small hooks
• Immature proglottids are broader than long, mature ones are
nearly square & gravid ones are longer than broad
 2. Eggs/Ova
• Spherical or subspherical in shape, at 31 to 43 um in
diameter
• Pale buff to walnut brown in color
• Shell is thick walled consisting of many truncated prisms
cemented together
• Within the shell is fully developed oncosphere that has
3 pairs of hooklets
Taenia solium
• Adult worms enter the intestines→ encysted larvae may produce damage in
tissues where they disseminate
• Brain- may manifest as space occupying lesions
• Larvae encyst in various tissues → evoke little inflammatory response
• If encysted larvae die it may release substance inducing allergic reaction
that may potentially be fatal → shock
Taeniasis
• produced by adult worms, mostly asymptomatic but with high worm burden
manifestations similar with beef tapeworm
• Cysticercosis- larval encystation in various tissues of the body, most common
on skeletal muscles, with muscle pain
• Neurocysticercosis- brain involvement, most fear & severe form.
• Symptoms like seizure, headache & vomiting
• Ocular cysticercosis- may lead to visual disturbances, development of
uveitis (inflammation of the uvea) & retinitis (inflammation of the retina)
Diphyllobutrium Latum
• – Broad/ Fish tapeworm
Morphological characteristic
1. Adult worm
• Ivory colored & measures up to 10 meters or more in
length as many as 3,000 or more proglottids
• Scolex- is small, spatulate with dorsal & ventral median
longitudinal sucking groove
• Immediately behind the scolex is an unsegmented neck
region which is several times the length of the head
• It is extremely mobile & seen in wide range of shapes
both in the living or preserved state
 Egg/Ova
• Discharged periodically through the uterine pore of each
functional proglottid
• A single worm may discharge as many as 1,000 eggs
daily
• Broadly ovoid, operculate, moderately thick-shelled,
light golden yellow & each contain immature embryo
when discharged in the feces
• Measures 58 to 76 x 40-51 um
Diphyllobotrium latum
• Longest tape worm- may reach 13 meters
• Eggs consist of ciliated larva called Coracidia
• Operculum- a lid structure on the end of the egg
• Scolex- contain a pair of long sucking grooves
• Gravid segments-contain a uterine structure that is
centrally located & assumes a rosette formation
• Ingestion of improperly cooked or raw fish containing
plerocercoid or infective stage→ precursor of larval
stage
• Plerocercoid attaches to the intestinal mucosa & matures
into the adult worm
• Adult worm→ Self fertilize & egg passed out in the stool
• If eggs come in contact with fresh water→ coracidium hatches & is
ingested by the 1st intermediate host Copepod( tiny crustacean Cyclops sp)
• Coracidium develops into the larval stage precercoid
• Copepod eaten by fresh water fish 2nd intermediate host where precercoid
develops to plerocercoid
• Definitive host –humans or other fish eating mammals like dogs, cats, bears
& seals
• Parasites may compete for Vit B12→ vitamin deficiency
Diphyllobothriasis
• Asymptomatic- most common presentation
• Diphyllobothriasis- may manifest with symptoms of gastrointestinal
involvement like diarrhea & abdominal discomfort.
• Adult worms attaches to the jejunum & ileum, the patient may develop
deficiency of Vit B12 leading to anemia similar to pernicious anemia
characterized as megaloblastic anemia from lack of maruration of RBC
Hymenolepsis nana
• H.nana – is different from other tapeworms because it does not require an
obligate intermediate animal host
• Eggs- are directly infectious & humans get infected after accidental
ingestion of eggs of parasite
1) After ingestion of fecally contaminated food or water
2) By touching one’s mouth with contaminated fingers
3) Through ingestion of contaminated soil
4) Accidental ingestion of rice or flour bettles containing infective larvae that
may gotten into food is another way of getting infected
• Rodents-serve as additional source of infection
• Once the eggs or infective stage gain entry after ingestion → eggs
transform into cystecercoid larvae
• Larva matures into adult capable of self reproduction → eggs released after
disintegration of the gravid segments
• 2 pathways for the eggs
1) It may passed to the outside through feces
2) Some may remain inside the host and hatch into larvae & mature into adult
worms→ starting a new cycle within the human host → re-infection or auto
infection
Hymenolepiasis
• Most are asymptomatic
• High worm burden may complain of nausea, weakness, loss of appetite,
diarrhea & abdominal pain
• Young children with heavy infection- anal itchiness leading to headaches due
to difficulty of sleeping
• Maybe confused with pinworm infection
• Auto infection may lead to hyper-infection syndrome →can result in
secondary bacterial infection & spread to other tissues of the body
Hymenolepsis nana- dwarf tapeworm
Egg Cystececoid Hydatid cyst
Scolex Proglottids -rosette
Echinococcus granulosus or Dog or Hydatid Tapeworm

• Extra intestinal Cestode

• Primarily zoonotic infection
• Dogs- most important definitive hosts
• Sheep –usually intermediate host
• Humans –considered accidental & dead end host
• Eggs- are identical to those of Taenia spp.
• Diagnostic stage is the larval form which is encased in a
cyst wall called hydatid
• Transmission: Ingestion of eggs or
infective stage from food & water
contaminated by dog feces
• Or coming in contact with dog feces
• Eggs transform into larvae→ penetrates
the intestines & migrate through the
bloodstream → To different tissues of the
body part particularly the lungs & liver
• Hydatid cyst or pathogenic stage , then
develop in the tissues
• Dog acquire it by eating visceral organs of
intermediate host
• Embryos develop into large fluid
filled cyst→ act as space occupying
lesions
• The cyst fluid contain antigen that
can sensitize the host
• Rupture of cyst either spontaneous
or during trauma or surgical
removal → lead to the release of
antigens leading to anaphylaxis &
wide spread dissemination of
parasites
Disease: Echinococcocis, Hydatid Cyst Disease, Hydatid
Disease, Hydatidosis
• Most are asymptomatic in the early stages
• As cyst enlarge, necrosis of tissue occurs
• Liver involvement may result in obstructive jaundice
• Lung involvement manifest with cough, chest pain & shortness of breath
• Other organs: spleen, kidneys, heart, bone & CNS, brain & eyes
• Cyst rupture may lead to anaphylactic shock & death
Echinococcus granulosus
Characteristic Taenia saginata Taenia solium

Scolex
Number of suckers 4 4
Rostellum Absent Present
Hooks Absent Present double crown
Gravid proglottids
Appearance , shape Rectangular Somewhat square
Number of uterine
branches on each side of 15-30 7-15
the uterus
Taenia solium with rostellum
Taenia solium gravid proglottids
Taenia saginata no rostellum
Taenia saginata gravid proglottids
Lab Activity
1. What is a cysticercoid? How • 2. What is a hydatid disease?
is it treated? What complication/s can it
produce?