Cestodes 2 ORDERS OF CLASS CESTODA

Pseudophyllidea Cyclophyllidea
▪ Diphyllobothrium latum ▪ Taenia spp.
General Characteristics
Cestodes ▪ Dipylidium caninum
 Belong to Phylum Platyhelminthes (flatworms) ▪ Hymenolepis spp.
 Generally, they are dorsoventrally flattened with bilateral symmetry; worms are
segmented with a ribbon-like appearance, hence the common name Tapeworms ▪ Spatulate with sucking ▪ Globular with four muscular
grooves (bothria) suckers (acetabula)
Scolex
 Morphologic forms: eggs → one or more larval stages → adult worms ▪ Some has apical protrusion
 Adult worms do not have a digestive tract, a circulatory system and respiratory (rostellum)
system; they excrete waste products through their outer surface called tegument. ▪ With genital pore ▪ With genital pore
Segments /
 Hermaphrodites (monoecious) ▪ With uterine pore ▪ No uterine pore
Proglottids
▪ Anapolytic ▪ Apolytic
 Adult worms are divided into three distinct parts ▪ Eggs only ▪ Both eggs and segments
 Scolex (head) Diagnosis
▪ Anterior attachment organ– used for the
attachment of the worm to the intestinal
▪ Covered by 1 layer: egg shell ▪ Covered by 2 layers: egg shell
mucosa of the definitive host
▪ Ovoid in shape and embryophore
▪ Freshly passed eggs in feces ▪ Spherical
 Neck
Ova / Eggs are unembryonated ▪ Embryonated from the
▪ Region of growth
▪ Eggs are operculated and the beginning
▪ Part which is immediately behind the
embryo is ciliated ▪ Eggs are not operculated and
head; it is where the segments of the body
the embryo is not ciliated
(proglottids) are being generated
▪ Coracidium→ procercoid → Types of encysted larva
continuously
plerocercoid ▪ Cysticercoid (Hymenolepis and
 Strobila (body/trunk) Larval Stage Dipylidium, Raillietina)
▪ Composed of a chain of segments/ ▪ Cycticercus (Taenia)
proglottids ▪ Hydatid (Echinococcus)
▪ Proglottids near the neck, are the young Requires 2 IH; crustaceans Requires 1 IH
immature segments, behind them are the (copepods) and freshwater fish ▪ Usually lower forms of mammal
Intermediate
mature segments, and at the hind end, are ▪ 1st IH: eggs encyst as or arthropod
Hosts
the gravid segments procercoid larva
▪ Every mature segment contains both male ▪ 2nd IH: plerocercoid larva
and female sex organs
▪ Gravidity – eggs are released by rupturing,
disintegrating, or passing through the
uterine pore

Review Notes in Clinical Parasitology by RMDM 34

Life Cycle
Taenia spp.
 Human ingestion of an egg or larval stage results in an adult worm eventually emerging in
the intestine.
Taenia saginata Taenia solium
 Adult worms are found in the intestines of the definitive host, and the larval stage is
Common Name Beef tapeworm Pork tapeworm
encysted in the tissues of the intermediate host
Intermediate host Cattle / beef Pig / swine
Mode of transmission Ingestion Ingestion
Laboratory Diagnosis
 Stool – primary specimen necessary for the recovery and identification of intestinal Habitat Small intestine (jejunum) Small intestine (jejunum)
tapeworms Length 4 to 10 m 2 to 4 m
 Eggs, proglottids / segments may be recovered - 4 acetabula
- 4 acetabula
 Scolex may be recovered if treatment is successful - Spherical/round (1mm)
Scolex - Quadrate/cuboidal (1-2mm)
- Has rostellum w/ double
- No rostellum and hooks
crown of hooks (25-30)
- Less than 1,000
- 1,000 to 4,000
- With accessory ovarian
Proglottids - With vaginal sphincter
lobe
- 300-400 follicular testes
- 100-200 follicular testes
- 16-20 mm x 5-7mm - 7 to 13 lateral branches
- 15 to 20 lateral branches - Thick and dendritic
Gravid proglottid - Thin and dichotomous - 30,000 – 50,000 ova
- 97, 000 – 124,000 ova - Expelled passively chains
- Expelled singly of 5-6
- Spherical (30-45 µm)
- Striated
Eggs - Inside is an embryo with 6 hooklets (3 pairs)
- Infective both to pig and
- Not infective to man
man
Cysticercus cellulosae
Cysticercus bovis
Larva Present in pig and also in
Present in cow not in man
man
Cysticercus cellulosae,
Infective stage Cysticercus bovis
embryonated egg
Pathogenesis Taeniasis Taeniasis, Cysticercosis
Diagnostic stage Eggs and proglottids Eggs and proglottids

Review Notes in Clinical Parasitology by RMDM 35

 Life Cycle of Taenia saginata  Life Cycle of Taenia solium

1. Gravid proglottids are either passed out in the feces or crawl out of the bowel. Eggs are
released and viable in the soil for weeks.
1. Gravid proglottids are either passed out in the feces or crawl out of the bowel. Eggs are 2. Once inside the hogs, the oncosphere is released, penetrates the intestinal mucosa, enters a
released and viable in the soil for weeks. venule, and carried to other parts of the body.
2. Once inside the cattle, the oncosphere is released, penetrates the intestinal mucosa, enters 3. Inside the muscle fiber, oncosphere develops into the infective stage called Cysticercus
a venule, and carried to other parts of the body. cellulosae.
3. Inside the muscle fiber, oncosphere develops into the infective stage called Cysticercus 4. Human infection is initiated through ingestion of encysted larvae from raw or improperly
bovis in 2 months. cooked pork.
4. Human infection is initiated through ingestion of encysted larvae from raw or improperly 5. Larva is digested out of the meat, and the scolex attaches to the mucosa of the small intestine
cooked beef. and becomes mature w/in 12 weeks.
5. Larva is digested out of the meat, and the scolex attaches to the mucosa of the small intestine 6. The resulting adult multiplies, producing numerous eggs.
and becomes mature w/in 12 weeks. 7. The same process, eggs may be ingested by man. The oncosphere will be released and will
6. The resulting adult multiplies, producing numerous eggs. encyst in the muscle / tissue of man.

Cysticercus cellulosae
Cysticercus bovis
 Larval and infective stage/form of T. solium
 Larval and infective stage/form of T. saginata
 An ovoid, opalescent milky-white fluid-filled vesicle measuring 8-10 mm in breadth and 5
 An ovoid, milky-white opalescent fluid-filled vesicle measuring 5mm by 10mm in
mm in length.
diameter; contains a single invaginated scolex (bladder worm)
 The scolex of the larva, with its suckers, lies invaginated within the bladder and can be
 The cysticerci are found in the muscles of mastication, cardiac muscles, diaphragm and
seen as a thick white spot. It remains viable for several months.
tongue of infected cattle
 They can be seen on visual inspection as shiny white dots in the infected beef (measly
beef)

Review Notes in Clinical Parasitology by RMDM 36

 Clinical Manifestation of Taenia saginata (Taeniasis)  Treatment
 Mild irritation at the site of attachment  Drug of choice (Taeniasis): praziquantel (5 to 10 mg/kg as a single dose); niclosamide
 Nonspecific symptoms: Epigastric pain, vague discomfort, hunger pangs, weakness, may also be used for T. solium
weight loss, loss of appetite, and pruritus ani  Drug of choice (Cysticercosis): praziquantel or albendazole; corticosteroids are then
 Obstruction of the bile and pancreatic ducts, and appendix caused by actively motile given 4 hours after the last dose
proglottids  Surgical treatment for ocular cysticercosis before praziquantel or albendazole is given
 Criteria for the cure
 Clinical Manifestation of Taenia solium ✓ Recovery of the scolex
 Taeniasis ✓ Negative stool exam 3 months after treatment

 Intestinal infection results in mild nonspecific abdominal complaints  Prevention and Control
 Cysticercosis  Thorough cooking of meat is a primary measure
 Living cyst may cause inflammation  Freezing at -20°C for 10 days kills the cysticerci.
 Calcification may occur upon the death of the cysticerci.  Sanitary inspection of all slaughtered pigs, cows, and cattle should be done.
 Neurocysticercosis - headache, seizures, confusion, ataxia, and even death.  Liver should also be examined during meat inspection
 Convulsions are thee most common manifestations of cerebral cysticercosis
 Visual and motor deficits, headache, and vomiting may occur Hymenolepis spp.
 Chorioretinitis and vasculitis – intraorbital pain, photopsia, and blurring or loss of
vision Hymenolepis nana Hymenolepis diminuta
Common Name Dwarf tapeworm Rat tapeworm
 Laboratory Diagnosis Associated disease Hymenolepiasis Hymenolepiasis
Intermediate host May or may not require an Insects
 Stool – specimen of choice for the recovery of Taenia eggs and gravid proglottids. intermediate host
 Concentration techniques (formalin ether/ethyl acetate concentration technique)
Length 25-45 mm 60 cm
increases the chance of demonstrating the eggs
Scolex - 4 acetabula - 4 acetabula
 Cellophane tape prep procedure may also be done - With rostellum armed with - With unarmed rostellum
 Gravid proglottids are pressed/flattened between two glass slides and are examined 20-30 hooks
against the light. Eggs - Contain an oncosphere - Contain an oncosphere
 Cysticercosis enclosed in an inner enclosed in an inner
membrane with 2 polar membrane with 2 polar
 Neurocysticercosis thickenings, from each of thickenings but without
▪ CSF abnormalitites = elevated protein, reduced glucose, and increased which arise 4-8 polar filaments
mononuclear cells filaments
▪ Computed axial tomography (CAT) scans and MRI Gravid proglottids - Rectangular
 Ophthalmic cysticercosis: ophthalmoscopy - Each segment contains one set of female and one set of male
 Muscular and subcutaneous cysticerci: tissue biopsy reproductive organs
 Serologic tests – serum and CSF ELISA and EITB or Western blot for specific IgG and - consists of a saclike uterus filled with eggs
IgM anticysticercal antibodies Infective stage Eggs and cysticercoid larva Cysticercoid larva
Diagnostic stage Eggs Eggs
Treatment Praziquantel Praziquantel
Review Notes in Clinical Parasitology by RMDM 37
Hymenolepis nana
As noted, H. nana does not require an intermediate host to complete its life cycle. However, this parasite may exist
 Smallest tapeworm infecting humans
in a number of animal transport hosts, such as fleas, beetles, rats, and house mice. Note that the cysticercoid larval
 The only human tapeworm which can complete its entire life cycle in a single host, hence it stage may develop in these hosts; when this occurs, such hosts are infective to both man and rodents.
does not require an obligatory intermediate host

 Clinical Manifestation of H. nana infection

 Life Cycle of H. nana
 Light worm burden is generally asymptomatic.
1. When eggs are ingested by an arthropod intermediate host (2) (various species of beetles
 Symptoms: headache, dizziness, anorexia, pruritus of nose and anus, diarrhea, vomiting,
and fleas may serve as intermediate hosts), they develop into cysticercoids, which can
abdominal pain, pallor, and weight loss.
infect humans or rodents upon ingestion (3) and develop into adults in the small intestine.
 Heavy infections may result to enteritis due to necrosis and desquamation of the
2. When eggs are ingested (4) (in contaminated food or water or from hands contaminated
intestinal epithelial cells.
with feces), the oncospheres contained in the eggs are released.
3. The oncospheres (hexacanth larvae) penetrate the intestinal villus and develop into
cysticercoid larvae (5).  Laboratory Diagnosis for H. nana
4. Upon rupture of the villus, the cysticercoids return to the intestinal lumen, evaginate their  Specific diagnosis is made by demonstration of the characteristic eggs in the patient’s
scolices (6), attach to the intestinal mucosa and develop into adults that reside in the ileal stool.
portion of the small intestine producing gravid proglottids (7).  Concentration technique is useful for light infections
5. Eggs are passed in the stool when released from proglottids through its genital atrium or  Diagnostic stage: eggs
when proglottids disintegrate in the small intestine (8).  Remember, proglottids disintegrate as they pass out of the intestine, hence, it is not used
for diagnosis.

 Treatment for H. nana infection

 Drug of Choice: Praziquantel (25mg/kg single dose)
 Function: vacuolization and disruption of the tegument in the neck
 Treatment is usually repeated after 2 weeks to cover for the worms emerging from the
remaining viable cysticercoids.
 Alternative drug: Nitazoxanide (500 mg orally for 3 days)

 Prevention and Control

 Personal hygiene and environmental sanitation practices are crucial in 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.
 Rodent control must be observed
 Food must be properly stored and protected from possible infestation with beetles.

Review Notes in Clinical Parasitology by RMDM 38

Hymenolepis diminuta  Clinical Manifestation of H. diminuta infection
 Primarily a parasite of rats  Many patients infected with H. diminuta typically remain asymptomatic
 At risk of transmitting the parasite are the areas in which foodstuffs (grains and cereals) are  Persons infected usually present with mild symptoms such as diarrhea, nausea, abdominal
not protected from rats and insects. pain, and anorexia.
 The life span of H. diminuta in humans is short, which possibly explains why human
 Life Cycle of H. diminuta infections are usually light.

1. The gravid proglottids separate from the main body of the adult, disintegrate, and release
eggs into the feces.  Laboratory Diagnosis and Treatment for H. diminuta
2. Eggs will be ingested by an arthropod intermediate host and will develop into the infective  Method of choice: stool examination
cysticercoid larva.  Diagnostic stage: eggs; at times, the whole worm is expelled and the morphology of the
3. When this infected insect is ingested by the rat or accidentally ingested by man, the larva scolex may be used as an aid in diagnosis
is released and develops into adult worm about three weeks.  Drug of Choice: Praziquantel (25mg/kg single dose)

 Prevention and Control

 Administering effective rodent control measures is crucial to ensure the halt of the normal
parasite life cycle
 Protection of foods from both rat droppings and from intermediate host insects
 Thorough inspection of all potentially contaminated foodstuffs prior to human
consumption
Hymenolepis nana Hymenolepis diminuta

Review Notes in Clinical Parasitology by RMDM 39

 Dipylidium caninum  Life Cycle
1. Gravid proglottids will be passed out in the feces of either animal or human host.
Common Name: ___________________________________________________________________________________
2. The proglottids will disintegrate and release the egg packets.
Associated Diseases: _____________________________________________________________________________ 3. Egg packets containing embryonated eggs are ingested by the larval stage of flea. (some
Mode of Transmission: __________________________________________________________________________ of the egg capsules may remain in the fur of the host or in the host’s resting place)
Habitat: ____________________________________________________________________________________________ 4. Oncosphere hatch from the eggs and penetrate the intestinal wall of the larvae.
Infective stage: ___________________________________________________________________________________ 5. The larval stage of the flea will develop into adult flea harboring the infective
Diagnostic stage: _____________________________________________________________________________________ cysticercoid.
6. Definitive host cat or dog / Accidental Intermediate Hosts: (larval stages)
human host may be infected by ingestion of ✓ Ctenocephalides canis (dog flea)
 It is a very common intestinal parasite of cats and dogs (especially where ectoparasitism the infected flea. ✓ Ctenocephalides felis (cat flea)
✓ Pulex irritans (human flea)
is high) worldwide 7. Or infected cat / dog may transmit the ✓ Trichodectes canis (dog louse)
 Dipylidiasis in humans is accidental and is observed to be more common in children than infected flea to human.
in adults. 8. The cysticercoid is liberated and becomes adult in 3 to 4 weeks.

 Morphology
 Adult worms
 Pale reddish measuring approximately 10-70cm in length
 Scolex
▪ Small and globular with 4 deeply cupped suckers and protrusible rostellum
(armed with one to seven rows of rose thorn-shaped hooklets)

 Strobila
▪ Mature proglottids are narrow with two sets of
male and female reproductive organs and bilateral
genital pores (double-pored tapeworm)
▪ Gravid proglottids have the size and shape of a
pumpkin seed and are filled with capsules or
packets
▪ These are detached, either migrate out of the anus
or are passed out with the feces.

 Eggs
 Eggs are spherical, thin-shelled with a hexacanth
embryo
 Egg packets or capsules contain about 8-15 eggs
enclosed in an embryonic membrane

Review Notes in Clinical Parasitology by RMDM 40

 Clinical Manifestation  Morphology
 Many patients infected with D. caninum typically remain asymptomatic; infection is rarely  Adult worms
 Slight intestinal discomfort, epigastric pain, diarrhea, anal pruritus, and allergic reactions  measures 3-6 mm in length
have been reported.  possesses a pyriform scolex, small neck, and three segments, one at each
 Patients with heavy infection of Dipylidiasis may develop appetite loss, diarrhea, developmental stage: immature, mature, and gravid
abdominal discomfort, and indigestion.  Scolex
▪ contains 4 acetabula and armed with 30 to 36 hooks
 Pruritus ani may also be experienced because of the migrating gravid proglottids.
 Strobila
▪ The uterus is midline, with lateral evaginations, and is filled with eggs
 Laboratory Diagnosis and Treatment  Eggs
 Diagnosis is based on the recovery of gravid proglottids in stool samples.  Eggs of E. granulosus are identical to, and thus indistinguishable from those of the
 Egg packets are rarely recovered from stool because proglottids disintegrate in the Taenia spp.
environment and not in the intestine.  Hydatid cyst
 Proglottids should be pressed or flattened between two glass slides for examination.  Within the cyst, miniatures of the entire hydatid cyst can be seen, and these are called
daughter cysts.
 Has an outer laminated hyaline layer and an inner nucleated germinal layer
 Treatment
 Protoscoleces may be found in the brood capsules. Up to 2 million protoscoleces may
 Drug of choice: Praziquantel be found in an average cyst.

 Prevention and Control

 Periodic deworming of cats and dogs
 Dogs and cats must be treated and protected against flea infestation regularly
 Children should be taught not to let dogs or cats lick them in or near their mouths.

Echinococcus granulosus
Common Name: ___________________________________________________________________________________
Associated Diseases: _____________________________________________________________________________  Life Cycle
Mode of Transmission: __________________________________________________________________________
1. The adult Echinococcus granulosus (2—7 mm long) resides in the small intestine of the
Habitat: ____________________________________________________________________________________________ definitive host.
Infective stage: ___________________________________________________________________________________ 2. Gravid proglottids release eggs that are passed in the feces and are immediately
Diagnostic stage: _____________________________________________________________________________________ infectious.
3. After ingestion by a suitable intermediate host, eggs hatch in the small intestine and
release six-hooked oncospheres that penetrate the intestinal wall and migrate through
the circulatory system into various organs, especially the liver and lungs.
4. In these organs, the oncosphere develops into a thick-walled hydatid cyst that enlarges
gradually, producing protoscoleces and daughter cysts that fill the cyst interior.

Review Notes in Clinical Parasitology by RMDM 41

5. The definitive host becomes infected by ingesting the cyst-containing organs of the  Clinical Manifestation
infected intermediate host. After ingestion, the protoscoleces evaginate, attach to the  Cystic Echinococcosis: caused by the developing larval cyst in the tissues;
intestinal mucosa, and develop into adult stages in 32 to 80 days.
 Simple or uncomplicated cysts may not produce any symptoms and may only be detected
6. Humans are aberrant intermediate hosts and become infected by ingesting eggs.
incidentally in routine radiographic examinations.
Oncospheres are released in the intestine, and hydatid cysts develop in a variety of
 Hepatic cyst: hepatic enlargement, right epigastric pain, or jaundice. Once ruptured into
organs. If cysts rupture, the liberated protoscoleces may create secondary cysts in other
the biliary duct, cysts may cause intermittent jaundice, fever, and eosinophilia
sites within the body (secondary echinococcosis).
 Brain involvement: increased intracranial pressure and Jacksonian epilepsy
 Renal involvement: intermittent pain, hematuria, kidney dysfunction, and hydatid
❖ Human infection begins following ingestion of Echinococcus eggs obtained by contact with
material in urine.
contaminated dog feces.
❖ Larvae from eggs penetrate the intestine and migrate via the bloodstream to a number of tissue
sites. The hydatid cyst develops in the infected tissue.  Laboratory Diagnosis and Treatment
❖ Humans are considered to be the dead-end hosts because the E. granulosus life cycle ceases in
human tissue.
 Radiographic findings, and/or ultrasonography and Computed tomography (CT) scan may
be used in the detection of the hydatid cyst
 Hydatid cyst fluid may also be examined on tissue biopsies for the presence of scolices,
daughter cysts, or hydatid sands.
 Adjunctive diagnostic test: Indirect hemagglutination test (IHA), indirect fluorescent
antibody test (IFA), and enzyme immunoassays (EIA)
 Gold standard serology: ELISA or immunoblot (detection of IgG antibodies to hydatid
cyst)

 Treatment
 Treatment of Choice: surgical removal of the hydatid cyst, when located in a suitable area
for surgery (surgical resection)
 In cases of small cysts, or patients with negative serology, chemotherapy with
benzimidazole compounds is used.
 Percutaneous aspiration, injection, reaspiration (PAIR) technique
 Treatment with albendazole or mebendazole for a minimum of three months

 Prevention and Control

 Prevention is achieved by reducing the infected populations and by minimizing
opportunities for transmission
 Regular testing and quarantine, and treatment of infected dogs with praziquantel
 Dogs should not be allowed in slaughterhouses, and refuse from these facilities should be
sterilized or properly disposed of
 Instituting a thorough education program for those in high-risk areas for transmission of
the parasite
 Vaccination of livestock, which has been proven to provide >95% protection against E.
granulosus.

Review Notes in Clinical Parasitology by RMDM 42

 Raillietina garrisoni
 Raillietina garrisoni is a common intestinal cestode of rodents in the Philippines.
 It may cause rare accidental innocuous infections in humans.
 Other synonyms: R. madagascariensis, R. celebensis, and R. formosana

 Morphology
 Adult worms
 It is approximately 60cm in length with a minute, subglobular scolex with 4
acetabula
 Scolex
▪ Contains rostellum which is armed with 90-140 hammer-shaped hooks
▪ Several rows of spines also surround the rostellum.
 Strobila
▪ Mature proglottid has a bilobed ovary surrounded by 36-50 ovoid testes
▪ Fully gravid segments contain 200-400 egg capsules with one to four spindle-
shaped eggs.
▪ The gravid segments detach from the rest of the strobila by apolysis and may be
passed out in the feces.
▪ These segments are motile, white, and appear like grains of rice when passed
out with the feces.
 Eggs
 The oncosphere is enclosed in two thin membranes: an outer elongated membrane
and an inner spherical membrane.

 Clinical Manifestation
 Life Cycle  Patients are usually asymptomatic
 Motile proglottids containing numerous egg capsules are shed in the definitive host’s  Gastrointestinal disturbances and other vague complaints (irritability, nausea) have been
feces. described.
 Arthropod intermediate hosts ingest proglottids or free egg capsules released as the  Laboratory Diagnosis and Treatment
proglottid breaks down in the environment.
 Diagnosis is made by finding the characteristic proglottids or ova in stools.
 Within the intermediate host, oncospheres are released from the eggs and develop into
cysticercoids.  Treatment
 The definitive host becomes infected after ingesting intermediate hosts containing  Drug of choice: Praziquantel
cysticercoids.  However, even without treatment, patient may expel the whole tapeworm spontaneously.
 The scolex, armed with two rows of hammer-shaped hooks, everts and anchors to the  Prevention and Control
small intestinal wall, where maturation to the adult stage occurs.
 Elimination of rodents from households
 Aberrant human infections may occur when infected arthropod intermediate hosts  Proper storage of grain products, and sanitary waste disposal.
are ingested.
Review Notes in Clinical Parasitology by RMDM 43
 Diphyllobothrium latum  Eggs
 It is broadly ovoid, about 66µm by 44µm, with a
Common Name: ___________________________________________________________________________________ thick, yellowish-brown shell.
Associated Diseases: _____________________________________________________________________________  It has an operculum at one end and often a small
knob (abopercular knob) on the other.
Mode of Transmission: __________________________________________________________________________  The embryo with 6 hooklets inside the egg is
Habitat: ____________________________________________________________________________________________ called the oncosphere.
Infective stage: ___________________________________________________________________________________
Diagnostic stage: _____________________________________________________________________________________  Life Cycle

 Largest / longest cestode infecting man

 Occurs in central and northern Europe, particularly in Scandinavian countries.
 It is present in the Baltic countries, Switzerland, Romania, and the Danube Basin.
 Seven human infections have been documented in the Philippines.

 Morphology
 Adult worms
 It is ivory-colored and very long,
measuring up to 10 meters or more. It
is the largest tape worm inhabiting
the small intestine of man.
 A single worm may pass about 1
million eggs in a day.
 Scolex
▪ Almond / spatulate / spoon-shaped, about 2-3 mm long and 1 mm broad.
▪ It consists of 2 slit-like longitudinal sucking grooves (bothria), which are located
dorsally and ventrally.
 Strobila
▪ Consists of 3,000-4,000 proglottids
▪ Mature proglottid is broader than long, about 2-4
mm long and 10-20 mm broad and contains one
set of reproductive organs.
▪ The ovary is bilobed. The large rosette-like
uterus lies convoluted in the center. 1. Eggs are passed unembryonated in feces.
 Larva: There are three stages of larval development 2. Under appropriate conditions, the eggs mature (approximately 18 to 20 days) and yield
▪ First stage larva (coracidium) oncospheres which develop into a coracidia (a ciliated embryo).
▪ Second stage larva (procercoid) 3. After ingestion by a suitable crustacean (first intermediate host) the coracidia develop
▪ Third stage larva (plerocercoid) into procercoid larvae (it still retains the three hooklets).

Review Notes in Clinical Parasitology by RMDM 44

 4. Procercoid larvae are released from the crustacean upon predation by the second  Treatment
intermediate host (usually a small fish) and migrate into the deeper tissues where they  Drug of choice: Praziquantel
develop into a plerocercoid larvae (spargana/sparganum), which is the infectious stage
 Criterion for cure: presence of scolex in feces
for the definitive host.
 If not: repeat stool exam after 3 months to be certain that the patient is no longer infected.
5. Because humans do not generally eat
 Parenteral Vitamin B12 should be given if B12 deficiency is present.
these small fish species raw, the second The preference for eating raw fish and the
intermediate host probably does not lack of sanitary toilet facilities contribute
to the transmission of the parasite.  Prevention and Control
represent an important source of human
infection.  All freshwater fish should be thoroughly cooked
6. However, these small second intermediate hosts can be eaten by larger predator species  Freezing at -18°C (-10°C) for 24-48 hrs. kills all plerocercoids
that then serve as paratenic hosts.  Control the source of infection, proper disposal of sewage and marketing of fish.
7. In this case, the plerocercoid migrates to the musculature of the larger predator fish;
humans (and other definitive host species) acquire the parasite via consumption of
undercooked paratenic host fish. Additional Notes :
8. In the definitive host, the plerocercoid develops into adult tapeworms in the small
intestine. Adult diphyllobothriids attach to the intestinal mucosa by means of two
bilateral groves (bothria) of their scolex.
9. Eggs appear in the feces 5 to 6 weeks after infection.

 Clinical Manifestation
 Diphyllobothriasis: digestive discomfort; weakness, weight loss, nervous disturbances
and abdominal pain. These symptoms may be due to absorbed toxins or by-products of
degenerating proglottids, or due to mucosal irritation.
 D. latum infection results in hyperchromic, megaloblastic anemia with
thrombocytopenia, and leukopenia.
 In severe cases, patients may exhibit neurologic sequelae of vit B12 deficiency.

 Laboratory Diagnosis and Treatment

 Method of Choice: Examination of stool for the presence of the characteristic operculated
eggs and/or proglottids (less frequent)
 Direct fecal smear is enough for the diagnosis because of numerous eggs; however, Kato
technique may also be used in demonstrating eggs
 Serodiagnosis: A coproantigen detection test is available to diagnose diphyllobothriasis
 Examination of gastric juice: used to differentiate anemia due to diphyllobothriasis from
pernicious anemia; to detect the presence of free hydrochloric acid = pernicious anemia is
associated with achlorhydria

Review Notes in Clinical Parasitology by RMDM 45