Bomet Mtc Series@ Mocha Clifford.

CESTODES
(TAPEWORMS)
10/25/2024 UNIT TEN . Mocha Clifford.
 Intro.
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 The tapeworms are hermaphroditic

and require an intermediate host.
 The adult tapeworms found in

humans have flat body, white or

grayish in color.
 They consist of an anterior

attachment organ or scolex and a

chain of segments also called
strobilla.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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 The strobilla is in the entire body

except the scolex.
 The scolex has suckers or grooves.

 It has rosetellum, which has 1 or 2

rows of hooks situated on the center

of the scolex.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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 Adult tapeworms inhabit the small

intestine, where they live attached to
the mucosa.
 Tapeworms do not have a digestive

system.
 Their food is absorbed from the

host’s intestine.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

 Cestodes (Tapeworms)
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*Hymenolepis
*Taenia saginata
nana
*Taenia soliumdiminuta
*Hymenolepis
*Diphyllobothrium
Dipylidium caninum
latum
*Echinococcus multilocularis
granulosus
Multiceps spp

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

Parasites you should study are indicated with
 General Characteristics
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 The tapeworms are hermaphroditic

and require an intermediate host.
 The adult tapeworms found in

humans have flat body, white or

grayish in color.
 They consist of an anterior

attachment organ or scolex

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

 Cont.
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 Adult tapeworms inhabit the small

intestine, where they live attached to
the mucosa.
 Tapeworms do not have a digestive

system.
 Their food is absorbed from the

host’s intestine.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

 Cont.
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1.A. HYMENOLEPIS NANA (DWARF

TAPEWORM)
Morphology
 Adult worm measures 1-3 cm in

length.
 It is made up of head (scolex), neck

and segmented body.

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 The head carries four suckers and a

rostellum armed with one row of
hooks.
 The segments of the body are

divided into mature and gravid

segments.
 In the mature segment, there are

three testes in the middle.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Infective stage and mode of infection

 The egg, which is immediately infective

when passed by the patient, is rounded,

about 40 microns in diameter.
 It contains a six- hooked oncosphere within

a rigid membrane (the embryosphere).

 This embryosphere has two polar thickening

or knobs from which project 4-8 mm long,

thin filaments called polar filaments.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Infection takes place by:

1. Ingestion of egg with contaminated raw
vegetables.
2. Direct infection from a patient
3. Auto infection: the eggs of H. nana are
infective as soon as they are passed with
feces by the patient.
 If the hands of the patient are

contaminated by these eggs, she/he

infects herself/himself again and again.
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Pathogenicity
 Light infections produce no symptoms.

 In fairly heavy infections, children may

show lack of appetite, abdominal pain

and diarrhea.
Treatment -
 Niclosamide: 4 tablets chewed in a

single dose daily for 5 days.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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1.B. HYMENOLEPIS DIMINUTA (RAT

TAPEWORM)
 Hymenolepis diminuta differs from

Hymenolepis nana in that:

♦ The adult worm measures about 10-60 cm
♦ The rosetellum on the head has no hooks
♦ In the mature segment, there are two
testes at one side and another testis on
the other side.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Life cycle
 The adult worms are present in the small

intestine of man and rats.

 Eggs passed in stool are similar to the eggs of

H. nana but are brown in color with no polar

filaments arising from the polar thickening.
 The eggs are ingested by the rat flea where

they develop to cysticercoid stage.

 Infection to man takes place accidentally by

food or contaminated hands by cysticercoid

stage.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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Pathogenecity
 Most infections are asymptomatic, but

occasionally, patients may present with

nausea, anorexia and diarrhea.
Treatment
 Same as Hymenolepis nana.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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2. ECHINOCOCCUS
 There are two different species.

 These are: Echinococcus granulosus and

Echinococcus multilocularis
2.A. Echinococcus granulosus (dog tape
worm)
 Responsible for most cases of echinococcosis.

 Echinococcosis is caused by larval tapeworms.

 The disease is common in East Africa (the

highest prevalence is seen in Kenya: 10-15%).

Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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Morphology
 The adult worm measures 3-6 mm in

length (up to 1 cm).

 It has scolex, neck and strobilla.

 Adult worms live in small intestine of

definitive host (dog).

 Man is an intermediate host - carrying

the hydatid cyst (larva).

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Life cycle and Pathogenecity

 Oncosphere hatch in duodenum or small

intestine into embryos (oncosphere)

which:
♦ Penetrate wall
♦ Enter portal veins
♦ Migrate via portal blood supply to
organs: e.g.: lungs, liver, brain etc., thus,
causing extra intestinal infections.
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 In these organs, larvae develop into

hydatid cysts.
 The cysts may be large, filled with clear
fluid and contain characteristic
protoscolices (immature forms of the
head of the parasite).
 These mature into developed scolices,
which are infective for dogs.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Mode of human infection

 Ingestion of eggs by the following ways:

i) Ingestion of water or vegetables polluted by

infected dog feces.
ii) Handling or caressing infected dogs where
the hairs are usually contaminated with
eggs.
Clinical features
 Asymptomatic infection is common, but in

symptomatic patients
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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♦ It may cause cough - with hemoptysis in lung

hydatid disease.
♦ Hepatomegaly - with abdominal pain and discomfort
♦ Pressure -from expanding cyst
♦ Rupture of cyst - severe allergic reaction -
anaphylaxis.
Diagnosis:
 ♦ X-ray or other body scans

 ♦ Demonstration of protoscolices in cyst after

operation
 ♦ Serology

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Treatment
♦ Surgery
♦ Albendazole 400 mg
2.B. Echinococcus multilocularis
 Foxes are the definitive hosts, while

various rodents such as mice serve as

intermediate hosts.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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3.A. TAENIA SAGINATA (BEEF

TAPEWORM)
 In adult stage, T. saginata inhabits the

upper jejunum where it may survive for

as long as 25 years.
 It causes intestinal infection, Taeniasis.

 It has worldwide distribution.

 These are one of the true and

segmented tapeworms.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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 Their body is divided into three regions;

1. Scolex: hold fast organ
2. Neck: posterior to the scolex
3. Stobilla: the main bulk, made up of
proglottids.

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Life cycle
 The adult worm lives in the small

intestine of man.
 Gravid segments pass out in the stool

and become disintegrated and eggs

come out to the soil.
 The gravid proglottid uterus contains

about 100,000 eggs.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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 The egg of T. saginata is round, about 40

microns in diameter.
 The 6-hooked embryo is enclosed in a
radially striated embryosphere.
 Eggs are ingested by an intermediate
host, cattle.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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 The 6-hooked embryo escapes from its shell,

penetrates through the intestinal wall into the
blood vessels and is carried to the muscles
where it develops into a larval stage,
cysticercus bovis (made up of an invaginated
/inverted head and spherical body).
 Infection to man takes place by the ingestion
of raw or insufficiently cooked beef.
 In the small intestine of man, the head of the
cysticercus gets invaginated and the body
becomes segmented.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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Morphology
 Adult worm measures 5-10 meters in

length.
 The pyriform scolex has 4 suckers but no

rostellum.
 The mature segments have irregularly

alternate lateral genital pores.

 Each of the terminal segments contains

only a uterus made up of a median stem

with 15-30 lateral branches.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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Pathogenecity
 Infected persons may complain of

epigastric pain, abdominal discomfort,

diarrhea, weight loss, hunger sensation,
vomiting, etc.
Diagnosis
 Recovery of the gravid segments or the

eggs from the stool

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Treatment:
 Niclosamide: Four tablets chewed in a

single dose.
 Mebendazole 100mg twice daily for

three days
Prevention:
♦ Thorough cooking of meat.
♦ Proper disposal of human excreta

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

 Cont.
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3.B. TAENIA SOLIUM (PORK TAPEWORM)

 The adult worms of T. solium reside or inhabit the

upper jejunum.
 Infection has worldwide distribution.

Morphology:
 Adult worm measures about 3 meters in length.

 The globular scolex has rostellum with 2 rows of

hooklets.
 There are <1000 proglottids.

 Gravid proglottid liberates about 30,000-50,000

eggs.
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Life cycle
 Embryonated eggs passed with stool are

ingested by pig and the embryo is released.

 It penetrates the intestinal wall and is carried

by vascular channels to all parts of the body.

 After a period of 2-3 months of development

the encysted larval stage called cysticerci or

bladder worm occurs in the striated muscles
of the tongue, neck, trunk brain, eye, and
the nervous system.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
 Cont.
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 The cysticercus survives for 5 years.

 Humans become infected by eating pork

containing larvae, cysticercus cellulosae.

 When improperly cooked cysticercus

infected meat is eaten by man, the

scolex remains undigested and attaches
itself to the intestinal wall and chain of
proglottids begin to grow to adult worm.
Clinical manifestations
 Resembles that of T. saginata infection
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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Diagnosis
 Demonstration of eggs in stool specimen

Treatment
 Niclosamide: 2 gm PO stat

Prevention:
 ♦ Treatment of infected persons.

 ♦ Thorough cooking of pork and proper

processing
 ♦ Proper disposal of human excreta (good

hygiene/sanitation).
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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Taenia Taenia
saginata solium

Length (m) 5-10 2-3

Proglottid 1000-2000 800-900

number

Hooklets Absent Present

Suckers Pigmented Non-

Bomet Mtc Series@ Mocha Clifford. Pigmented.
10/25/2024
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3. DIPHYLOBOTRIUM LATUM (FISH TAPEWORM

OR BROAD TAPEWORM
 The broad tapeworm infecting man has worldwide

distribution, occurring in areas where improperly

cooked or raw fresh water fish is prominent in diet.
Morphology
 Diphylobotrium latum is the broadest and

longest tapeworm.
 The adult worm measures up to 30 feet with 3000-

4000 proglottids, which are wider than they are

long.
 The tapeworm has no rostellum hooks or suckers.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Life cycle
 Unlike Taenia, the gravid segments are retained by

the worm.
 Operculated eggs passed in feces hatch into small

ciliated coracidium larvae which swim about freely.

 These are eaten by crustaceans -Cyclops or

Diaptomus in which the larvae develop into second

stage larvae the procercoid.
 When the crustaceans are swallowed by fresh water

fish, the larvae migrate into the flesh of the muscle

fish and develop to pleurocercoid or sparganum
larvae.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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 Humans are infected by ingesting

raw or improperly cooked fish.
 The tapeworm matures in the

intestine and after 3 weeks, the adult

worm discharges eggs.
 The life cycle requires two

intermediate hosts.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024

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Clinical manifestation
 Most infections are asymptomatic.

 Rarely, it causes severe cramping,

abdominal pain, vomiting, weakness

and weight loss.
 Pernicious anemia can also result,

due to interference of vitamin B12

absorption in jejunum.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
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Diagnosis
 Eggs in stool: Single shell with operculum at

one end and a knob on the other.

Treatment
 Niclosamide: 2 gm PO stat after light breakfast.

Prevention:
 Prohibiting the disposal of untreated sewage

into fresh water /lakes.

 Personal protection: cooking of all fresh water

fish.
Bomet Mtc Series@ Mocha Clifford. 10/25/2024
41
THE END.ALL THE BEST
OF LUCK
REVELATION 3:6
He that hath an ear, let him hear what
the Spirit saith unto the churches.

Bomet Mtc Series@ Mocha Clifford. 10/25/2024