Vous êtes sur la page 1sur 39

Tape worms

Fish Tape worm Diphylobothrium latum


Dog Tape worm Echinococcus granulosus
Beef Tape worm Taenia saginata
Pork Tape worm Taenia solium
Dwarf Tape worm Hymenolepis nana

Dr. Sudheer Kher

1/3/2015

Include all tapeworms.


They have suckers and teeth that grasp the host.
Behind a short neck are repeated parts of the
worm, each containing reproductive structures with
eggs and sperm, which can be released with the
host's feces.
The pieces give the worm a ribbon-like structure,
beneficial for absorbing nutrients from the
intestine.

Dr. Sudheer Kher

1/3/2015

http://www.ndpteachers.org/
perit/biology_image_gallery1
.htm
2

HOSTS
INTERMEDIATE: harbors the
immature forms of the parasite.
DEFINITIVE: Harbors the mature
forms of the parasite

Man is an intermediate host in Dog


tape worm infection.
Man can occasionally be intermediate
host in pork tape worm infection

Tapeworms
scolex
neck

strobila

The reproductive system

Pseudophyllidean Cestodes

Slit like grooves ( bothria )

Diphyllobothrium latum ( Fish tape worm )


Cyclophyllidean Cestodes

Cup like & round suckers ( acetabula )

Taenia saginata ( Beef tape worm )


Adult worm in intestine

Taenia solium ( Pork tape worm )


Hymenolepis nana ( Dwarf tape worm )
Echinococcus granulosus ( Dog tape worm )

Larval stage in man

Dr. Sudheer Kher

1/3/2015

(Fish Tape Worm)


Definitive host

Man

1st Intermediate host

Cyclopes

2nd Intermediate host

Fish

Infective form

Pleurocercoid larva

Mode of transmission

Ingestion

Site of localization

Small intestine
Dr. Sudheer Kher

1/3/2015

1/3/2015

Common in fish
eating carnivores
with little host
specificity. Salmon,
trout, perch, white
fish, eel, pike, etc.
Adults get quite
long (10 m) and
shed up to a million
eggs per day
Eggs must reach
water for
embryonation
After several days a
coracidium hatches
through the
operculum and is
eaten by a copepod

http://www.dpd.cdc.gov/DPDx/HTML/Diphyllobothri
asis.htm
Dr. Sudheer Kher

Disease

Digestive disturbances
Vit B 12 deficiency

Diagnosis

Operculated eggs/ segments


in stool

Treatment

Niclosamide /
Praziquantel
Dr. Sudheer Kher

1/3/2015

(Dog Tape Worm)


Definitive host

Dogs / wolves

Intermediate host

Pigs, grazing animals


Man occasional

Infective form

Eggs

Mode of transmission

Ingestion

Site of localization

Liver, lung / any organ


Dr. Sudheer Kher

1/3/2015

10

Echinococcus
multilocularis:
alveolar
echinococcosis.
Invasive solid lesions of firm
consistency, full of
connective tissue and a jellylike material.

Echinococcus
granulosus:
cystic
echinococcosis.
Produces cystic lesions

Dr. Sudheer Kher

1/3/2015

11

Liver cysts cause liver


swelling, right epigastric
pain, nausea, vomiting
Obstruction of bile ducts
and blood vessels can
cause cholangitis,
jaundice, cirrhosis and
portal hypertension

This upper abdominal CT scan shows multiple cysts in the liver, caused
by echinococcus. Note the large circular cyst (seen on the left side of
the screen) and multiple smaller cysts throughout the liver.
http://www.drkoop.com/ency/93/ImagePages/1177.html

1/3/2015

1
2

Dr. Sudheer Kher

1/3/2015

1
3

Sylvatic zoonosis in Europe


and northern America
Humans get infected by
eating contaminated berries
and mushrooms collected in
forests populated by foxes
Life Cycle: (A) Adult parasite.
(B) Foxes (left, red fox; right,
Arctic fox) as principal
definitive hosts; dogs, other
canids, and cats can be
involved in the cycle. (C)
Proglottid with eggs. (D) Egg
with oncosphere. (E) Infection
of humans. (F) Rodent
infected with metacestodes.
(G) Rodent liver with
metacestodes. (H) single
metacestode cyst with
protoscoleces.
Dr. Sudheer Kher

The Hydatid Cyst

1/3/2015

1
4

The cyst is lined by a multilayer parasite


tissue with the innermost layer being the
germinal layer
This layer is a undifferentiated stem cell
layer that can spawn the formation of brood
capsules which are themselves lined by GL
The daughter cysts (the encircled body)
"bud" into the center of the fluid-filled cyst.
This is a very small portion of the cyst which
may become quite large.
Each of the smaller bodies will develop into
diminutive tapeworms should this be eaten
by a definitive or final host such as a canine.

Dr. Sudheer Kher

Hydatid Cyst
(Intermediate
Host)
Liver / Lung /
Any organ

Eaten by
definitive host

Embryos
penetrate
intestine

Larva escapes

Embryo
released from
egg

Adult worm in
Intestine

Eggs eaten by
intermediate
host

Eggs
discharged

Dr. Sudheer Kher

1/3/2015

15

Disease

Hydatid cyst or disease

Clinical
presentation

Nonspecific or asymptomatic
60% right hypochondriac pain

15% jaundice

Others like skin rashes, pruritus, allergic reaction


Cyst can rupture leading to broncho biliary fistula
Diagnosis

Aspiration is contraindicated

X ray / US / CT / MRI
Casonis intradermal test
IHA / ELISA
Dr. Sudheer Kher

1/3/2015

16

Drugs are not curative

Act as adjunct to kill spilled scolices


Praziquantel, albendazole, mebendazole

Surgical removal of the cyst

Dr. Sudheer Kher

1/3/2015

17

Taenia life cycle


Humans are the only
DHs
The eggs can survive
for days to months in the
environment
The adult worm
attaches by their scolex
to the human small
intestine.
The adults produce
proglottids passed with
stool
The eggs are released
after the proglottids are
passed with the feces
1/3/2015

Dr. Sudheer Kher

18

(Beef Tape Worm)

Definitive host

Man

Intermediate host

Cattle

Lenghth

5 meters
Max reported 25 meters

Infective form

Cysticercus bovis (larva)

Mode of transmission

Ingestion

Site of localization

Small intestine
Dr. Sudheer Kher

1/3/2015

19

TAENIA SAGINATA
Beef tapeworm
Ranges in length from 6-30 ft
Geographic distribution: cosmopolitan.
Most common where poor sanitation
and no inspection of meat combine
Africa and South America
Transmission: Ingestion of larval form
in undercooked beef
In N. America 1 in 100 is infected. In
third-world nations could be up to 10%
No symptoms or some abdominal
discomfort
Diagnosis: finding eggs or proglottids
in feces

1/3/2015

Dr. Sudheer Kher

Taenia
saginata
adult
worm.

Taenia saginata,
Scolex
(Mit freundlicher
Genehmigung
Roche AG)

20

TAENIA SOLIUM
The armed
scolex of T.
solium (note
hooks on top
of scolex).
CDC

T. solium has a scolex (A) with four suckers and a double


crown of hooks, a narrow neck, and a large strobila (2-4 m) (B)
consisting of several hundred proglottids.
About 2 months after ingestion, proglottids begin to detach from
the distal end and are excreted in the feces.
Each segment contains 50-60,000 fertile eggs.
1/3/2015

Dr. Sudheer Kher


The Lancet (2003) 361: 547

21

TAENIA SOLIUM

Endemic in less developed countries


where pigs are raised as food source. Latin
America, most of Asia, sub-saharan Africa,
and parts of Oceania.
Infection with the adult forms of the
parasite produces similar symptoms to
infection with T. saginata.

1/3/2015

Dr. Sudheer Kher

22

Human cysticercosis
When humans plays the role of the
Intermediate Host

Larval stages develop in the human host


Humans acquire cysticercosis through faecal-oral contamination with T. solium

eggs
The oncosphere in the eggs is released by the action of gastric acid and
intestinal fluids
Cross the gut wall and enter the bloodstream
They are carried to the muscles and other tissues
They encyst as cysticerci at small terminal vessels (1 cm) (A) and (B)
Neurocysticercosis and ophtalmic cysticercosis serious

1/3/2015
Racemose Cysticercosis-MRI

Dr. Sudheer Kher

MRI of multiple
cysts. Image
courtesy of the
Centers for Disease
Control and 23
Prevention.

Neurocysticercosis

Neuroimaging: MRI of viable (A) and degenerating (B) cysts and CT of


calcified cysticerci. The Lancet (2003) 361: 547

The parasite infects the CNS


Epileptic seizures (58-80% when parenchymal

brain cysts).
Intracranial hypertension, hydrocephalus, or
both. This syndrome is related to the location of
parasites in the cerebral ventricles or vasal
cisterns.
Occasionally a cyst may grow larger (giant cyst)
Geographical variation in clinical manifestations
1/3/2015

Dr. Sudheer Kher

From: NEJM (2001) 345:879

24

Cysticercosis pathology

Cysts are rounded or oval vesicles from a few mm to 1-2 cm


Most common location is in the cerebral hemispheres, mainly at the junction of
grey and white matter.
Cysts can be found in the cerebellum, ventricles, brainstem, basal cisterns, and
spine.
Viable cysts have a translucent membrane through which the scolex is visible.
Cysts degenerate: the fluid becomes opaque and dense and edges irregular and
shrink.
Calcification starts in the cephalic portion and leaves a whitish calcified nodule

1/3/2015

Dr. Sudheer Kher

25

Cysticercosis diagnosis
Serologic diagnosis:
Antibody assays for cysticercosis:
Antigen-detection assays: circulating
antigens means live parasites.
Ongoing viable infection. Monoclonal
antibodies seem to detect AGs in
CSF.
Antibody assays for taeniasis:
TSE33 and TSE38 were recognized
by a panel of taeniasis but not
cysticercocis, patient serum samples.
Neuroimaging diagnosis: CT and
MRI provide objective evidence on
number and location of cysticerci. Also
their viability and the severity of the host
inflammatory reaction.

1/3/2015

MRI showing parenchymal (A) and


extraparenchymal (basal ccs) (B) viable NCC.

Dr. Sudheer Kher

MRI showing
calcified cyst with
surrounding
edema

26

Cysticercosis treatment
Treatment should be individualized based on cyst location,
level of inflammation and clinical presentation
Therapy should include analgesics, antiepileptic drugs,
cysticidal drugs, surgical resection of lesions and placement
of ventricular shunts
Parenchymal cysticercosis with viable cysts: Albendazole
15 (mg/kg/day) with dexamethasone (0.1 mg/kg/day).
Praziquantel.
Subarachnoid ccs: antiparasitic therapy
No reason to use antiparasitic drugs to treat dead calcified
cysts. Symptomatic therapy.
Surgical therapy: ventricular shunting to resolve
hydrocephalus. Also excision of giant cysts or intraventricular
cysts

1/3/2015

Dr. Sudheer Kher

27

Transmission
You do not get NCC by eating pork
Ingestion of infected pork only causes adult
tapeworm infestation: taeniasis.
Infected pork contains only the larval cysts that
develop into adult worms in the human intestine
What is that transmits CCS?
The eggs
Most common source of infective eggs?
A symptom-free tapeworm carrier in the household
1/3/2015

Dr. Sudheer Kher

28

Adult worms
(intestine)
Scolex release in
intestine

Eggs (stool)

Man eats
undercooked beef

Cattle ingest

Cysticercus
(bladder)

Onchosphere
release

Blood to muscles

Intestine
penetration
Dr. Sudheer Kher

1/3/2015

29

Disease

Digestive disturbances

Diagnosis

Eggs / segments in stool

Treatment

Niclosamide / Praziquantel
Dr. Sudheer Kher

1/3/2015

30

(Pork Tape Worm)


Definitive host

Man

Intermediate host

Pig

Infective form

Cysticercus cellulosae (larva)


Eggs

Mode of transmission

Ingestion

Site of localization

Small intestine
Dr. Sudheer Kher

1/3/2015

31

Adult worms
(intestine)
Scolex release
in intestine

Eggs (stool)

Man eats
undercooked pork

Pigs ingest

Cysticercus
(bladder larva)

Onchosphere
release

Blood to
muscles

Intestine
penetration

Dr. Sudheer Kher

1/3/2015

32

T solium lateral branches of


uterus 7-13

T saginata lateral branches of


uterus 15-20

Dr. Sudheer Kher

1/3/2015

33

(Dwarf Tape Worm)


Definitive host

Man

Intermediate host

No

Infective form

Eggs
Internal autoinfection

Mode of transmission

Ingestion

Site of localization

Small intestine
Dr. Sudheer Kher

1/3/2015

34

Adult worms (intestine)

Scolex release in
intestine

eggs (stool)

Cysticercoid larva

ingestion

Onchosphere
release
Dr. Sudheer Kher

1/3/2015

35

Hymenolepis nana the dwarf tape worm


Hymenolepis nana
occurs relatively
frequently world
wide and is usually
an infection of
children
An intermediate
host is not required
and autoinfections
occur frequently
Cysicercoids
develop in the
lymphatics of villi
Alternatively
infection through
cysticercoids in
insects that
contaminate grains
or cereal

1/3/2015

Dr. Sudheer Kher

36

Disease

Digestive disturbances

Diagnosis

Eggs / segments in stool

Treatment

Niclosamide / Praziquantel

Dr. Sudheer Kher

1/3/2015

37

A Tale of a Tapeworm
Once upon a time, an unsuspecting gentleman
Gorged on a succulent pork steak with lan
Never realized he acquired an elite companion
A slithering tapeworm in his intestine
And never did he live happily ever in his lifespan
The ribbon-like flatworm hijacked his gut
Hooked onto the wall with its armed head
As it feasted on his meals with delight
Sprouted segments to grow a healthy three
metres in height
Taenia solium is the exotic name of this notso-pretty sight!
While our gentleman was oblivious to the fact
He passed some segments teeming with eggs
From. Err. you-know-where!
Not a stickler for regular hand-washing
He swallowed some eggs at breakfast one
morning!
The eggs hatched into curious baby larvae
Which set out on an adventure trail
Through coursing blood vessels like a metrorail

1/3/2015

And decided to relax at destination BRAIN


But alas! Could not find their way back again
Some years later the victim had seizures one night
As Doctors peeked and prodded the verdict was out
Neurocysticercosis the radiologist pronounced
There was a worm in his brain; Dead and
Mummified
Like a tomb-stone with an epitaph that read
"Catch me if you can!
Vegetarians need not sneer at pork-eaters
And assume they can escape the sly tapeworm
A delicious salad or a sandwich tainted with eggs
Is all that it takes for the tapeworm to make you its
prey
So keep your hands crossed, while you pray
God, save me from the tapeworm everyday!
Dr Reeta Mani
Senior Resident,
Department of Neuromicrobiology,
National Institute of Mental Health and
Neurosciences (NIMHANS)
Bangalore, INDIA

drreeta@gmail.com

Dr. Sudheer Kher

38

1/3/2015

Dr. Sudheer Kher

39