1/3/2015
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
Tapeworms
scolex
neck
strobila
Pseudophyllidean Cestodes
1/3/2015
Man
Cyclopes
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
Treatment
Niclosamide /
Praziquantel
Dr. Sudheer Kher
1/3/2015
Dogs / wolves
Intermediate host
Infective form
Eggs
Mode of transmission
Ingestion
Site of localization
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
1/3/2015
11
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
1/3/2015
1
3
1/3/2015
1
4
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
1/3/2015
15
Disease
Clinical
presentation
Nonspecific or asymptomatic
60% right hypochondriac pain
15% jaundice
Aspiration is contraindicated
X ray / US / CT / MRI
Casonis intradermal test
IHA / ELISA
Dr. Sudheer Kher
1/3/2015
16
1/3/2015
17
18
Definitive host
Man
Intermediate host
Cattle
Lenghth
5 meters
Max reported 25 meters
Infective form
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
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
21
TAENIA SOLIUM
1/3/2015
22
Human cysticercosis
When humans plays the role of the
Intermediate Host
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
MRI of multiple
cysts. Image
courtesy of the
Centers for Disease
Control and 23
Prevention.
Neurocysticercosis
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
24
Cysticercosis pathology
1/3/2015
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
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
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
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
Treatment
Niclosamide / Praziquantel
Dr. Sudheer Kher
1/3/2015
30
Man
Intermediate host
Pig
Infective form
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
1/3/2015
32
1/3/2015
33
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
Scolex release in
intestine
eggs (stool)
Cysticercoid larva
ingestion
Onchosphere
release
Dr. Sudheer Kher
1/3/2015
35
1/3/2015
36
Disease
Digestive disturbances
Diagnosis
Treatment
Niclosamide / Praziquantel
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
drreeta@gmail.com
38
1/3/2015
39