Cestoda Dr. E. B. Kia School of Public Health Tehran University of Medical Sciences

● Platyhelminth Helminth ● Nemathelminth (round worms) -trematoda (flukes) -cestoda (tapeworms) ● Nemathelminth (round worms)

Fasciola hepatica

Taenia saginata

Ascaris lumbricoides

Transmission of Helminth Snail Transmitted Helminthes Soil Transmitted Helminthes Meat Transmitted Helminthes Direct Transmitted Helminthes Arthropod Transmitted Helminthes

Adult cestodes in human Taenia saginata Taenia solium (sometimes larvae in different tissues) Taenia asiatica Hymenolepis nana (larvae in intestinal mucous) Diphyllobothrium latum

Cestodes larvae in human Hydatid cyst….Echinococcus granulosus Alveolar cyst…Echinococcus multilocularis Cysticercus cellulosae…Taenia solium

Tegument- Microthrix

Onchosphere & egg embryophore

تنيای غير مسلح کرم کدوی گاو Taenia saginata تنيای غير مسلح کرم کدوی گاو

Taenia saginata beef tape worm Location in host The scolex of the adult tapeworm is embedded in the mucosa of the wall of the small intestine ( jejunum and ileum)

Transmission

Mature proglottid

Gravid proglottides T. saginata: 15–32 (usually 20–23) lateral branches.

Cysticercus bovis

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Infectivity with C.bovis

Long life: 25 years

Clinical manifestations Often only sign of infection is feeling of them ‘crawling’ out through the anus. epigastric pain, stomach ache- nausea, weakness, loss of weight, alteration of appetite, and headache. allergic reactions such as urticaria and pruritus presence of a lump in the throat intestinal obstruction and appendicitis A moderate eosinophilia occurs in 5–45% of patients. واكنشهاي آلرژيك، كهير، خارش و يا احساس وجود شئ خارجي در حلق هم ديده شده. درد اپي گاستر، درد ناف، ، دل درد سردرد، اسهال، تهوع، ضعف و لاغري، كاهش اشتها.

Clinical manifestations constipation -diarrhea –dizziness- headache - Migrating proglottids can cause: inflammation of the appendix) inflammation of the bile duct) Cholangitis/ appendicitis, obstruction -unpleasant surprise when seen in the feces.

Symptoms Vague abdominal discomfort Hunger pangs Chronic indigestion Moderate eosinophilia- Eos. (10%)/ IgE

دفع بند واکنشهای آلرژيك، كهير، خارش و يا احساس وجود شئ خارجي درحلق احساس دفع ناخواسته احساس حرکت کرم درروده درد اپي گاستر، درد ناف، دل درد سردرد، اسهال، تهوع، ضعف و لاغري، كاهش اشتها. کاهش اسیدیته معده اختلالات عملی روده: افزایش فعالیت تریپسین

عوارض انسدادوسوراخ شدن روده نفوذ بند به آپاندیس، مجرای صفراوی یا پانکراس و فضای صفاقی

Taenia in appendix

Diagnosis Proglottids examination Cellophane tape swab Stool examination is not specific method

proglottid

Taenia saginata

Onchosphere & egg embryophore

Treatment Niclosamide (Yomesan) 4x500 mg, Side effects Scolex Praziquantel, 5-10 mg/kg, single dose Mode of action

Treatment Praziquantel (100%): a single oral dose of 5–10 mg/ kg Niclosamide (90%): adult: 2 g children aged 2–6 years:1 g side-effects disturb mitochondrial phosphorylation

مکانیسم اثر دارو نیکلوزامید: وقفه فسفریلاسیون اکسیداتیو در میتوکندری های کرم پرازیکوانتل: اختلال در متابولیسم کلسیم- تخریب پوشش کرم

Prevention & Control

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Health Education

Proper cooking

Freezing

Meat inspection

Taenia saginata Beef tapeworm Morphology Life cycle Adults: 4-6mm; scolex:1-2mm; gravid s.:16-20x5-7mm; mature s.:12mm; proglottids:1000-2000 Long life:25 years Cysticercous bovis: 5-9mm; development:12-15 weeks; degeneration: after one year Geographical distribution/ Iran, world No. of adults Symptomology Cholangitis/ appendicitis, obstruction Pathology Eos./ IgE Diagnosis Treatment Prevention

Taenia asiatica Epidemiology Morphology Life cycle Symptomology Diagnosis Control & treatment

Cysts of Taenia asiatica in the liver of intermediate host

میزبانان واسط متعدد سیستی سرک ها اغلب در کبد

Taenia solium

Taenia saginata

Cysticercous cellulosae

Clinical manifestations of taeniasis Usually no distinct clinical signs. Sometimes abdominal pain, with diarrhoea or constipation loss of weight and weakness. There is often an eosinophilia of 10–13%. Symptoms may be psychological in origin or perhaps due to toxic waste products produced by the worm. There is usually slight traumatic damage to the mucosa at the site of attachment of the scolex, very rarely causing death.

Treatment of taeniasis Give an antiemetic and follow treatment Praziquantel at 5–10 mg/ kg in a single oral dose is usually completely effective. Niclosamide at an oral dose of 2 g for an adult minor side effects

neurocysticercosis

Cysticercosis در هر بافتی، اغلب در عضلات و مغز شایعترین عفونت انگلی مغز و مهمترین عامل تشنج بالغین در مناطق آندمیک در چشم معمولا کیست منفرد

علائم بالینی علائم بالینی بستگی به تعداد ومحل استقرار لاروها در بدن دارد. در عضلات: در اكثر موارد بدون علامت، ميوزيت به همراه تب، افزایش حجم کاذب عضلات، گرفتگی عضلانی و ضعف عمومی در زير پوست: شبيه ليپوما در چشم: اختلالات بينائي و جدائي شبكيه در سيستم عصبي(نوروسیستی سرکوزیس) التهاب عنكبوتيه و هيدروسفالي صرع، سردرد و استفراغ سكته مغزي اختلال بينائي و شنوایی اختلال در تکلم، فلجی و عدم تعادل

Convultion

Racemose cysticercosis

Neurocysticercosis The most common parasitic D. of CNS Epileptic seizure Intracranial hypertension Headache, vomiting, vertigo, behavior disturbances,… Cerebral edema

NEUROCYSTICERCOSIS Cysticerci in the brain are initially viable but do not cause much inflammation in surrounding tissues; this phase of infection is usually asymptomatic. The host develops a state of immune tolerance to the parasite, and cysticerci can remain in this stage for many years. Clinical manifestations frequently develop when an inflammatory response develops around a degenerating cysticercus. It is not known what triggers this degeneration, but after a variable number of years, the cyst seems to lose its ability to modulate the host immune response.

NEUROCYSTICERCOSIS If symptoms are present, these are mainly due to mass effect, an inflammatory response, or obstruction of the foramina and ventricular system of the brain. The symptoms of NCC depend upon the stage, site, and number of cysticerci. The most common symptoms include seizures, focal neurological signs, and intracranial hypertension.

NEUROCYSTICERCOSIS The peak of NCC has been estimated to occur three to five years after infection, but it can be delayed for >30 years. After a variable period of degeneration, cysts can become calcified and may then become inactive. Once they are calcified, they may cease to cause symptoms or may serve as a focus for epileptic activity. Patients frequently have cysts in more than one location, and it is not uncommon to have active and inactive cysts present in the same patient.

Ocular cysticercosis Ocular cysticercosis occurs in approximately one to three percent of all infections. Patients with ocular cysticercosis may have parasites located in the subretinal space or vitreous humor. These are often asymptomatic, but inflammation around degenerating cysticerci can threaten vision by causing chorioretinitis, retinal detachment, or vasculitis. Parasites may also be present in the anterior chamber or may affect the conjunctiva or extraocular muscles. Ocular cysticercosis should be excluded by a proper ophthalmologic examination in all patients with NCC prior to initiating therapy.

Ocular cysticercosis

Cysticercosis in eye

Subcutaneous and intramuscular cysticercosis Cysticerci can develop in almost any body site, but tend to have a predilection for muscle or subcutaneous tissues. Cysticerci at these sites are usually asymptomatic, but the patient may notice subcutaneous, pea-like or walnut-sized nodules. Subcutaneous nodules are more common in patients from Asia and Africa than from Latin America. In cases of major muscle involvement, acute myopathy can develop. Both subcutaneous and intramuscular cysts often undergo calcification and may be detected incidentally when radiographs are performed for unrelated problems. Cysts have also been found in the heart. Depending upon the location of the cysts, these may be asymptomatic or may result in arrhythmias and/or conduction abnormalities.

Cysticercosis در زير پوست: ضايعات شبيه ليپوما

Diagnosis

تشخيص آزمايشات سرولوژي: الایزا و وسترن بلات بیوپسی روش های تصویر برداری: X-rays تنها برای تشخیص کیستهای کلسفیه مناسب است. CT اسکن و MRI نیز برای تشخیص کمک کننده هستند (بخصوص در موارد نوروسیستی سرکوزیس). ELISA using recombinant antigens A Western blot technique, using commercially available affinity purified glycoprotein antigen strips

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Eye Examination

Management: Management Anti helminthic agents Tab. Albendazole 15 mg/kg daily x 1 month Tab. Praziquantel 50 mg/kg/day x 15 days Steroids Anti epileptic drugs Surgery

Praziquantel

Albendazole- Mode of action

Corticosteroid

Surgery

Control

Health Education

Meat inspection

Proper cooking

Freezing