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

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

3. Fasciola hepatica

4. Taenia saginata

5. Ascaris lumbricoides

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

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

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

14. Tegument- Microthrix

15. Onchosphere & egg
embryophore

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

18. 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)

20. Transmission

22. Mature proglottid

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

24. Cysticercus bovis

26. 26

28. Infectivity with C.bovis

32. Long life: 25 years

33. 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.

34. 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.

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

36. 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

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

38. Taenia in appendix

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

40. proglottid

42. Taenia saginata

43. Onchosphere & egg
embryophore

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

45. 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

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

47. Prevention & Control

48. 48

49. Health Education

50. Proper cooking

51. Freezing

52. Meat inspection

53. Taenia saginata
Beef tapeworm
Morphology
Life cycle
Adults: 4-6mm; scolex:1-2mm; gravid s.:16-20x5-7mm; mature s.:12mm; proglottids:
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

54. Taenia asiatica Epidemiology Morphology Life cycle Symptomology
Diagnosis
Control & treatment

55. Cysts of Taenia asiatica in the liver of intermediate host

56. میزبانان واسط متعدد
سیستی سرک ها اغلب در کبد

57. Taenia solium

60. Taenia saginata

62. Cysticercous cellulosae

67. 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.

68. 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

72. neurocysticercosis

73. 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

74. 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

76. Convultion

79. Racemose cysticercosis

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

81. 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.

82. 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.

83. 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.

84. 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.

85. Ocular cysticercosis

86. Cysticercosis in eye

87. 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.

89. Cysticercosis در زير پوست: ضايعات شبيه ليپوما

90. Diagnosis

91. 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

92. 92

98. Eye Examination

99. 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

100. Praziquantel

101. Albendazole- Mode of action

102. Corticosteroid

103. Surgery

104. Control

106. Health Education

107. Meat inspection

108. Proper cooking

109. Freezing