1. بسم الله الرحمن الرحيم

2. 'Today‘ Frozen eyelashes Russia's remote diamond- rich Yakutia region, which hit minus 67 degrees Celsius (minus 88.6 degrees Fahrenheit) in some areas on 14-01-2018 Tuesday.

3. Abdullah Akhtar Ahmed Professor of Microbiology Khwaja Yunus Ali Medical College Enayetpur Sharif, Sirajgonj

4. Focus Objective Classification of Cestodes General characters Structure of Taenia worm Taenia egg and larva – cysticercus Clinical presentation of Taeniasis Diagnosis of Taeniasis Description of T. saginata Description of T. solium Differences between T. saginata & T. solium

5. Objective Students will be able to solve following problems after attending this class. 1. How will you identify a tape worm in the clinical specimen? 2. How will classify Cestodes on the basis of habitat? 3. What are the components of a tape worm? 4. Write down the pathogenesis and lab diagnosis of beef tape worm infection 4. Why T. solium infection is more dangerous than that of T. saginata? 5. State the pathogenesis cysticercosis. diagnose Taeniasis 6. How will you diagnose Taeniasis in the laboratory? 7. Compare between T. saginata and T. solium in morphology and pathogenesis. 8. How autoinfections occur in cysticercosis?

6. Classification 1. Pseudophylidean Cestodes – false/slit like groove (bothria) Diphylobothrium latum - intestine 2. Cyclophylidean Cestodes – cup like & round suckers (acetabula) Taenia saginata - intestine Taenia solium – intestine and tissue Hymenolepis nana - intestine Echinococcus granulosus & E. multilocularis – tissue

7. Intestinal Cestodes 1. Diphyllobothrium latum - Fish tape worm 2. Taenia solium - Pork tape worm 3. Taenia saginata - Beef tape worm 4. Hymenolepis nana 5. Hymenolepis diminuta 6. Dipylidium canis

8. Tissue Cestodes Echinococcus grqnulosa Echinococcus multilocularis Diphyllobothrium spp Taenia solium Disease Hydatid disease Sparganosis Cysticercosis Tissue (extra intestinal) Cestodes

9. General characters 1. Long, segmented, tape like and flattened dorsoventrally 2. Sizes vary from a few mm to several meter. 3. Mouth or alimentary tract and body cavity absent 4. Elongated body - divided into 3 parts: head (scolex), neck and strobila (body) consisting proglottids (segments) 5. “ Head ” is provided with suckers and sometimes with hooks for attachment. 6. Excretory and nervous system are present 7. Body cavity and alimentary system are absent. 8. Reproductive system is present in each segment 9. Adults are found in intestines of vertebrates 10. Larval stages in 1 or 2 intermediate hosts 11. It may live for more than 10 years.

10. 2. Flattened dorsoventrally 3. Tape like 4. Segmented 5. No body cavity 6. No alimentary canal 7. Head has suckers (with or without hooks) 8. Sex not separate 1. Long 9. Highly developed reproductive system Head with sucker neck body Cestode

11. scolex neck Mature segment Gravid segment Taenia worm 1. Taenia saginata 2. Taenia solium

12. General Terms Scolex - head Neck- region behind head Strobila- body/trunk Proglottids – individual segment of tape worm Rostellum – beak like projection on the head Oncosphere – 6 hooked embryo in eggs Cysticercus – resting stage of larva Hydatid cyst – larval stage of E. granulosus

13. Taenia spp. adult worm The chain of proglottids is called the strobila, and may be composed of over 1.000 proglottids. T.saginata may measure 9 m, whereas T.solium may reach 6 m.

14. General Body Shape of a Tapeworm a.Scolex b.Neck c.Strobila made up of proglottids

15. Head (scolex) The hooked spines and suckers are used for attachment to intestinal surfaces

16. Scolex (pl: Scolices) Sucker like Organs of Scolex: –Acetabula Cup shaped, circular with heavy muscular wall; usually four.

17. Scolex (pl: Scolices) Sucker like Organs of Scolex: –Bothria – with slit - like groove with weak suction powers and usually two in number

18. Neck Undifferentiated stem cells that give rise to proglottids in strobila.

19. Proglottids 1. Unique structure of Cestodes Contains both male and female organs. 2. Essentially a whole reproductive package in one segment of the strobila.

21. Tapeworm Proglottid with Eggs

22. Taenia spp. egg Wet mount. Note : Brown, striated embryophore. Can not differentiate T. saginata from T. solium

23. Cysticercus's cellulose in pig’s muscle Tape worm segments (proglottids) in the faecal mass

24. Cysticercus ( Larva ) Cysticercus bovis – beef tape worm Cysticercus cellulosae – pork tape worm Shape is ovoid, cystic, size = a bean Invaginated scolex and neck

25. T.solium: cysticercus cellulosae with invaginated scolex

26. Clinical Features Of Taeniasis Incubation period: Taeniasis - eggs appear in 8-14 weeks Cysticercosis - days to years Symptoms: Mild abdominal symptoms Occasionally appendicitis or cholangitis from Migrating proglottids Passage of proglottids (active or passive)

27. Clinical features of Cysticercosis 1. Migrating larvae may localize in eye, CNS, or cardiac tissue 2. Neurocysticercosis - severe, may be fatal a) Headache b) Nausea c) Vomiting d) Epileptiform seizures 3. Hydrocephalus - either by accumulation of CSF behind cyst or my inflammatory response

28. Diagnosis Taeniasis Taeniasis 1. Microscopy of stool for identification of eggs and proglottids (eggs do not distinguish species) 2. Macroscopy of stool for proglottids and or scolex. Presence of scolex in faeces indicate successful dewarming therapy.Cysticercosis 1. Serology 2. CT for visualization of calcified cysts 3. MRI for cysts in fourth ventricle

31. Taenia saginata (beef tape worm) Double striated egg shell Hexacanth embryo More than 12 lateral uterine branch

32. Taenia saginata Beef tapeworm Most common tapeworm in humans. Large species reaching up to 20 m. No hooks on scolex.

33. Beef tapeworm life cycle

34. Maturation time 8-10 weeks. Life span up to 25 years. Scolex evaginate in small intestine and attach it self to mucosa of intestine.

35. Pathology Mode of infection – eating of undercooked beef containing cysticerci (measly beef) Clinical presentation – Usually asymptomatic but may cause Dizziness Abdominal pain Diarrhea Headache Nausea. Proglottids passed in feces.

39. Taenia solium Distinct difference with T. solium is that humans can be infected with egg stage and onocosphere migrates to some site in body and develops into cycticercus Cysticercosis This can be serious, called Cysticercosis

40. -Scolex with hook -Uterine lateral Branches less than 12

41. Usual Intermediate host liberated embryo,via bloodstream to tissue especially muscle Measly pork Definitive and reservoir hosts Cysticercus is liberated, scolex evaginates, attaches itself to mucosa of small intestine. develops to adult. Maturation time 3months.Life span up to 25 years. Development of cysticercus cellulosea-5x8-10mm

42. Taenia solium Cysticercus cellulose found in the most common tissues in order: 1.Connective tissues 1. Connective tissues 2. Eye 2. Eye 3. Brain 3. Brain 4. Muscles 4. Muscles 5. Heart 5. Heart 6. Liver 6. Liver 7. Lungs 7. Lungs

43. Taenia solium 1. When in brain, may cause severe central nervous system dysfunction. 2. Most common and distinct symptom is sudden onset epilepsy. 3. Brain imaging can now spot cysticercus in brain.

46. Mode of infection Larva - Ingestion of undercooked pork containing Cysticercus cellulosae. Egg 1. Direct transmission by I. ingestion of food with parasite egg contaminated patients own hands due to unclean and unhygienic habit. II. autoinfection - reverse peristalsis of eggs and proglottids. 2. Indirect transmission by contaminated food or water (eggs)

47. Clinical presentation Adult: may be abdominal pain with some abdominal disturbance and occasionally appendicitis or cholangitis from migrating proglottids Larvae of T. solium (cysticercosis): migrating larvae may localize in eye, CNS, or cardiac tissue Neurocysticercosis - severe, may be fatal headache nausea vomiting Epileptiform seizures hydrocephalus - either by accumulation of CSF behind cyst or my inflammatory response

48. Internal — antiprestalsis movement of intestine gets its contents back to the stomach External ova in stool of infected patient contaminate his own food or hands (due to unclean and unhygienic personal habit). Cysticercosis can occur by autoinfection:

49. T. Solium – severe form of disease Its larval cyst form produce cystercercosis which may be in the vital organs like lung, liver, eye and brain resulting in irreparable damage causing serious outcome of blindness and neurological disorders.

54. The scolex T. saginataT. solium

55. Gravid proglottid T. saginata T. solium

56. The beef tapeworm (Living specimen)

57. Morphology Point T. saginataT. solium Size in length4- 8 m2- 4 m ScolexPyriform & 4 suckers Globular & 4 suckers with rostellum & hooklets Mature proglottid Ovary 2 lobes3 lobes Testes300-400150-200 Gravid proglottid: Uterine branches 15-307-12 No. of segments 1000-2000, thicker, untransparent and length is mor ethan breadth 700-1000, thinner, transparent and breadth is more than length

58. Point T. saginataT. solium Definitive host Human Interm. hostCattleSwineHuman HabitationSmall intestine Tissue (brain, eye, skin etc.) Infective stage Cysticercus bovis Cysticercus Cellulosae Egg DiseaseTaeniasis Cysticercosis Other Usually on surface of fecal material. May be single detached proglottids Usually on surface of fecal material. May be in short chains of 2-3 proglottids. Differences

59. What you need to know about a parasite Scientific name (and common name) Geographic distribution ( in general terms) Life-cycle Pathogenesis Diseases caused Diagnosis Treatment ( drug of choice) & prevention

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