intestinal cestode concise pharmacy
TRANSCRIPT
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Life cycle in human trematodes
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Intestinal Cestodes
Dr Mohiedden M Abdul-Fattah
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2-Egg in soil
3-Larva in
tissue of IH
Pseudophyllidea:
Diphyllobothrium latum
2-Egg in soil
1-Adult in
intestine of
Man
3- Larvae in tissue
of intestinal villi of Man
Cyclophyllidea:
H. Nana
Direct LC
1-Adult in
intestine
of man
2-Egg
in
water
3- 1st
Larva incyclops
4- 2nd larva
in fish
Intestinal cestodes
1-Adult in
intestine of
Man
Cyclophyllidea:
1.Taenia saginata2.T. solium
3.Hymenolepis
nana.
4.H. diminuta
5.Dipylidium
caninum
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Man is usually infected by intestinal cestodes
when ingests the larvae except H.nana,
infection occurs by eggs.
All Cyclophyllidea must need one intermediate
host in their life cycle except H. nana
The IH in Taenia is vertebrate host (cattle or pigs). In Hymenolepis and Dipylidium it is invertebrate
insect (fleas, beetles or cockroach)
Pseudophyllidea (D. latum) needs twointermediate hosts in their life cycles:
(Cyclops as 1st IH and Salmon fish as 2nd IH.
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OUTLINE OF LLIFE CYCLE IN INTESTINAL CESTODES
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Taenia
saginata
1. Biology:
Final host: human.
Habitat: small intestine. Exit stage: mature egg or
gravid segments.
Diagnostic morphology of adult:
1. segmented 4-7 meter long
2. with globular scolex without
rostellum or hooks.
3. 4 circular suckers.
4. Each mature segment has
central tube shaped uterus.
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Taenia Life Cycle
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4. Lab Diagnosis:
Detection of either of the following in
stool: the non hooked scolex of the adult after
treatment,
The gravid segment (15 ± 20 branches on
each side) .
The egg: 30-40 µm, spherical, with outer
thick and inner thin shell and embryo.
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2. Epidemiology
Distribution: cosmopolitan.
Intermediate host: cattle. Infective stage: Cysticercus bovis larva in meat.
Mode of infection: ingestion of under cooked
meat containing the infective stage. Reservoir host: None.
3. Host parasite relationship:
Light infections remain asymptomatic, but Heavier infections may produce abdominal
discomfort, epigastric pain, vomiting and diarrhea.
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5. Treatment:
Praziquantel is the drug of choice,(10-
20mg/kg PO for single dose), or Niclosamide (1-2 g children and 4 g for
adults; for single dose).
Expulsion of scolex must be assured toassume a satisfactory treatment.
6. Control:
Thorough inspections of beef and pork, Adequate cooking or freezing of meat.
cysticerci do not survive temperatures below -10o
C and above 50o C.
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Taenia
solium
Biology:
Man is the only final host but canact as blind end intermediate host
also. Habitat: small intestine
Exit stage from the final host:scolex, gravid segments and/or mature egg.
Diagnostic morphology
1. segmented 3-5 meter long
2. with quadrate scolex with 4 circular suckers.
3. It has rostellum with double rows of hooks.
4. Each mature segment has central
tube shaped uterus
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Taenia solium Life Cycle
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2. Epidemiology
Distribution: where pork is eaten.
Transmission
Intermediate hosts: pigs (mainly) and man (if swallowed
the eggs).
No reservoir hosts.
Infective stages:
Intestinal adult: - C. cellulosae larva
larval infection (cysticercosis): T. solium eggs.
Mode of infection:
1. Adult taeniasis solium: ingestion of infected pork.
2. Larva taeniasis solium (cysticercosis): If man ingests T. solium egg, cysticercus cellulosae
develops in human tissues.
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3. Host parasite relationship:
Disease due to adult: mild enteritis with indigestion.
Disease due to larva: cysticercosis .
4. Lab diagnosis:
Adult: - Detection of the following in stool samples:
Gravid segment with 12 lateral branches.
scolex with rostellum having double rows of hooks
Eggs similar to that of T. saginata.
Cysticercosis: Imaging (sonar, CT) and serology
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5. Treatment:
Intestinal:
A. Praziquantel is the drug of choice,(10-20mg/kg PO
for single dose), or
B. Niclosamide (1-2g for children and 4 g for adults;
(single dose).
Neurocysticercosis:A. albendazole (15mg/kg/day PO for 30 days)
B. Corticosteroids are used to control the inflammation
due to death of the larva.
Symptomatic cysticercosis outside CNS:
Surgery is the management of choice.
6. Control: like Taenia saginata.
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Hymenolepis nana
1. Biology: Final hosts: Humans and rodents.
Habitat: small intestines.
Exit stage (diagnostic): mature egg. Life cycle and Diagnostic morphology:
segmented, 0.5 ± 1 cm long with retractile
armed scolex.
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H.nana Life Cycle
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2. Epidemiology:
Distribution: cosmopolitan. Children more than
adults.
Intermediate hosts: Fleas act as intermediate host
when its larva ingests the egg and cysticercoids
develops within its body cavity.
Reservoir hosts: rodents. Infective stage: egg.
Mode of infection: 1-Ingestion of foods and drinks
contaminated with egg. 2- Autoinfection.
3. Host parasite relationship:
Disease: mild enteritis and allergy to the worm
excretion. Heavy infection may cause diarrhea
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4. Diagnosis:
By detection of eggs in stool sample.
Characteristics of egg: - 30-40 µm, round, colorless,
with hexacanth embryo and polar filaments.
5. Treatment:
6. Praziquantel is the drug of choice,(25mg/kg PO for
single dose), or 7. Niclosamide (1g - 2g for children and 4 g for adults;
for 7 days). There is relative resistance of
cysticercoids to drug therapy.
6. Control: Health education and personal hygiene.
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Hymenolepis diminuta1. Biology:
Final Hosts: mainly
rats; occasionally man.
Habitat: small intestine
Exit stage (diagnostic):
the egg;
Diagnosticmorphology:
segmented, 90 cm long
with unarmed scolex.
Life cycle
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2. Epidemiology: Distribution:
Common parasite of rats allover the world. Human is occasionally infected.
Resevoir hosts: rats
Intermediate hosts: grain beetles and cockroaches.
Infective stage: The cystic larva (cysticercoid).
Mode of infection: Ingestion of cereals, dried fruits
contaminated with insects containing the cysticercoid.
3. Host- parasite relationship: Disease: affects mainly children and may
suffer abdominal pain, diarrhea, insomnia
and convulsions.
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4.Lab. Diagnosis:
Detection of the characteristic eggs in stool
samples. Egg characteristics: 60- 80 µm, round, yellow
brown, with hexacanth embryo and polar knobs.
5.T
reatment:Niclosamide (2g first day+ 1g daily for 6 days).
6.Control: health education and personal hygiene.
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Dipylidium caninum1. Biology:
Final Hosts: mainly dogs and cats;occasionally man.
Habitat: small intestine.
Exit stage: eggs in feces within egg capsules
Life cycle and Diagnostic morphology: scolexwith retractile rostellum armed with 4-6 rows of
hooks, with cucumber like segments and length
of 30 cm.
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Life Cycle of D. caninum
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2. Epidemiology:
Distribution: Common parasite of dogs, cats.
Accidental in humans specially children.. Intermediate hosts: fleas (pulex) and dog louse.
Their larvae ingest the eggs passed in the faeces.
The eggs release onchospheres that develop into
cysticercoids in the haemocele of the adults.
Reservoir host: dog
Infective stage: The cystic larva (cysticercoid).
Mode of infection:1. Ingestion of cereals, contaminated with insects
containing the cysticercoid.
2. Accidental swallowing of the infected fleas.
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3.Host - parasite relationship:
The worms affect mainly children that may
suffer abdominal pain.4.Lab. Diagnosis: - Detection of egg capsules; each
containing 8 ± 25 eggs. Or the segments in stool
samples.
5.T
reatment:N
iclosamide (2g first day+ 1g daily for 6days.
6. Control: health education and personal hygiene.
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Diphyllobothrium latum
A. Biology:
Final host: Fish eating animal includinghuman.
Habitat: Attach to mucosa of ileum or
sometimes jejunum.
Exit stage: Immature egg or chains of mature segments.
Diagnostic morphology of adult:
segmented 3-10 meter long with scolex that
has no hooks, but with 2 elongated sucking
grooves.
Each mature segment has central rosette
shaped uterus.
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Life cycle of D. Latum
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B. Epidemiology:
Intermediate hosts: cyclops (1st I.H.) and
fresh water fish; salmon (2nd I.H ). Reservoir host: fish eating animals
Infective Stage: pleurocercoid larva in
muscle fish. Mode of infection: ingestion of
undercooked fish containing plerocercoid
C. Host parasite relationship:
1. Macrocytic anemia and neurological
problems of vitamin B12 deficiency are
seen in heavily infected individuals.
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D. Lab diagnosis:
Detection of eggs in faeces (many).Yellowishbrown ovoid 70x40 µm with anterior operculum and posterior knob
long chains of segments with rosette shapeduterus.
E. Treatment:
1. Praziquantel is the drug of choice, (10-
20mg/kg PO for single dose), or 2. Niclosamide (1g -2g for children and 4 g for
adults; single dose).
F. Control:
1. Freezing for 24 hours.2. Thorough cooking or pickling of fish kills the
larvae.
3. Fish reservoirs should be kept free of rawsewage.
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Man is usually infected by intestinal
cestodes when ingests the larvae exceptH.nana, infection occurs by eggs.
Psuedophyllidea (D. latum) needs twointermediate hosts in their life cycles (Cyclops
as 1st IH and Salmon fish as 2nd IH.All Cyclophyllidea must need one intermediatehost in their life cycle except H. nana.
1.The IH in Taenia is vertebrate host (cattle or pigs).
2.In Hymenolepis and Dipyllidium it is invertebrateinsects (fleas, beetle, cockroach)
Summary
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OUTLINE OF LLIFE CYCLE IN INTESTINAL CESTODES