[DR.

ASUNCION]
Case
A 38 year old male presented with diffuse
abdominal pain and vomiting of billous material
for days. He recalled having weight loss for the
last 4 months with on and off abdominal
discomfort and fever.
On examination, there was muscle guarding with
tenderness on all quadrants, both direct and
rebound. The abdomen was slightly distended.
**Billous- bile-stained
** This is a case of acute surgical
abdomen
** muscle guarding = intensed pain
An abdominal X-ray was requested , normally a
solid organ is white in color but in this case
there are patches of black color indicating that
there is air fluid levels indicating an obstruction
in a nearby structure
**What are the adjacent structures in the
liver? Bowels or SI
**X-ray: air fluid in the RUQ: obstruction
of the duodenum
An emergency laparotomy was scheduled:
Dilation of the bowel loops with a tapeworm
that has intact proglottids perforating a portion
of the jejunum. The tapeworm was yellow in
colored since it is bile-stained.
CBC revealed leukocytosis (18,000/cumm) with
mild eosinophilia (9%)
Stool exam was requested
TAENIA SOLIUM
Disease: Taeniasis, Pork tapeworm
infection
Common name: Pork tapeworm
DH: Humans ONLY
IH: Hogs and wild boars/ swines
Tissue habitat: Upper jejunum
EPIDEMIOLOGY
Life span: up to 25 years (exceeds the
usual 20 years)
Variable incidence throughout the world
Common in Central and South America,
Africa, India and China
Factor affecting incidence:
Food preparation habits and
religious customs concerning meat
(Middle East countries dont
consume pork meat)
Lack of sanitation (over-crowding)

Nov. 26, 2014 (AM, PM)

Faulty methods of fecal disposal
(India: below the comfort rooms are
the pig pens)
ADULT:
Mature in upper jejunum within 8-10wks
One of the longest tapeworms that infects
man:
o 2-4m in length
o Even 1 worm can cause obstruction
o Proglottids/ Segments: 800-1000
Scolex: globular scolex with 4 muscular
suckers
o (+) Armed Rostellum double
crowned set of hooks
(25.30 hooks all in all)
Proglottids
o square-like in shape having same
horizontal and vertical dimensions
Geni
tal
pore:

Alternating (presence of
skipping of pores in the
segments)
o Ovaries: posterior
o Lateral uterine branches: 7-12
(<15: T. solium; >15: T. saginata)
Gravid proglottids: could contain 30,00050,000 eggs

[DR. ASUNCION]

Nov. 26, 2014 (AM, PM)

EGG

Mature egg is
indistinguishable from
other Taenia spp eggs
Striated thick shell
Embryonated when laid
o containing the hexacanth embryo
(6 hooklets)
Life cycle:

Infective stage: cysticercus embedded in

pork
Diagnostic stage: eggs or proglottids
Taenia
Taenia solium
saginata
DH
Human
Human
Human
IH
Cattle
Swine
Human
Habitat
Small
Small
Tissues
intestine
intestine
(Brain, Eye,
Skin)
Infectiv Cysticerc Cysticercu
Egg
e stage
us bovis
s
cellulosae
Diagnos
Eggs/
Eggs/
Cyticercus
tic
gravid
Gravid
larva
stage
proglotti proglottids
ds
Disease Taeniasis
Taeniasis
Cysticercosis
Lateral
>15
<15 (7-12)
uterine
branch
es

SYMPTOMATOLOGY
Small intestine slight local inflammation of
the intestinal mucosa
o By scolex attachment
Rare: Secondary peritonitis and gall
bladder infection
o Being in the upper jejunum it is
close to the Ampulla of Vater
(cause cholangitis)
Serious lesions: associated with larval
cysticercus
No significant peripheral eosinophilia
(EXCEPT in Cysticercosis)
Diagnosis: proglottids and eggs in feces or
perianal region
No significant eosinophilia as it is inside
the intestine only
Treatment: Same treatment with D. latum
infection (basis: to decrease
autoinfections)
Prevention:
Treatment of infected person
Sanitation, inspection of pork and
thorough cooking of pork and processing
of pork

CASE
A 42 year old Brazilian woman presented to an
eye doctor with a visual impairment and
papilledema. Upon neurological examination, she
was diagnosed with communicating
hydrocephalus.
A ventriculo-peritoneal shunt was implanted and
the hydrocephalus improved. Neuroendoscopic

[DR. ASUNCION]
surgery showed multiple cysts in the
subarachnoidal space. Serology for cycticercus
larva was strongly positive, but copromultiplex
PCR was negative.
** Tapeworm brain involvement: Taenia
solium or E. granulosus
CYSTICERCOSIS
An infection in humans harboring the
larval stage of T. solium, Cysticercus
cellulosae larvae
Human: both DH and IH
o Patients have been reported with
history of T. solium already
Sources:
o Ingestion of food/ water contaminated
with human feces
o Autoinfection by unclean hands of the
adult worm
o Regurgitation of stomach contents of
patients infected with adult Taenia
worms (even vomiting)
Pertinent eosinophilia
T. solium
Racemose larva: infiltrating the meninges
and proliferates without encapsulation
(spreads and produce multiple cysts)
Oval cyst with an embedded scolex with 4
muscular suckers and armed rostellum
EPIDEMIOLOGY
Poor sanitation permits environmental
dissemination of T. solium eggs and their
ingestio9n
Prevalent in China, India, many countries
of Africa, Central and South America,
Mexico
CNS (more common) and striated muscles
commonly involved

Nov. 26, 2014 (AM, PM)

LIFE CYCLE:

PATHOLOGY and SYMPTOMATOLOGY

Sites: brain, striated muscles,
subcutaneous tissue, eyes, heart, lung and
peritoneum
o Brain and eye involvement causes
serious tissue damage
Growing cystic lesion: produce
inflammation reaction and pronounced
tissue response > mass-like effect
o Increase In a span of 5 years
patient undergoes degenerative
processes and may die
Cerebral cysticercosis: Cerebral cortex,
meninges and ventricles
- Convulsion, motor and sensory and
mental changes, headache, vomiting,
visual disturbances
- Increase in intracranial pressure and
headache
- multiple lesions are common (rarely as
solitary lesion) because of the ability of
worm to invade and multiply in the
same brain tissue (manifest seizures or
convulsions)
- (intact capsulation means larva are
calcified and DEAD)
Pseudohypertrophic myopathy: muscular
cysticercosis
- It is not the muscle that is enlarging, it
is the mass
SKIN INVOLVEMENT:
Skin nodules, Subcutaneous involvement
Fluctuant- type of mass

[DR. ASUNCION]

Nov. 26, 2014 (AM, PM)

BRAIN (Neurocysticercosis or Cerebral

Cysticercosis)
Most common cause of seizure or epileptic
episodes in Latin America
Multiple cystic spaces or ring-like lesions
Causes opening of cystic lesions
Multiple lesions due to the ability of
Cysticercus to invade and multiply
Manifestation seizure and convulsion in
the infected individual
CT-SCAN: intact encapsulation indicates a
dead or calcified larva

EYE

Single lesion subretinal or vitreous humor

area
Grayish blurred patch in the eye
o Unencapsulated cysticercus within
the vitreous
o It could wander due to continuous
flow of humor
o Causes blurring of vision and pain
Flashes of light/ variability of shapes

DIAGNOSIS
Important data: Residency in endemic,
Clinical findings
a) Tissue biopsy
b) CSF analysis by increase ICP (DDx:
Meningitis)
c) Imaging techniques
d) Serology: IHA, ELISA, Western blot (best test,
Ab against Ag is 100% specificity)
TREATMENT
(main) Surgery: Extirpation of lesions on
shunting to relieve hydrocephalus (remove
infiltrating nodules)
Chemotherapy: Praziquantel 50mg/kg/d
TID for 5d
>Alternative: Albendazole 15mg/kg/d
for 30d

Anticonvulsants (for patients with

seizures)

Prevention: Personal hygiene and

environmental sanitation
CASE
A 17yo male was seen in infectious
diseases clinic at the request of his
primary
physician
because
of
a
subcutaneous nodule on his lft anterior
chest.
Born near Acapluco, Mexico, the patient
had moved to Washington, USA, with his
family when he was 12yo
He was in good health and was a HS
student. He liked to swim in a large
mountain river. His family had dogs when
they lived in Mexico but not during their
five years residence in Washington State.
He liked seafood and occasionally, his
family would butcher a cow or pig for their
own consumption. He had not travelled
out of North America,
His primary physician had excised a small
2-3cm subcutaneous lump and found out
that the nodule contained larvae. It was
confirmed by CDC that the larvae were a
cysticercus larvae
TAENIA saginata
Ds: taeniasis, beef tapeworm infection
Common Name: Beef tapeworm
DH: Humans only
IH: Cattles, camels
Habitat: Upper jejunum (SI)
Epidemiology
o Cosmopolitan distribution (in beefeating countries)
o Transmission:
Humans: eating of raw, improperly
cooked beef with cysticercus
Cattle: contamination with human
wastes, thru use of night soil and
sewage laden water
Cross contamination of preparation
of food
Morphology
o Adult worm:
4-6m in length
1k-2k proglottids

[DR. ASUNCION]
Scolex:
Lack rostellum (the rostellum is
underdeveloped)
Globular
Four muscular suckers
Proglottids
Lateral uterine branches (>15)
Pine tree appearance of lateral
uterine branches
T. solium: <15 (T. saginata > T.
solium)
Life cycle
o Eggs/ proglottid in feces cattle
infected
by
ngesting
infected
vegetation eggs release/ hatch
oncosphere attachment to intestinal
mucosa and borring thru muscle
becomes cysticercus bovis (stays
years in muscles) human ingests
infected beef meat develops into
adult worm in the upper jejunum
scolex attaches to the intestinal
mucosa and matures
Symptomatology
o Adult worm rarely causes symptoms, if
ever,
the
following
signs
and
symptoms are manifested
Epigastric pain, vague abdominal
discomfort, diarrhea, N/V, and loss
of apetite (gastric disturbances),
moderate eosinophilia
It is the adult worm that migrates
o Intestinal obstruction, mimic acute
appendicitis
o Rarely: larval invasion/ migration
Diagnosis
o Recovery of gravid proglottids/ eggs in
feces or perianal region through
Scotch Tape Swam
Tendency of the adult worm to
migrate pruritus ani
Treatment
o Same treatment with D. latum
infection
Prevention
o Prophylactic measures
o Removal of sources of infection
o Thorough cooking of beef
o Inspection, refrigeration of beef

Nov. 26, 2014 (AM, PM)

TAENIA MULTICEPS/COENUROSIS
Aka: Infection by coenurus ,
Larval stage of dog tapeworm

**It includes:
T. seralis,
T. brauni,
T. glomerata
- rare cause of human infection: > accidental
infection of eggs from dog feces in contaminated
fruits and vegetables
DH: canines
IH: sheeps, goats, rabbits, humans
COENUROSIS: - very rare in the Western
Hemisphere with the majority of cases (65%)
occurring in Europe and Africa.
EPIDEMIOLOGY
T. multiceps:
France
Africa

[DR. ASUNCION]
England
Brazil
United States
T. seralis
Canada
United States

Nov. 26, 2014 (AM, PM)

Embryonated egg>human>intestinal
wall>lymphatics>cutaneous and subcutaneous
IS for humans: embryonated eggs
DS: eggs and coenurus
Specimen of choice: Tissue biopsy
SYMPTOMS:

LIFE CYCLE

-Several years to develop and depend on

the organ infected
- Brain: increased ICP, seizures
- Eye: Papilledema
Kua, Warren, Albon, Tamayo