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Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt > Cestodes (tapeworms) > Flashcards

Cestodes (tapeworms) Flashcards

1
Q

Tapeworm infection is from?

A

Consumption of undercooked meat containing cysts

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2
Q

Beef tapeworm name? Life cycle?
How big does it get?

A

Taenia saginata
-Humans consume cysts enclosed in muscles of herbivores
-Worm then attaches to small intestine with suckers
-Slowly grows more segments from its head
-May grow up to 10m and live 25 years producing 50k eggs a day
-Eggs out in stool which infect cattle

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3
Q

Which worm causes cysticercosis? life cycle? difference to taeniasis

A

Taenia Solium

Cysticercosis
Consumption of food contaminated with T solium eggs
->Hatch into larvae and migrate to muscle /brain
-> form cysts

Taeniasis
Eat Pig meat containing cysts (with larvae)
-> adult T solium hatch in gut -> Taeniasis

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4
Q

Usual Sx of taeniasis?

A

Minimal with abdo discomfort and vauge sx.
May pass large segment of worm or vomit it out

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5
Q

Dx taenia ? 2 ways to differentiate saginata and solium?

A

Microscopy of stool for eggs / scolex

-PCR
-Saginata has >12 branches on uterus on microscopy

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6
Q

Size of tissue cysts in cysticercosis? where are they found?

A

1-2cm

Muscle (palpable) - eventually form calcified streaks

brain - seizures

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7
Q

Most common cause of non-epileptic seizures worldwide

A

Neurocysticercosis

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8
Q

Neurocysticercosis rx? What else is needed?

A

praziquantel and Albendazole
Dexamethasone
Needs antiepileptics if seizures

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9
Q

Fish tapeworm called?

A

Dibothriocephalus latum/Adenocephalus pacificus (formerly
diphyllobothrium latum)

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10
Q

Usual drug for all intestinal cestode (tapeworm)?
Main alternative?

A

Praziquantel single dose (around 10mg/kg)
[Niclosamide is alternative]

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11
Q

What causes hydatid disease

A

Echinococcus granulosus

Tapeworm from dogs / sheep / cattle
-Usually in areas of sheep / cattle farming

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12
Q

Echinococcus granulosus life cycle

A

dogs (definative host) harber 3-6mm adult tapeworm which lays eggs -> faeces
-> Ingested by sheep / humans and develop into cyts with fibrous capule (hydatid cyst) which may grow over several years
-> Dogs eat meat with cysts in

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13
Q

Where do hydatid cysts usually develop? sx?

A

70% in liver (usually right lobe)
-Usually painless (unless secondary bacterial infection which is common)

20% in lungs -> general respiratory sx and may cough up cyst
[may be single or multiple]

Bone enters bone marrow - may cause pathological fractures

Brain, spleen, heart, kidneys …

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14
Q

What is ‘water lily’ appearance on CXR

A

Collapse hydatid cyst

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15
Q

Hydatid cysts ix?

A

CXR
CT - eg water-lilly sign
US - Snowflake sign
-Either see Single cyst or with daughter cysts

ELISA for IgG (sensitive but not specific)
Western blot

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16
Q

Hydatid cysts rx options?

A

Albendazole

Percutenous aspiration under US
-PAIR - Puncture, aspirate, Inject (hypertonic saline / alcohol) Re-aspirate
ONLY for liver cysts

Surgery
[Albendazole +/- praziquantel before and after procedure]

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17
Q

Prevention / control hydatid

A

Mostly around dog control measures (prevent eating infected cysts or treat with praziquantel

Vaccination of sheep / dogs

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18
Q

What is the difference in host and cysts between Echinococcus multilocularis vs E granulomatosus? Rx?

A

Multilocularis - mostly foxes
Doesnt tend to have fibrous capsules -> invades similar to a malignant liver Ca

Sugery with pre and post albendazole

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19
Q

Dwarf tapeworm real name

A

Hymenolepis nana
2-3mm

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20
Q

Hymenolepis nana life cycle?

A

Infected when injest eggs (either from infected insects or human fecaes)
Develop in intestines

Autoinfection

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21
Q

Hymenolepis nana clinical features? Infective vs diagnostic stage?

A

Often Asx
Non-specific symptoms often abdo/ headaches
Children get sleep and behaviour disturbance
[Nana annoys the kids]

-Infective stage: embryonated egg
infected arthropods (beetles, fleas)
-Diagnostic stage: eggs ,

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22
Q

Hymenolepis nana Dx rX?

A

Eggs in stools / ELISA

Praziquantel dose then dose after 10 days

[Niclosamide for 7 days, Nitrazoxanide for 3 days]

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23
Q

18 fever, jaundice, RUQ pain, Respiratory distress,
CT - hepatomegaly with cholangitis and large cystic lesions

A

Hydatid

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24
Q

3 species of hydatid

A

Echinococcus granulosus: Cystic HD
- E. multilocularis: Alveolar HD
- E. vogeli, (E. oligarthra): Polycystic HD

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25
Q

Intermediate vs definitive host Echinococcus

A

Sheep - intermediate
Dogs - definitive

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26
Q

How does hydatid cysts cause issues (3 parts)

A
  1. Mass effect: Compression, obstruction, erosion
  2. Allergy, anaphylaxis
  3. Infection
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27
Q

Rupture of hydatid cyst causes what issues

A

Allergic reaction
Peritoneal seeding - may develop 100s of cysts
Cholangitis - especially if communication with bile duct
Liver abscess

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28
Q

Hydatid looks like some big bubbles with smaller ones inside or near what species is this?

A

Echinococcus granulosus
Main cysts which forms lots of daughter (smaller than main) cysts around

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29
Q

Hydatid stage 1 vs 2 vs 3 vs 4 vs 5

A

1 single cyst

2 - Single with daughter cysts

3a - Transitional with partial detachement of membrane
3b - cyst with solid components and daughter cysts

4 - Solid compnents predominate

5 - Inactive - with complete calcification of boarder

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30
Q

When surgery for hydatid?

A

Cyst >10cm
Presense of daughter cysts
Infected
Likely to rupture
compression of vital structures…..

Mortality 1%

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31
Q

Albenzadole monitoring

A

Monitor WBC and transaminases every 2 weeks
[then monthly after 2 months]

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32
Q

Contra indications albendazole

A

Pregnancy
Chronic liver disease
Bone marrow depression

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33
Q

2 options for perisurgical chemo in hydatid

A

Albendazole or praziquantel

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34
Q

Who is PAIR used for in hydatid

A

Liver: CE1 and CE3a
Abdominal cavity, spleen, kidney

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35
Q

Bar PAIR what is the other percutaneous option for hydatid ? In who? differences to PAIR ?

A

Modified Catheterization Techniques (MoCAT)
- Liver: CE2 and CE3b
- Evacuation of the entire parasitic membranas
- Catheter left in place

Dont need to check bilirubin

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36
Q

When using PAIR for liver cysts what do you need to check?

A

After aspirate make sure no bilirubin -> otherwise when inject alcohol will cause necrosis of bile duct

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37
Q

Hydatid stages and rx?

A

1 - < 5 cm ABZ
> 5 cm PAIR + ABZ

2 Non-PAIR PT + ABZ
Surgery + ABZ

3a < 5 cm ABZ
> 5 cm PAIR + ABZ

3b Non-PAIR PT + ABZ
Surgery + ABZ
[W&W]

4 Watch and Wait
5 Watch and Wai

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38
Q

Echinococcus multilocularis called? Key difference in host?

A

alveolar hydatid
Fox

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39
Q

Where alveolar cyst (E multilocularis) most common

A

LIVER - 99%

[Echinococcus multilocularis]

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40
Q

Rx Echinococcus multilocularis

A

Radical surgery
Long term albendazole for minimum 2 years

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41
Q

CT showed Multiple cysts in liver without daughter cysts in ‘bunch of grapes’ = which hydatid?
Rx

A

Echinococcus vogeli, E. oligarthra
[polycystic hydatid]
Looks more like a bunch of grapes

Radical surgery
Long term albendazole for minimum 2 years

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42
Q

Dog tapeworm called ? Life cycle

A

Dipylidium caninum

Eggs → flea larvae → cysticercoid (adipose tissue and muscles) → adult flea
→ human swallows → adult tapeworm

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43
Q

Where do the fleas live for dog tapeworm

A

Dogs and cats

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44
Q

Dipylidium caninum - key clinical features ?
Rx?

A

General abdo / eosinophilia

Proglottids pass out of the anus, seen moving in
stools, contain egg packets

Praziquantel
[or Niclosamide]

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45
Q

Which intestinal tapeworm classically causes b12 deficiency

A

Diphyllobothrium latum (fish)

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46
Q

Taenia general life cycles for solim/saginata

A
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47
Q
A

Hymenolepis nana scloex

48
Q
A

Hymenolepis nana egg
[nana has the dolies round her egg]

49
Q
A

echinococcus granulosus

50
Q
A

echinococcus granulosus

51
Q
A

Dipylidium caninum proglotid

52
Q
A

Dipylidium caninum egg packet

53
Q

Diphyllobprthroid tapeworm life cycles

A
54
Q
A

Taenia egg
- thick, radially striated shell
-six hooked embryo

55
Q
A

Taenia egg
- thick, radially striated shell
-six hooked embryo

56
Q
A

Taenia egg
- thick, radially striated shell
-six hooked embryo

57
Q
A

T saginata - 4 suckers (may be pigmented), no rostellum, no hooks, thin and long

58
Q
A

T saginata - >12 uterine branches (range 12 30), motile , lateral genital pore

59
Q
A

T saginata - >12 uterine branches (range 12 30), motile , lateral genital pore

60
Q
A

T Solium - 4 suckers , rostellum with double crown of hooks (armed), thin neck

61
Q
A

T Solium - 4 suckers, rostellum with double crown of hooks (armed), thin neck

62
Q
A

T Solium - <12 uterine branches (range 7 13), lateral genital pore.

63
Q

T solium life cycle

A
64
Q

Cysticercosis Infective vs diagnosic?

A

Infective stage: embryonated eggs

Diagnostic stage: cysticercus (imaging,

65
Q
A

Taenia solium
Cysticercus cellulosae (larval stage)

66
Q
A

Taenia solium
Cysticercus cellulosae (larval stage)

67
Q

Development of a spreading, multilobular cyst that may lack a scolex typically in the subarachnoid region called?

A

racemose cysticercosis

68
Q

Echinococcus granulosus Life cycle? Infective stage? Diagnostic stage?

A

Infective stage : embryonated egg
Diagnostic stage: hydatic cyst

69
Q
A

Echinococcus granulosus
4 suckers , rostellum with double crown of hooks (armed), strobila 1 immature proglottid 1 mature proglottid 1 2 gravid proglottid

70
Q
A

Echinococcus granulosus
4 suckers , rostellum with double crown of hooks (armed), strobila 1 immature proglottid 1 mature proglottid 1 2 gravid proglottid

71
Q

3 layers of cyst in echinococcus granulosus

A

Pericyst
(outer adventitia , host-derived fibrous tissue and blood

Ectocyst
(middle layer): elastic, laminated/cuticular layer, acellular hyaline layer.

Endocyst
(inner layer): germinal layer . Forms the ectocyst , brood capsules, hydatic

72
Q
A

echinococcus granulosus

73
Q

What are A-F

A

A - host tissue
B - Laminated layer
C - Germinal layer
D - Brood capsule
E - Protoscolites
F - immature hooklets

74
Q
A

E Granulosus protoscolex (note hooklets)

75
Q

Buzz words for CE2 and CE3a in E. granulosus

A
76
Q
A

Hymenolepis nana

77
Q
A

Hymenolepis nana

78
Q

Who am I and what fun facts?

A

Hymenolepis nana - smallest (2 4cm) and most common cestode infecting humans

79
Q
A

Hymenolepis spp.
rectangular (4x wider than longer: trapezoidal, “overlapped”)
Structures : lateral genital pore (not visible), lobulated uterus filled with eggs , 3 testicular follicles.

80
Q
A

Hymenolepis spp.
lobulated uterus filled with eggs

81
Q
A

Hymenolepis nana
4 suckers , short rostellum with a single row of hooklets (armed), thick neck

Nana puckering for a kiss

82
Q

Hymenolepis diminuta life cycle? Difference to nana?
Infective vs diagnostic stage?

A

NO autoinfection

-Infective stage : ingestion of an intermediate
host carrying the cysticercoid larva
-Diagnostic stage : eggs , proglottids (rare)

83
Q
A

Hymenolepis Diminuta
2 membranes outer shell and inner embryophore Oncosphere with 6 hooklets
Space between membranes
has a smooth appearance
No polar filaments
no polar thickening
Bile stained

84
Q
A

Hymenolepis Diminuta

85
Q
A

Hymenolepis Diminuta
4 suckers , rostellum with no hooks.

86
Q
A

Hymenolepis Diminuta
4 suckers , rostellum with no hooks.

87
Q

What disease might I give you?

A

Intermediate host (H. diminuta

Confused flour beetle - T. confusum 3-6mm long

88
Q
A

H diminuta - hookless invaginated scolex, tail .

89
Q
A

Dibothriocephalus latus / Adenocephalus pacificus

Look for the
-operculum (Lid bit can be inconspicuous)
- abopercular knob (barely discernible),

90
Q

Longest tapeworm?

A

Dibothriocephalus latus / Adenocephalus pacificus 15m long wow nasty

91
Q
A

Dibothriocephalus latus / Adenocephalus pacificus
- spoon shaped , two sucking grooves

92
Q
A

Dibothriocephalus latus / Adenocephalus pacificus
-centrally located coiled + rosette shaped uterus

93
Q
A

Dibothriocephalus latus / Adenocephalus pacificus

94
Q

Prevention and control taeniasis

A

Adequate cooking of meat
Vaccinate livestock from t saginata and t solium

95
Q

How did peru interupt t solium?

A

Chemo of community - niclosamide
Chemo of pigs - oxfendazole

96
Q

Korean
46 yo F with 3 d perianal pruritus and passing noodle like material
During year prior, had intermittent colicky abd pain, loose stool, “irritable bowel
Colonoscopy revealed a long, moving tapeworm, in the terminal ileum and extending to the sigmoid colon
Dx?
Get from?
Rx?

A

Dibothriocephalus ssp.
-consumption raw fish

Praziquantel single dose

97
Q

Diphyllobothriid species locations?
Key issue?

A

Cause b12 deficiency - as have a higher affinity b12 receptor than ours

[Learn the europe and south america name]

98
Q

Ten year old from India with new onset seizures=? rx?

A

NeuroCysticercosis
Praziquantel + albendazole + steroids + antiepileptics

[if only 1 lesion can use just albendazole]

99
Q

Why seizures in cysticercosis only after several years

A

Older cysts lose the ability to suppress inflammation
-> Granuloma and inflammatory reaction around

100
Q

Symptoms: young person with HA, altered mental status, reduced visual acuity,
Obstructive hydrocephalus - first thing you’re thinking as a Dx? rx?

A

Ventricular cysticerci
-> mechanical obstruction of CSF

Optimal Rx is neuro endoscopic removal

101
Q

Subarachnoid cysticercosis key issue?

A

Stroke

102
Q

What clinical picture would you expect from NCC cysts in these locations?
1. Calcified
2. Subarachnoid
3. Ventricular
4. Single enhancing
5. Multiple cystic
6. Spinal

A
  1. Calcified - Chronic epilepsy
  2. Subarachnoid - meningitis and stroke
  3. Ventricular - obstructive hydrocephalus
  4. Single enhancing - benign
  5. Multiple cystic - recurrent seizures
  6. Spinal - paraplegia
103
Q

Relevance of Ocular Cysticercosis

A

Make sure surgical removal before giving antiparasitics
-Otherwise risk of inflammation and blindness

104
Q

Cysticercosis ix?

A

Neuroimaging
Western blot

105
Q

Rx of calcified cysts in neurocysticercosis

A

Antiepileptics only +/- rx of oedema if present
[You need to be sure they’re not viable]

106
Q

Name 3 worms capable of autoinfection

A

Strongy
Hypenolepis nana
capillaria philippinensis
Enterobius vermicularis (kind of)
T solium - rarely

107
Q

Neurocystercircosis
-If it is a SINGLE lesion rx?
-Multiple?

A

Albendazole + Steroids
+antiepileptics if needed

+ praziquantel for multiple

108
Q

Multiple round 8-10 cm diameter spherical lesions in the right lung in a kid =? rx?

A

Echinococcus granulosus
Surgery + post op albendazole

109
Q

A college student returns from a vacation in Mexico noting passing long-thin noodle-like structures that wiggle as they come out. The structures are 1 cm wide 1-2 mm thick and in chains that vary from 2-12 cm
Dx? Rx? 2nd line?

A

Tapeworm
Praziquantel
Niclosamide (or nitazoxanide)

110
Q

Basal Subarachnoid NCC called?

A

racemose

111
Q

Neurocystercecosis rx of:
Viable live cysts:
Calcified cysts:
Extra-parenchymal eg ventricular cysts:
Subarachnoid cysts eg racemose:
Hydrocephalus but no viable cyst:
Ophthalmic:
Spinal:

A

Viable live cysts: Antiparasitic + steroids

Calcified cysts: Steroids

Extra-parenchymal eg ventricular cysts: Neuroendoscopic removal

Subarachnoid cysts eg racemose: Antiparasitic + steroids (+ VP shunt if hydrocephalus)

Hydrocephalus but no viable cyst: VP shunt

Ophthalmic: Surgical
Spinal: Surgical

112
Q

What stage hydatid am I? Rx?

A

CE2 - Surgical + albendazole

113
Q

What stage hydatid am I? Rx?

A

CE1
<5cm Albendazole
>5 PAIR + albendazole

114
Q

What stage hydatid am I? Rx?

A

CE3a - detachment of membranes
<5cm Abz
>5 PAIR + abz

115
Q

What stage hydatid am I? Rx?

A

CE3b solid with daughters
Surgery + Abz

Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt (26 decks)

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