The incubation period of tapeworms can range from 20 days to 3 years. The clinical features of tapeworm disease depend on which organ or tissue in the human body is affected. Subcutaneous tissues are most commonly affected by this parasite, but viscera and eyeballs are dangerous if involved and sometimes tapeworms can cause disease in the brain (although rare).
Continued Part 1
Biological cycle & development of tapeworm disease
Adult worms lay eggs that fall into the water, and the eggs are eaten by plankton and crustaceans (first intermediate hosts). These plankton and crustaceans are then eaten by frogs, toads, snakes or birds (second intermediate hosts). When parasitizing in the intermediate host, the larvae are in the form of worms (plerocercoids) about a few centimeters long, ivory‐white, unsegmented, without a head (scolex) in the front, only a pseudo‐sucker.
Humans can become secondary hosts in cases such as drinking water contaminated with pathogens, having plankton and crustaceans infected with tapeworms; eating raw, undercooked frogs, toads, snakes, birds. From here, tapeworm larvae penetrate the digestive tract, burrow into the stomach and intestines and form tumors there. In addition, some backward living habits in rural areas of Vietnam, such as people have the notion that if red eye is treated with raw frog meat, which is cool and cold, and applied to the eyes to cool down, the disease will be cured. This unscientific practice creates favorable conditions for tapeworm larvae to penetrate the skin and eyes, causing eye tumors, which can cause blindness. In some other less common cases, humans can also be infected with tapeworm larvae by washing their faces with water containing plankton and crustaceans infected with tapeworm larvae.
When the second host is invaded and parasitized by the larvae, the disease will occur. The symptoms of the disease depend on where the worm larvae parasitize. If the parasite is in the eye, it will cause pain, watery eyes, inflammation of the cornea, eyelids, and eyelids. If the parasite is in the skin, it will cause itching, rash, and infiltration around the parasite site. Sometimes the patient feels like the larvae are moving.
The life cycle is similar to that of D. latum, but the animals that serve as intermediate hosts and paratenics include humans, mammals, birds, crustaceans, and amphibians. The definitive host is infected by ingestion of asexually encapsulated plerocercariae that are present in the intermediate/paratenic host, which adhere to the intestinal wall and mature. In rare cases, these encapsulated larvae penetrate various tissues, where they remain parasitic without further development. It is also argued that in rarer cases, development to the adult stage in humans has occurred in some reported cases (Miyazaki et al., 1991).
Adult Spirometra tapeworms live in the small intestine of their definitive hosts, dogs, cats, raccoons, and other mammals, for up to nine years, where they lay numerous eggs. When these hosts defecate, the unfertilized/embryoed eggs pass out of the body in the feces and hatch when they fall into fresh water. The eggs are swallowed by crustaceans (molluscs of the genus Cyclops) which are the first intermediate hosts. In copepods, the eggs develop into hook‐tailed larvae (procercoid larvae) that live in body cavities.
The second intermediate hosts include fish, reptiles and amphibians that feed on crustaceans. The larvae penetrate the intestinal wall of the second intermediate hosts, where they become plerocercoid larvae and proliferate in the subcutaneous tissue and muscle. The second intermediate hosts are eaten by carnivorous definitive hosts such as dogs and the cycle begins again. Humans are accidental hosts in the developmental cycle, becoming infected with asexual plerocercoid larvae through exposure to or ingestion of infected primary and secondary intermediate hosts. The larvae migrate to the subcutaneous tissues of humans. However, no development occurs and there is no ability to transmit the disease. In S. proliferum, multiple larvae can in some cases proliferate throughout the subcutaneous tissue of the body.
The biological cycle and pathogenesis of tapeworms in humans can be summarized as follows: Adult tapeworms of the genus Spirometra live in the intestines of dogs and cat ⑦. Eggs hatch in the feces① and embryonate in the environment under suitable conditions②. Eggs are laid in water and then lyse to form coracidia larvae ③, which are eaten by copepods. The coracidia larvae then develop into procercoid larvae and lodge in the intermediate host, a copepod ④. The second intermediate host includes some fish, crustaceans and amphibians that have ingested infected copepods and contracted these procercoid larvae. The procercoid larvae then develop into adult procercoid larvae inside this second intermediate host for a period of time ⑤. The cycle is completed when a dog or cat eats an infected second intermediate host ⑥. Humans cannot serve as a definitive host for Spirometra spp., but serve as a paratenic or second intermediate host ⑧and develop cysticercosis. Humans acquire cysticercosis by drinking water contaminated with infected copepods or by ingesting undercooked eels.
Tapeworms can live up to 20 years in a human host. The parasite is transmitted to humans in three different ways:
First, humans can become infected by drinking water contaminated with copepods. Second, humans can become infected by eating the raw flesh of one of the intermediate hosts, such as frogs or snakes. For example, people eat live snakes or tadpoles for medicinal purposes in some Asian cultures; if the snakes or tadpoles are infected, the larvae can infect humans.
Third, humans can be infected with tapeworms by poultices prepared from second intermediate hosts applied to open wounds, or acquired for medical or religious reasons. If these poultices are contaminated with plerocercoid larvae, humans can be infected.
According to Zunt et al., human infection most often occurs after ingestion of infected raw snake, frog, or pig meat, although contact with infected meat from intermediate hosts can also cause parasitic infection.
Clinical symptoms
The incubation period of tapeworm can range from 20 days to 3 years.
The clinical features of tapeworm disease depend on which organ or tissue in the human body is affected. Subcutaneous tissue is most commonly affected by this parasite, but viscera and eyeballs are at risk, and occasionally the tapeworm can cause disease in the brain (although this is rare). The early ATDC stage in the development process is usually asymptomatic, but when it reaches its final location and begins to grow, it begins to cause symptoms, creating inflammation and pain in the surrounding tissues.
The clinical features of echinococcosis usually occur after the larvae have migrated to subcutaneous sites. The larval site is usually a tissue or muscle of the chest, abdominal wall, limbs, or scrotum. Although other sites such as the eye, brain, urinary tract, pleura, pericardium, or spinal cord may also be involved. The early stages of the disease in humans are usually asymptomatic, but when typical, the worms can cause inflammation and pain in the tissues surrounding the subcutaneous site where they are developing. Occasionally, S. proliferum can cause proliferative lesions in infected tissues, characterized by the presence of multiple plerocercoids in the same site.
Clinical forms
‐ Ocular sparganosis
This is the most typical form of echinococcosis, the ocular disease has a distinctive appearance and clinical characteristics of echinococcosis. Early symptoms include eye pain, epiphora and optosis. Other symptoms include periorbital edema and swelling resembling the “Romana” sign of exposed corneal ulcer. The most common symptom is a mass lesion in the eye, which, if left untreated, can lead to blindness.
When the larvae enter the eye, it creates a painful reaction, especially edema around the eyeball, which can lead to blindness if not intervened promptly because the parasite moves into the conjunctiva and into the eye socket. In the tissues of the eye socket, the larvae remain at the posterior pole, causing an inflammatory reaction, leading to bulging eyes and impaired vision, some cases with corneal ulcers. In general, this form often causes eye pain, soreness, irritation, corneal ulcers, watery eyes, and significant swelling of the eyelids.
The eye manifestations are usually after 1 week with the manifestation of swollen eyes, redness, reduced vision and sometimes watery eyes, which can easily be confused with other eye diseases, especially corneal disorders, causing doctors to easily diagnose late and not treat promptly if they do not think about it, even patients arbitrarily use medicine to treat themselves with some eye drops. Only when going to a specialist for examination and testing can we discover that the disease is caused by the larvae of the tapeworm S. erinacei. The disease can cause damage and infection to spread to the eyeball and eye socket, and if there is a secondary infection, the disease becomes more severe.
‐ Cerebral sparganosis
This form of the disease is characterized by partial seizures, confusion, weakness, headache, memory loss, coma, fever, paresthesia, motor weakness, and other central nervous system symptoms. This form usually involves one cerebral hemisphere, especially the frontoparietal lobes, in some cases extending to the cerebellum. The disease can cause cerebral hemorrhage.
Multiple discrete subcutaneous nodules may appear and disappear over time. The nodules are often itchy, swollen, red, and mobile, often accompanied by painful edema. Seizures, convulsions, hemiparesis, and headache are also common symptoms of the disease, especially cerebral tapeworms and increased BCAT are also common paraclinical signs in such cases.
The eye manifestations are usually after 1 week with the manifestation of swollen eyes, redness, reduced vision and sometimes watery eyes, which can easily be confused with other eye diseases, especially corneal disorders, causing doctors to easily diagnose late and not treat promptly if they do not think about it, even patients arbitrarily use medicine to treat themselves with some eye drops. Only when going to a specialist for examination and testing can we discover that the disease is caused by the larvae of the tapeworm S. erinacei. The disease can cause damage and infection to spread to the eyeball and eye socket, and if there is a secondary infection, the disease becomes more severe.
‐ Cerebral sparganosis
This form of the disease is characterized by partial seizures, confusion, weakness, headache, memory loss, coma, fever, paresthesia, motor weakness, and other central nervous system symptoms. This form usually involves one cerebral hemisphere, especially the frontoparietal lobes, in some cases extending to the cerebellum. The disease can cause cerebral hemorrhage.
Multiple discrete subcutaneous nodules may appear and disappear over time. The nodules are often itchy, swollen, red, and mobile, often accompanied by painful edema. Seizures, convulsions, hemiparesis, and headache are also common symptoms of the disease, especially cerebral tapeworms and increased eosinophilia are also common paraclinical signs in such cases.
In one case of brain infection with S. erinaceieuropaei, a man presented with headaches, seizures, memory loss, and a strange sense of smell. MRI showed a cluster of rings, initially in the right medial temporal lobe but then moving over time to other areas of the
The cause was not determined for four years until the disease was discovered, and a tissue biopsy finally revealed a 1 cm long worm found and removed. The patient continued to suffer from the same symptoms.
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Athor: Ph.D. Dr. Huynh Hong Quang
(Institute of Malariology Parasitology and Entomology Quy Nhon)
