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Trichuriasis

Trichocephaliases

Trichuriasis is an infection caused by Trichuris trichiura or whipworm. As a disease strongly associated with poor hygiene, it occurs mainly in tropical regions or rural areas of developing countries. However, impoverished regions in developed countries also show high incidence rates. The cornerstone of therapy is anthelmintic medications.


Presentation

The whipworm (Trichuris), together with the roundworm (Ascaris) and the hookworm, is an important representative of soil-transmitted helminths, which are estimated to cause infections in over a billion people yearly [1]. The life cycle includes the passage of Trichuris eggs with stool. People become infected by ingesting food contaminated with eggs. After the eggs hatch, the larvae migrate to the cecum or large intestine, where they will stay attached to the intestinal mucosa after developing into adult form [1].

Trichuriasis is associated with poor sanitation, and hence, with poverty. It occurs mainly in developing countries, most often in tropical Asia, but also in Africa and South America. A Nigerian study found a correlation between the preponderance of parasitic worm infections and poor hygiene [2]. Because the organism is transmitted from the soil to humans, rural populations are strongly affected, especially where the use of human feces is done as a fertilizer. However, trichuriasis appears in other areas as well, including developed countries. For example, people suffer from Trichuris infection in regions with high rates of poverty in the USA (the Mississippi delta, Appalachia, tribal lands, and inner city slums) [3], and in poorer regions in Europe, mainly in the eastern and southern parts [4]. Some minorities, especially the Roma population [4], show high rates of infection. Immigrants from developing countries also carry parasitic infections, as do migrants from rural areas [5] [6].

Symptoms are usually only apparent if the infection is heavy. Children between the ages of 5 and 15 have the most severe infections for reasons not completely understood [7]. They may have frequent stools, sometimes containing mucus or blood. Nocturnal stool, abdominal pain, and rectal prolapse also occur. The organism does not migrate to other tissues, thus, there are only gastrointestinal problems. However, the condition can cause vitamin A deficiency, anemia, and failure to thrive. It may also have a negative impact on children’s progress in school [8]. Finger clubbing occurs in some cases.

Although trichuriasis in humans is caused by Trichuris trichiura, there are some incompletely substantiated reports suggesting infection in humans by Trichuris vulpis, the canine whipworm [9] [10].

Abdominal Pain
  • The patient was a 75-year-old man who complained of abdominal pain, and weight loss. Diagnosis was achieved by colonoscopic biopsy. Abdominal computed tomography showed irregular and nodular thickening of the wall of the cecum and ascending colon.[ncbi.nlm.nih.gov]
  • She complained of abdominal pain, diarrhea, and vomiting.[ncbi.nlm.nih.gov]
  • Long-standing colitis resembles inflammatory bowel disease, including chronic abdominal pain and diarrhoea, as well as impaired growth, anaemia of chronic disease, and finger clubbing.[patient.info]
  • Abdominal pain (61.2%) and/or altered bowel habits (32.2%) were the most common indication for colonoscopy. Most (66.6%) of the Trichuris were located in the cecum and ascending colon.[ncbi.nlm.nih.gov]
Chronic Diarrhea
  • Geohelminths are responsible for the high levels of debility found in the younger population and are often related to cases of chronic diarrhea and malnutrition, which put the physical and intellectual development of children at risk.[ncbi.nlm.nih.gov]
  • RESULTS: Day 35 infected AKR displayed chronic diarrhea, weight loss, and transmural colonic inflammation; BALB/c remained asymptomatic, cleared the infection, and demonstrated normal histology.[ncbi.nlm.nih.gov]
  • However, heavy infestations can manifest as: · distention · abdominal pain · flatulence · chronic diarrhea (can be bloody) · vomiting · weight loss · headache · malnutrition · anemia · anorexia · nervousness · urticaria Untreated chronic or severe infections[austincc.edu]
Failure to Thrive
  • However, the condition can cause vitamin A deficiency, anemia, and failure to thrive. It may also have a negative impact on children’s progress in school. Finger clubbing occurs in some cases.[symptoma.com]
Dry Skin
  • Craig and Faust 2 have stated that in cases of heavy uncomplicated whipworm infection, the patients show pronounced emaciation, dry skin, mucous diarrhea, rarely with blood, and a reduction in hemoglobin to 40 or 50 per cent.[jamanetwork.com]

Workup

The adult worm invades the intestinal mucosa with its threadlike head and feeds on tissue secretions. The invasion sometimes causes eosinophilia. Other laboratory tests (complete blood count) may reveal anemia in the patients.

Trichuriasis is diagnosed by microscopic identification of Trichuris eggs in stool samples. The eggs have a characteristic lemon shape with transparent plugs at both ends. Some sources recommend concentrating the stool samples to detect possible light infections. Others do not regard concentration essential, because females may produce 20,000 eggs daily. Endoscopy can show the adult worms appended to the gastrointestinal wall.

Colonoscopy may accidentally detect whipworm infection. One study of mildly infected patients whose colonoscopy results were positive for adult worms found that only a small percentage had identifiable eggs in stool samples. The authors of the study advocate the use of colonoscopy for diagnosis of mild infections, as well as for the removal of adult worms through the use of colonoscopy pincers [6].

Salmonella Typhi
  • typhi co-infection: a case report. ( 19918413 ) Nimir AR...Shaker AR 2009 20 Sonographic whipworm dance in trichuriasis. ( 19321687 ) Vijayaraghavan SB 2009 21 Whipworm infection resulting in eosinophilic colitis with occult intestinal bleeding. ( 17141232[malacards.org]
  • typhi ) and exacerbation of symptoms and pathogenesis of the other parasitic infection (as is typical with coinfection with Schistosoma mansoni, in which higher worm burden and liver egg burden is common).[en.wikipedia.org]
Bloody Ascites
  • Ascites and intestinal wall thickening was found by CT scan, and Douglas pouch centesis aspirated bloody ascites which included many eosinophils. She was medicated with prednisolone and albendazole and cured.[ncbi.nlm.nih.gov]
Colonic Ulcer
  • The number of worms was single or a few ( KEYWORDS: Colonic ulceration; Colonoscopy; Trichuris trichiura[ncbi.nlm.nih.gov]

Treatment

  • Mebendazole appears to be a safe drug for use in the treatment of human parasitic intestinal nematode infestations, and should be especially useful in the treatment and control of trichuriasis.[ncbi.nlm.nih.gov]
  • However, significant differences were found among the percentage cure rates and egg reduction rates of the four treatment groups in the treatment of trichuriasis.[ncbi.nlm.nih.gov]
  • Further studies are needed to determine the etiology of this apparent association between the albendazole treatment group and the delay in growth rate at 6 months post-treatment.[ncbi.nlm.nih.gov]
  • Post-treatment parasitological examinations were carried out on 3 faecal samples, each collected on a different day between 21 and 30 days following initiation of treatment.[ncbi.nlm.nih.gov]
  • Higher doses of anthelmintics for longer periods of treatment generally improve the cure rates but treatment of such associated symptoms as diarrhoea is recommended before starting anthelmintic therapy.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis Full recovery is expected with treatment. Prevention Improved facilities for disposal of faeces have decreased the incidence of whipworm.[patient.info]
  • Part I explores basic techniques to researching trichuriasis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient[amazon.com]

Etiology

  • Further studies are needed to determine the etiology of this apparent association between the albendazole treatment group and the delay in growth rate at 6 months post-treatment.[ncbi.nlm.nih.gov]
  • FAQs Data Reporting Investigation Resources Organism, Causative agent, Etiologic agent Trichuriasis is caused by infection with the intestinal nematode Trichuris trichiura.[dshs.state.tx.us]
  • Trichuriasis by Rachel Bass Disease Etiology: Trichuriasis [ trik- uh - rahy - uh -sis ] refers the infection of the intestines caused by the parasitic nematode Trichuris trichiura. [1] T. trichiura, a soil-transmitted helminth, is a roundworm and is[austincc.edu]
  • Trichuriasis by Rachel Bass Disease Etiology: Trichuriasis [ trik- uh - rahy - uh -sis ] refers the infection of the intestines caused by the parasitic nematode Trichuris trichiura . [1] T. trichiura , a soil-transmitted helminth, is a roundworm and is[austincc.edu]

Epidemiology

  • E Epidemiology of trichuriasis ‎ (1 C) S SVG trichuriasis ‎ (2 F) Media in category "Trichuriasis" The following 2 files are in this category, out of 2 total.[commons.wikimedia.org]
  • Author information 1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. ronaldo.scholte@unibas.ch Abstract The impact of intestinal helminths on human health is well known among the population[ncbi.nlm.nih.gov]
  • Epidemiology Trichuriasis is common worldwide (the third most common roundworm parasite of humans).[patient.info]
  • Weekly Epidemiological Record. 2006; 81(16):145-63. Steinmann P, Utzinger J, Du ZW, Jiang JY, Chen JX, Hattendorf J, Zhou H, Zhou XN.[id-press.eu]
Sex distribution
Age distribution

Pathophysiology

  • […] occasionally in the Southeast Incidence of infection is decreasing with globally improved sanitation Sites Worms usually reside in the cecum and ascending colon More distal colon may be involved with more severe infection No migratory phase through the lungs Pathophysiology[pathologyoutlines.com]
  • Pathophysiology Trichuris, as with Ascaris lumbricoides, is spread via fecal-oral transmission. Eggs are deposited in soil through human feces. After 10-14 days in soil, eggs become infective.[emedicine.medscape.com]
  • It is thought there is partial protective immunity that develops with age. [3] [4] Pathophysiology A human host consumes infected eggs, typically while eating food. Once the embryonated eggs are ingested, the larvae hatch in the small intestine.[ncbi.nlm.nih.gov]

Prevention

  • Contact Us: Centers for Disease Control and Prevention 1600 Clifton Rd.[web.archive.org]
  • More on: Handwashing Transmission of infection to others can be prevented by Not defecating outdoors. Effective sewage disposal systems.[web.archive.org]
  • The World Health Organization (WHO) excludes pregnant women from mass prevention campaigns that use ivermectin.[cdc.gov]

References

Article

  1. Bethony J, Brooker S, Albonico M, et al. The soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367:1521–1532.
  2. Ekpo UF, Odoemene SN, Mafiana CF, Sam-Wobo SO. Helminthiasis and hygiene conditions of schools in Ikenne, Ogun State, Nigeria. PLoS Negl Trop Dis. 2008 Jan 30;2(1):e146.
  3. Hotez PJ. Neglected infections of poverty in the United States of America. PLoS Negl Trop Dis. 2008 Jun 25;2(6):e256.
  4. Hotez PJ, Gurwith M. Europe's neglected infections of poverty. Int J Infect Dis. 2011 Sep;15(9):e611-619.
  5. Chen YD, Tang LH, Xu LQ. Current status of soil-transmitted nematode infection in China. Biomed Environ Sci. 2008 Apr;21(2):173-179.
  6. Wang DD, Wang XL, Wang XL, Wang S, An CL. Trichuriasis diagnosed by colonoscopy: case report and review of the literature spanning 22 years in mainland China. Int J Infect Dis. 2013 Nov;17(11):e1073-1075.
  7. Galvani AP. Age-dependent epidemiological patterns and strain diversity in helminth parasites. J Parasitol 2005; 91: 24–30.
  8. Miguel EA, Kremer M. Worms: identifying impacts on education and health in the presence of treatment externalities. Econometrica 2003; 72: 159–217.
  9. Traversa D. Are we paying too much attention to cardio-pulmonary nematodes and neglecting old-fashioned worms like Trichuris vulpis? Parasit Vectors. 2011 Mar 8;4:32.
  10. Masuda Y, Kishimoto T, Ito H, Tsuji M. Visceral larva migrans caused by Trichuris vulpis presenting as a pulmonary mass. Thorax. 1987 Dec;42(12):990-991.

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Last updated: 2019-07-11 22:25