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.
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 . 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 .
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 . 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) , and in poorer regions in Europe, mainly in the eastern and southern parts . Some minorities, especially the Roma population , show high rates of infection. Immigrants from developing countries also carry parasitic infections, as do migrants from rural areas  .
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 . 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 . Finger clubbing occurs in some cases.
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 .