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].

• Pain

  Ascariasis The presence of a large volume of adult Ascaris worms in the intestine causes abdominal distension and pain from intestinal obstruction, intussusception, and volvulus. [visualdx.com]

  Patients with heavy infections may have abdominal pain, anorexia, and diarrhea; weight loss, anemia, and rectal prolapse may result, particularly in children. [msdmanuals.com]

  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]

  The pain in the abdomen may be generalized, but is often localized to the right lower quadrant. [isradiology.org]

• Malnutrition

  The most serious effects of hookworm infection are chronic blood loss leading to iron deficiency anemia and protein energy malnutrition. [visualdx.com]

  Prolonged exposure to whipworm can cause serious health consequences including malnutrition, anemia, and physical growth retardation, particularly in children. [sabin.org]

  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]

  Malnutrition. Heavy infections may cause anaemia. Prolonged infections may lead to growth and developmental delay in children. Prognosis Full recovery is expected with treatment. [patient.info]

• Weight Loss

  Patients with heavy infections may have abdominal pain, anorexia, and diarrhea; weight loss, anemia, and rectal prolapse may result, particularly in children. [msdmanuals.com]

  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]

  However, in people with heavy infections, whipworm can cause gastrointestinal problems, such as abdominal pain, diarrhea, mucous or bloody stools weight loss, painful urination, and weakness. [web.stanford.edu]

• Weakness

  Symptoms, including bloody diarrhoea, anaemia, weakness, and abdominal pain, are evident only in heavy infestations. Trichuriasis can be treated with mebendazole. [oxfordreference.com]

  We report a case of a 5-year-old girl who presented with generalized weakness, bleeding per rectum and rectal prolapse of 1 year duration. She was investigated for bleeding per rectum. [ijmedph.org]

  However, in people with heavy infections, whipworm can cause gastrointestinal problems, such as abdominal pain, diarrhea, mucous or bloody stools weight loss, painful urination, and weakness. [web.stanford.edu]

  […] available for $US 0.02 per pill Currently no vaccine exists for trichuriasis Disease Burden Prevalence 800 million people worldwide, particularly in warm, humid, tropical climates World’s third most common worm infection Disease Impact Causes physical weakness [sabin.org]

• Anorexia

  Patients with heavy infections may have abdominal pain, anorexia, and diarrhea; weight loss, anemia, and rectal prolapse may result, particularly in children. [msdmanuals.com]

  Middle infection: Clinical manifestations are usually abdominal pain, anorexia, diarrhea, constipation. 3. Heavy infection: Bloody diarrhea, emaciation, prolapse of the anus may occur. 10. IV. [slideshare.net]

• Cough

  Symptoms and Signs of Hyperinfection Anemia, constipation Cough, diarrhea Eosinophilic pneumonitis (during larvae migration through the lungs) Nausea, vomiting weight loss. 20. [slideshare.net]

  Over a period of 2-3 months larvae mature through a process that involves coughing up and swallowing larvae from the lungs. [globalhealthprimer.emory.edu]

• Abdominal Pain

  Patients with heavy infections may have abdominal pain, anorexia, and diarrhea; weight loss, anemia, and rectal prolapse may result, particularly in children. [msdmanuals.com]

  […] in colitis, presenting with bloody diarrhoea, abdominal pain, iron-deficiency anaemia and, in severe infestations, rectal prolapse. [patient.info]

  In those who are infected with many worms, there may be abdominal pain, tiredness and diarrhea. The diarrhea sometimes contains blood. Infections in children may cause poor intellectual and physical development. [dbpedia.org]

  Patients with very heavy chronic trichuriasis infection have a characteristic clinical picture consisting of diarrhea, abdominal pain, nausea, anemia, and weight loss. It may rarely cause rectal prolapse. [onlinelibrary.wiley.com]

• 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]

  A heavy infection with Trichuris, especially in poorly nourished children, can cause severe chronic diarrhea or dysentery which may last from 6 months to 3 years, with blood and excess mucus in the stools, tenesmus, abdominal pain, rectal prolapse (Fig [isradiology.org]

  Patients infected with T. trichiura may present with a chronic dysentery-like syndrome if they have a massive infestation leading to anemia and growth retardation. In some cases, diarrhea may last for years without blood and mucus. [med-chem.com]

• Loss of Appetite

  Abdominal pain, loss of appetite, and diarrhea occur when a large number of worms are present in the colon. Weight loss, bleeding from the intestine, and anemia may result, especially in children with heavy infections. [msdmanuals.com]

  Symptoms of Trichuriasis Most patients have no symptoms, but with severe infestations abdominal pain, loss of appetite and diarrhoea may occur. Badly infested children may have bloody diarrhoea and become malnourished. [familygp.online]

  Most patients have no symptoms, but with severe infestations abdominal pain, loss of appetite and diarrhoea may occur. Badly infested children may have bloody diarrhoea and become malnourished. [afairgo.net]

  Symptoms of trichocefalosis: disorders of the gastrointestinal tract, loss of appetite, nausea, vomiting, increased salivation. There may be pains in the right ileocecalarea, they are very similar to pain with appendicitis. [doctorsask.com]

• Rectal Bleeding

  This causes the typical symptoms of rectal bleeding and abdominal pain. The parasite usually takes up residence in the terminal ileum and cecum. In some patients, the entire colon and rectum may be infested with the worm. [ncbi.nlm.nih.gov]

• Hypotension

  The ideal chronotrope depends on the patient's hemodynamics and baseline blood pressure: Baseline severe hypotension: epinephrine infusion. Baseline normotension or mild hypotension: dobutamine or isoproterenol infusion. [emcrit.org]

  For those patients with hypotension or in cardiac arrest from Torsades de Pointes, electrical cardioversion should be performed. [ncbi.nlm.nih.gov]

  […] ultrasound If patient is unstable: IV fluid resuscitation, urgent obstetrics and gynecology consultation If patient is stable: continue diagnostic workup, establish OBGYN follow-up Abdominal aortic aneurysm[14] Abdominal pain, flank pain, back pain, hypotension [en.wikipedia.org]

• Flushing

  If the type of sanitation facilities was mentioned, a wide variety of terms was used (e.g., flush toilet, water closet, ventilated improved pit latrine, pit latrine, and open latrine). [doi.org]

• Headache

  Side effects were noted in 9% and included gastrointestinal upset, lightheadedness and headache. [ncbi.nlm.nih.gov]

  Other symptoms include nervousness, irritability, headache, insomnia, decreased cognitive ability, vomiting and abdominal distention. The pain in the abdomen may be generalized, but is often localized to the right lower quadrant. [isradiology.org]

  In order for trichocephalosis to be diagnosed correctly, the specialist needs the following important items: Presence of clinical data similar to invasive withered headache. [treat-simply.com]

  Very frequent headaches, nausea, dizziness, weakness, and irritability. Abdominal pain are often paroxysmal character. [medicalency.com]

  Headaches, nausea, dizziness, weakness and irritability are very common. Pain in the abdomen is often paroxysmal. [en.handbookmedical.com]

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].

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]

Treatment is with mebendazole, albendazole, or ivermectin. Trichuriasis is the 3rd most common roundworm infection. An estimated 604 to 795 million people are infected worldwide. [msdmanuals.com]

At 48 h after treatment, AEs due to the treatment were assessed by a pretested questionnaire. [doi.org]

Prognosis The prognosis of trichuriasis is excellent with proper treatment; however, without education and changes in behavior/waste management, re-infection is very common. Patient Education Good personal hygiene is highly recommended. [emedicine.medscape.com]

Prognosis Full recovery is expected with treatment. Prevention Improved facilities for disposal of faeces have decreased the incidence of whipworm. [patient.info]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

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]

Data FAQs Investigation Reporting Resources Organism, Causative agent, Etiologic agent Trichuriasis is caused by infection with the intestinal nematode Trichuris trichiura. [dshs.state.tx.us]

The various etiologies of torsade de pointes have therefore as common grounds either to prolong the QT interval or to slow the heart rate, or both at the same time. [cardiocases.com]

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]

Trichuris and hookworm infections associated with anaemia during pregnancy Division of Clinical Epidemiology, Department of Epidemiology, Biostatistics and Occupational Health, Research Institute of the McGill University Health Centre, McGill University [doi.org]

The Epidemiology and the Landscape. [infectionlandscapes.org]

Introduction Agent History of Discovery Symptoms Diagnosis and Treatment Epidemiology Links and References Contact Clinical Presentation In Humans Many people that are infected with T. trichiura are asymptomatic due to light infections. [web.stanford.edu]

Author information 1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. [email protected] Abstract The impact of intestinal helminths on human health is well known among the population [ncbi.nlm.nih.gov]

[…] 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]

The pathophysiology of disease varies depending on the species and the worm burden. [unboundmedicine.com]

Additional hints, tips and definitions within specific codes provide extra guidance in coding anatomy, pathophysiology, or other coding directions. [books.google.ro]

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]

Parasites A-Z ; Centers for Disease Control and Prevention Bethony J, Brooker S, Albonico M, et al ; Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006 May 6367(9521):1521-32. [patient.info]

More on: Handwashing Transmission of infection to others can be prevented by Not defecating outdoors. Effective sewage disposal systems. [web.archive.org]

More on: Handwashing Transmission of infection to others can be prevented by: Not defecating outdoors. Effective sewage disposal systems. Page last reviewed: January 10, 2013 [cdc.gov]

Prevention The best method for prevention of Trichuriasis is proper disposal of human waste. Avoiding the use of human waste based fertilizer (night soil) will also decrease the risk of transmission. [dshs.state.tx.us]

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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.
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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.