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.
- 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 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]
[…] in colitis, presenting with bloody diarrhoea, abdominal pain, iron-deficiency anaemia and, in severe infestations, rectal prolapse. [patient.info]
- 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]
In Costa Rica, it is found in 25% of persons without diarrhea and in 50% of patients with acute diarrhea, but in those with chronic diarrhea the incidence is almost 100%. (This does not necessarily indicate a causative role, however.) [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]
diarrhea with the presence of fecal secretion in the stool and prolapse of the rectum. [treat-simply.com]
- Chronic Abdominal Pain
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, diarrhea, tenesmus, chronic anemia, nocturnal incontinence, growth retardation that may be due in part to vitamin A deficiency and rectal prolapse Patients may also suffer from other parasitic infections Diagnosis Diagnosis is made by [pathologyoutlines.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 .
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]
Mebendazole in treatment of severe Trichuris trichiura infection in Malaysian children. Am J Trop Med Hyg 1976;25(4):568–572. 5. Kan SP. Efficacy of single doses of mebendazole in the treatment of Trichuris trichiura infection. [parasitol.kr]
At 48 h after treatment, AEs due to the treatment were assessed by a pretested questionnaire. [doi.org]
Prognosis Full recovery is expected with treatment. Prevention Improved facilities for disposal of faeces have decreased the incidence of whipworm. [patient.info]
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]
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]
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
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]
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]
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]
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]
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