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Trichuris trichiura (whipworm)
Epidemiology:
1) common world-wide in tropical & subtropical regions
2) unembryonated eggs passed in the feces develop in the soil
3) several weeks under appropriate soil conditions are required for maturation
4) infection is acquired by ingestion of embryonated eggs
Pathology:
1) ingested eggs release larvae which mature into adults in the large intestine, especially the cecum
2) adults attach to the intestinal mucosa by their long slender anterior end, while the thicker posterior end moves freely within the intestinal lumen
3) adult worms may be found throughout the colon & rectum with heavy infestation
4) females are elongate, males have coiled tails
5) males & females measure up to 5 cm in length
6) adults may survive for 10 years in the intestine of their host
7) eggs are passed unembryonated in the feces
Clinical manifestations:
1) light infections are asymptomatic
2) diarrhea, dysentery, dehydration & anemia may develop with heavy infestations (> 300 worms)
3) rectal prolapse may occur in heavily infected children
Laboratory:
1) diagnosis is made by recovering eggs in the feces
a) barrel-shaped with refractile plugs at both ends
b) 50-55 by 22-24 um
2) quantitation techniques may be used to assess parasitic load & response to therapy
Complications:
- coinfection with Ascaris lumbricoides [3]
Management:
- antihelmintics
a) mebendazole
b) albendazole
Related
trichuriasis
General
Trichuris
Properties
KINGDOM: animal
PHYLUM: helminth
References
- Clinical Diagnosis & Management by Laboratory Methods,
19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia,
PA. 1996, pg 1283-84
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 917-19
- Blount T, Hartsell A.
Tubular Opacities in the Gastrointestinal Tract.
N Engl J Med 2017; 377:2375. December 14, 2017
PMID: 29236643 Free full text
http://www.nejm.org/doi/full/10.1056/NEJMicm1703094