You are in: eMedicine Specialties > Emergency Medicine > INFECTIOUS DISEASES Trichuris TrichiuraArticle Last Updated: Jul 12, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 9
  Author: Kwame Adusei-Poku Donkor, MD, Staff Physician, Department of Emergency Medicine, Olive View Internal Medicine, University of California Los Angeles Medical Center Kwame Donkor is a member of the following medical societies: Society for Academic Emergency Medicine Coauthor(s): Scott Lundberg, MD, Assistant Clinical Professor of Medicine, UCLA School of Medicine; Consulting Staff, Departments of Medicine and Emergency Medicine, Olive View Medical Center; Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine Editors: Mark Louden, MD, FACEP, Assistant Medical Director, Emergency Department, Duke Raleigh Hospital; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Mark L Plaster, MD, JD, Editor-in-Chief of Emergency Physicians' Monthly, Department of Emergency Medicine, Memorial Hermann Hospital System; John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center; Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School Author and Editor Disclosure Synonyms and related keywords: whipworm, trichuriasis, Trichuris trichiura, intestinal helminthic infection, whipworm infection INTRODUCTIONSection 2 of 9
  BackgroundTrichuris trichiura, or the whipworm, is notable for its small size compared with Ascaris lumbricoides. Around the world, trichuriasis is a very common intestinal helminthic infection, and about one quarter of the world population is thought to carry the parasite. Principally a problem in tropical Asia and, to a lesser degree, in Africa and South America, a lack of a tissue migration phase and a relative lack of symptoms characterize whipworm infection. Only patients with heavy infections become symptomatic. Poor hygiene is associated with trichuriasis transmission, and children are especially vulnerable because of their high exposure risk. The worm derives its name from its characteristic whiplike shape; the adult (male, 30-45 mm; female, 35-50 mm) buries its thin, threadlike anterior half into the intestinal mucosa and feeds on tissue secretions, not blood. This relative tissue invasion causes occasional eosinophilia. The cecum and colon are the most commonly infected sites. Note that T trichiura is usually found in association with other helminths that flourish under similar conditions, a common pathogen being A lumbricoides. PathophysiologyAfter 10-14 days in soil, eggs become infective. Trichuriasis is transmitted by the fecal-oral route, as with A lumbricoides, but in contrast to this parasite and to hookworm, no tissue migratory phase occurs. Larvae hatch in the small intestine, where they grow and molt, finally taking up residence in the large intestine. The time from ingestion of eggs to development of mature worms is approximately 3 months. Adult females lay eggs for up to 5 years. Immunologically, cytokines such as interleukin 25 (IL-25) mediate type 2 immunity and are required for the regulation of inflammation in the gastrointestinal tract. FrequencyUnited StatesWhipworm infection is rare overall but is less rare in the rural Southeast, where 2.2 million people are infected. InternationalWhipworm infection is common in less-developed countries. This parasite is carried by nearly one quarter of the world population. Mortality/MorbidityWhipworm infection is rarely fatal. Rectal prolapse may occur in heavily infected hosts. RaceNo racial predilection exists. SexBoys are more likely to be infected because they are thought to eat more dirt than girls. AgeChildren, due to a higher propensity to directly or indirectly consume soil, are more commonly and more heavily infected. Also, it is widely believed that partial protective immunity develops with age and children are not protected initially. CLINICALSection 3 of 9
HistoryMost patients are asymptomatic. Clinical symptoms are limited to patients with heavy infection, who tend to be small children or others who eat a lot of dirt. Note that there is no pulmonary migration and, thus, no pulmonary symptoms.
Physical
CausesWhipworm is caused by consumption of soil or food that has been fecally contaminated. (Eggs are infective or embryonated about 2-3 weeks after being deposited in the soil). DIFFERENTIALSSection 4 of 9
Anemia, Chronic Gastroenteritis Giardiasis WORKUPSection 5 of 9
Lab Studies
Imaging Studies
Other Tests
TREATMENTSection 6 of 9
Emergency Department CareEffective anthelmintic therapy is available. ConsultationsSpecialty consultation is not necessary unless rectal prolapse or severe anemia is present; both are rare. MEDICATIONSection 7 of 9
The drug of choice for trichuriasis is mebendazole. A single dose of 500 mg can results in a cure rate of 40-75%. Albendazole is an alternative drug. However, its efficacy for trichuriasis is slightly lower than for mebendazole.
Drug Category: Anthelmintic agentsParasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.
FOLLOW-UPSection 8 of 9
Further Inpatient Care
Deterrence/Prevention
Complications
Prognosis
Patient Education
REFERENCESSection 9 of 9
Article Last Updated: Jul 12, 2006 |
