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Whipworm: Diagnosis and Differentials

Authors: Robert W. Tolan, Jr, MDAuthor Information and Disclosures

Contents

Clinical

History:
  • When evaluating a patient suspected of having a whipworm infection, the most important part of the history is travel to or living in an area of known infestation.
  • GI complaints associated with these infections are diverse. Long-term GI complaints with associated exposure suggest whipworm infection.
  • Most infections are asymptomatic. Patients with fewer than 100 worms are frequently asymptomatic; however, they may present with lower abdominal discomfort, flatulence, and diarrhea or constipation.
  • Patients with heavy infection have hundreds to thousands of worms and may present with lower or epigastric pain, vomiting, abdominal distension, anorexia, weight loss, anemia, diarrhea, tenesmus (painful straining), and rectal prolapse. Trichuris dysentery syndrome is observed in heavy infections and characterized by bloody mucoid diarrhea, small frequent stools, tenesmus, anemia, and growth retardation.
  • Polyparasitic infections can occur with whipworms, ascaris, and hookworms because all these parasites live in similar environments.

Physical:

  • Generally, physical examination findings are normal.
  • Each worm causes an estimated 5 mL of blood loss every day.
  • Heavy infections are required to cause anemia.
  • Prolonged infections are reported to lead to growth failure, intellectual delays, and digital clubbing; however, growth and intellectual delays are likely to be multifactorial.

Causes:

  • The organism is spread via the fecal-oral route. Potential hosts ingest the embryonated (mature) eggs.
  • Most heavy infections are observed in the pediatric population because children are more likely to have poor hygiene and to play in soil that carries the worms' mature eggs.

Differentials

Amebiasis
Ancylostoma Infection
Anemia, Chronic
Appendicitis
Ascariasis
Campylobacter Infections
Colitis
Constipation
Cryptosporidiosis
Cyclosporiasis
Cystic Fibrosis
Cytomegalovirus Infection
Diarrhea
Dientamoeba Fragilis Infection
Diphyllobothrium Latum Infection
Echovirus
Encopresis
Enterobiasis
Enteroviral Infections
Failure to Thrive
Food Poisoning
Gastroenteritis
Giardiasis
Growth Failure
Helicobacter Pylori Infection
Hookworm Infection
Intestinal Protozoal Diseases
Intestinal Volvulus
Intussusception
Irritable Bowel Syndrome
Isosporiasis
Malabsorption Syndromes
Malnutrition
Meckel Diverticulum
Protein Intolerance
Protein-Losing Enteropathy
Rectal Prolapse
Salmonella Infection
Shigella Infection
Soy Protein Intolerance
Sprue
Strongyloidiasis
Thalassemia
Toxicity, Iron
Toxicity, Lead
Tuberculosis
Ulcerative Colitis
Yersinia Enterocolitica Infection


Other Problems to be Considered:

Gastrointestinal bleeding
Intestinal duplications
Milk protein allergy
Eosinophilic colitis
Neglect
Malignancy
Atopy
Copper deficiency
Pediatrics, Rotavirus
Clostridium Difficile Colitis

Workup

Lab Studies:

  • Diagnosis is usually established by means of microscopic examination of stool.
    • Whipworm eggs have a characteristic barrel (American football) shape with translucent polar plugs.
    • The stool commonly contains RBCs and WBCs, including eosinophils/Charcot-Leyden crystals.
  • Perform a CBC count. Eosinophilia is uncommon; however, when present, it ranges from 5-20%.

Procedures:

  • Anoscopy may be useful. In heavy infections, worms can be directly visualized.
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Synonyms And Related Keywords

Nematoda, parasite, parasite infection, parasitic disease, trichuriasis, Trichuris trichiura, T trichiura, whipworm, rectal prolapse, Trichuris dysentery syndrome, ascaris, anemia

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Author Information and Disclosures

Author: Robert W. Tolan, Jr, MD, Chief of Allergy, Immunology and Infectious Diseases, The Children's Hospital at St Peter's University Hospital, Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Coauthor(s): Tina Slusher, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Critical Care, West Virginia University; Steven L. Lanski, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University and Children's Healthcare of Atlanta at Egleston

Robert W. Tolan, Jr, MD, is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Disease Society, Phi Beta Kappa, and Physicians for Social Responsibility

Editor Information

Editor(s): Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University; Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine; and Russell W Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center

 
 
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