Trichuris trichiura (whipworm)

Epidemiology

• common world-wide in tropical & subtropical regions
• unembryonated eggs passed in the feces develop in the soil
• several weeks under appropriate soil conditions are required for maturation
• infection is acquired by ingestion of embryonated eggs

Pathology

• ingested eggs release larvae which mature into adults in the large intestine, especially the cecum
• adults attach to the intestinal mucosa by their long slender anterior end, while the thicker posterior end moves freely within the intestinal lumen
• adult worms may be found throughout the colon & rectum with heavy infestation
• females are elongate, males have coiled tails
• males & females measure up to 5 cm in length
• adults may survive for 10 years in the intestine of their host
• eggs are passed unembryonated in the feces

Clinical manifestations

• light infections are asymptomatic
• diarrhea, dysentery, dehydration & anemia may develop with heavy infestations (> 300 worms)
• rectal prolapse may occur in heavily infected children

Laboratory

• diagnosis is made by recovering eggs in the feces
  • barrel-shaped with refractile plugs at both ends
  • 50-55 by 22-24 um
• quantitation techniques may be used to assess parasitic load & response to therapy

Complications

• coinfection with Ascaris lumbricoides

Management

• antihelmintics
  • mebendazole
  • albendazole

More general terms

• Trichuris

Additional terms

• trichuriasis