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. In contrast to other
parasites, such as A lumbricoides, no tissue migratory phase occurs with Trichuris organisms,
confining infection to the GI tract. 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. During this time, there may be no shedding of eggs and only
limited evidence of infection in stool samples. Worms may live from 1-5 years, and adult female
worms lay eggs for up to 5 years, shedding up to 20,000 eggs per day.
See the image below.

This is an illustration of the life cycle of Trichuris trichiura, the causal agent of
trichuriasis. Image courtesy of Centers for Disease Control and Prevention, Alexander J. da Silva, PhD, and Melanie
Moser.

Immunologically, cytokines such as interleukin 25 (IL-25) mediate type 2 immunity and are required
for the regulation of inflammation in the gastrointestinal tract.
Recent linkage analyses of a genome-wide scan revealed that 2 quantitative trait loci on
chromosomes 9 and 18 may be responsible for the susceptibility to infection with T trichiura in some
genetically predisposed individuals.[2]

History
Most patients are asymptomatic. Clinical symptoms are limited to patients with heavy infection, who
tend to be small children or others with significant exposure. Note that there is no pulmonary migration
and, thus, no pulmonary or extra-gastrointestinal symptoms.

Nocturnal loose stools

Dysentery can occur in patients with greater than 200 worms.
Rectal prolapse
Failure to thrive
Symptoms of anemia (massive infection only)
Vague abdominal discomfort
Stunted growth

Medication Summary
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.

Anthelmintic agents
Class Summary
Parasite biochemical pathways are sufficiently different from the human host to allow selective
interference by chemotherapeutic agents in relatively small doses.
View full drug information

Mebendazole (Vermox)
Causes worm death by selectively and irreversibly blocking glucose uptake and other nutrients in the
susceptible adult intestine where helminths dwell.

Administer a second course if patient is not cured within 3-4 wk.

View full drug information

Albendazole (Albenza)
Decreases whipworm ATP production, causing energy depletion, immobilization, and death.

Further Inpatient Care

Inpatient care may be warranted for patients with rectal prolapse or severe anemia.

Deterrence/Prevention

Household contacts are at low risk because of life-cycle requirements.

If fecal contamination of soil is possible (eg, children defecating in the back yard, human
waste used as fertilizer), consider the possibility of household transmission.
Contacts may be screened for asymptomatic carrier state.
Improved sanitation is the best way to eradicate T trichiura infection.
Careful washing of vegetables and fruits grown in contaminated areas is also important.

Complications

Rectal prolapse or anemia may occur.

Vitamin deficiency

Prognosis

Prognosis 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. Where relevant, community waste

management systems should be developed to reduce exposure to potentially infected waste.