Trichuris trichiura

Blood Streak Stools

01 Parasite Biology
• Trichuris trichiura or the whipworm is a
soil-transmitted helminth (STH)
• The male worm (Plate 3.5a) measures 30
to 45 mm, slightly shorter than the
female, which is 35 to 50 mm long.
• The female (Plate 3.5b) has a blunt
posterior end, while the male has a
coiled posterior with a single spicule and
retractile sheath.
• A female lays approximately 3,000 to
10,000 eggs per day (60 million eggs
over an average lifespan of 2 years)
 Life Cycle
• Embryonic development → outside the host (eggs in clayish soil)
Trichuris eggs in soil susceptible to desiccation compared with Ascaris eggs,
• Embryonated eggs → ingested → larvae escape → penetrate intestinal villi →
remain for 3 to 10 days.
• TT secrete pore-forming protein TT47 → imbed their entire whip-like portion →
intestinal wall (cecum and the colon)
• After copulation → female worm lays eggs → passed out with the feces and
deposited in the soil.
• Under favorable conditions in the soil, the eggs → embryonated w/in 2 to 3
weeks.
• If swallowed, the infective embryonated eggs → small intestine
→ four larval stages → adult worms.

This process takes about 12 weeks

Unlike Ascaris, there is no heart-lung migration.
02 Pathogenesis and
Manifestation
• The anterior portions of the worms → embedded in the mucosa → cause
petechial hemorrhages, → amebic dysentery → ulcers provide a suitable site for
tissue invasion by E. histolytica.
→ mucosa is hyperemic and edematous → enterorrhagia or intestinal bleeding
• Worms fill the lumen of the appendix → appendicitis or granuloma formation.
• Intensity of infection → Severity of Symptoms
• >5,000 T. trichiura eggs/gram of feces → symptomatic.

• Children 5 to 15 years of age are most frequently infected, and have the highest
intensities of infection
Heavy chronic trichuriasis
• Frequent blood-streaked diarrheal stools (dysentery)
• Abdominal pain and tenderness,
• Nausea and vomiting, and
• Weight loss.
• Anemia and blood loss (0.8 to 8.6 ml / day). Furthermore, infection with over
800 worms can result in anemia in children.

In patients with heavy intensity infection, the worms may be found throughout the
colon and rectum → Trichuris dysentery syndrome manifested by chronic
dysentery and rectal prolapse (due to ↑peristalsis to remove the worms)
Light infections
• Anemia (moderately rare)
• Most likely Asymptomatic
• Presence of the parasite may be discovered only in routine stool
examinations.
• Poor appetite, wasting, stunting, as well as reduced intellectual and
cognitive development in children.
03 Diagnosis
Clinical diagnosis is possible only in very heavy infection In light infections where
symptoms are absent, laboratory diagnosis
is essential.
• Direct fecal smear (DFS) with a drop of saline.
• Kato thick smear method - uses about 20 to 60 mg of stool sample (highly
recommended)
• Kato-Katz technique - quantitative method, egg counting → intensity of helminth
infection.
(Test anthelminthic therapy in terms of cure rate (CR) and egg reduction rate (ERR)
and helminth control program).

• lemon-shaped or barrel shaped eggs

with bipolar plugs/football-shaped
eggs
04 Treatment
• DOC: Mebendazole 100 mg twice a day for 3 days (OR) 500 mg once a day
for 3 days(greatest cure rate) or once
• ADOC: Albendazole 400mg once a day for 3 days

Adverse effects
usually mild and transient and may present as
• H/A, N/V
• GIT discomfort, and
• itchiness

Contraindication
• hypersensitivity and
• early pregnancy (within the 1st trimester)
05 Prevention
The WHO recommends
• Biannual mass drug administration → school-age children → STH
prevalence is ≥50%.
• Once a year treatment → STH prevalence <50%.
• Provision of safe water, environmental sanitation and hygiene education.
(WASH)

Preventive chemotherapy (mass drug administration/Deworming)

• Mebendazole 500 mg single dose
• Albendazole 400 mg single dose ( + ivermectin)
• contribute to improved motor language and intellectual development and
reduced malnutrition.
Common Name Whipworm

Parasite Biology/Characteristic Soil-Transmitted Helminth

Habitat L.I (Cecum)

Transmission FO, ingestion of embryonated egg

Infective Stage Embryonated Egg

Diagnostic Stage Unembryonated Egg

Diagnosis DFS, kato-katz

Pathogenesis - Burrow their anterior ends into Intestinal

mucsa
- Does NOT cause significant anemia

Spectrum of Disease Diarrhea → Rectal Prolapse

Treatment Mebendazole
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