TRICHURIASIS,

LEARNING OBJECTIVES
• a) Define Helminthiasis
• b) Explain risk factors/aetiology of Helminthiasis
• c) Explain clinical features and complications of
Helminthiasis
• d) Perform clinical assessment for a patient with
Helminthiasis
• e) Establish provisional and differential diagnoses
• f)Determine appropriate investigations to be performed to
patients with Helminthiasis
• g) Treat, conduct follow up and refer patients with
Helminthiasis as appropriate
• h) Provide preventive measures to patients with Helminthiasis
INTRO
• Trichuris trichiura or Trichocephalus trichiuris is intestinal
nematode worm

• Inhabit a human large intestine (ceacum)

• Causing the disease known as trichiuriasis

• It is soil transmitted infection (eggs are infective stage found in

soil)

• Is commonly known as the whipworm because it looks like the

whip 2
CONT…
• The worms has thin anterior
and thick posterior part

• They attach to intestinal

mucosa by embedding their
anterior part.

• They feed on tissue fluid (not

blood).
Morphology (the worm)
• Shape: round • narrow long
anterior part end and shorter
and thicker posterior.

• Color: pinkish-white

• Size: ♀ 35–50 mm long ♂ 30–

45 mm, with a coiled posterior
end
CONT….
• Eggs of Trichuris trichiura

• Shape: oval (barrel-shaped) has polar

hyaline mucoid blugs

• Size: 60 x40 µm

• Color: honey brown

• Shell: Thick

• Contents: • Mass of granules

(Unembryonated)
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 cecum and ascending colon.
How man become infected?
• Infection to man is by ingestion of the infective eggs
(contain larva) that may be in contaminated food or drink,
hands with soil.

• The larva hatch in the human small intestine then migrate to

large intestine

• They attach to mucosa of the large intestine.

• Then develop into mature worms with in three months

• After mating female produce 2,000–10,000 single-celled

eggs per day which come out with feces.

• Worms can live up to five years 10

HISTORY
• Most individuals with whipworm infection
(trichuriasis) 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.
CONT
• Nocturnal loose stools • Symptoms of anemia
(massive infection only)
• Dysentery can occur in
patients with greater • Vague abdominal
than 200 worms. discomfort

• Rectal prolapse • Stunted growth

• Failure to thrive
Physical
• Physical findings include the following:

• Signs of anemia.

• Finger clubbing can sometimes suggest the diagnosis in infected

patients.

• Mild abdominal tenderness

• Blood on rectal examination or positive guaiac test result

• Rectal prolapse

• Direct visualization of adult worms on rectal mucosa via

endoscopy or if rectum is prolapsed (adult worms only in lower
colon in heavy infection)
Differential Diagnoses

• Chronic Anemia

• Gastroenteritis

• Giardiasis

• Other parasitic helminth infections

Complications

• Colonic obstruction because of the tangle of worms

• Ulceration of large intestine which result in blood

loss.

• Iron deficiency anemia

• Rectal prolapse
CONT….
• Stool sample is suitable for the diagnosis.

• 2- suitable diagnostic technique:

• A- direct wet examination for feces (heavy infection)
• B-Concentration by sedimentation or by floatation
to detect (very light infection)

• 3- diagnostic stages: eggs

Treatment
• Several anthelmintics drugs of choice:

• The drug of choice for trichuriasis is mebendazole.

• A single 500-mg dose can result in a cure rate of 40-75%.

• Albendazole is an alternative drug.

• However, its efficacy for trichuriasis is slightly lower than for

mebendazole.

• Prognosis :The prognosis is good in light infection Poor in

Prevention & control

• Prevent contamination of soil with human feces

• Construction of latrines

• Washing hands before eating (children, soil

worker).

• Washing vegetables & fruits

• Do not use the night soil as fertilizer 20

THE END