Trichuriasis
Pictures of trichuriasis and disease information have been excerpted from the VisualDx® clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.
Synopsis
Trichuriasis is a nematode infestation caused by the whipworm Trichuris trichiura. It is mainly found in the soil of tropical and subtropical countries, especially in suburban or rural areas where sanitation practices are suboptimal. Trichuriasis also occurs in the southern United States.
According to the Centers for Disease Control and Prevention (CDC), there are approximately 800 million people infected with whipworm globally. Coinfection with two other common soil-transmitted helminths, roundworms (Ascaris lumbricoides) and hookworms (Necator americanus and Ancylostoma duodenale), is common. Children living in endemic regions are commonly infected with all three, which has a significant negative impact on their nutritional status and intellectual, cognitive, and educational development. At least one of these three soil-transmitted helminths infects more than one billion people currently, and hence they are responsible for a major disease burden worldwide.
Trichuriasis is spread person-to-person through ingestion of whipworm eggs. Infections are caused by contamination of soil with infected feces, as may occur where human feces is used as fertilizer or improper waste disposal systems exist. The absence of a safe water supply, consumption of improperly washed or cooked food, and poor hand hygiene practices also contribute to infection.
Following ingestion of eggs, T. trichiura larvae hatch and mature within 30 to 90 days and usually inhabit the cecum, although in heavy infections, worms may be present throughout the colon from the cecum to the rectum. Adult worms live one to two years with females laying 2000 to 30 000 eggs daily. Light infection of trichuriasis is usually asymptomatic. Slow bleeding from the worm attachment site may lead to anemia. In children with heavy Trichuris infection, symptoms of chronic colitis, including abdominal pain, mucoid diarrhea, iron deficiency anemia, growth retardation, and finger clubbing may be present. A distinct clinical syndrome known as Trichuris dysentery syndrome is a rare but more serious complication of heavy infection. It occurs more commonly in children and is manifested as tenesmus, chronic mucoid diarrhea, anemia, protein malnutrition, and rectal prolapse.
Look For
Children with heavy Trichuris infection may have features of chronic anemia and malnutrition, low school attendance and performance, and chronic diarrhea.
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