Trichuris trichiura

From Wikipedia, the free encyclopedia

Jump to: navigation, search
Whipworm

Scientific classification
Kingdom: Animalia
Phylum: Nematoda
Class: Adenophorea
Order: Trichurida
Family: Trichuridae
Genus: Trichuris
Species: T. trichiura
Binomial name
Trichuris trichiura
(Linnaeus, 1771)

The round worm (Trichuris trichiura or Trichocephalus trichiuris) is a worm that causes
trichuriasis when it infects a human large intestine. It is commonly known as the whipworm
which refers to the shape of the worm; it looks like a whip with wider "handles" at the posterior
end.

Contents
[hide]

 1 Life cycle
 2 Morphology
 3 Epidemiology
 4 Infection
 5 Symptoms and pathology
 6 Diagnosis
 7 Treatment and control
 8 Dog and cat whipworms
 9 Whipworm as a therapeutic agent for IBD and other inflammatory disorders
 10 See also
 11 References
  12 External links

[edit] Life cycle

The female T. trichiura produces 2,000–10,000 single-celled eggs per day.[1] Eggs are deposited
from human feces to soil where, after two to three weeks, they become embryonated and enter
the “infective” stage. These embryonated infective eggs are ingested and hatch in the human
small intestine. This is the location of growth and molting. The infective larvae penetrate the villi
and continue to develop in the small intestine. The young worms move to the cecum and
penetrate the mucosa and there they complete development to adult worms in the large intestine.
The life cycle from time of ingestion of eggs to development of mature worms takes
approximately three months. During this time, there may be limited signs of infection in stool
samples due to lack of egg production and shedding. The female T. trichiura begin to lay eggs
after three months of maturity. Worms can live up to five years, during which time females can
lay up to 20,000 eggs per day.

Recent studies using genome-wide scan revealed two quantitative trait loci on chromosome 9
and chromosome 18 may be responsible for genetic predisposition or susceptibility to infection
of T. trichiura by some individuals.

[edit] Morphology
Trichuris trichiura has a narrow anterior esophageal end and shorter and thicker posterior anus.
These pinkish-white worms are threaded through the mucosa. They attach to the host through
their slender anterior end and feed on tissue secretions instead of blood. Females are larger than
males; approximately 35–50 mm long compared to 30–45 mm.[2] The females have a bluntly
round posterior end compared to their male counterparts with a coiled posterior end. Their
characteristic eggs are barrel-shaped and brown, and have bipolar protuberances.

[edit] Epidemiology
There is a worldwide distribution of Trichuris trichiura, with an estimated 1 billion human
infections.[3][4][5] However, it is chiefly tropical, especially in Asia and, to a lesser degree, in
Africa and South America. Within the United States, infection is rare overall but may be
common in the rural Southeast, where 2.2 million people are thought to be infected. Poor
hygiene is associated with trichuriasis as well as the consumption of shaded moist soil, or food
that may have been fecally contaminated. Children are especially vulnerable to infection due to
their high exposure risk. Eggs are infective about 2–3 weeks after they are deposited in the soil
under proper conditions of warmth and moisture, hence its tropical distribution.

[edit] Infection
Infection occurs through ingestion of eggs (which are usually found in dry goods such as beans,
rice, and various grains) and is more common in warmer areas. The eggs hatch in the small
intestine, and then move into the wall of the small intestine and develop. On reaching adulthood,
the thinner end (the front of the worm) burrows into the large intestine and the thicker end hangs
into the lumen and mates with nearby worms. The females can grow to 50 mm (2 inches) long.
Neither the male nor the female has much of a visible tail past the anus.[1]

Whipworm commonly infects patients also infected with Giardia, Entamoeba histolytica,
Ascaris lumbricoides, and hookworms.

[edit] Symptoms and pathology

 Light infestations (<100 worms) are frequently asymptomatic.
 Heavy infestations may have bloody diarrhea.
 Long-standing blood loss may lead to iron-deficiency anemia.
 Rectal prolapse is possible in severe cases.
 Vitamin A deficiency may also result due to infection.[2]

Mechanical damage to the mucosa may occur as well as toxic or inflammatory damage to the
intestines of the host.

[edit] Diagnosis
Trichuriasis can be diagnosed when T. trichiura eggs are detected in stool examination. Eggs
will appear barrel-shaped and unembryonated, having bipolar plugs and a smooth shell.[5] Rectal
prolapse can be diagnosed easily using defecating proctogram and is one of many methods for
imaging the parasitic infection. Sigmoidoscopy show characteristic white bodies of adult hanging
from inflamed mucosa (coconut cake rectum).

[edit] Treatment and control

Mebendazole is 90% effective in the first dose, and albendazole may also be offered as an anti-
parasitic agent. Adding iron to the bloodstream helps solve the iron deficiency and rectal
prolapse.

Infection can be avoided by proper disposal of human feces, avoiding fecal contamination of
food, not eating dirt, and avoiding crops fertilized with night soil. Simple and effective proper
hygiene such as washing hands and food is recommended for control.

Background
Globally, Trichuris trichiura, or whipworm, is a very common intestinal helminthic infection,
and about one quarter of the world's population is thought to carry the parasite. Principally a
problem in tropical Asia and, to a lesser degree, in Africa and South America, a lack of a tissue
migration phase and a relative lack of symptoms characterize whipworm infection. Trichuris is
also notable for its small size compared with Ascaris lumbricoides. Only patients with heavy
parasite burden become symptomatic. Vitamin A deficiency has been seen in patients with T
trichiura infection .

Poor hygiene is associated with trichuriasis transmission, and children are especially vulnerable
because of their high exposure risk. This is especially true in developing countries, where poor
sanitary conditions correlate with heavy disease burden and infections. One study in Nigeria was
undertaken to determine helminth infection status and hygienic conditions in primary schools.
Prevalence of helminth infection was higher in the schools where hygiene conditions (ie,
tapwater, handwashing soap) were lacking. The study results recommended that the school
health programs include deworming, health education, and improvement of hygiene
conditions.[1]

The whipworm derives its name from its characteristic whiplike shape; the adult (male, 30-45
mm; female, 35-50 mm) buries its thin, threadlike anterior half into the intestinal mucosa and
feeds on tissue secretions, not blood. This relative tissue invasion causes occasional peripheral
eosinophilia. The cecum and colon are the most commonly infected sites, although in heavily
infected individuals, infection can be present in more distal segments of the GI tract, such as the
descending colon and rectum. See the image below.

Adult males of Trichuris trichiura are 30-45 mm long, with a

coiled posterior end. Adult females are 35-50 mm with a straight posterior end. Both sexes have
a long, whip-like anterior end. Adults reside in the large intestine, cecum, and appendix of the
host. Image shows the posterior end of an adult T trichiura, taken during a colonoscopy. Image
courtesy of Duke University Medical Center and Centers for Disease Control and Prevention.

Note that T trichiura is usually found in association with other helminths that flourish under
similar conditions, a common pathogen being A lumbricoides.