QJM: An International Journal of Medicine, 2019, 1
doi: 10.1093/qjmed/hcy303
CLINICAL PICTURE
Trichuris trichiura
A 30-year-old female from Kozhikode, Kerala, South India pre-
sented with complaints of diarrhoea and fever of 2 weeks dur-
ation. She was passing loose, watery stools without any blood
or mucus in it multiple times a day. Physical examination
revealed anaemia and free fluid in the abdomen. Blood investi-
gations showed a haemoglobin of 5.1 g/dl, a total leucocyte
count of 1900/ml and a platelet count of 89 000/ml. Serum albu-
min was 2.0 g/dl, bilirubin and aminotransferase levels were
normal. Ultrasound examination of the abdomen showed cir-
rhosis of liver with portal hypertension. Initial stool microscopy
was reported normal and stool for bacterial culture was sterile.
A flexible sigmoidoscopy showed whip shaped adult Trichuris
trichiura worms protruding from the mucosa (Figure 1).
Subsequently repeat stool microscopy revealed eggs of T. tri-
chiura. Despite extensive workup no cause could be found for
her cirrhosis. She was treated with albendazole for 3 days by
which her diarrhoea subsided.
Trichuriasis is transmitted by ingestion of food and water
contaminated with embryonated eggs of T. trichiura.1 Most
infections are asymptomatic. However, heavy infections can
cause colitis, dysentery and rectal prolapse and growth retard-
ation in children. Diagnosis is usually made by the visualization
of the characteristic eggs in stools. Anti-helminthic therapy
Figure 1. (a) Adult trichuris worms seen on sigmoidoscopy (arrow heads). (b) Whip shaped adult worms retrieved by sigmoidoscopy.
C The Author(s) 2018. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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Clinical picture
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with mebendazole or albendazole is effective in most of the
patients.2
Patient consent has been obtained for publication of the clin-
ical image.
Photographs and text from: V.K.M. Niyas , Department of
Medicine, All India Institute of Medical Sciences, New Delhi,
110029, India; P. Balasubramanian Department of Internal
Medicine, Yale New Haven Bridgeport Hospital, Bridgeport,
CT, USA; N.K. Thulaseedharan Department of Medicine,
Government Medical College, Kozhikode, Kerala, India. email:
niyas987@gmail.com
Conflict of interest. None declared.
References
1. Parija SC, Chidambaram M, Mandal J. Epidemiology and clinical
features of soil-transmitted helminths. Trop Parasitol 2017; 7:81–5.
2. Forrester JE, Bailar JC, Esrey SA, José MV, Castillejos BT,
Ocampo G. Randomised trial of albendazole and pyrantel in
symptomless trichuriasis in children. Lancet 1998; 352:1103–8.