2.

TRICHURIS TRICHIURA

─ “Whipworm”
─ Holomyarian (muscle quadrant contains only 1 or 2 cells across)
─ Life span: 1-2 years

Appearance

─ Flesh colored or pinkish slender worms

─ Anterior end (thin portion)
o Colorless
o Resembles a WHIP
o Contains a slender esophagus
o Thin portion

─ Posterior end (thicker portion)

o Contains (1) digestive and (2) reproductive organs

• FEMALE T. trichiura
─ slightly larger than male measuring 3.5 to 5 cm in length; 35 to
50 mm
─ with a straight /blunt posterior end
─ can produce 3,000 - 10,000 eggs/day

• MALE T. trichiura
─ 3 to 4.5 cm; 30 to 45 mm
─ the posterior end is coiled or curved through 360º; with a
o single spicule &
o retractile sheath

TRICHURIS EGG

─ 50-54 by 22-23 microns

─ Barrel-shaped with “bipolar mucus plug”
o Japanese lantern,
o Football shaped
o lemon-shaped
─ Thick shelled
─ bile stained and yellowish
─ outer and transparent inner shell
─ discharged in the stool in an unsegmented stage
IMPORTANT NOTES

─ Final Habitat: Large Intestine

─ Soil- embryonation of the egg/ova
─ Mode of Transmission: Ingestion of Embryonated Egg
─ Diagnostic stage: Unembroyonated egg stage
─ Infective stage: Embryonated Egg
o Embryonation period: 15-30 days
─ “TT47-pore forming protein” that allows them to imbed
─ 4 larval stages to become adult
─ Once inside the body, bipolar plugs will soften and larvae will come out of the two
ends
─ Larvae DOES NOT migrate, will only hatch in the small intestines
─ Then go to large intestines and stay in the CECUM where it will mature
─ Maturation period: 2-3 months → will start laying eggs after
PATHOLOGY

─ Can cause petechial hemorrhages predispose to → amebic dysentery

─ Mucosa is hyperemic and
o edematous enterorrhagia or
o intestinal bleeding is common
─ Lumen of appendix may be filled with worms
─ Infection with over 5,000 eggs are symptomatic

• TRICHURIASIS

❖ Causes
▪ Blood-streaked diarrheal stools
▪ Abdominal pain & tenderness
▪ nausea & vomiting
▪ Hypoalbuminaemia
▪ The worm is capable of causing ULCERATION of the intestines
→ which can lead to iron deficiency anemia (IDA)
▪ 0.8 - 8.6 ml of blood is loss per day per Trichuris (/day/trichuris)
▪ 0.005ml in other references
▪ Heavy worm burden may lead to prolapse of the rectum
(“RECTAL PROLAPSE”)

❖ GENERAL Symptoms
✓ Poor appetite
✓ Wasting
✓ Stunting
✓ Reduced intellectual and cognitive development in children
✓ Prognosis is very good

DIAGNOSIS OF TRICHURIS TRICHIURA

• DIRECT FECAL SMEAR (DFS)

1. Formed stooladd one drop of Normal Saline Solution In the slide
Watery stool no need
2. Spread the fecal sample on the slide
3. Microscopic Exam Observe for Ascaris egg and quantitate the ova
EPIDEMIOLOGY

─ 80-90% in rural areas

─ Favors temperate and tropical countries but more on warm, moist areas
─ 604 to 795 million are infected
─ Commonly seen in:
o 5 to 15 years old
o Pre-school & school-age children

TREATMENT PREVENTION AND CONTROL

─ Deworming
o 3x a year for 3 years (PALP DeworMing) – antithelmintic drugs
▪ Pyrantel Pamoate
▪ Albendazole
▪ Levamisole
▪ Piperazine salts
▪ Mebendazole
─ Sanitary disposal of feces
─ Personal hygiene
─ Avoid use of feces as fertilizer
─ Thorough cooking of food