Trichuris trichiura

( WHIP WORM )
IAN LOON GENALDO,MD
LECTURER
Trichuris trichiura:
 is
a soil transmitted helminths
 Holomyarian – based on the arrangement of
somatic muscle in a cross section. ( the cells are
small, numerous and closely packed in a narrow
zone ).
Parasite Biology: (Male Worms)
 measurement: 30 to 45 mm ( long )
 posterior end: coiled posterior with a single spicule and
a retractile sheath ( capable of drawn back or in ).
Male Worm:
Spicules:
Spicule protruding from
the spicular sheath at the
posterior end of a male (
worm )
Parasite Biology: (Female Worms)
 measurement: 35 to 50 mm
 BLUNT posterior end
Parasite Biology: Trichuris trichiura
 has attenuated anterior three – fifths.
- traverse by a narrow esophagus ( resembling a
string of beads ).
 Parasite Biology: Trichuris trichiura
 posterior two – fifths:
- contains: 1. intestine
2. single set of
reproductive
organs
Eggs:
 measurements: 50 um to 54 um by 23 um
 shape: lemon foot ball shape with plug – like translucent
polar prominences.
 outer: yellowish
 inner shell: transparent
Egg:
Fertilized egg – unsegmented at oviposition
 Embryonic development – takes place outside the host
when eggs are deposited in clayish soil.
Ascaris eggs VS Trichuris eggs in soil:
( comparison on dessication )

 Ascaris eggs – are resistant

 Trichuris eggs – are susceptible.
Life cycle: Trichuris trichiura
 important to note:
- Ascaris – HAS heart – lung migration
- Trichuris – NO heart – lung migration
 Life cycle: Trichuris trichiura
Embryonated eggs – INGESTED.
Small Intestine – larva hatch and
penetrate the intestinal villi.
( they remain for 3 to 10 days ).
Life cycle: Trichuris trichiura
 INHABIT – the Cecum and Colon – ( as ADULT
WORMS )
( worms secret a pore forming protein
called TT47 – allows them to imbed
their entire whip like portion into
the intestinal wall ).
Life cycle: Trichuris trichiura
 undergo Copulation.
 after copulation – female worms lay eggs.
 passed out with the feces and deposited
in the soil.

SOIL – under favorable condition

> eggs develop.
> become embryonated
( with in 2 to 3 weeks )
Pathogenesis and Clinical manifestions:
 Petechial hemorrhages – caused by the anterior portion
of the worm – embedded in the mucosa ( hyperemic and
edematous ).
 Enterorrhagia or intestinal
bleeding – common.
> predispose to Amoebic
dysentery.
- because the ulcers
provide suitable site
for tissue invasion by
Entamoeba histolytica.
Pathogenesis and Clinical manifestions:
 Appendicitis or Granuloma formation:
- the appendix ( lumen ) is filled with worms – result to
irritation ------- Inflammation.
Pathogenesis and Clinical manifestions:
 Trichuris Dysentery Syndrome – manifested by chronic
dysentery and a rectal prolapse.
- seen in patient with heavy intensity
infection.
( the worms maybe found throughout the
colon
and rectum ).
Rectal Prolapse:
Intensity of Infection:
 Important in understanding the clinical picture.
- e.g. infection with over 5,000 Trichuris trichiura
eggs per gram of feces – SYMPTOMATIC.
Intensity of Infection:
 Heavy Chronic Trichuriasis:
- frequent blood streaked diarrheal stool.
- abdominal pain
- nausea and vomiting
- weight loss
Intensity of Infection:
ANEMIA – strongly correlated to heavy intensity
Trichuriasis.
- blood loss ( from such infection )
- ( 0.8 to 8.6 ml/day )
children:
- > 800 worms ------- ANEMIA
Intensity of Infection:
 Light infection:
- moderately associated with anemia.
- usually ASYMPTOMATIC.
- presence of parasite maybe discovered only in
routine stool examinations.
Other Signs and Symptoms:
 poor appetite
 wasting (low weight-for-height )
 stunting (low height-for-age )
 reduced intellectual and cognitive development in
children
Other Signs and Symptoms:
Other Signs and Symptoms:
Prognosis:
 very good
Diagnosis:
 Clinical diagnosis – possible in very heavy chronic
trichuris infection.
 signs and symptoms:
1. frequent blood streaked diarrhea.
2. abdominal pains
3. rectal prolapse – adult worms attached to the rectal
mucosa.
Diagnosis:

 Light infections:
symptoms – are absent
Laboratory diagnosis - essential
 Laboratory Diagnosis:
 Direct Fecal Smear (DFS) – with a drop of saline solution.
 Kato Thick Smear Method – alternative diagnostic
technique.
- uses 20 to 60 mg of stool
sample.
- highly recommended in the
diagnosis
of Trichuriasis.
 Diagnosis: (Kato – Katz Technique)
 is a quantitative method.
 employs egg counting – to determine the intensity of
helminth infections.
 used to assess the efficacy of antihelminthic drugs in
terms of cure rates and egg reduction rate.
 used in epidemiological surveys to monitor helminth
control programs.
 single examination: for Trichuris detection - ( sensitivity:
91.4%; specificity: 94.4%)
Kato Thick and Kato – Katz Techniques:

 both are simple and low cost.

 has high sensitivity and specificity for the detection of
Trichuris egg as well as Eggs of other soil transmitted
helminths ( STH ).
Acid Ether Formalin – Ether/ Ethyl Acetate
Concentration Techniques:

Used for the diagnosis of Trichuriasis.

FLOTAC Technique:
 Shown to be more sensitive in the
diagnosis of trichuriasis compared to
kato katz and ether/ethyl acetate
concentration technique.
Treatment:
 Mebendazole – Drug of choice
- 100mg BID x 3 days.
- preparations: 500mg/tablet
oral suspension – 20mg/ml x 30 ml
- 50mg/ml x 10 ml

How to give?
1 dose treatment: 500mg to be taken as single dose
 3 day treatment: 5ml bid x 3 consecutive days
 20mg/ml suspension: 5ml bid x 3 consecutive days.
 50mg/ml suspension: 10ml in a single dose
Mebendazole: ( Antiox )
Albendazole:
 alternative drug.
Mebendazole VS Albendazole: (Cure rates)
 mebendazole 500mg/tablet once daily for 3 days shown
to have a highest cure rate ( 71% ) COMPARED to
Albendazole 400mg/tablet given once a day for 3 days
( 56% ).
Preventive Chemotherapy:
 Through mass drug administration:
- Mebendazole: given as a 500mg single dose
- Albendazole: is given as a 400 mg single dose.
Recent Local studies:
 It has been shown that:
- Albendazole in combination with Ivermectin ( a
drug used to treat filariasis ) exhibited better cure and
egg reduction rates than Albendazole alone.
Contraindications for Mebendazole and
Albendazoles:
 hypersensitivity
 early pregnancy ( with the first trimester )
Adverse effects:
 mild and transient:
- headache
- nausea and vomiting
- gastrointestinal discomfort
- itchiness
Deworming: ( children )
 improved and language development
 reduced malnutrition
 nutritional status and intellectual development have been
shown to improve after deworming
Epidemiology:
 Trichuriasis – occurs in both temperate and tropical
countries.
 more widely distributed in warm, moist areas of the
world.
 globally – approximately 604 to 795 million are
infected.
 most prevalent in east asia and pacific island regions
 least prevalent – middle east and north african region
Epidemiology: ( different age group )

 Children 5 to 15 years of age – are most frequently infected

and have highest intensity of infection.
 recent sentinel survey ( philippines ):
- PREVALENCE of Trichuris: ranged from 4.5 to 55.1 % in
preschool children.
- school aged children: 8.1 to 57.9%

> distribution of trichuris is similar to A. lumbricoides.

> Prevalence of coinfections with the two helminths is 19.1%.
( recent sentinel survey )
Prevention and Control:
 strategies for prevention and control of Trichuris infection are
similar to those for Ascaris infection.
 WHO recommendations:
- mebendazole 500 mg OR Albendazole 400 mg among
school aged children in communities where the prevalence of
STH infections is greater than 50%.
- Treatment of other High risk group:
- preschool children
- women of childbearing age
- pregnant women in the 2nd and 3rd
trimester.
- lactating women
- high risk occupation
Prevention and Control:
 communities with Soil Transmitted Helminths prevalence
of <50%.
- ONCE A YEAR treatment is recommended.
Prevention and Control: ( other strategies )
(Important in STH control)

Provision of safe water.

 Environmental sanitation
 Hygiene education
Referrences:
Medical Parasitology in the Philippines, 3rd edition
2015 by Vicente Belizario Jr.
 WHO
 Center for Disease and Prevention -
https://www.cdc.gov/dpdx/trichuriasis/index.html