TRICHURIS TRICHIURA

MD. Nguyễn Thị Thảo Linh

Email: nttlinh@ctump.edu.vn
 LEARNING OBJECTIVE : MỤC TIÊU

1. Describe morphology of adult worm and egg

2. Present life cycle
3. Describe epidemiology
4. Demonstrate pathogenicity clinical features
5. Study of laboratory diagnosis
6. Understand how to prevent disease
 INTRODUCTION OF TRICHURIS TRICHIURA

- belong to Nematode
- parasite in cecum and ascending colon
- Trichuris means a hair-like tail.
(But the anterior end of the worm is like-hair and
not the tail)
- common name whipworm
(whipworms is more appropriate
as the thick posterior part resembles the stock
and thin anterior end resemble the lash of a whip)
 Phylum Nemathelminthes (Nematoda)
General characteristics :
- Body shape: Elongated, cylindrical, unsegmented
- Body cavity: Present
- The digestive system is complete with month, pharynx, intestine, anus
- The sexes are separate (male and female)
- They have simple excretory and nervous systems
- requires one host in life cycle
 1. MORPHOLOGY
1. Trichuris trichiura adult
Body shape resembles a whip
the anterior three-fifth (⅗) thin and thread-like
the posterior two-fifth (⅖) thick and like the handle of a whip
● Male worm:

30 - 35 mm long

The posterior end is coiled ventrally

● Female worm:

40 - 50 mm long

The posterior end is straight, blunt and rounded.

-
 1. MORPHOLOGY
1. Trichuris trichiura adult

The anterior portion is attenuated (very thin)

contains the capillary esophagus (thực quản)

embed in the mucosa.

The posterior part contains the intestines and reproductive organ.

- The fertilized female lays about 5.000 eggs per day.

 1. MORPHOLOGY

2. Trichuris trichiura ova

- It is brown in color being bile-stained
- It is barrel-shaped.
- long x wide = 50 x 25 mcm
- a projecting mucus plug (nút nhầy) at each pole
- The mucus plugs are colourless
- When freshly passed, the eggs contain an unsegmented ovum.
→ not infective for human in this stage.
- The eggs floats in saturated salt solution *.
 Helminths whose eggs float in saturated salt solution
1. Enterobius vermicularis
2. Ancylostoma duodenale
3. Necator americanus
4. Ascaris lumbricoides
5. Trichuris trichiura
Helminths whose eggs do not float in saturated salt solution
1. Taenia solium and Taenia saginata
2. Intestinal flukes
3. Unfertilized eggs of Ascaris lumbricoides
 2. LIFE CYCLE

- Con trưởng thành - Phần đầu bám vào

- Giun tóc hút máu. - Giun cái đẻ trứng #
sống ở manh tràng và thành ruột, phần thân
0,005 ml/con 2.000 trứng/ngày.
ruột già. treo lơ lửng.

Người nuốt phải trứng

- Sau 3 - 4 tuần ở ngoại Giun non di chuyển
có ấu trùng, vào đến
cảnh, trứng phát triển xuống manh tràng và - Đời sống: 6 năm hoặc
ruột non ấu trùng thoát
thành phôi có tính ruột già và trưởng có thể lâu hơn
vỏ, đi vào các hốc ruột
nhiễm. thành, đẻ trứng.
phát triển ở đó 1 tuần
 2. LIFE CYCLE

- definitive host: man, no intermediate host

- infective form: Embryonated eggs contain
rhabditiform larva in contaminated food
or water
- lifespan: 1- 2 years
- development in soil (10 - 14 days)
- development in man
 2. LIFE CYCLE

1. Adult female worm lives in large intestine

Female worm lays eggs which are passed/ are
discharged in feces
2. The eggs undergoes development in soil,
optimally under warm, moist, shady conditions.
3. After 3 - 4 weeks, the rhabditiform larva
develops within the eggs.
These embryonated eggs can be infective to human.
 2. LIFE CYCLE

4. The embryonated eggs containing the rhabditiform larva /

infective larvae / in contaminated food or water are ingested.
5. In the small intestine, the eggs hatch the larva through the
pole of the eggs /mucus plugs.
→ passes down into cecum.
in about 2-3 months, they become mature adults and lie
embedded in the cecal wall.
+ the thread-like anterior portion piercing the mucosa
+ the thick posterior end projecting out.
The gravid adult female lays eggs after 3 months infection
The eggs are discharged in the feces and the cycle is repeated
 2. LIFE CYCLE

Notes:
+ The entire life cycle can be passed in one host.
From ingested infective eggs → to the development of
the adults → release of their eggs in feces.
+ For transmission of infection to other host and
perpetuation of the species, the eggs has to undergoes
development in soil and then infection another person.
+ Eggs starts appearing in the feces about 3 months
after infection
 3. EPIDEMIOLOGY / DỊCH TỄ HỌC
1. Phân bố / Geography distribution determined by:
- climate / khí hậu
- sanitation / vệ sinh
- human behavior / hành vi
Eggs are embryonated and become infective only on soil in warm, humid environment
2. Phương thức lây truyền/ Mode of transmission
- through contaminated drinking water
- through fresh vegetable
- hand to mouth through dirty finger
3. Yếu tố ảnh hưởng / predisposing factors
- environment / môi trường
- human behavior / hành vi con người
- genetic predisposition/khung hướng di truyền
- host immunity / miễn dịch của ký chủ
 4. PATHOGENICITY AND CLINICAL FEATURE

* Asymptomatic in light infection/ không triệu chứng

* Symptomatic in heavy load patient:

- abdominal pain as dysentery/ đau bụng kiểu lỵ
- diarrhea /tiêu chảy
- iron deficiency anemia/ thiếu máu
(not significant as in hookworm infection)
- undernutrition or growth retardation/ suy dinh dưỡng
- rectal prolapse (sa trực tràng)
 5. LABORATORY DIAGNOSIS
Detection of parasite: find eggs in stool microscopy
Shape:
- barrel or lemon shape
- thick shell
- bipolar protuberance / mucus plugs / nút nhầy less colour
- size: 50 x 25 mcm
 6. TREATMENT

● Anti parasitic drug:

- Albendazole 400 mg once
- Mebendazol (Vermox 100mg, Fugacar 100 mg)
100 mg twice daily for 3 days
- Mebendazole (Fugacar 500mg) one.
● Iron supplement: Anemia
 6. PROPHYLAXIS / PHÒNG BỆNH

- Prevention of fecal contamination of soil: proper disposal of

human feces
- Treatment vegetable with water containing iodine
- Make vegetable fresh to avoid eating eggs infection vegetable
- Improve personal hygiene: good hand & food hygiene
- Treatment infective children