Infections caused by Nematodes
TRICHURIASIS
It is a parasitic disease caused by Trichuris trichiura (whipworm) infection which belongs to phylum: Nematoda,
genus: Trichuris. It is one of the most common intestinal parasites of humans in tropical areas.
OCCURRENCE
Trichuris trichiura is a soil-transmitted helminth. It is prevalent in warm, moist, tropical and subtropical regions of
the world with poor sanitation (e.g. Sub-Saharan Africa, India, China, a large part of Asia, Latin America and
Caribbean and Middle Eastern Crescent).
CYCLE OF INFECTION
Causative agent: Trichuris trichiura (T. trichiura)
Habitat
Adults inhabit the large intestine of man mainly the caecum, less commonly the appendix and colon. They are
deeply embedded by their anterior thin portions in the mucosa.
Morphology (Figures 1& 2)
Life cycle and mode of transmission (Figure 3)
Female worms lay about 1000-7000 eggs daily that are unsegmented when passed in the feces of infected
persons. Fertilized eggs are barrel-shaped, brownish with pale polar mucoid like plugs. In humid shady soil, the
eggs become larvated in 2-3 weeks. This period may be delayed to several months in cool atmosphere.
Larvated eggs are the infective stage. Human infection results from the ingestion of the larvated eggs
contaminating the hands or food. Children are more susceptible. In the small intestine, larvae are liberated,
enter the intestinal crypts for few days where they molt and grow, then come out and migrate to their final
habitat in the caecum where they mature in about one month embedding their thin anterior part in the
mucosa and start to lay eggs after about three months. Adults live for many years in the human intestine.
Figure 3: Life cycle of T. trichiura
PATHOGENESIS
Adult T. trichiura introduces their anterior region into the intestinal mucosa, mainly in the caecum where
they prevalently reside. However, during severe T. trichiura infections, worms colonize the entire intestine
down to the rectal region. They may cause significant trauma to the mucosa resulted in cell destruction,
tissue damage and activation of the host immune system. They are capable of causing anemia, which is due
to malnutrition and blood loss from the friable colon and is unrelated to blood ingestion by the parasite.
CLINICAL PICTURE
It is usually asymptomatic. Heavy whipworm infection may cause Trichuris dysenteric syndrome (TDS)
especially in young children. This syndrome is characterized by mucoid diarrhea, rectal bleeding causing
chronic iron-deficiency anemia with malnutrition and growth retardation. Also, rectal prolapse complicated
with severe bacterial secondary infection may occur.
In adults, heavy trichuriasis can result either in TDS or in a chronic colitis that shares many clinical features
with other bowel diseases such as Crohn’s disease or ulcerative colitis; worms can also spread proximally
and may cause ileitis and appendicitis.
DIAGNOSIS
Stool analysis; demonstrates the characteristic eggs in stools.
Proctoscopy; reveals worms attached to a reddened, ulcerated mucosa (Figure 4).
Blood count
Complete blood count (CBC) is done to check for anemia.
TREATMENT
Albendazole: is the drug of choice given orally in a single dose of 400 mg
Mebendazole: 100 mg twice daily for 3– 7 days
Flubendazole: 100 mg twice daily for 3– 7 days.
Iron supplement may be needed for the correction of anemia.
PREVENTION & CONTROL
1. Prevent defecation in soil through health education and sanitary disposal of sewage.
2. Avoid the use of human excreta as soil fertilizer.
3. Careful cleaning of the hands and vegetables.
4. Control of the house flies.
