Trichuris trichiura whip-worm

- Trichuriasis
- soil-transmitted helminth
- classified as HOLOMYARIAN (arrangement of somatic muscles in cross-section)
- Cells: small, numerous, & closely packed in a narrow zone
- First described by Linnaeus (1771)
- 71 species
Habitat Host Infective form Diagnostic form
LARGE INSTESTINE
(cecum & appendix) ONLY HUMANS EMBRYONATED EGGS (in soil) UNEMBRYONATED EGGS (in feces/stool)

Mode of Transmission Laboratory Diagnosis Pathogenicity Treatment

• Ingestion of contaminated food and water Stool examination – detects barrel-shaped eggs • Patients with low intensity infection: ASYMPTOMATIC • Mebendazole (drug of choice): 500mg
containing EMBRYONATED eggs with mucus plugs at the ends • Patients with high intensity infection: once a day for 3 days
• Ingestion of soil through contaminated - Dysentery syndrome alternative: Albendazole (400mg once a day for 3
hands • DFS with a drop of saline  manifested by chronic diarrhea & rectal prolapse days)
alternative: Kato cellophane thick smear - Anemia
- Adult female worm: gets buried in the large intestinal mucosa that leads to:
• Kato-Katz technique (quantitative o Mechanical distortion
method): egg counting to determine the o Allergic response
intensity
• Acid-ether & formalin-ether / ethyl Incubation period: 70 – 90 days
acetate concentration techniques
Heavy Chronic:
• Preservative: Formalin - frequent blood-streaked diarrheal stools
- abdominal pain
Adult Worms: Proctoscopy - nausea & vomiting
- weight loss

Common Manifestations:
- Dysentery syndrome (bloody / mucoid diarrhea)
- Iron deficiency anemia (due to blood loss)
- Recurrent rectal prolapse (malnutrition)
- Growth retardation & impaired cognitive function

MORPHOLOGY
Adult Worm (whip-shaped) Egg
GENERAL CHARACTERISTICS: SHAPE
o Anterior: 3/5, thin hair-like (like rope of a whip) o Lemon
o Posterior: 2/5, short and thick (intestine & single set of reproductive organs) o Football 4 LAYERS (VCAB)
o Barrel
MALE FEMALE - with plug-like translucent polar prominence (protruding mucus plug) o Vitelline membrane
- whitish - longer - Japanese lantern ova o Chorionic / True shell
- 30 – 45 𝑚𝑚 - 30 – 50 𝑚𝑚 - Bile-stained; yellowish brown (saline mount) o Albuminous covering
- Coiled posterior end with a single spicule - Bluntly rounded posterior end: comma / o outer: yellowish o Bile-stained layer
and retractile sheath arc-shaped (like a handle of a whip) o inner: transparent shell

- UNEMBRYONATED: when firstly passed (non-infectious)

Fertilized eggs: unsegmented at oviposition (oviparous)

Embryonic development: outside the host when eggs are deposited in clayish soil
 Capillaria philippinensis smaller whip-worm
- Capillariasis
- First human infection: reported by Chitwood et al. (1963)
 29-year-old male from Northern Luzon
- Zoonotic disease
Habitat Host Infective form Diagnostic form
DEFINITIVE HOST:
o Fish-eating birds (natural hosts & reservoir)

ACCIDENTAL / INCIDENTAL HOST:

SMALL INSTESTINE Infective LARVAE UNEMBRYONATED EGGS (in feces/stool)
o Humans

INTERMEDIATE HOST:
o Fresh / salt water fish (containing larval stage)
Mode of Transmission Laboratory Diagnosis Pathogenicity Treatment
• Ingestion of undercooked or pickled fishes Stool examination – detects peanut-shaped eggs USUAL SYMPTOMS: In severe cases with Electrolyte and Protein loss
containing the infective LARVAE o Abdominal pain - Electrolyte replacement
• DFS / Wet mount o Borborygmi (gurgling stomach) - High protein diet
• Stool concentration methods o Chronic diarrhea • Anthelminthic drugs

Disease may also associated with: • Mebendazole (drug of choice): 200mg twice a
Other Studied Diagnosis: - Protein losing enteropathy day for 20 days
- sandwich ELISA (coproantigen detection) - Electrolyte imbalance
- ELISA using T. spiralis antigen - Intestinal malabsorption alternative: Albendazole (400mg once daily for 10 days)

Severe disease: can result to death

SEVERE WORM LOAD

o Intestinal inflammation
o Eosinophilic granuloma
o Loss of villi
o Crypt proliferation

MORPHOLOGY
Adult Worm Egg
GENERAL CHARACTERISTICS: - Peanut-shaped with striated thick shells and flattened bipolar plugs (not
o Anterior: thin filamentous end protruding)
o Posterior: slightly thicker & shorter end - 36 – 45 𝑥 20 𝜇𝑚

UNIQUE FEATURES:
o Stichocytes: rows of secretory cells in the esophagus
o Stichosome: entire esophageal structure

MALE FEMALE
- 1.5 – 3.9 𝑚𝑚 - 2.3 – 5.3 𝑚𝑚
- Spicule: 230 – 300 𝜇𝑚 long and has an unspined
sheath
 Enterobius vermicularis pin worm ; thread worm ; seat worm ; societal worm
- causes Enterobiasis / Oxyuriasis
- First described by Leuckart (1865)
- can cause complications in ectopic areas
- classified as MEROMYARIAN
- Cells: 2 – 5 cells per dorsal or ventral half
- most common identified in temperature regions (where environmental sanitation is in place)
Habitat Host Infective form Diagnostic form
LARGE INSTESTINE
ONLY HUMANS EMBRYONATED EGGS UNEMBRYONATED EGGS
(cecum, appendix, & adjacent portion of colon)
Mode of Transmission Laboratory Diagnosis Pathogenicity Treatment
• Ingestion of eggs contaminated with fingers Microscopic examinations – detects planoconvex eggs containing Most infection are ASYMPTOMATIC • drug of choice: Mebendazole (100mg PO single
due to inadequate hand washing or nail- larvae Symptomatic patients: dose)
biting habit o Females, children, and young adults • Albendazole (400mg PO single dose)
• Autoinfection: o Cellophane Tape Method • secondary drug of choice: Pyrantel pamoate
o Endogenous: retrograde migration - collected in the morning before child goes for bath - Irritation of the perianal region (11mg/kg base PO single dose)
of the larva hatched from the eggs o NIH Swab Method - Intense itching
in the perianal skin - consists of a glass rod attached to a cellophane tape by a rubber - Insomnia due to pruritus
band Enuresis (bed wetting)
o Exogenous: eggs cause intense -
irritation of the perianal skin and - Poor appetite, weight loss, irritability, grinding of
scrapping of the area leads to Graham’s scotch adhesive tape swab (perianal cellulose tape swab) teeth & abdominal pain
contaminated finger - Highest percentage of positive result
- Greatest number of eggs seen Nocturnal Perianal itching or Pruritus ani
• Inhalation of the airborne eggs (rare)

MORPHOLOGY
Adult Worm Egg
- found in the cecum and adjacent portion of the small and large intestines SHAPE
o Asymmetrical
GENERAL CHARACTERISTICS: o D-shaped
o Anterior: cuticular alar expansions o Oval
o Posterior: prominent esophageal bulb o Planoconvex
 (one side is plain and the other side is flat because it is compressed laterally)
MALE FEMALE - 50 – 60 𝑥 20 – 30 𝜇𝑚
- 2 – 5 𝑥 0.1 – 0.2 𝑚𝑚 - 8 – 13 𝑥 0.4 𝑚𝑚 - surrounded by a double layered translucent shell
- has a curved tail and bears a copulatory - has a long-pointed tail (tapering, straight, or thin) o outer: triple albuminous covering for mechanical protection
bursa with a single spicule o inner: embryonic lipoidal membrane for chemical protection
- DIES after fertilization - contains a tadpole larvae inside
o Rhabditiform larva (140 – 150 𝑥 10 𝜇𝑚)

EMBRYONATED – when passed fresh

 Ascaris lumbricoides round worm
- Ascariasis
- giant / largest
- Askaris (intestinal worm) ; Lumbricus (common earthworm)
- soil-transmitted helminth (STH)
- POLYMYARIAN
- Cells: numerous and project well into the body cavity
- produces Pepsin Inhibitor 3 (PI-3): protects worms from digestion ; Phosphorylcholine (suppresses lymphocyte proliferation)
Habitat Host Infective form Diagnostic form
• FERTILIZED EGGS
SMALL INSTESTINE
ONLY HUMANS EMBRYONATED EGGS (containing 𝑳𝟐 larvae) • UNFERTILIZED EGGS
(85% jejunum ; 15% ileum)
• ADULT WORM
Mode of Transmission Laboratory Diagnosis Pathogenicity Treatment
• Ingestion of EMBRYONATED eggs from EGG detection (stool examination) Majority infections are ASYMPTOMATIC Administration of anthelmintic drugs
the contaminated soil, food, and water • DFS
• Kato thick Smear ADULT WORM • Mebendazole
• Kato-Katz techniques • Malnutrition & growth retardation • Albendazole
• FECT (concentration technique) • Allergic manifestations • Pyrantel pamoate (pregnancy)
o Fever
ADULT WORM detection (stool / sputum) o Urticaria alternative: Ivermectin & Nitazoxanide
• Barium meal X-ray o Angioneurotic edema
• Troller car lines o Conjunctivitis
• Ultrasound (USG)  occur due to toxic fluid (ascaron /
• Cholangiopancreatography ascarase)

LARVA detection (sputum / gastric aspirates) MIGRATING LARVA

• Pneumonia & bronchospasm
Serology (antibody detection) • Bolus formation
• ELISA, IFA, IHA test
ECTOPIC MIGRATION
Other findings: eosinophilia & Charcot Leyden crystals (sputum & • Appendix
stool) • Bile duct
• Pancreatic duct
MORPHOLOGY
Adult Worm Egg
GENERAL CHARACTERISTICS: FERTILIZED UNFERTILIZED
- pinkish creamy (freshly passed from intestine) to whitish - brownish, ovoid, 45 – 70 𝑥 35 – 50 𝜇𝑚 - elongated, 88 – 94 𝑥 39 – 44 𝜇𝑚
- head / terminal mouth: 3 lips with minute teeth or denticles (1 dorsal ; 2 ventral) - shorter and broad / round - longer and narrower
- cylindrical with tapering ends ; has a thick cuticle - has an outer, coarsely mamillated albuminous - thin shell and irregular mamillated coating filled
- Body cavity: ascaron / ascarase – characteristic fluid that is irritant in nature and if leaked it can cause allergic coat (absent or lost in “ decorticated ” eggs) with refractile granules
manifestations) - has a thick, transparent, hyaline shell - difficult to identify
 thick outer layer (supporting structure) - uninseminated (absence of males)
MALE FEMALE
 - 10 − 13 𝑐𝑚 - 22 − 35 𝑐𝑚  delicate vitelline, lipoidal, inner - non-embryonated
- has a curved tail with 2 broad spicules - has a straight & pointed tail membrane (highly impermeable) - 2 – 5 infections
(for copulation) - paired reproductive organs
- single, long, tortuous tubule - Vulva: at the junction of anterior & middle third of the body - ovoid mass of protoplasm: develop into larvae in
(on the ventral surface)  Vulvar waist about 14 days
Rectum & genital duct: open together at cloaca near - produces about 200,000 eggs/day (decreases with increase worm
the posterior end load)

Anus: sub-terminal & situated posteriorly Larva may be seen in the lungs (2𝑚𝑚 𝑥 55 𝜇𝑚)