Trichuriasis

Last updated
Trichuriasis
Other namesWhipworm infection
Trichuriasis lifecycle.jpg
Life cycle of Trichuris trichiura
Specialty Infectious disease
Symptoms Abdominal pain, tiredness, diarrhea [1]
Complications Anemia, poor intellectual and physical development [1] [2]
CausesEat food containing Trichuris trichiura eggs [2]
Diagnostic method Stool microscopy [3]
PreventionImproved sanitation, handwashing, mass treatment [4] [5]
Medication Albendazole, mebendazole, ivermectin [6]
Frequency464 million (2015) [7]

Trichuriasis, also known as whipworm infection, is an infection by the parasitic worm Trichuris trichiura (whipworm). [2] If infection is only with a few worms, there are often no symptoms. [1] In those who are infected with many worms, there may be abdominal pain, fatigue and diarrhea. [1] The diarrhea sometimes contains blood. [1] Infections in children may cause poor intellectual and physical development. [1] Low red blood cell levels may occur due to loss of blood. [2]

Contents

The disease is usually spread when people eat food or drink water that contains the eggs of these worms. [1] This may occur when contaminated vegetables are not fully cleaned or cooked. [1] Often these eggs are in the soil in areas where people defecate outside and where untreated human feces is used as fertilizer. [2] These eggs originate from the feces of infected people. [1] Young children playing in such soil and putting their hands in their mouths also become infected easily. [1] The worms live in the large bowel and are about four centimetres in length. [2] Whipworm is diagnosed by seeing the eggs when examining the stool with a microscope. [3] Eggs are barrel-shaped. [8] Trichuriasis belongs to the group of soil-transmitted helminthiases. [9]

Prevention is by properly cooking food and hand washing before cooking. [5] Other measures include improving access to sanitation such as ensuring use of functional and clean toilets [5] and access to clean water. [10] In areas of the world where the infections are common, often entire groups of people will be treated all at once and on a regular basis. [4] Treatment is with three days of the medication: albendazole, mebendazole or ivermectin. [6] People often become infected again after treatment. [11]

Whipworm infection affected about 464 million in 2015. [7] It is most common in tropical countries. [4] Those infected with whipworm often also have hookworm and ascariasis infections. [4] These diseases have a large effect on the economy of many countries. [12] Work is ongoing to develop a vaccine against the disease. [4] Trichuriasis is classified as a neglected tropical disease. [9]

Signs and symptoms

Light infestations (<100 worms) frequently have no symptoms. Heavier infestations, especially in small children, can present gastrointestinal problems including abdominal pain and distension, bloody or mucus-filled diarrhea, and tenesmus (feeling of incomplete defecation, generally accompanied by involuntary straining). Mechanical damage to the intestinal mucosa may occur, as well as toxic or inflammatory damage to the intestines of the host. While appendicitis may be brought on by damage and edema of the adjacent tissue, if there are large numbers of worms or larvae present, it has been suggested that the embedding of the worms into the ileocecal region may also make the host susceptible to bacterial infection. A severe infection with high numbers of embedded worms in the rectum leads to edema, which can cause rectal prolapse, although this is typically only seen in small children. The prolapsed, inflamed and edematous rectal tissue may even show visible worms.[ citation needed ]

Physical growth delay, weight loss, nutritional deficiencies, and anemia (due to long-standing blood loss) are also characteristic of infection, and these symptoms are more prevalent and severe in children. It can cause eosinophilia but it is not common. [13]

Coinfection of T. trichiura with other parasites is common and with larger worm burdens can cause both exacerbation of dangerous trichuriasis symptoms such as massive gastrointestinal bleeding (shown to be especially dramatic with coinfection with Salmonella typhi ) and exacerbation of symptoms and pathogenesis of the other parasitic infection (as is typical with coinfection with Schistosoma mansoni , in which higher worm burden and liver egg burden is common). Parasitic coinfection with HIV/AIDS, tuberculosis, and malaria is also common, especially in sub-Saharan Africa, and helminth coinfection adversely affects the natural history and progression of HIV/AIDS, tuberculosis, and malaria and can increase clinical malaria severity. In a study performed in Senegal, infections of soil-transmitted helminths like T. trichiura (as well as schistosome infections independently) showed enhanced risk and increased the incidence of malaria. [14]

Heavy infestations may have bloody diarrhea. Long-standing blood loss may lead to iron-deficiency anemia. [15] Vitamin A deficiency may also result due to infection. [16]

Cause

Trichuriasis is caused by a parasitic worm also known as a helminth called Trichuris trichiura . It belongs to the genus Trichuris , formerly known as Trichocephalus, meaning hair head, which would be a more accurate name; however the generic name is now Trichuris, which means hair tail (implying that the posterior end of the worm is the attenuated section). Infections by parasitic worms are known as helminthiasis.[ citation needed ]

Reservoir

Humans are the main, but not the only reservoir for T. trichiura. Recent research verified by the application of molecular techniques (PCR) that dogs are a reservoir for T. trichiura, as well as T. vulpis. [17]

Vector

Non-biting cyclorrhaphan flies (Musca domestica, M. sorbens, Chrysomya rufifacies, C. bezziana, Lucina cuprina, Calliphora vicina and Wohlfarthia magnifica) have been found to carry Trichuris trichiura. A study in two localized areas in Ethiopia found cockroaches were carriers for several human intestinal parasites, including T. trichiura.[ citation needed ]

Transmission

Humans can become infected with the parasite due to ingestion of infective eggs by mouth contact with hands or food contaminated with egg-carrying soil. However, there have also been rare reported cases of transmission of T. trichiura by sexual contact. Some major outbreaks have been traced to contaminated vegetables (due to presumed soil contamination).[ citation needed ]

Life cycle

Unembryonated eggs (unsegmented) are passed in the feces of a previous host to the soil. In the soil, these eggs develop into a 2-cell stage (segmented egg) and then into an advanced cleavage stage. Once at this stage, the eggs embryonate and then become infective, a process that occurs in about 15 to 30 days). Next, the infective eggs are ingested by way of soil-contaminated hands or food and hatch inside the small intestine, releasing larvae into the gastrointestinal tract. These larvae burrow into a villus and develop into adults (over 2–3 days). They then migrate into the cecum and ascending colon where they thread their anterior portion (whip-like end) into the tissue mucosa and reside permanently for their year-long lifespan. About 60 to 70 days after infection, female adults begin to release unembryonated eggs (oviposit) into the cecum at a rate of 3,000 to 20,000 eggs per day, linking the life cycle to the start.[ citation needed ]

Incubation period

Morphology

Trichuris trichiura egg Trichuris trichiura egg (01).tif
Trichuris trichiura egg

Adult worms are usually 3–5 centimetres (1.2–2.0 in) long, with females being larger than males as is typical of nematodes. The thin, clear majority of the body (the anterior, whip-like end) is the esophagus, and it is the end that the worm threads into the mucosa of the colon. The widened, pinkish gray region of the body is the posterior, and it is the end that contains the parasite's intestines and reproductive organs. T. trichiura eggs are prolate spheroids, the shape of the balls used in Rugby and Gridiron football. They are about 50–54  μm (0.0020–0.0021 in) long and have polar plugs (also known as refractile prominences) at each end.[ citation needed ]

Diagnosis

A stool ova and parasites exam reveals the presence of typical whipworm eggs. Typically, the Kato-Katz thick-smear technique is used for identification of the Trichuris trichiura eggs in the stool sample. Trichuria eggs often appear larger and more swollen on Kato-Katz preparation compared to when using other techniques. [18]

Although colonoscopy is not typically used for diagnosis, as the adult worms can be overlooked, especially with imperfect colon, there have been reported cases in which colonoscopy has revealed adult worms. Colonoscopy can directly diagnose trichuriasis by identification of the threadlike form of worms with an attenuated, whip-like end. Colonoscopy has been shown to be a useful diagnostic tool, especially in patients infected with only a few male worms and with no eggs presenting in the stool sample. [19]

Trichuriasis can be diagnosed when T. trichiura eggs are detected in stool examination. Eggs will appear barrel-shaped and unembryonated, having bipolar plugs and a smooth shell. [20] Rectal prolapse can be diagnosed easily using defecating proctogram and is one of many methods for imaging the parasitic infection. Sigmoidoscopys show characteristic white bodies of adult worms hanging from inflamed mucosa ("coconut cake rectum"). [21]

Prevention

Deworming

Limited access to essential medicine poses a challenge to the eradication of trichuriasis worldwide. Also, it is a public health concern that rates of post-treatment re-infection need to be determined and addressed to diminish the incidence of untreated re-infection. Lastly, with mass drug administration strategies and improved diagnosis and prompt treatment, detection of an emergence of antihelminthic drug resistance should be examined.[ citation needed ]

Mass Drug Administration (preventative chemotherapy) has had a positive effect on the disease burden of trichuriasis in East and West Africa, especially among children, who are at highest risk for infection.[ citation needed ]

Sanitation

Infection can be avoided by proper disposal of human feces, avoiding fecal contamination of food, not eating soil, and avoiding crops fertilized with untreated human feces. Simple and effective proper hygiene such as washing hands and food is recommended for control.[ citation needed ]

Improved facilities for feces disposal have decreased the incidence of whipworm. Handwashing before food handling, and avoiding ingestion of soil by thorough washing of food that may have been contaminated with egg-containing soil are other preventive measures. In addition to washing, it is also advisable to peel and/or cook fruits and vegetables. Improvement of sanitation systems, as well as improved facilities for feces disposal, have helped to limit defecation onto soil and contain potentially infectious feces from bodily contact. [22]

A study in a Brazilian urban centre demonstrated a significant reduction in prevalence and incidence of soil-transmitted helminthiasis, including trichuriasis, following implementation of a citywide sanitation program. A 33% reduction in the prevalence of trichuriasis and a 26% reduction in the incidence of trichuriasis was found in a study performed on 890 children ages 7–14 years old within 24 different sentinel areas chosen to represent the varied environmental conditions throughout the city of Salvador, Bahia, Brazil. Control of soil fertilizers has helped eliminate the potential for contact of human fecal matter and fertilizer in the soil.

Treatment

Trichuriasis is treated with benzimidazole anthelmintic agents such as albendazole or mebendazole, sometimes in conjunction with other medications.[ citation needed ]

Mebendazole is 90% effective in the first dose. Higher clearance rates can be obtained by combining mebendazole or albendazole with ivermectin. [23] The safety of ivermectin in children under 15 kg (33 lb) and pregnant women has not yet been established.

In people with diarrhea, loperamide may be added to increase the contact time between anthelmintic agents and the parasites. Oral iron supplementation may be useful in treating the iron-deficiency anemia which often accompanies trichuriasis.[ citation needed ]

Epidemiology

Disability-adjusted life year for trichuriasis per 100,000 inhabitants in 2004 .mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column} .mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{} no data less than 5 5-10 10-15 15-20 20-25 25-30 30-35 35-40 40-45 45-50 50-60 more than 60 Trichuriasis world map - DALY - WHO2004.svg
Disability-adjusted life year for trichuriasis per 100,000 inhabitants in 2004
  no data
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  10-15
  15-20
  20-25
  25-30
  30-35
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  45-50
  50-60
  more than 60

Regions

Infection of T. trichiura is most frequent in areas with tropical weather and poor sanitation practices. Trichuriasis occurs frequently in areas in which untreated human feces is used as fertilizer or where open defecation takes place. Trichuriasis infection prevalence is 50 to 80 percent in some regions of Asia (noted especially in China and Korea) and also occurs in rural areas of the southeastern United States.[ citation needed ]

Infection estimates

T. trichiura is the third most common nematode (roundworm) infecting humans. Infection is most prevalent among children, and in North America, infection occurs frequently in immigrants from tropical or sub-tropical regions. It is estimated that 600–800 million people are infected worldwide, with 3.2 billion individuals at risk because they live in regions where this intestinal worm is common.[ citation needed ]

History

The first written record of T. trichiura was made by the Italian anatomist Giovanni Battista Morgagni, who identified the presence of the parasite in a case of worms residing in the colon in 1740.[ citation needed ] An exact morphological description and accurate drawings were first recorded in 1761 by Johann Georg Roederer, a German physician.[ citation needed ] Soon after, the name Trichuris trichiura was given to this species.

Synonyms

Human whipworm, trichocephaliasis, and tricuriasis are all synonyms for trichuriasis, human infection of the T. trichiura intestinal nematode. In Spanish, trichuriasis is called tricuriasis, while in it is known as trichuriose in French and Peitschenwurmbefall in German.[ citation needed ]

Research

Development of subunit vaccines requires the identification of protective antigens and their formulation in a suitable adjuvant. Trichuris muris is an antigenically similar laboratory model for T. trichiura. Subcutaneous vaccination with adult excretory–secretory products (ES) protects susceptible mouse strains from T. muris. Larval stages may contain novel and more relevant antigens which when incorporated in a vaccine induce worm expulsion earlier in infection than the adult worm products. Nematode vaccines marketed to date have been of the irradiated larval type and used exclusively for the treatment of animals. These vaccines are not stable and require annual production, involving the yearly production and sacrifice of donor animals for passage. There has been much interest in the production of subunit vaccines against human and agricultural parasites since the early 1980s. Development of subunit vaccines requires the identification of protective antigens and their formulation with a suitable adjuvant to stimulate the immune response appropriately.[ citation needed ]

Related Research Articles

<i>Trichuris trichiura</i> Parasitic roundworm that causes intestinal infection

Trichuris trichiura, Trichocephalus trichiuris or whipworm, is a parasitic roundworm that causes trichuriasis when it infects a human large intestine. It is commonly known as the whipworm which refers to the shape of the worm; it looks like a whip with wider "handles" at the posterior end.

<span class="mw-page-title-main">Ascariasis</span> Disease caused by the parasitic roundworm Ascaris lumbricoides

Ascariasis is a disease caused by the parasitic roundworm Ascaris lumbricoides. Infections have no symptoms in more than 85% of cases, especially if the number of worms is small. Symptoms increase with the number of worms present and may include shortness of breath and fever in the beginning of the disease. These may be followed by symptoms of abdominal swelling, abdominal pain, and diarrhea. Children are most commonly affected, and in this age group the infection may also cause poor weight gain, malnutrition, and learning problems.

<span class="mw-page-title-main">Helminthiasis</span> Any macroparasitic disease caused by helminths

Helminthiasis, also known as worm infection, is any macroparasitic disease of humans and other animals in which a part of the body is infected with parasitic worms, known as helminths. There are numerous species of these parasites, which are broadly classified into tapeworms, flukes, and roundworms. They often live in the gastrointestinal tract of their hosts, but they may also burrow into other organs, where they induce physiological damage.

<span class="mw-page-title-main">Hookworm infection</span> Disease caused by intestinal parasites

Hookworm infection is an infection by a type of intestinal parasite known as a hookworm. Initially, itching and a rash may occur at the site of infection. Those only affected by a few worms may show no symptoms. Those infected by many worms may experience abdominal pain, diarrhea, weight loss, and tiredness. The mental and physical development of children may be affected. Anemia may result.

<i>Necator americanus</i> Species of hookworm

Necator americanus is a species of hookworm commonly known as the New World hookworm. Like other hookworms, it is a member of the phylum Nematoda. It is an obligatory parasitic nematode that lives in the small intestine of human hosts. Necatoriasis—a type of helminthiasis—is the term for the condition of being host to an infestation of a species of Necator. Since N. americanus and Ancylostoma duodenale are the two species of hookworms that most commonly infest humans, they are usually dealt with under the collective heading of "hookworm infection". They differ most obviously in geographical distribution, structure of mouthparts, and relative size.

<i>Echinococcus multilocularis</i> Species of flatworm

Echinococcus multilocularis, the fox tapeworm, is a small cyclophyllid tapeworm found extensively in the northern hemisphere. E. multilocularis, along with other members of the Echinococcus genus, produce diseases known as echinococcosis. Unlike E. granulosus,E. multilocularis produces many small cysts that spread throughout the internal organs of the infected animal. The resultant disease is called Alveolar echinococcosis, and is caused by ingesting the eggs of E. multilocularis.

<span class="mw-page-title-main">Parasitic worm</span> Large type of parasitic organism

Parasitic worms, also known as helminths, are large macroparasites; adults can generally be seen with the naked eye. Many are intestinal worms that are soil-transmitted and infect the gastrointestinal tract. Other parasitic worms such as schistosomes reside in blood vessels.

<span class="mw-page-title-main">Helminthic therapy</span> Deliberate infestation with parasitic worms

Helminthic therapy, an experimental type of immunotherapy, is the treatment of autoimmune diseases and immune disorders by means of deliberate infestation with a helminth or with the eggs of a helminth. Helminths are parasitic worms such as hookworms, whipworms, and threadworms that have evolved to live within a host organism on which they rely for nutrients. These worms are members of two phyla: nematodes, which are primarily used in human helminthic therapy, and flat worms (trematodes).

<i>Ancylostoma duodenale</i> Species of the roundworm genus Ancylostoma

Ancylostoma duodenale is a species of the roundworm genus Ancylostoma. It is a parasitic nematode worm and commonly known as the Old World hookworm. It lives in the small intestine of hosts such as humans, cats and dogs, where it is able to mate and mature. Ancylostoma duodenale and Necator americanus are the two human hookworm species that are normally discussed together as the cause of hookworm infection. They are dioecious. Ancylostoma duodenale is abundant throughout the world, including Southern Europe, North Africa, India, China, southeast Asia, some areas in the United States, the Caribbean, and South America.

The soil-transmitted helminths are a group of intestinal parasites belonging to the phylum Nematoda that are transmitted primarily through contaminated soil. They are so called because they have a direct life cycle which requires no intermediate hosts or vectors, and the parasitic infection occurs through faecal contamination of soil, foodstuffs and water supplies. The adult forms are essentially parasites of humans, causing soil-transmitted helminthiasis (STH), but also infect domesticated mammals. The juveniles are the infective forms and they undergo tissue-migratory stages during which they invade vital organs such as lungs and liver. Thus the disease manifestations can be both local and systemic. The geohelminths together present an enormous infection burden on humanity, amounting to 135,000 deaths every year, and persistent infection of more than two billion people.

<i>Trichuris</i> Genus of roundworms

Trichuris, often referred to as whipworms, is a genus of parasitic worms from the roundworm family Trichuridae, which are helminths. The name whipworm refers to the shape of the worm; they look like whips with wider "handles" at the posterior end. The name Trichocephalus is sometimes used for this genus.

<span class="mw-page-title-main">Ancylostomiasis</span> Medical condition

Ancylostomiasis is a hookworm disease caused by infection with Ancylostoma hookworms. The name is derived from Greek ancylos αγκύλος "crooked, bent" and stoma στόμα "mouth".

Necatoriasis is the condition of infection by Necator hookworms, such as Necator americanus. This hookworm infection is a type of helminthiasis (infection) which is a type of neglected tropical disease.

<i>Toxocara canis</i> Species of roundworm

Toxocara canis is a worldwide-distributed helminth parasite that primarily infects dogs and other canids, but can also infect other animals including humans. The name is derived from the Greek word "toxon," meaning bow or quiver, and the Latin word "caro," meaning flesh. T. canis live in the small intestine of the definitive host. This parasite is very common in puppies and somewhat less common in adult dogs. In adult dogs, infection is usually asymptomatic but may be characterized by diarrhea. By contrast, untreated infection with Toxocara canis can be fatal in puppies, causing diarrhea, vomiting, pneumonia, enlarged abdomen, flatulence, poor growth rate, and other complications.

<i>Trichuris suis</i> Species of roundworm

Trichuris suis is a whipworm; the variations in thickness of the anterior and posterior segments give the parasite the characteristic "whip-like" appearance. Adult females measure 6 to 8 cm and adult males 3 to 4 cm. T. suis eggs are oval and yellow-brown with bipolar plugs. T. suis is also used in helminthic therapy studies.

<span class="mw-page-title-main">Pinworm infection</span> Medical condition

Pinworm infection, also known as enterobiasis, is a human parasitic disease caused by the pinworm, Enterobius vermicularis. The most common symptom is itching in the anal area. The period of time from swallowing eggs to the appearance of new eggs around the anus is 4 to 8 weeks. Some people who are infected do not have symptoms.

Trichuris vulpis is a whipworm that lives in the large intestine of canines in its adult stages. Out of different types of worms, Trichuris vulpis is one of the smaller worms with a size ranging from 30–50 mm in length. As the name suggests, the worm has a whip-like shape with distinct features including a small, narrow anterior head, which is the digestive part of the worm, and a larger posterior tail, which is the reproductive part of the worm. Eggs from T. vulpis are oval shaped with bipolar plugs and contain a thick outer shell. Their sizes range from 72–90 μm in length and 32–40 μm in width. Because of their thick outer shell, T. vulpis eggs are very resistant to environmental extremes such as freezing or hot temperatures, thus allowing for their long viability in the outside world.

<span class="mw-page-title-main">Anthelmintic</span> Antiparasitic drugs that expel parasitic worms (helminths) from the body

Anthelmintics or antihelminthics are a group of antiparasitic drugs that expel parasitic worms (helminths) and other internal parasites from the body by either stunning or killing them and without causing significant damage to the host. They may also be called vermifuges or vermicides. Anthelmintics are used to treat people who are infected by helminths, a condition called helminthiasis. These drugs are also used to treat infected animals.

<span class="mw-page-title-main">Soil-transmitted helminthiasis</span> Roundworm infection contracted from contaminated soil

Soil-transmitted helminthiasis is a type of worm infection (helminthiasis) caused by different species of roundworms. It is caused specifically by those worms which are transmitted through soil contaminated with faecal matter and are therefore called soil-transmitted helminths. Three types of soil-transmitted helminthiasis can be distinguished: ascariasis, hookworm infection and whipworm infection. These three types of infection are therefore caused by the large roundworm A. lumbricoides, the hookworms Necator americanus or Ancylostoma duodenale and by the whipworm Trichuris trichiura.

<span class="mw-page-title-main">Hookworm</span> Intestinal, blood-feeding, parasitic roundworms that cause types of infection known as helminthiases

Hookworms are intestinal, blood-feeding, parasitic roundworms that cause types of infection known as helminthiases. Hookworm infection is found in many parts of the world, and is common in areas with poor access to adequate water, sanitation, and hygiene. In humans, infections are caused by two main species of roundworm, belonging to the genera Ancylostoma and Necator. In other animals the main parasites are species of Ancylostoma. Hookworm is closely associated with poverty because it is most often found in impoverished areas, and its symptoms promote poverty through the educational and health effects it has on children. It is the leading cause of anemia and undernutrition in developing countries, while being one of the most commonly occurring diseases among poor people. Hookworm thrives in areas where rainfall is sufficient and keeps the soil from drying out, and where temperatures are higher, making rural, coastal areas prime conditions for the parasite to breed.

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  20. ↑ "Trichuris trichiura". WrongDiagnosis.com. 2009-05-06. Archived from the original on 2004-06-19. Retrieved 2009-05-19.
  21. ↑ Viswanath, A; Yarrarapu, SNS; Williams, M (26 June 2018). "Trichuris trichiura Infection". Europe PMC . PMID   29939620.
  22. ↑ "Prevention & Control". Parasites - Trichuriasis (also known as Whipworm Infection). Centers for Disease Control and Prevention. 25 April 2019. Retrieved 27 October 2022.
  23. ↑ Knopp S, Mohammed KA, Speich B, et al. (2010). "Albendazole and mebendazole administered alone or in combination with ivermectin against Trichuris trichiura: a randomized controlled trial". Clin Infect Dis. 51 (12): 1420–8. doi: 10.1086/657310 . PMID   21062129. (Knopp S, Mohammed KA, Speich B, Hattendorf J, Khamis IS, Khamis AN, Stothard JR, Rollinson D, Marti H, Utzinger J ).
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