Whipworm Infection - Causes, Diagnosis, and Treatment

Introduction:

The human whipworm, Trichuris trichiura, is a roundworm that affects the distal part of the human large intestine, which might result in a high worm burden in some individuals. They reside in the colon, and their eggs are passed out in the infected person's feces. The severity of the infection varies from mild to heavy in each individual.

What Is Trichuriasis?

Trichuriasis is one of the soil-transmitted helminths (worms) (STH). The whipworm has a round body with a slender anterior region with the esophagus and a thick posterior region called the anus. It appears like a whip with a handle and hence the name “whipworm.” They are usually pink in color and vary from three to five centimeters in size. They get attached to the host cells through the anterior portion. The male worms are generally smaller than the female worms. These female worms lay around 2000 to 10000 eggs a day. The eggs mature after 14 to 21 days and enter the infective stage.

What Causes The Infection?

In most cases, it is caused due to the ingestion of eggs from the soil. If someone comes in contact with these eggs, they begin their life cycle, multiply and hatch their larvae as soon as they enter our body. They extract nutrients from the host cells and use the bacterial microflora for their growth and survival. Other causes of infection are:

• Poor sanitation.

• Open defecation.

• Some genetic conditions (that increase the susceptibility to trichuriasis).

What Is The Incidence Of This Condition?

• It is a very common infection; about five billion people are affected by this helminth annually.

• It is more common in male children than in females. This is because boys are engaged more in outdoor activities.

• Trichuriasis is seen more in developing countries, parts of Africa, and Asia as they prefer warm and humid climates.

How Does This Infection Spread?

Trichuriasis is a soil-contaminated disease that gets transmitted through the fecal-oral route. When someone accidentally ingests contaminated food or water, the eggs enter the body and begin to hatch into larvae in the small intestine and then travel to the large intestine. This leads to the destruction of the cells, thus activating the host immune system. This causes severe abdominal pain and bleeding in the affected individual. In some individuals, these worms reside along the terminal portion of the intestine. In severe cases, they reside along the entire colon and rectum, causing inflammation. The eggs are now passed out in the human feces in an embryonated form, becoming infectious within two to four weeks of getting embryonated. Also, consuming fruits and vegetables that are not properly washed or cooked may cause infection.

How Do They Manifest Clinically?

Patients with mild infection are generally asymptomatic. However, in severe cases, the following features are seen.

• Abdominal pain and discomfort.

• Painful bowel movements with mucus discharge.

• Diarrhea and constipation.

• Blood in the feces.

• One typical feature that is specific to trichuriasis is nocturnal stool passage.

• Children are more prone to anemia. In severe cases, they may encounter cognitive development problems due to iron deficiency.

• Loss of appetite.

• Rectal prolapse.

How To Diagnose This Infection?

The clinician diagnoses the infection from the history obtained from the parents and caretakers. However, a microscopic examination of the stool sample may be necessary to analyze the number of worms present and their severity.

What Is The Kato Katz Method?

The World Health Organization (WHO) recommends this method for counting the eggs in the stool. The sample also shows red blood cells, white blood cells, and eosinophils.

• Stool Ova And Parasite Examination: This test looks for the presence of parasites and their eggs in the stool sample.

• Complete Blood Count (CBC): They help to diagnose anemia.

• Sigmoidoscopy and Colonoscopy: Non-surgical procedures where the internal aspect of the large intestine is viewed using a small tube (endoscope) with a light and camera. It shows the characteristic “coconut cake rectum.”

• Ultrasonography: Abdominal ultrasonography shows “whipworm dance.” This is due to the wriggling of the lumen of the appendix.

• Polymerase Chain Reaction (PCR): They are currently developed that are more specific and sensitive for the whipworms.

Can This Infection Be Prevented?

Yes, the infection can be prevented by following simple protocols. They are:

1. Wash the hands regularly with soap and water, especially before having food.

2. Avoid contact with human feces in the soil.

3. The use of human fecal manure as fertilizers should be discouraged.

4. Wash the fruits and vegetables thoroughly before cooking and eating.

5. Always teach your children the importance of being hygienic and washing hands regularly.

What Is Mass Drug Administration?

The drugs used for trichuriasis infection are relatively safe and cost-effective. Hence these medications are given to the possible risk groups as a preventive measure. They are given in large quantities to the drug distributors who go from door to door and provide these medications to the concerned people. Many other neglected tropical diseases are also treated with mass drug administration.

What Are Possible Complications?

Trichuris dysentery syndrome is the most common complication, especially in children with a high worm burden. It causes:

• Diarrhea.

• Tenesmus (the sensation of passing stools even if the colon is empty).

• Iron deficiency anemia.

• Cognitive impairment and developmental delays.

How Is Trichuriasis Managed?

The first line of treatment is Mebendazole which is more effective than Albendazole and hence used as the first line of defense. Ivermectin can also be used but is not as effective as Mebendazole.

What Is The Outcome Of The Treatment?

The prognosis of the infection is generally low, with a higher recurrence rate. The whipworms show more resistance to the medications, and they are present even after the treatment. However, these medications may lower the worm count. Studies have shown that a low worm count does not cause serious infections. This may lead to poor growth and loss of appetite in children leading to vitamin and mineral deficiencies.

Conclusion:

Although trichuriasis is not a fatal infection, it might cause several other health complications, particularly in children. It is always advised to teach and motivate the children, parents, and others at home to maintain a personal hygiene routine. Parents should inculcate in their children the habit of washing hands regularly, before food, after play, etc. Parents should be educated about the recurrence of this infection. The preventive tablets being issued at schools annually should not be avoided. This can lower the infection in children.