Whipworm infection overview: Difference between revisions
No edit summary |
No edit summary |
||
| Line 10: | Line 10: | ||
==Classification== | ==Classification== | ||
[[Trichuriasis]] infection is classified by [[WHO|World Health Organization (WHO)]] for helminth control programs based on the number of eggs per gram of feces into light, moderate and heavy infection. | [[Trichuriasis]] infection is classified by [[WHO|World Health Organization (WHO)]] for [[helminth]] control programs based on the number of eggs per gram of [[feces]] into light, moderate and heavy [[infection]]. | ||
==Pathophysiology== | ==Pathophysiology== | ||
Infection is acquired by the ingestion of embryonated eggs from contaminated drinking water and food. The eggs once ingested hatch in the [[small intestine]], and the larvae enter the intestinal crypts. The larve migrate to the proximal [[colon]] and mature into adult worms. The females begin to oviposit 60 to 70 days after infection and shed between 3,000 and 20,000 eggs per day. [[Whipworm infection|Whipworm]] causes disease by [[Colon|colonic]] mucosal invasion of the adult worms and resulting in [[inflammation]] of the colonic mucosa. | [[Infection]] is acquired by the ingestion of [[Fertilised|embryonated]] eggs from [[Contamination|contaminated]] drinking water and food. The eggs once ingested hatch in the [[small intestine]], and the larvae enter the [[Intestinal mucosa|intestinal crypts]]. The larve migrate to the proximal [[colon]] and mature into adult worms. The females begin to [[Oviposition|oviposit]] 60 to 70 days after [[infection]] and shed between 3,000 and 20,000 eggs per day. [[Whipworm infection|Whipworm]] causes disease by [[Colon|colonic]] [[Mucous membrane|mucosal]] invasion of the adult worms and resulting in [[inflammation]] of the [[Colon (anatomy)|colonic]] [[Mucous membrane|mucosa]]. | ||
==Causes== | ==Causes== | ||
The '''human whipworm''' ('''''Trichuris trichiura''' or '''Trichocephalus trichiuris''''') is a [[round worm]] that causes [[trichuriasis]]. 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. | The '''human whipworm''' ('''''Trichuris trichiura''' or '''Trichocephalus trichiuris''''') is a [[round worm]] that causes [[trichuriasis]]. 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 [[Anatomical terms of location|posterior]] end. | ||
==Differentiating whipworm infection from other diseases== | ==Differentiating whipworm infection from other diseases== | ||
| Line 22: | Line 22: | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
[[Trichuris trichiura]] is the third most common [[nematode]] worldwide following [[Ascariasis|Ascaris]] and [[Pinworm|Enterobius]], all three together affect close to 1 billion people. [[Whipworm infection|Whip worm]] infection is endemic in tropical and subtropical countries. The prevalence of [[Trichuris trichiura]] is high affecting 95% in children in countries where protein energy [[malnutrition]] and [[anaemias]] are prevalent. | [[Trichuris trichiura]] is the third most common [[nematode]] worldwide following [[Ascariasis|Ascaris]] and [[Pinworm|Enterobius]], all three together affect close to 1 billion people. [[Whipworm infection|Whip worm]] infection is [[Endemic (epidemiology)|endemic]] in [[Tropical disease|tropical]] and subtropical countries. The prevalence of [[Trichuris trichiura]] is high affecting 95% in children in countries where protein energy [[malnutrition]] and [[anaemias|anemias]] are [[Prevalence|prevalent]]. | ||
== Risk Factors == | == Risk Factors == | ||
Risk factors predisposing patients for the development of [[Whipworm infection|whip worm infection]] include low socio-economic status, low levels of education, poor sanitation and poor hygiene. | [[Risk factor|Risk factors]] predisposing patients for the development of [[Whipworm infection|whip worm infection]] include low socio-economic status, low levels of education, poor sanitation and poor [[hygiene]]. | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
[[Whipworm infection]] in majority of people causes no clinical symptoms. A heavy wihpworm infection (greater than 10,000 eggs per gram of faeces) infection can cause [[abdominal pain]], [[diarrhea]], [[constipation]], [[weight loss]], and [[anemia]]. If left untreated, severe infection can result in Trichuris [[dysentery]] syndrome associated with heavy infection. Complications of heavy whipworm infection include chronic [[Dysentery|dysentry]], [[rectal prolapse]] and growth retardation. Prognosis is excellent with | [[Whipworm infection]] in majority of people causes no clinical symptoms. A heavy wihpworm infection (greater than 10,000 eggs per gram of faeces) [[infection]] can cause [[abdominal pain]], [[diarrhea]], [[constipation]], [[weight loss]], and [[anemia]]. If left untreated, severe infection can result in [[Trichuris trichiura|Trichuris]] [[dysentery]] syndrome associated with heavy [[infection]]. Complications of heavy whipworm infection include chronic [[Dysentery|dysentry]], [[rectal prolapse]] and [[growth retardation]]. [[Prognosis]] is excellent with [[antihelminthic]] treatment and complete recovery occurs in 1 to 2 weeks. | ||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Majority of patients with light trichuriasis infection are asymptomatic. In patients with moderate to heavy infection present with [[Weight loss|weight loss]], bloody [[diarrhea]], [[abdominal pain]], [[tenesmus]] and [[rectal prolapse]]. | Majority of patients with light trichuriasis infection are [[asymptomatic]]. In patients with moderate to heavy [[infection]] present with [[Weight loss|weight loss]], bloody [[diarrhea]], [[abdominal pain]], [[tenesmus]] and [[rectal prolapse]]. | ||
===Physical Examination=== | ===Physical Examination=== | ||
| Line 38: | Line 38: | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
The diagnosis of whip worm infection is confirmed by a [[stool examination]] for [[ova]] and [[parasites]] | The diagnosis of whip worm infection is confirmed by a [[stool examination]] for [[ova]] and [[parasites]]. It will demonstrate the presence of [[whipworm]] eggs. There are no specific laboratory findings associated with whip worm infection. Chronic blood loss may demonstrate a [[iron deficiency anemia]] picture on [[peripheral blood smear]] examination with [[Microcytic anemia|microcytic]] and [[Hypochromic anemia|hypochromic]] anemia. | ||
===EKG=== | ===EKG=== | ||
There are no specific [[EKG]] findings associated with [[whipworm]] | There are no specific [[EKG]] findings associated with [[whipworm]] [[infection]]. | ||
===Chest X-Ray=== | ===Chest X-Ray=== | ||
There are no specific chest X-Ray findings associated with [[whipworm]] | There are no specific chest X-Ray findings associated with [[whipworm]] [[infection]]. | ||
===CT Scan=== | ===CT Scan=== | ||
[[CT]] scan findings are non specific in patients with [[Whipworm Infection|whipworm]] infection, but irregular nodular colonic thickening of the [[cecum]] and the [[ascending colon]] may be present. | [[CT]] scan findings are non specific in patients with [[Whipworm Infection|whipworm]] infection, but irregular [[Nodular lesions|nodular]] [[Colon (anatomy)|colonic]] thickening of the [[cecum]] and the [[ascending colon]] may be present. | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
A double contrast [[barium enema]] will demonstrate the presence of multiple tiny target like or a pin wheel shape collections of [[barium]], associated with s-shaped filling defects | A double contrast [[barium enema]] will demonstrate the presence of multiple tiny target like or a pin wheel shape collections of [[barium]], associated with s-shaped filling defects and appearance characteristic of a male worm with a coiled tip. | ||
===Other Diagnostic Findings=== | ===Other Diagnostic Findings=== | ||
| Line 57: | Line 57: | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
Medical therapy with | Medical therapy with [[Helminthic therapy|antihelminthic]] medications is the primary modality of treatment. The treatment options include [[albendazole]], [[mebendazole]] and [[ivermectin]]. | ||
===Surgery=== | ===Surgery=== | ||
| Line 64: | Line 64: | ||
==Prevention== | ==Prevention== | ||
===Primary Prevention=== | ===Primary Prevention=== | ||
[[Primary prevention]] measures include maintaining proper hygiene, hand washing, and encouraging people not to defecate outdoors and improving sewage disposal systems. | [[Primary prevention]] measures include maintaining proper [[hygiene]], hand washing, and encouraging people not to defecate outdoors and improving sewage disposal systems. | ||
===Secondary Prevention=== | ===Secondary Prevention=== | ||
Revision as of 14:56, 26 July 2017
|
Whipworm infection Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Whipworm infection overview On the Web |
|
American Roentgen Ray Society Images of Whipworm infection overview |
|
Risk calculators and risk factors for Whipworm infection overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Trichuris trichiura is the third most common nematode worldwide, following Ascaris and Enterobius infections. Infection is acquired by the ingestion of embryonated eggs from contaminated drinking water and food. Whipworm causes disease by colonic mucosal invasion of the adult worms and resulting in inflammation of the colonic mucosa. Whipworm infection in majority of people causes no clinical symptoms, but a severe infection can cause abdominal pain, diarrhea, constipation, weight loss, and anemia. The diagnosis of whip worm infection is confirmed by a stool examination for ova and parasites, it will demonstrate the presence of whipworm eggs. the characteristic features of whip worm egg include a barrel like egg with two polar plugs. Medical therapy with anti helminthic medications is the primary modality of treatment with albendazole, mebendazole and ivermectin.
Historical Perspective
In 1761, Roederer described whipworm for the first time. In 1771, Carl Linnaeus coined the binomial name for human whipworm as Trichuris trichiura. The human whipworm (Trichuris trichiura) is generally considered "heirloom", since it is found in the African non-human primates, and parasite eggs were found in fossilized human faeces in archaeological sites before animal domestication and before the Columbian colonization. The origin of human Trichuris is believed to be in Africa, where the parasite was transmitted to humans through early primates.
Classification
Trichuriasis infection is classified by World Health Organization (WHO) for helminth control programs based on the number of eggs per gram of feces into light, moderate and heavy infection.
Pathophysiology
Infection is acquired by the ingestion of embryonated eggs from contaminated drinking water and food. The eggs once ingested hatch in the small intestine, and the larvae enter the intestinal crypts. The larve migrate to the proximal colon and mature into adult worms. The females begin to oviposit 60 to 70 days after infection and shed between 3,000 and 20,000 eggs per day. Whipworm causes disease by colonic mucosal invasion of the adult worms and resulting in inflammation of the colonic mucosa.
Causes
The human whipworm (Trichuris trichiura or Trichocephalus trichiuris) is a round worm that causes trichuriasis. 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.
Differentiating whipworm infection from other diseases
Trichuris trichiura must be differentiated from other nematode infections such as ascariasis, hook worm infection and Strongyloides stercoralis that can present with diarrhea and abdominal pain.
Epidemiology and Demographics
Trichuris trichiura is the third most common nematode worldwide following Ascaris and Enterobius, all three together affect close to 1 billion people. Whip worm infection is endemic in tropical and subtropical countries. The prevalence of Trichuris trichiura is high affecting 95% in children in countries where protein energy malnutrition and anemias are prevalent.
Risk Factors
Risk factors predisposing patients for the development of whip worm infection include low socio-economic status, low levels of education, poor sanitation and poor hygiene.
Natural History, Complications and Prognosis
Whipworm infection in majority of people causes no clinical symptoms. A heavy wihpworm infection (greater than 10,000 eggs per gram of faeces) infection can cause abdominal pain, diarrhea, constipation, weight loss, and anemia. If left untreated, severe infection can result in Trichuris dysentery syndrome associated with heavy infection. Complications of heavy whipworm infection include chronic dysentry, rectal prolapse and growth retardation. Prognosis is excellent with antihelminthic treatment and complete recovery occurs in 1 to 2 weeks.
Diagnosis
History and Symptoms
Majority of patients with light trichuriasis infection are asymptomatic. In patients with moderate to heavy infection present with weight loss, bloody diarrhea, abdominal pain, tenesmus and rectal prolapse.
Physical Examination
There are no specific physical examination findings associated with whip worm infection. Patients with severe infection may present with pallor, finger nail clubbing, rectal prolapse and abdominal tenderness.
Laboratory Findings
The diagnosis of whip worm infection is confirmed by a stool examination for ova and parasites. It will demonstrate the presence of whipworm eggs. There are no specific laboratory findings associated with whip worm infection. Chronic blood loss may demonstrate a iron deficiency anemia picture on peripheral blood smear examination with microcytic and hypochromic anemia.
EKG
There are no specific EKG findings associated with whipworm infection.
Chest X-Ray
There are no specific chest X-Ray findings associated with whipworm infection.
CT Scan
CT scan findings are non specific in patients with whipworm infection, but irregular nodular colonic thickening of the cecum and the ascending colon may be present.
Other Imaging Findings
A double contrast barium enema will demonstrate the presence of multiple tiny target like or a pin wheel shape collections of barium, associated with s-shaped filling defects and appearance characteristic of a male worm with a coiled tip.
Other Diagnostic Findings
The other diagnostic studies for whip worm infection include stool examination for ova and parasites, colonoscopy and an abdominal ultrasound. The characteristic features of whip worm egg include a barrel like egg with two polar plugs. Colonoscopy is not routinely indicated, but it can be performed in patients with non specific symptoms and a negative stool test for the presence of eggs.
Treatment
Medical Therapy
Medical therapy with antihelminthic medications is the primary modality of treatment. The treatment options include albendazole, mebendazole and ivermectin.
Surgery
Surgery is not recommended for the treatment of whipworm infection.
Prevention
Primary Prevention
Primary prevention measures include maintaining proper hygiene, hand washing, and encouraging people not to defecate outdoors and improving sewage disposal systems.
Secondary Prevention
Secondary preventive measures for whip worm infection are similar to the primary preventive measures.