Trichuriasis (whipworm infection)
Trichuriasis is fecal-oral infection of the colon with Trichuris trichiura (whipworm), treated with albendazole 400 mg daily for 3 days; light infection is often asymptomatic, while heavy pediatric worm burden causes chronic dysentery, growth impairment, and rectal prolapse.
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What this article covers
- Overview
Fecal-oral colonic nematode infection: trichuriasis is caused by Trichuris trichiura (whipworm), acquired by ingesting embryonated eggs from soil contaminated by human feces.
- Epidemiology
One of the most common soil-transmitted helminth infections worldwide, distributed alongside ascariasis and hookworm in tropical and subtropical regions with poor sanitation, and frequently co-infecting the same patients.
- Risk factors
Poor sanitation and open defecation: the dominant driver, since eggs shed in feces must embryonate in soil before becoming infective.
- Pathophysiology
Ingestion of embryonated eggs: infective eggs are swallowed and hatch in the small intestine.
- Clinical features
Light infection is often asymptomatic, the most common presentation, frequently found incidentally on stool exam.
- Differential diagnosis
Ascariasis: small-bowel infection causing obstruction or Loffler pulmonary eosinophilia rather than colitis or prolapse; see ascariasis.
- Diagnosis
Confirmed by identifying barrel-shaped, bipolar-plugged eggs on stool ova and parasite microscopy, the standard confirmatory test; this distinctive egg morphology is diagnostic.
- Management
First-line: albendazole 400 mg PO once daily for 3 days, preferred over a single dose because single-dose albendazole has a substantially lower cure rate for Trichuris than for Ascaris or hookworm.
- Complications
Rectal prolapse: the most feared complication in children with heavy infection, from chronic mucosal inflammation and straining.
- Prognosis
Excellent with antihelminthic treatment in light to moderate infection: most infections clear with a standard 3-day course.
- Prevention
Improved sanitation and safe excreta disposal: the definitive long-term measure, interrupting the soil-fecal-oral transmission cycle shared with ascariasis and hookworm.
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Related articles
- Ascariasis (roundworm infection)
Ascariasis is fecal-oral infection with Ascaris lumbricoides, the largest intestinal nematode, treated with albendazole 400 mg single dose; it causes Loffler pulmonary eosinophilia during larval lung migration and, with heavy adult worm burden, intestinal, biliary, or pancreatic duct obstruction.
- Hookworm infection
Hookworm infection, caused by Necator americanus or Ancylostoma duodenale, is treated with albendazole 400 mg single dose plus iron repletion; it is acquired when soil larvae penetrate bare skin and produces microcytic iron-deficiency anemia from chronic intestinal blood loss by adult worms attached to the small bowel mucosa.
- Strongyloidiasis
Strongyloides stercoralis is a soil-transmitted nematode uniquely capable of autoinfection, so it can persist for decades and, in a host started on glucocorticoids or otherwise immunosuppressed, progress to hyperinfection with gram-negative bacteremia; diagnosis is by stool larvae or serology and treatment is ivermectin.
- Pinworm infection (enterobiasis)
Pinworm infection (enterobiasis) is caused by the nematode Enterobius vermicularis and is the most common helminthic infection in children, presenting with perianal pruritus that is worse at night. Diagnosis is made by the cellophane tape test performed on first waking, and treatment is a single oral dose of albendazole, mebendazole, or pyrantel pamoate given to the patient and all household members, repeated after two weeks to break the autoinfection cycle.
- Taeniasis (intestinal tapeworm infection)
Taeniasis is intestinal infection with the adult tapeworm Taenia solium (pork), Taenia saginata (beef), or Diphyllobothrium latum (fish tapeworm, from raw freshwater fish), acquired by eating undercooked meat or fish containing larval cysts, usually mild or asymptomatic, and treated with a single dose of praziquantel.