Trichuriasis - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Passage of loose stools associated with blood and mucus. Due to inflammation at the site of attachment to the colonic mucosa from large numbers of whipworms which results in colitis . Passage of loose stools associated with blood and mucus.
Due to inflammation at the site of attachment to the colonic mucosa from large numbers of whipworms which results in colitis .
Lump protruding out at the anus. It is due to rectal prolapse which occurs as a result of straining at defecation in the presence of a large number of worms and/or the irritation of nerve endings with increased peristalsis . Lump protruding out at the anus.
It is due to rectal prolapse which occurs as a result of straining at defecation in the presence of a large number of worms and/or the irritation of nerve endings with increased peristalsis .
Lethargy. This is a symptom of anemia, which occurs due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa . Lethargy.
This is a symptom of anemia, which occurs due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa .
Abdominal discomfort. It occurs as a result of spasms of the intestinal wall due to local irritation by the parasite . Abdominal discomfort.
It occurs as a result of spasms of the intestinal wall due to local irritation by the parasite .

Clinicals - Examination

Fact Explanation
Conjunctival pallor and other features of anemia. Due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa . Conjunctival pallor and other features of anemia.
Due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa .
Rectal prolapse. It occurs as a result of straining at defecation in the presence of a large number of worms and/or the irritation of nerve endings with increased peristalsis . Rectal prolapse.
It occurs as a result of straining at defecation in the presence of a large number of worms and/or the irritation of nerve endings with increased peristalsis .
Finger clubbing. Due to increased tumor necrosis factor alpha and other cytokines in the lamina propria of the colonic mucosa and peripheral blood, decreased plasma insulin like growth factor I, and decreased collagen synthesis which occurs in the pathogenesis of Trichuris dysentery syndrome . Finger clubbing.
Due to increased tumor necrosis factor alpha and other cytokines in the lamina propria of the colonic mucosa and peripheral blood, decreased plasma insulin like growth factor I, and decreased collagen synthesis which occurs in the pathogenesis of Trichuris dysentery syndrome .

Investigations - Diagnosis

Fact Explanation
Eosinophilia on full blood count. It is associated with helminth infections, especially during their tissue-invasive stages of development . Eosinophilia on full blood count.
It is associated with helminth infections, especially during their tissue-invasive stages of development .
Reduced hemoglobin levels on full blood count. Due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa . Reduced hemoglobin levels on full blood count.
Due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa .
Characteristic oval shaped eggs (with transparent bipolar plugs) of trichuris trichiura on stool smear. In their definitive host which is man, each adult female whipworm produces thousands of eggs per day. They are passed in stool . Characteristic oval shaped eggs (with transparent bipolar plugs) of trichuris trichiura on stool smear.
In their definitive host which is man, each adult female whipworm produces thousands of eggs per day. They are passed in stool .
Colonoscopy. For direct visualization of the adult whipworm which inhabits the rectum and colon, being attached to the bowel mucosa . Colonoscopy.
For direct visualization of the adult whipworm which inhabits the rectum and colon, being attached to the bowel mucosa .

Management - Supportive

Fact Explanation
Iron supplimentatiom To combat the anemia which occurs due to blood loss during whipworm infection . Iron supplimentatiom
To combat the anemia which occurs due to blood loss during whipworm infection .

Management - Specific

Fact Explanation
Mebendazole (500mg oral, single dose). It is a benzimidazole, which is known to have selective antimitotic activity due to the preferential binding of this agent to
helmintic tubulin over mammalian tubulin, which leads to its anthelminthic activity .
Mebendazole (500mg oral, single dose).
It is a benzimidazole, which is known to have selective antimitotic activity due to the preferential binding of this agent to
helmintic tubulin over mammalian tubulin, which leads to its anthelminthic activity .
Albendazole. It is also a benzimidazole . Albendazole.
It is also a benzimidazole .

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  11. WARREN K.S. and A.A.F. MAHMOUD. Algorithms in the diagnosis and management of exotic diseases. IX. Trichuriasis. Journal of Infectious Diseases[online] 1976, 133(2): 240-243. [viewed 22 April 2014] available from: DOI: 10.1093/infdis/133.2.240
  12. WARREN K.S. and A.A.F. MAHMOUD. Algorithms in the diagnosis and management of exotic diseases. IX. Trichuriasis. Journal of Infectious Diseases[online] 1976, 133(2): 240-243. [viewed 22 April 2014] available from: DOI: 10.1093/infdis/133.2.240
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