TT

1. Trichuris trichiura (Whipworm)
 Known as the whipworm is also a soil transmitted helminth.
 Ascaris and Trichuris are frequently observed as occuring together.
 Trichuris is also notable for its small size compared with Ascaris lumbricoides.
 It is a very common intestinal helminthic infection, and about one quarter of the world's
population is thought to carry the parasite.
 Tropical Asia & to a lesser degree, in Africa and South America.
 Only patients with heavy parasite burden become symptomatic
 Poor hygiene is associated with trichuriasis transmission, and children are especially
vulnerable because of their high exposure risk.
 Prevalence of helminth infection was higher in the schools where hygiene conditions
(i.e., tap water, hand washing soap) are lacking.
Morphology:
Adult:
 The worm looks like a buggy whip, the anterior 3/5 is slender and the posterior 2/5 is
thick.
 It is pinkish gray in color.
 The female worm is 3-5 cm in length and has a long slender esophageal region.
 The male is smaller than the female and has a curved tail.
 The reproductive organs of male and female are all double tubule.
Egg:
 It is barrel or spindle in shape and 50 x 20µm in size.
 It is brownish and has a translucent polar plug at either ends.
 The content of the egg is an undeveloped cell

3. Life Cycle
 Site of inhabitation: cecum
 Infective stage: embryonic egg
 Infectve mode and route: passively swallowed by the mouth
 Without intermediate host and reservoir host
 The life span of the adult is about 3-5years
 The female T. trichiura produces 2,000–10,000 single-celled eggs per day.
 Eggs are deposited from human feces to soil where, after two to three weeks, they
become embryonated and enter the "infective" stage.
 These embryonated infective eggs are ingested and hatch in the human small
intestine exploiting the intestinal microflora as hatching stimulus.[3]
 This is the location of growth and molting.
 The infective larvae penetrate the villi and continue to develop in the small intestine.
 The young worms move to the caecum and penetrate the mucosa, and there they
complete development to adult worms in the large intestine.

4.  The life cycle from the time of ingestion of eggs to the development of mature worms
takes approximately three months.
 During this time, there may be limited signs of infection in stool samples due to lack of
egg production and shedding.
 The female T. trichiura begin to lay eggs after three months of maturity. Worms
commonly live about 1 year during which time females can lay up to 20,000 eggs per
day.

5. Pathogenesis:
1. Light infection: Asymptomatic
2. Middle infection: Clinical manifestations are usually abdominal pain, anorexia, diarrhea,
constipation .
3. Heavy infection: Bloody diarrhea, emaciation, prolapse of the anus may occur.

6. Laboratory Diagnosis
 Direct fecal smear (DFS) with a drop of saline.
 Kato-Katz technique – used for egg counting to determine cure rate (CR), egg reduction
rate (ERR), and intensity of infection.
 Formalin ether and acid ether concentration techniques
 CBC for Eosinophilia
 Histopathology of Intestinal mucosa
 Antibody Test
 PCR
Treatment
 Mebendazole
 Alternatively, albendazole or ivermectin
 Mebendazole 100 mg orally twice a day for 3 days is recommended.
 A single dose of mebendazole 500 mg has been used in mass treatment programs.
Alternatives are albendazole 400 mg orally once a day for 3 days or ivermectin 200
mcg/kg orally once a day for 3 days.
 These drugs should usually not be used during pregnancy.