Whipworm Clinical Presentation

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 9, 2012
 

History

  • When evaluating a patient suspected of having a whipworm infection, the most important part of the history is travel to or living in an area of known infestation.
  • GI complaints associated with these infections are diverse. Long-term GI complaints with associated exposure suggest whipworm infection.
  • Most infections are asymptomatic. Patients with fewer than 100 worms are frequently asymptomatic; however, they may present with lower abdominal discomfort, flatulence, and diarrhea or constipation.
  • Patients with heavy infection have hundreds to thousands of worms and may present with lower or epigastric pain, vomiting, abdominal distension, anorexia, weight loss, anemia, diarrhea, tenesmus (painful straining), and rectal prolapse. Trichuris dysentery syndrome is observed in heavy infections and characterized by bloody mucoid diarrhea, small frequent stools, tenesmus, anemia, and growth retardation.
  • Polyparasitic infections can occur with whipworms, ascaris, and hookworms because these parasites live in similar environments.[4]
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Physical

  • Generally, physical examination findings are normal.
  • Each worm causes an estimated 5 µL of blood loss every day.
  • Heavy infections are required to cause anemia.
  • Prolonged infections are reported to lead to growth failure, intellectual delays, and digital clubbing; however, growth and intellectual delays are likely to be multifactorial.
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Causes

  • The organism is spread via the fecal-oral route. Potential hosts ingest the embryonated (mature) eggs.
  • Most heavy infections are observed in the pediatric population because children are more likely to have poor hygiene and to play in soil that carries the worms' mature eggs.
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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

Tina Slusher, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Critical Care, West Virginia University

Tina Slusher, MD is a member of the following medical societies: Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Steven L Lanski, MD  Department of Pediatrics, Division of Pediatric Emergency Medicine, Assistant Professor, Emory University and Children's Healthcare of Atlanta at Egleston

Steven L Lanski, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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