eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Whipworm

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
Coauthor(s): Tina Slusher, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Critical Care, West Virginia University; Steven L Lanski, MD, Department of Pediatrics, Division of Pediatric Emergency Medicine, Assistant Professor, Emory University and Children's Healthcare of Atlanta at Egleston
Contributor Information and Disclosures

Updated: Jan 27, 2009

Introduction

Background

Trichuris trichiura (whipworm) is a roundworm of the phylum Nematoda. It is one of the most common human parasites. The common name is derived from the worm's distinctive whiplike shape. The adult worm usually reaches 3-5 cm in length and has a lifespan of 1-3 years.

Pathophysiology

Humans are the only known host of T trichiura. The organism is spread via the fecal-oral route. Potential hosts ingest the embryonated (mature) eggs. The eggs hatch in the small intestine, and the larvae attach to and penetrate the small intestinal mucosa, where they begin to mature. After approximately one week, the immature worms move passively to the large intestine and proximal colon. The worms' anterior portions penetrate the mucosal epithelium and the worms can imbed over one half of their length into the mucosal surface.

Once the worms are sexually mature, mating begins. Egg production occurs 2-3 months after initial ingestion. The female worm is capable of producing 3,000-20,000 eggs a day. Once the eggs are passed in the feces, they develop in a warm humid environment. Egg maturation occurs in approximately 2-6 weeks. The embryonated egg can maintain viability for several months under suitable conditions. Destruction occurs with exposure to direct sunlight for more than 12 hours and to temperatures of less than -8°C or higher than 40°C for one hour.

Frequency

United States

Prevalence of whipworm infestation is less than 0.1%. The most common areas of infection are the southern Appalachian range and Gulf coast states.1

International

Whipworm infections are among the most common of all human parasites, with an estimated 750-800 million infections worldwide. The most affected regions are rural areas with poor sanitation and tropical climates, including Southeast Asia, Africa, the Caribbean, and Central and South America. Prevalence rates are as high as 80% in these regions. In contrast, prevalence in areas of Western Europe and Japan is similar to that in the United States.

Mortality/Morbidity

Most infections are asymptomatic. Symptoms are related to the worm load or number of worms involved in an infection. Heavy infections (hundreds to thousands of worms) can lead to death secondary to GI and hematologic complications.

Age

Although infections are observed in all age groups, most heavy infections are observed in the pediatric population. This probably reflects the increased likelihood of children to have poor hygiene and to play in soil that carries the worms' mature eggs.

Clinical

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.2

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.

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.

More on Whipworm

Overview: Whipworm
Differential Diagnoses & Workup: Whipworm
Treatment & Medication: Whipworm
Follow-up: Whipworm
References
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References

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Further Reading

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Keywords

whipworm, anemia, ascaris, Nematoda, parasite, parasite infection, parasitic disease, rectal prolapse, trichuriasis, Trichuris dysentery syndrome, Trichuris trichiura, T trichiura

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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: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare 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.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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; Pfizer 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: None None None

 
 
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