Whipworm Clinical Presentation

Updated: Apr 10, 2018
  • Author: Shipra Gupta, MD; Chief Editor: Russell W Steele, MD  more...
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Presentation

History

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  • 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.

  • Gastrointestinal complaints associated with these infections are diverse, ranging from mild to severe, including diarrhea, dysentery, abdominal discomfort, flatulence or constipation. Long-term gastrointestinal 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. [5]

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Physical

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  • Generally, physical examination findings are normal.

  • Pallor, fatigue and failure to thrive are common in children.

  • 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

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  • 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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