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.
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. [7]
Physical Examination
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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Adult T trichiura worm removed during a colonoscopy. Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).
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Life cycle of whipworm. The unembryonated eggs are passed with the stool (1). In the soil, the eggs develop into a 2-cell stage (2), an advanced cleavage stage (3), and then they embryonate (4). Eggs become infective in 15 to 30 days. After ingestion in soil-contaminated hands or food, the eggs hatch in the small intestine, and release larvae (5) that mature and establish themselves as adults in the colon (6). The adult worms (approximately 4 cm in length) live in the cecum and ascending colon. The adult worms are fixed in that location, with the anterior portions threaded into the mucosa. The females begin to oviposit 60 to 70 days after infection. Female worms in the cecum shed between 3,000 and 20,000 eggs per day. The life span of the adults is about 1 year. Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).
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Distribution of soil transmitted helminths (STH) Trichuris trichiura infection prevalence in 2010 based on geostatistical models for sub-Saharan Africa and available empirical information for all other regions. Courtesy of Parasites & Vectors (Pullan RL, Smith JL, Jasrasaria R, Brooker SJ. Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors. 2014;7:37).
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Rectal prolapse in a female child due to a parasitic Trichuris trichiura infestation. Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).
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Egg from the "human whipworm". Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).
