Medical Care
Treatment with broad-spectrum anthelminthic agents is key. Most infections can be treated successfully with mebendazole, albendazole, or ivermectin. These anthelminthic medications should be taken for 3 days. Dosage guidelines and important drug interactions are summarized in the medication section. Albendazole should be taken with food. Ivermectin should be taken with water on an empty stomach and the safety of ivermectin for children weighing less than 15 kg has not been established. Neither albendazole nor ivermectin has been approved by the US Food and Drug Administration (FDA) for treating whipworm.
A systematic review and network meta-analysis by Moser et al reported that T. trichiura cure rates with albendazole and mebendazole were 30.7% and 42.1%, respectively. The study also reported that between 1995 to 2015, albendazole cure rates decreased from 38.6% to 16.4% and egg-reduction rates decreased from 72.6% to 43.4% for albendazole and 91.4% to 54.7% for mebendazole. [11]
The combination of single dose of ivermectin and albendazole, or ivermectin and mebendazole, improves cure rates of 38% and 55% respectively. [12] Studies have shown that combination therapy with ivermectin and albendazole has higher cure rates than monotherapy with albendazole alone. [13]
Emodepside, a veterinary drug, has shown superior activity against T trichiura when compared with albendazole. It is being studied as a therapeutic candidate to treat trichuriasis and other helminth infections. [14]
Further outpatient care
Reexamination of stool specimens 2 weeks after therapy to determine whether the worms have been eliminated is helpful for assessing therapy. Retreatment may be necessary if symptoms persist 2-3 weeks after initial therapy.
Prevention
Proper disposal of fecal material is indicated. Mass treatment of infected school-aged populations can reduce whipworm transmission in communities with endemic infection.
Some clinicians have suggested periodic deworming programs for children in endemic areas. [15]
Consultations
Consultations with the following specialists may be appropriate:
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Infectious diseases specialist
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Gastroenterologist
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Hematologist
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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).
