Laboratory Studies

Diagnosis is based on the microscopic detection of eggs or larvae in fresh or fixed stool samples.^[6]The eggs are bile stained with characteristic barrel (American football) shape with translucent polar plugs.

Egg from the "human whipworm". Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).

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The stool commonly contains RBCs and WBCs, including eosinophils.

No serological tests or PCR testing in stool have been validated to detect infection with Trichuris.

Other Tests

Other laboratory findings are non-specific. Peripheral CBC may reveal anemia (iron deficiency anemia) and ESR could be elevated due to ongoing inflammation.^[7]

Procedures

Anoscopy may be useful. In heavy infections, worms can be directly visualized.

Histologic Findings

The pathologic changes are noted in the large intestine, confined primarily to the mucosal epithelium. This differentiates whipworm infection with IBD as there is little or no involvement of the submucosa and muscularis layer.

The anterior part of the worm is embedded in the mucosa and the posterior two-fifth floats in the lumen. On biopsy there is intense eosinophilic infiltrate noted around the worm.^[8]

Treatment & Management

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Media Gallery

Adult T trichiura worm removed during a colonoscopy. Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).
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).
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).
Rectal prolapse in a female child due to a parasitic Trichuris trichiura infestation. Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).
Egg from the "human whipworm". Courtesy of the CDC (http://phil.cdc.gov/phil/home.asp).

of 5

Author

Shipra Gupta, MD Assistant Professor of Pediatrics, West Virginia University School of Medicine

Shipra Gupta, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jocelyn Y Ang, MD, FAAP, FIDSA, FPIDS Clinical Professor of Pediatrics, Wayne State University School of Medicine; Professor of Pediatrics, Central Michigan University College of Medicine; Consulting Staff, Division of Infectious Diseases, Children's Hospital of Michigan

Jocelyn Y Ang, MD, FAAP, FIDSA, FPIDS is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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: Academic Pediatric Association, American Academy of Pediatrics, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.