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    74 views13 pages

    Trichuris Trichiura

    Uploaded by

    Alvin Laurence
    Tt

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 13

    Trichuris trichiura & Trichuriasis

    Trichuris trichiura
    • Trichuris trichiura occurs worldwide
    • The worm is most prevalent in warm humid
    climates
    • It is estimated to affect 795 million people
    worldwide with associated morbidity
    • Annual mortality is estimated to be 60,000
    • T. trichiura are commonly referred as
    whipworm
    Morphology: Eggs

    • Length: 50x 22μm


    • Colour: brown
    • Shape: Barrel shaped or
    electrical bulb shaped
    • Single shelled with a plug at
    each end
    • Fertilized egg contains
    unsegmented embryo
    Morphology: Adult
    • T. trichiura is greyish-white worm,
    slightly pink
    • Adult worm live in the caecum and
    appendix.
    Male
    • Length: 30-45mm long with attenuated
    anterior portion containing a cellular
    esophagus
    • Caudal extremities is curved ventrally
    and have a single spicules in sheath.
    Female
    • Have anterior attenuated portion, twice
    as long as the posterior half.
    • A sacculate tubular ovary run from
    posterior end
    • Female are in the host are more than
    males 400 to 1.
    Life cycle
    • Infections occurs when eggs contaminating soil, food or formites are
    swallowed.
    • The egg shell is digested by the digestive juices and the larvae emerge in
    the small intestines and penetrates the villi and develops for a week and
    re-enters the lumen.
    • Larvae enters caecum, penetrate the crypts of Lieberkühn and migrate
    within the mucosa
    • Mature adult worms insert their thinner anterior half of the body in the
    mucosa of the larger bowel of the host (caecum, colon, rectum)
    • Adult worms, they feed on tissue juices not blood
    • Female worms release several thousand eggs per day.
    • After about 2wks development in warm moist soil, the eggs are
    embryonated and infective
    Life cycle of Trichuris trichiura
    Epidemiology
    • T. trichiura is primary a human infections but T. suis of pigs is
    indistinguishable from the human spp and can infect human
    • Zoonotic infections with T. suis is increasing in people
    handling pigs
    • T. trichiura is common in areas of high rainfall, high humidity,
    dense shade, poor sanitation and contaminated soil.
    • Distribution: worldwide and is highly common in Malaysia
    • Greatest prevalence in children of primary school age who
    pollute the soil around the house and they carry heavy burden
    • Trichuriasis is associated with ascariasis, hookworm infections
    and toxocariasis
    • Transmission: direct from mature eggs to the mouth via
    fingers contaminated from infected soil.
    Symptoms & signs
    • In light infections no symptoms
    • When Trichuriasis is associated with ascariasis or hookworm disease,
    symptoms develops.
    • Epigastric pain, vomiting, distension, flatulence, anorexia and weight loss.
    • Pain in the epigastrium and right iliac fossa is common.
    • When associated with E.histolytica or B.coli or shigellosis symptoms are
    aggravated and dysentery may occur
    • Bleeding from the friable mucosa may result in iron- anaemia in children
    poor diets.
    • Heavy infections:-infections extends from the caecum to the rectum and
    results in severe dysentery with blood and mucus in the stools and prolapse
    of the rectum
    • Chronic infection is associated with growth retardation
    • In severe massive infantile trichuriasis digital clubbing, hypoproteinaemia,
    severe anaemia and growth retardation.
    Rectal prolapse
    Diagnosis
    • Sample: Stool
    • Direct wet smear preparation, concentration techniques
    such Kato Katz tech, Formol-ether conc tech.
    • Infection intensity of more than 30,000eggs/g of faeces or
    more indicate heavy infections.
    • Clinical signs: children presenting with rectal prolapse and
    adult worms can be seen attached to the mucosa of
    prolapsed bowel.
    • Protoscopy in cases of dysentery will show numerous
    worms attached to the mucosa, which is reddened and
    ulcerated where they are responsible for the dysentery.
    Management
    • Single oral dose of Mebendazole- 500mg is more
    infective than Albendazole 400mg.
    • Severe infections: MEB 100gm BID for 3dys or ALB
    400mg daily for 3 days
    • Single dose combination treatment using ALB 400
    mg + Ivemectin 200μg/kg is highly effective
    Control & prevention
    • The same as A. lumbricoides and hookworms
    • Mass chemotherapy, improve sanitation and
    hygiene and public health education.

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