Diploma in Biomedical Science / (SBD 2114) Medical Parasitology

Whipworm (Trichuris trichiura)

History and Distribution

Trichuris trichiura, the human whipworm was first described by Linnaeus in 1771. It is
worldwide in distribution, but is much more common in the tropics. Some 750 million people
are estimated to be infected with this worm. While whipworm infection is extremely frequent,
whipworm disease is relatively rare.

The name Trichuris means a hair-like tail (Greek trichoshair, ouratail). This name is not
quite correct because it is the anterior end that is hair-like, and not the tail. The name
whipworm is more acceptable as the thick posterior part resembles the stock and the thin
anterior the lash of a whip.

Trichuris trichiura adult worms

o The adult worms are found attached to the wall of the caecum and appendix.
o The male is 30 mm to 45 mm long, while the female is slightly larger, about 40 mm to 50
mm. The worm is flesh coloured. In shape it resembles a whip, with the anterior three-fifth
Thushara Balasuriya (B.Sc. in MLS (Sp))
Lecturer,
Management & Science Institute, Colombo
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Diploma in Biomedical Science / (SBD 2114) Medical Parasitology

thin and thread-like, and the posterior two-fifth thick and fleshy, appearing like the handle
of a whip. The attenuated anterior portion which contains the capillary oesophagus, is
embedded in the mucosa.
o The posterior part contains the intestines and reproductive organs. The posterior end of the
male is coiled ventrally, while the hind end of the female is straight, blunt and rounded. The
worm has a lifespan of 5 to 10 years.

o The fertilised female lays about 5000 eggs per day. The egg has a characteristic appearance.
It is brown, being bile stained. It has a triple shell, the outermost layer of which is stained
brown. It is barrel-shaped, about 50 m long and 25 m wide in the middle, with a
projecting mucous plug at each pole. The egg floats in saturated salt solution.
Thushara Balasuriya (B.Sc. in MLS (Sp))
Lecturer,
Management & Science Institute, Colombo
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Diploma in Biomedical Science / (SBD 2114) Medical Parasitology

Trichuris trichiura egg

o The egg passed in feces contains an unsegmented ovum. At this stage it is not infective for
humans.

o The egg undergoes development in soil, optimally under warm moist, shady conditions,
when the infective rhabditiform larva develops within the egg in 3 to 4 weeks. At lower
temperatures this may be delayed for 3 months or more .

o Infection occurs when the mature embryonated eggs containing the infective larvae are
swallowed in food or water.

o The eggs hatch in the small intestine and the larva which emerges through the pole of the
egg passes down into the caecum. In about 2 to 3 months they become mature adults and
lie embedded on the caecal wall, with the thread-like anterior portion piercing the mucosa
and the thick posterior end projecting out.

o Eggs start appearing in faeces usually about 3 months after infection.

Thushara Balasuriya (B.Sc. in MLS (Sp))

Lecturer,
Management & Science Institute, Colombo
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Diploma in Biomedical Science / (SBD 2114) Medical Parasitology

o The entire life cycle can be passed in one host, from the ingested infective egg to the
development of the adults and the release of their eggs in faeces.
o But for transmission of infection to other hosts and perpetuation of the species, the egg has
to undergo development in the soil and then infect another person.
o Humans are the only natural host for T.trichiura, but morphologically similar worms are
found to infect pigs and some monkeys.

Pathogenesis and Clinical Features

Infection with T.trichiura (trichuriasis) is asymptomatic except when the worm load is
heavy. Disease may result either due to mechanical effects or allergic reaction.

The worms lie threaded into the caecal mucosa and even though it is not a blood feeder,
oozing of blood may occur at the sites of attachment. The blood loss is about 0.005 ml per
worm per day. Over a period of time this may lead to anaemia and malnutrition.

It has been suggested that mechanical blockage of the appendiceal lumen by masses of
whipworms may cause acute appendicitis.

In heavy infection, the worm may be abundant on the colonic mucosa, even up to the
rectum. Mucus diarrhoea, chronic dysentery and abdominal pain are frequently seen in
such cases. Some patients, particularly young children may develop rectal prolapse.

Colonoscopic finding shows a movable whitish

worm, T. trichiura, in the ileocecal valve

Rectal prolapse due to trichuriasis. In heavy infections

with Trichuris trichiura, adult worms can extend throughout the
length of the colon down to the rectum. Over time, inflammation in
the rectum causes tenesmus leading to prolapse. Notice here the
significant number of worms seen on the rectal mucosal lining.

Thushara Balasuriya (B.Sc. in MLS (Sp))

Lecturer,
Management & Science Institute, Colombo
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Diploma in Biomedical Science / (SBD 2114) Medical Parasitology

Diagnosis

The characteristic eggs are found in stools. The degree of infection can be assessed by egg
counts. Less than 10 eggs per smear in direct stool preparation is considered light infection
and more than 50 as heavy .Light infection is not considered to cause clinical disease.

Proctoscopy is useful as worms are found on the rectal mucosa in whipworm diarrhoea and
dysentery.

Charcot-Leyden crystals are usually abundant in stools of patients with whipworm

dysentery.

Trichuris trichiura eggs

Charcot-Leyden crystals

Treatment
o Mebendazole and albendazole are effective in treatment.

Prevention
o

Prevention of promiscuous defecation and proper disposal of feces would eliminate transmission of
infection.

Checking the consumption of unwashed fruits and vegetables grown on polluted fields can minimise the
risk of infection.

Thushara Balasuriya (B.Sc. in MLS (Sp))

Lecturer,
Management & Science Institute, Colombo
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