Presentation prepared by Glysdi Seth Panton

2.  Known as the whipworm is also a soil-
transmitted helminth.
 Ascaris and Trichuris are frequently
observed as occuring together.
 Trichuris is also notable for its small size
compared with Ascaris lumbricoides.
 A holomyarian, based on the
arrangement of somatic muscles in cross
section where cells are small, numerous
and closely packed in a narrow zone.

3.  The male worm measures 30 to 45 mm,
slightly shorter than the female.
 The female worm is about 35 to 50 mm
long.
 The female has a bluntly rounded
posterior end.
 The male has a coiled posterior with a
single spicule and retractile sheath.

4.  Both worms have an attenuated anterior
three-fifths traversed by a narrow
esophagus resembling a string of beads.
 And the robust posterior two-fifths
contain the intestine and a single set of
reproductive organs.

5. The female
worm is about
35 to 50 mm
The male
worm
measures
30 to 45 mm

6. Posterior part of male
Trichuris trichuria
Posterior part of
female Trichuris
trichuria

7.  A female lays approximately 3000 to
10000 eggs per day.
 The eggs approximately measures about
50 to 54 um. It is lemon shaped with plug
like translucent polar prominence.
 Fertilized eggs are unsegmented at
oviposition and embryonic development
takes place outside the host.
 Compared to Ascaris eggs, Trichuris eggs
in soil are more susceptible to
desiccation.

8. Eggs
Eggs are lemon
shaped with
plug-like
translucent
polar
prominences.
50~54um

9.  Trichuris worm inhabit the large intestine.
 After copulation, the female worm lays
eggs, which are passed out with feces and
deposited in the soil.
 Under favorable conditions, the eggs
develop and become embryonated within
two to three weeks.
 If swallowed, the infective embryonated
eggs go to small intestine and undergo four
larval stages to become adult worm.
 Unlike Ascaris, there is no heart lung
migration.

11.  The anterior portion of the worm, which is
embedded in the mucosa, cause
petechial hemorrhages, which may
predispose to amebic dysentery.
 The mucosa is hyperemic and
edematous; enterorrhagia is common
and there may even be rectal prolapse.
 The lumen may be filled with worms, and
irritation and inflammation may lead to
appendicitis or granulomas.

12.  Infection with over 5,000 T. trichuria eggs
per gram of feces are usually
symptomatic.
 Those with more than 20,000 eggs per
gram feces often develop severe
diarrhea or dysenteric syndrome.
 Light infections, usually
asymptomatic, and the presence of the
parasite is discovered in stool
examination.
 In heavily parasitized individuals, the
worm may be found throughout the
colon and rectum.

13. Heavy chronic trichuriasis are often
marked by:
 Frequent blood-streaked diarrheal stools
 Abdominal pain and tenderness
 Nausea
 Vomiting
 Anemia
 Weight loss

14.  Clinical diagnosis is possible only in
heavy chronic Trichuris infection.
 In light infection, where symptoms are
absent, laboratory diagnosis is essential.

15.  Direct fecal smear (DFS) with a drop of
saline.
 Kato thick smear method – highly
recommended in diagnosis of trichuriases
 Kato-Katz technique – used for egg
counting to determine cure rate (CR), egg
reduction rate (ERR), and intensity of
infection.
 Acid-ether
 Formalin-ether method
 Kato-cellophane – as well as Kato-Katz are
simpler and low-cost.

16.  Mebendazole – drug of choice for
Trichuris.
 Albendazole – may be used as an
alternative drug.
 Ivermectin in combination with
albendazole – exhibit better cure and
egg reduction rate than albendazole
alone.

17.  Egg reduction rate (ERR), cure rates
(CR), re-infection rate and egg count
should be determined pre and post-
treatment.
 Contraindication for albendazole is
pregnancy.
 Contraindication for mebendazole are
hypersensitivity and early pregnancy.

18.  Trichuris occurs in both temperate and
tropical countries, but is more widely
distributed in warm, moist areas of t
ranges he world.
 Prevalence in temperate countries
ranges from 20 to 30%.
 In tropical countries, it ranges from 60 to
85%.
 In the Philippines, the prevalence is from
80 to 84%.

19.  In school surveys conducted in 2001, T.
trichuria has been found to have higher
infection rates than A. lumbricoides.
 Factors affecting transmission are the
same as that of Ascariasis namely:
 Indiscriminate defecation of children
around yards
 Frequent contact between fingers and
soil among children at play
 Poor health education
 Poor personal and community hygiene
 Unhygienic behavior and eating habits.

20.  Mass treatment may be indicated id infection
rates are higher than 50%
 Infection in highly endemic areas may be
prevented by:
 Treatment of infected individuals
 Sanitary disposal of human feces by
construction of toilets
 Washing of hands with soap and water before
meal
 Health education on sanitation and personal
hygiene
 Washing and scalding of uncooked
vegetables especially if night soils is used as
fertilizers