Trichuriasis - Hochberg LabTrichuriasis • Infects; • Wild/domestic canines • Wild/domestic pigs • Humans • Non human primates Xie, Y. et al. Genetic characterization and

TrichuriasisSpecies Trichuristrichiura

MeghanBalich

Trichuristrichiura

PhylumNematoda

ClassEnoplea

OrderTrichocephalida

FamilyTrichuridae

Anatomy

• Endoparasites

• Canbefoundinthedigestivetractofthehost

• Onlytheadultseat,• Theyfeedontissuesecretionsofintestinalepithelium

Anatomy• Dioecious• Femalestypicallylargerthanmale.• Malehascurledposteriorend.

• Commonname:Whipworm• Narrowanterioresophagusandathickposterioranus.

• Attachtohostviaslenderanteriorend.

• Sizevariesfrom3to5cm.

• Typicallypink

Reproduction• Eachfemaleproduces2,000-6,000eggsperday.• Lifeexpectancyofawormwithinahostis~1-3years.

• Maleshaveaspiraclesurroundedbyasheathwithanejaculatoryduct

• Femalesmayproduceapheromonetoattractmales.

• Thecurvedportionofthemalecoilsaroundthefemalesgenitalpore.

• Themaleusesspiculestoholdthefemaleinplaceduringcopulation.

Egg Anatomy

• Barrelshaped

• Thickwalled

• Plugateachpole

Transmission

• Childrenarethemosteffectedbywhipworms

• Themainmodeoftransmissionisthroughcontaminatedwater,soil,andfood.• Touchingcontaminatedsoil,typicallyinareaswithpoorsanitation

practices.

Epidemiology

• Mostprevalentintheunderdevelopedcountries.

• Chronicillness,notanacuteillness.

• Effectofthisinfectiononeconomicandeducationburdenisnotquantified.

• Soil-transmittedhelminthesareconsideredaneglectedtropicaldisease,despitetheirprevalence.

• STHprevalenceisgenerallyhigherinruralareasdueto,

• Poorsanitarymeasures

• Inadequatewatersupply

• Overcrowding

Geographic Distribution• TheglobalprevalenceofTrichuristrichiurawas795million(2003)

• 3rd mostcommonroundwormofhumans.

• Mostfrequentinareaswithtropicalweatherandpoorsanitationpractices.

• MostprevalentinequatorialAfricaandSoutheastAsia.

LifecycleEggspassoutofbodyviafeces

Eggshatchinsmallintestine&migratetolargeintestine

Molttobecomeadultsinlargeintestine

Becomeinfectiveafterembryonation

Reproducewithnearby

worms

Trichuriasis• Infects;

• Wild/domesticcanines

• Wild/domesticpigs

• Humans

• Nonhumanprimates

Xie,Y.etal.Geneticcharacterizationandphylogeneticstatusofwhipworms (Trichuris spp.)fromcaptivenon-human primatesinChina, determinedbynuclearandmitochondrial sequencing.

Disease

• Trichuriasis

• Abdominalcolitis

• Trichurisdysenterysyndrome

SymptomsLightInfections

• Asymptomatic

HeavyInfections

• Diarrhea

• Abdominalpain

• Malnutrition(anemia)

• Rectalprolapse

PathologyDiarrhea/Malnutrition• Burrowingofwormheadsintointestinalepitheliumcanresultin

increasedfluidsecretionanddecreasedabsorptionoffluidincolon.

AbdominalPain• Adultsburrowthroughmucosainlargeintestine.• Leadstocelldestructionandimmuneresponse

RectalProlapse• Highnumbersofwormsembeddedintherectumcanleadto

excessfluidinthebody,leadingtorectalprolapse.

Diagnosis• Microscopicallyidentifyingthepresenceofeggsinastoolsample.• Difficulttoidentifyinlightinfections.• Kato-Katztechnique,athicksmearofstoolsampleispreparedpriortosearchingforparasiteeggs.

AdultT.trichiura foundduring colonoscopy.

• Proctoscopy• Examinationofrectalmucosacanoccasionally

demonstrateadultworms.

• Colonoscopy• Identifyadultswormsembeddedincolon

Treatment• Albendazole(egg/larval/adultstages)• Anthelminticagent• Blockseggproductionanddevelopment.• Impairsuptakeofglucosebythelarvalandadultstagesanddepletesglycogenstores.

• Ivermectin• UsedincombinationwithAlbendazole• Interfereswithnervoussystemandmusclefunction

• Mebendazole(larval/adultstages)• Anthelminticagent• Poorlyabsorbedintobloodstream.• Usedaloneinmildtomoderatecases,killsparasitesslowlywithlimitedadversesideeffects.

• Selectivelyandirreversiblyblocksglucoseuptakeandothernutrientsintheintestine.

ReferencesStroehlein,A.J.2017.Whipwormkinomesreflectauniquebiologyandadaptationtothehostanimal.InternationalJournalfor Parasitology.47:13.857-866.

Mohd-Sharharuddin,N.2019.MolecularcharacterizationofTrichurisspeciesisolatedfromhumans,dogs,andcatsinaruralcommunityinPeninsularMalaysia.ActaTropica.190:269-272.

Silber,S.A.2017.EfficacyandSafetyofaSingle-DoseMebendazole500mgChewable,Rapidly-DisintegratingTabletforAscarislumbricoidesandTrichuristrichiura InfectionTreatmentinPediatricPatients:ADouble-Blind,Randomized,Placebo-Controlled,Phase3Study.TheAmericanSocietyofTropicalMedicineandHygiene.97:6.1851-1856.

Silver,Z.,Kaliappan,S.,Samuel,P.,Venugopal,S.,Kang,G.,Sarkar,R.,Ajjampur,S.2018.Geographicaldistributionofsoil transmittedhelminthesandtheeffectsofcommunitytypeinSouthAsiaandSouthEastAsia– Asystematicreview.PLOSNeglectedTropicalDiseases.12:1.

Manz,K.,Clowes,P.,Kroidl,I.,Kowuor,D.,Gledmacher,C.,Ntinginya,N.,Maboko,L.,Hoelscher,M.,Saathoff,E.2017.Trichuristrichiura infectionanditsrelationtoenvironmentalfactorsinMbeyaregion,Tanzania:Across-sectional,population-basedstudy.12:4

Meekums,H.,Hawash,M.,Sparks,A.,Oviedo,Y.,Sandoval,C.,Chico,M.,Stothard,J,.Cooper,P.,Nejsum,P.,Betson,M.2015.AgeneticanalysisofTrichuristrichiura andTrichurissuisfromEcuador.BMCParasitesandVectors.8:168.

Severin,B.,Moldpveanu,A.,Adumitresi,C.,Ilasca,O.2017.ParticulariesRegardingtheEvolutionofTrichinosisinConstantaCounty.ARSMedicalTomitana.22:3.164-168

Panayotova,M.,Muchtarov,M.,Popov,D.,Boeva-Bangyozova,V.2017.Trichinosisinchildhood– currentaspects.MedicalUniversitySofia–CentralMedicalLibrary.53:1.5-12.

Ravasi,D.,O’Riain,M.,Illing,N.2012.PhylogeneticEvidenceThatTwoDistinctTrichurisGenotypesInfectBothHumansandNon-HumanPrimates.PLoSONE.7:8.

Speich,B.,Ame,S.,Keiser,J.2012.EfficacyandSafetyofNitazoxanide,Albendazole,andNitazoxanide-AlbendazoleagainstTrichuristrichiuraInfection:ARandomizedControlledTrial.PloSNeglectedTropicalDisease.6:6.