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Trichuriasis

(Whipworm)
3rd most common roundworm parasite of humans

Trichuriasis is an infection caused by Trichuris trichiura, an intestinal roundworm.

This parasite occurs mainly in the subtropics and tropic, where poor sanitation and warm, moist climate provide the conditions needed for the eggs to incubate in the soil. Infection results when a person swallows food containing eggs that have incubated in the soil for 2-3 weeks. The larvae hatch in the small intestine, migrate to the large intestine and embedded their heads in the intestinal lining. Each larva grows to about 4 inches. Mature female produce about 5000 eggs a day which are passed in the stool.

It is a common infection that mainly affects children. Children may become infected if they swallow soil contaminated with whipworm eggs. When the eggs hatch inside the body, the whipworm sticks inside the wall of the large intestine. Whipworm is found throughout the world, especially in countries with warm, humid climates. Some outbreaks have been traced to contaminated vegetables (believed to be due to soil contamination).

Etiology
Trichuriasis refers to the infection of the intestines caused by the parasitic nematode Trichuriasis trichuira. Trichiura, a soiltransmitted helminth, is a roundworm and is also known as the human whipworm due to its characteristic: thin, long, whip-like appearance. Of the roundworms that infect humans, the whipworm is the 3rd most common.

Epidemiology
There is a worldwide distribution of Trichuris trichiura, with an estimated 1 billion human infections. However, it is chiefly tropical, especially in Asia and, to a lesser degree, in Africa and South America. Within the United States, infection is rare overall but may be common in the rural Southeast, where 2.2 million people are thought to be infected.

Cause
Whipworm disease is caused by a parasitic roundworm named Trichuria trichiura.

Risk Factors
Soil-transmitted helminthes (STH) and whipworms causes an infection called Trichuriasis which often occurs In areas where human feces is used as fertilizers and where defecation onto soil happens. The worms can spread from person-person by oral transmission through contaminated food.

Infection occurs through ingestion of eggs (which are usually found in dry goods such as beans, rice, and various grains) and is more common in warmer areas. The eggs hatch in the small intestine, and then move into the wall of the small intestine and develop. On reaching adulthood, the thinner end (the front of the worm) burrows into the large intestine and the thicker end hangs into the lumen and mates with nearby worms. The females can grow to 50 mm (2 inches) long. Neither the male nor the female has much of a visible tail past the anus.

Life Cycle
Unembryonated eggs are passed in the feces of a previous host to the soil, these eggs develop into 2-cell stage(segmented egg) and then become infective, a process that occurs in about 15-30 days. Next, the infective eggs are ingested by way of soil-contaminated hands or food and hatch inside the small intestines, releasing larvae into the GI tract. These larvae burrow into avillus and develop into adults(over 2-3 days). They then migrate into the cecum and ascending colon where they thread their anterior portion(whip-like end) into the tissue mucosa and reside permanently for their year-long life span. About 60-70 days after infection, female adults begin to release unembryonated eggs into the cecum at a rate of 3,00020,000 eggs a day, linking the life cycle to the start.

Chain of Infection
ENTIOLOGIC AGENT

HOST

RESERVOIR

PORTAL OF ENTRY
MODE OF TRANSMISSION

PORTAL OF EXIT

Control
Trichuriasis is treated with anti helmintics such as oxantel, albendazole but more specifically, mebendazole which is taken orally for 3days. Mebendazole works by selectively and irreversibly blocking glucose uptake and other nutrients in the intestine where helminth dwell. The eggs are destryoed by sunlight and dehydration as well as temperatures above 52deg Celsius or below -9deg Celsius

Prevention
Improved facilities for disposal of feces have decreased the incidence of whipworm. Hand washing before food handling and avoiding ingestion of soil by through washing of food that may have been contaminated with egg-containing soil.

Poor hygiene is associated with trichuriasis as well as the consumption of shaded moist soil, or food that may have been fecally contaminated. Children are especially vulnerable to infection due to their high exposure risk. Eggs are infective about 23 weeks after they are deposited in the soil under proper conditions of warmth and moisture, hence its tropical distribution.