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Trichuris trichiura, the whipworm, infects about a billion persons throughout the world, particularly in humid tropical and subtropical environments Infection is heaviest and most frequent in children Infections are acquired by ingestion of eggs The larvae hatch in the small intestine and mature in the large bowel to adult worms of about 4 cm in length The worms do not migrate through tissues Most infected persons are asymptomatic Heavy infections may be accompanied by abdominal cramps, tenesmus, diarrhea, distention, nausea, and vomiting The Trichuris dysentery syndrome may develop, particularly in malnourished young children, with findings resembling inflammatory bowel disease including bloody diarrhea and rectal prolapse Chronic infections in children can lead to iron deficiency anemia, growth retardation, and clubbing of the fingers Trichuriasis is diagnosed by identification of characteristic eggs and sometimes adult worms in stools Concentration techniques are not needed Eosinophilia is common Treatment is with albendazole (400 mg/d) or mebendazole (200 mg/d), for 1 3 days for light infections or 3 7 days for heavy infections
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Most persons with Ascaris infection are asymptomatic A small proportion develop symptoms during migration of worms through the lungs, with fever, nonproductive cough, chest pain, dyspnea, and eosinophilia, occasionally with eosinophilic pneumonia Rarely, larvae lodge ectopically in the brain, kidney, eye, spinal cord, and other sites and may cause local symptoms Light intestinal infections usually produce no symptoms With heavy infection, abdominal discomfort may be seen Adult worms may also migrate and be coughed up, vomited, or may emerge through the nose or anus They may also migrate into the common bile duct, pancreatic duct, appendix, and other sites, which may lead to cholangitis, cholecystitis, pyogenic liver abscess, pancreatitis, obstructive jaundice, or appendicitis With very heavy infestations, masses of worms may cause intestinal obstruction, volvulus, intussusception, or death Although severe manifestations of infection are uncommon, the very high prevalence of ascariasis leads to large numbers of individuals, especially children, with important sequelae Moderate to high worm loads in children are also associated with nutritional abnormalities due to decreased appetite and food intake, and also decreased absorption of nutrients The diagnosis of ascariasis is made after adult worms emerge from the mouth, nose, or anus, or by identifying characteristic eggs in the feces Due to the very high egg burden, concentration techniques are generally not needed Imaging studies demonstrate worms, with filling defects in contrast studies and at times evidence of intestinal or biliary obstruction Eosinophilia is marked during worm migration but may be absent during intestinal infection
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HOOKWORM DISEASE
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ESSENTIALS OF DIAGNOSIS
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Transient pruritic skin rash and pulmonary symptoms Anorexia, diarrhea, abdominal discomfort Iron deficiency anemia Characteristic eggs and occult blood in the stool
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Infection with the hookworms Ancylostoma duodenale and Necator americanus is very common, especially in most tropical and subtropical regions Both worms are broadly distributed Prevalence is estimated at about 1 billion, causing approximately 65,000 deaths each year When eggs
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are deposited on warm moist soil they hatch, releasing larvae that remain infective for up to a week With contact, the larvae penetrate skin and migrate in the bloodstream to the pulmonary capillaries In the lungs, the larvae penetrate into alveoli and then are carried by ciliary action upward to the bronchi, trachea, and mouth After being swallowed, they reach and attach to the mucosa of the upper small bowel, where they mature to adult worms Ancylostoma infection can also be acquired by ingestion of the larvae in food or water Hookworms attach to the intestinal mucosa and suck blood Blood loss is proportionate to the worm burden
CMDT 2008
STRONGYLOIDIASIS
ESSENTIALS OF DIAGNOSIS
Transient pruritic skin rash and pulmonary symptoms Anorexia, diarrhea, abdominal discomfort Hyperinfection syndrome with varied severe presentations in the immunocompromised Larvae detected in stool With hyperinfection, larvae detected in sputum or other fluids Eosinophilia
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