Whipworm is an intestinal invasion caused by the parasitization of the round helminth – whipworm and occurring with a predominant violation of the function of the digestive tract and nervous system. Gastrointestinal dysfunction in whipworm is characterized by decreased appetite, salivation, nausea, vomiting, abdominal pain, diarrhea or constipation; central nervous system damage leads to headache, dizziness, sleep disorders, sometimes fainting and convulsions. Whipworm is diagnosed based on the detection of whipworm eggs in the feces or adult helminths in the intestinal lumen using endoscopy. Treatment is carried out with anthelmintic drugs (albendazole, mebendazole, carbendacim, etc.).
Whipworm is an intestinal nematodes characterized by a chronic course with the development of dyspeptic, asthenic and anemic syndromes. Whipworm is almost ubiquitous; it is more common in tropical and subtropical climate zones, where the invasion is detected in 40-50% of the local population. In endemic regions, whipworm is the second most common helminthiasis after ascariasis. The greatest incidence of whipworm is observed among children aged 5 to 15 years.
The etiological agent causing whipworm is the round helminth Trichocephalis trichiuris (whipworm). It is a thin nematode of brownish color with a thin filamentous anterior part and a rounded thickened posterior end. Helminth females reach a length of 3.5-5.5 cm, males – 3-4.5 cm– Adult helminths parasitize in the cecum, but with massive invasion they can inhabit the entire large intestine, including its terminal section – the rectum. Every day , the female whiptail allocates about 3.5 thousand. the eggs are barrel-shaped, covered with a thick brown shell with colorless “plugs” at the poles. With feces, eggs fall into the soil, where they mature to the invasive stage. The optimal conditions for the development of the causative agent of whipworm in the external environment are a temperature of 26-30 ° C, relative humidity of about 100%, oxygen access. The whipworm eggs retain their invasive properties in the soil for up to 2 years. Drying and insolation have a detrimental effect on them.
Infection with whipworm is realized by the fecal-oral mechanism when mature eggs are brought into the mouth with contaminated hands or when swallowed together with berries, fruits, herbs, vegetables, and water contaminated with soil. In the human gastrointestinal tract, larvae that have emerged from eggs are embedded in the wall of the small intestine. After 5-10 days, they descend to the cecum, where they are reintroduced into the mucosa and within 1-1.5 months they turn into adults. With its head part, the whipworm penetrates into the intestinal wall, and its rear end hangs freely in the intestinal lumen. The duration of helminth parasitization in the human intestine reaches 5-7 years. Whipworm is more common in children who have insufficiently formed hygienic skills, as well as people who have contact with the soil (gardeners, diggers, builders), housing and communal services workers. Infection occurs more often from late spring to early autumn.
Pathological effects in whipworm are caused by injury to the mucous, submucosal and muscular layers of the intestine, the release of enzymes and metabolites by helminths, which is accompanied by the development of local inflammatory and general toxic-allergic reactions. Infiltrates, erosions and ulcers of the mucous membrane, hemorrhages may occur. Irritation of the nerve endings of the intestine causes a violation of the motor and secretory function of the intestine. The consequence of a disorder of fluid absorption in the large intestine is the development of diarrheal syndrome. In the case of the addition of secondary microflora, typhlitis develops – inflammation of the caecum. Being facultative hematophages according to the method of nutrition, whipworms cause the development of iron deficiency anemia.
The severity of the clinical symptoms of whipworm depends on the severity and intensity of the invasion. The course of whipworm is divided into acute and chronic stages, as well as compensated, subclinical, manifest and complicated forms. The subclinical course is noted with a moderate degree of helminth infection; in these cases, rare spastic or stabbing pains occur in the right iliac region.
In the manifest form of whipworm, signs of damage to the gastrointestinal tract and the central nervous system are expressed. The main symptoms are associated with digestive disorders and include lack of appetite, salivation, nausea, vomiting, flatulence, unstable stools (diarrhea alternating with constipation). With high-intensity helminth invasion, severe colitis with uncupable diarrhea with an admixture of blood, tenesmus, rectal prolapse can develop. Abdominal pain may focus in the epigastrium, the right iliac region, or may not have a clear localization. Epigastric pain in whipworm often simulates the clinic of gastric ulcer and duodenal ulcer, and pain in the lower abdomen – chronic appendicitis.
Changes from the central nervous system in whipworm include general weakness, poor sleep, irritability, dizziness, headaches, fainting in children, convulsive syndrome, lag in physical development. The course of whipworm can be complicated by intestinal dysbiosis, acute appendicitis, cachexia, anemia. Severe forms of invasion are noted when whipworm is combined with acute intestinal infections, ascariasis, amoebiasis.
If there is an appropriate clinical picture, a comprehensive clinical, instrumental and laboratory examination is carried out. The patient’s belonging to the occupational risk group for the development of whipworm is taken into account. When examining the hemogram, moderate eosinophilia, hypochromic anemia is determined. Endoscopic examination of the intestine (rectoromanoscopy or colonoscopy) reveals a hyperemic, edematous mucosa with superficial erosions and spot hemorrhages; sometimes it is possible to see helminths hanging into the lumen of the sigmoid or rectum. The diagnosis of whipworm is not in doubt when the eggs of the whipworm are found in the feces by enrichment methods. At the stage of differential diagnosis, viral and bacterial gastroenteritis, ulcerative colitis, other helminthiasis (ascariasis, diphyllobothriosis), shigellosis, appendicitis are excluded. In case of suspicion of certain pathological conditions, consultations of a gastroenterologist, proctologist, surgeon are indicated.
Usually, patients with whipworm do not need hospitalization, except in cases of severe concomitant diseases and complications. Anthelmintic therapy is carried out with drugs albendazole, mebendazole, carbendacim, etc. A control examination of feces for helminth eggs is performed 3-4 weeks after the end of the course of treatment for whipworm. If necessary, a repeated course of antiparasitic therapy is repeated with another drug. Concomitant drug treatment includes the appointment of B vitamins, enzymes, probiotics, iron preparations.
Prognosis and prevention
In case of timely diagnosis and specific therapy of whipworm, the prognosis is favorable. With massive invasion, the disease is dangerous with its complications. A patient who has had whipworm and his family members are under dispensary supervision for 2 years after the cure. Prevention is similar to that of other intestinal helminthiasis. Its main links are hygiene (boiling water, washing hands, vegetables and fruits), protection of soil from fecal contamination, increasing the level of hygienic education of the population. It is necessary to conduct regular coprooscopic examination of children and decreed groups, timely deworming of patients with whipworm.