History

Fact Explanation
Passage of loose stools associated with blood and mucus. Due to inflammation at the site of attachment to the colonic mucosa from large numbers of whipworms which results in colitis [1].
Lump protruding out at the anus. It is due to rectal prolapse which occurs as a result of straining at defecation in the presence of a large number of worms and/or the irritation of nerve endings with increased peristalsis [2].
Lethargy. This is a symptom of anemia, which occurs due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa [3].
Abdominal discomfort. It occurs as a result of spasms of the intestinal wall due to local irritation by the parasite [4].
References
  1. BETHONY Jeffrey, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. The Lancet[online] 2006, Vol 367(9521): 1521–1532. [viewed 22 April 2014] available from: DOI: 10.1016/S0140-6736(06)68653-4
  2. STEPHENSON L.S., C.V. HOLLAND and E.S. COOPER. The public health significance of Trichuris trichiura. Parasitology [online] 2000, Vol 121(1): 73-95. [viewed 22 April 2014] available from: DOI: 10.1017/S0031182000006867
  3. WARREN K.S. and A.A.F. MAHMOUD. Algorithms in the diagnosis and management of exotic diseases. IX. Trichuriasis. Journal of Infectious Diseases[online] 1976, 133(2): 240-243. [viewed 22 April 2014] available from: DOI: 10.1093/infdis/133.2.240
  4. BAHON J., et al. Colonic obstruction and perforation related to heavy Trichuris trichiura infestation. J Clin Pathol [online] 1997, 50:615-616 [viewed 22 April 2014] available from: DOI: 10.1136/jcp.50.7.615

Examination

Fact Explanation
Conjunctival pallor and other features of anemia. Due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa [1].
Rectal prolapse. It occurs as a result of straining at defecation in the presence of a large number of worms and/or the irritation of nerve endings with increased peristalsis [2].
Finger clubbing. Due to increased tumor necrosis factor alpha and other cytokines in the lamina propria of the colonic mucosa and peripheral blood, decreased plasma insulin like growth factor I, and decreased collagen synthesis which occurs in the pathogenesis of Trichuris dysentery syndrome [3].
References
  1. WARREN K.S. and A.A.F. MAHMOUD. Algorithms in the diagnosis and management of exotic diseases. IX. Trichuriasis. Journal of Infectious Diseases[online] 1976, 133(2): 240-243. [viewed 22 April 2014] available from: DOI: 10.1093/infdis/133.2.240
  2. STEPHENSON L.S., C.V. HOLLAND and E.S. COOPER. The public health significance of Trichuris trichiura. Parasitology [online] 2000, Vol 121(1): 73-95. [viewed 22 April 2014] available from: DOI: 10.1017/S0031182000006867
  3. KHUROO Mohammad S., Mehnaaz S. KHUROO, and Naira S. KHUROO. < i> Trichuris dysentery syndrome: a common cause of chronic iron deficiency anemia in adults in an endemic area (with videos). Gastrointestinal Endoscopy[online] 2010, vol 71(1): 200-204. [viewed 22 April 2014] available from: DOI: 10.1016/j.gie.2009.08.002

Differential Diagnoses

Fact Explanation
Gastroenteritis. It presents with symptoms of diarrhoea, vomiting, abdominal cramps, etc [1].
Giardiasis. It commonly presents with diarrhoea, malaise, flatulence, greasy stools, abdominal cramps bloating and weight loss. Passage of blood and mucus in stool is rare [2].
Necatoriasis. Necator americanus infection results in iron deficiency anemia due to the blood loss associated with parasitic infestation of the small intestinal mucosa [3].
References
  1. DE WIT M. A. S., et al. Sensor, a population-based cohort study on gastroenteritis in the Netherlands: incidence and etiology. American journal of epidemiology [online] 2001, vol 154(7): 666-674. [viewed 22 April 2014] Available from: DOI: 10.1093/aje/154.7.666
  2. GARDNER Timothy B. and David R. HILL. Treatment of giardiasis. Clinical Microbiology Reviews[online] 2001, vol 14(1): 114-128. [viewed 22 April 2014] Available from: DOI: 10.1128/CMR.14.1.114-128.2001
  3. WINTER J.A., et al. The assessment of hookworm calreticulin as a potential vaccine for necatoriasis. Parasite Immunology[online] 2005, 27: 139–146. [viewed 22 April 2014] Available from: DOI: 10.1111/j.1365-3024.2005.00756.x

Investigations - for Diagnosis

Fact Explanation
Eosinophilia on full blood count. It is associated with helminth infections, especially during their tissue-invasive stages of development [1].
Reduced hemoglobin levels on full blood count. Due to the uptake of blood by the parasite at the site of attachment to the colonic mucosa [2].
Characteristic oval shaped eggs (with transparent bipolar plugs) of trichuris trichiura on stool smear. In their definitive host which is man, each adult female whipworm produces thousands of eggs per day. They are passed in stool [3].
Colonoscopy. For direct visualization of the adult whipworm which inhabits the rectum and colon, being attached to the bowel mucosa [4].
References
  1. SCHULTE C. et al. Diagnostic significance of blood eosinophilia in returning travelers. Clinical infectious diseases[online] 2002, vol 34(3): 407-411. [viewed 22 April 2014] available from DOI: 10.1086/338026
  2. WARREN K.S. and A.A.F. MAHMOUD. Algorithms in the diagnosis and management of exotic diseases. IX. Trichuriasis. Journal of Infectious Diseases[online] 1976, 133(2): 240-243. [viewed 22 April 2014] available from: DOI: 10.1093/infdis/133.2.240
  3. BETHONY Jeffrey, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. The Lancet[online] 2006, Vol 367(9521): 1521–1532. [viewed 22 April 2014] available from: DOI: 10.1016/S0140-6736(06)68653-4
  4. WANG Dong-dong, et al. Trichuriasis diagnosed by colonoscopy: case report and review of the literature spanning 22 years in mainland China. International Journal of Infectious Diseases[online] 2013, vol 17(11): 1073-1075. [viewed 22 April 2014] available from: DOI: 10.1016/j.ijid.2013.02.008

Management - General Measures

Fact Explanation
Iron supplimentatiom To combat the anemia which occurs due to blood loss during whipworm infection [1].
References
  1. WARREN K.S. and A.A.F. MAHMOUD. Algorithms in the diagnosis and management of exotic diseases. IX. Trichuriasis. Journal of Infectious Diseases[online] 1976, 133(2): 240-243. [viewed 22 April 2014] available from: DOI: 10.1093/infdis/133.2.240

Management - Specific Treatments

Fact Explanation
Mebendazole (500mg oral, single dose). It is a benzimidazole, which is known to have selective antimitotic activity due to the preferential binding of this agent to helmintic tubulin over mammalian tubulin, which leads to its anthelminthic activity [1].
Albendazole. It is also a benzimidazole [1].
References
  1. NAVARRETE-VAZQUEZ, Gabriel, et al. Synthesis and antiparasitic activity of albendazole and mebendazole analogues. Bioorganic & medicinal chemistry[online] 2003, vol 11(21): 4615-4622. [viewed 22 April 2014] available from: DOI: 10.1016/S0968-0896