The causative agent of trichuriasis is a roundworm, reaching a length of 5 cm (males 4.5 cm). In the front, narrower part of the body is the oral cavity and esophagus, and all other organs (intestinal tube and anus) in the back, wider part. The color of the worm varies from light gray to brown and reddish.

The disease is common in the Central Black Earth region of the country and in the regions of the North Caucasus, as well as in tropical and subtropical climatic zones.

Whipworm eggs enter the soil with the feces of a person who is the only and final owner of this helminth. They are round in shape, slightly narrowed on both sides, similar in structure to a lemon, and have a protective shell. Under certain conditions (humidity, heat, excess oxygen), eggs develop within 3 months, after which they become infectious.

The development cycle of the whipworm begins with the ingestion of eggs into the human body by the oral route from dirty hands or products that have not been washed or heat treated.

Once in the intestine, the larvae leave the shells of the eggs, with a thin end with a mouth opening, they penetrate into the walls of the mucous membrane and feed on blood and lymph. They mainly live in the caecum, nearby sections of the large intestine, as well as in the appendix, however, with significant invasion, they can live in the anus and small intestine. Puberty occurs a few weeks (5-7) after the invasion.

A sexually mature individual in the human body can live for about 5 years, when it enters the soil, its life does not stop, and in favorable conditions it lays eggs.

Causes of infection

Invasion with the whipworm occurs by the fecal-oral route. Helminth eggs, which were in the soil, and then on vegetables, fruits, greens, enter the human body. Worms can get into the human intestines from dirty hands, so the following are more susceptible to infection than others:

• children under 10 years old (they do not pay the necessary attention to the importance of personal hygiene);
• housing and communal services workers (mainly those who are directly connected with the city sewerage);
• people working with the soil (gardeners, gardeners).

Helminth eggs in the external environment are extremely resistant to adverse conditions, only the drying of the soil in which they are negatively affected.

And in conditions of 100% humidity, air temperature in the region of 23-26 ° C and a sufficient amount of oxygen, they develop and can live up to 2 years.

Disease pathogenesis

The influence of the helminth on the body is expressed in the destruction of the organs of the gastrointestinal tract (gastrointestinal tract), disturbances in the digestive system, as well as damage to the central nervous system (central nervous system).

Destructive changes in the intestines lead to stool disorders, affect the production of gastric secretions, and negatively affect peristalsis.

The human whipworm feeds on blood, so trichuriasis threatens with the development of anemia (anemia) in people infested with a large number of these worms (mainly found in residents of tropical zones).

The waste products of the worm released into the intestines have a strong toxic effect on the body, which primarily affects the nervous system.

Complications and consequences

Complications of invasion with whipworm worms are characterized primarily by a traumatic nature. The worm penetrates the intestinal mucosa, violating its integrity, this leads to various pathological consequences:

• inflammation in the intestines (disrupts the normal functioning of the organ, leads to frequent stool disorders, painful sensations);
• deep trauma (the worm, in search of food, can go deep into the wall of the intestine and pierce it through);
• abscess, peritonitis (complications possible with deep trauma);
• the formation of cysts, polyps (injuries of the intestinal walls are accompanied by the growth connective tissue, the formation of bubbles with liquid, which can cause intestinal obstruction).

The method of feeding the helminth involves the development of anemia and a deficiency of trace elements (proteins, vitamins) with an increase in the number of individuals and in the absence of the necessary treatment.

Launched inflammatory processes in the intestines, as well as various neoplasms, cause stagnation of feces, which in turn causes the development of a severe inflammatory disease of the caecum - typhlitis.

Symptoms and types

The general clinical picture of the disease does not have specific symptoms and is expressed as signs of other diseases, such as colds, gastrointestinal diseases, allergic reactions, disorders of the nervous system.

• weakness;
• nausea (sometimes vomiting);
• persistent diarrhea (not responding to medication);
• pain in the abdominal cavity;
• the appearance of blood and mucus in the stool;
• loss of appetite;
• migraine;
• dizziness;
• flatulence;
• weight loss
• SARS symptoms (runny nose, sore throat).

Pli prolonged invasion, manifestations begin to be psychosomatic in nature:

• insomnia;
• convulsions;
• irritability;
• unmotivated aggression.

Sometimes rectal prolapse can occur as a result of prolonged diarrhea.

Sometimes, if the disease is not treated correctly and in a timely manner, inflammation in the intestines caused by blockage, inflammation of appendicitis can be observed. Children may be diagnosed with developmental delay.

Invasion detection begins with a detailed history. The doctor must find out whether the victim is a resident of endemic areas, whether his profession is at risk. After a conversation with the patient, a series of tests is prescribed.

Diagnosis of symptoms and treatment of human whipworm infestation should only be carried out by a specialist in a medical facility!

Initially, it is necessary to conduct primary studies to exclude other diseases with similar symptoms.

After that, the following studies are carried out:

• coproscopy(an analysis of feces for the presence of helminth eggs can be carried out only a month or later after a possible invasion, which is explained by the fact that until individuals have reached reproductive age, they do not lay eggs);
• UAC(a general blood test will reveal eosinophilia of at least 20% in case of invasion, an increase in the level of leukocytes, as well as a significant decrease in hemoglobin levels);
• ELISA(immunoenzymatic analysis for the presence of antibodies to the pathogen in the blood, venous blood taken on an empty stomach is examined for the presence of immunoglobulins M and G, as well as their number and density per unit of blood);
• sigmoidoscopy(visual examination of the intestine using a sigmoidoscope, signs of infection are swelling and friability of the mucosa, in severe cases, the helminths themselves can be seen).

Before any study, you must not eat spicy, fried, smoked dishes, stop taking medications no later than 7 days before the analysis, do not drink alcohol and do not smoke. Before sigmoidoscopy, it is necessary to make an enema and not eat for 18 hours before the study.

Treatment

Treatment of invasion with a whipworm is prescribed exclusively by a doctor after all the necessary studies have been carried out.

Also, with whiplash, treatment is accompanied by ancillary therapy, which includes vitamin therapy and iron-containing drugs to eliminate anemia.

Hospitalization is not shown. Specialists recommended repeated coproscopy 30 days after treatment to obtain a control result. It is also recommended to give feces for analysis three times by people at risk (family members, colleagues).

You can use folk remedies in combination with traditional therapy:

• drink pumpkin juice daily on an empty stomach (150 ml);
• mix mistletoe leaf powder and valerian root in a ratio of 1 to 2, consume 1 time per day, in combination with carrots (fresh);
• infusion of thyme (1 tbsp pour 1 tbsp water) to drink during the day.

Forecast and prevention

With timely and adequate treatment, the prognosis for recovery is favorable.

With deep and prolonged invasion, severe secondary diseases that are difficult to treat or untreatable (oncology) may occur.

Possible preventive measures include:

• proper processing of products before eating (washing, heat treatment);
• drinking only filtered water;
• meticulous hygiene;
• observation of a previously infected but cured patient for 2 years;
• observation of family members and other people at risk for 2 years.

Each victim must remember that no matter how delicate the problem, with the slightest violation, it is necessary to contact a specialist. When a helminthic invasion is detected, it is extremely important to inform the family or people living in the same area as the infected person in order to avoid their infection.

By following preventive measures, you can reduce the risk of possible invasion.

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  1. General characteristics of helminths

  The human whipworm got its name because the front part of its body is very thin, like a hair, and the back part is expanded. They are dioecious helminths.

  Individuals are usually gray-brown in color, sometimes reddish. The ratio of the thin head to the widened back is 2:1 for females and 3:2 for males. The body sizes of females reach three to four centimeters, and for males - three and a half to five and a half. The extended end of the females is slightly curved, while the males are wrapped in a spiral.

  In the anterior narrowed part of the body there is a long esophagus with cells surrounding it, in the thickened end - the intestines and genitals. Also, males have a wavy testis in the narrow part, which ends with an ejaculatory canal at the posterior end of the body.

  The internal and external structure of the human whipworm is no different from other members of the nematode class.

  

  Figure 1 - Schematic representation of adult individuals of the human whipworm and its eggs

  The helminth is covered with a skin-muscular sac, consisting of a cuticle, muscles and hypodermis. The cuticle is a kind of barrier to penetration various substances. It has a complex biochemical structure. It also maintains the shape of the worm.

  Under the cuticle lies the hypodermis. It forms it, and also accumulates nutrients. The hypodermis is the link between the cuticle and muscle cells.

  Muscle cells contribute to the movement of the worm. They are represented by longitudinally located muscle strands. The movements of the worms occur in the direction from the back to the abdomen. The inner space is filled with liquid, which has a complex chemical composition and performs a supporting function.

  The digestive system is represented by the esophagus, middle and hindgut. The esophagus works like a pump. Swallowed food moves in one direction. excretory system is a long canal that merges into a common duct that opens on the abdomen.

  

  Figure 2 - Whipworms in the large intestine (colonoscopy)

  The nervous system is represented by a ring located near the esophagus. Nerve trunks run from it along the body, interconnected by nerve jumpers.

  The female reproductive organs are represented by the ovaries, which pass into the oviducts, the uterus. The male ones consist of the testis, the vas deferens and the ejaculatory canal.

  Circulatory and respiratory systems are absent, which indicates the primitive organization of this type of helminths. Breathing is done through the integument or with the help of chemical processes.

  2. Life cycle of Trichuris trichiura

  The source of infection is sick people, with the feces of which helminth eggs penetrate into the external environment. For the formation of the larvae, they must fall into the soil.

  They tolerate exposure to sunlight well and poorly - low temperatures. The size of the egg is about 52-54 x 22-27 microns, the shape is like that of a lemon, there are transparent caps at the ends, the shell is smooth, yellow-brown in color. In the ground, their viability lasts up to three years.

  

  Figure 3 - Life cycle of the whipworm Trichuris trichiura

  In humans, mature helminths live in the caecum and ascending part of the colon.. A person can live from a few individuals to several hundred. With massive infection roundworms able to fill the entire intestine up to and including the rectum.

  There, the helminth pierces the mucous membrane with its hair-like end and is held in this place until natural death. The development of the larvae takes approximately two weeks, and after a month the adult whipworm is already capable of fertilization. Approximately one and a half months after the moment of human infection, the release of eggs by the female begins.

  The life expectancy of adult whipworms in the human body is five to six years.

  Trichuriasis is common in places with a warm and humid climate. Usually found in the southwestern part of Russia, also in the Transcaucasus, Belarus and Ukraine. It is often detected in such countries and regions as Dagestan, Armenia, Buryatia, Central Asia.

  Most often, trichocephalosis is detected in children between the ages of five and fifteen, but adults can also become infected. A rare incidence in adults indicates age-related acquired immunity (the process has not been studied enough).

  

  Figure 4 - The prevalence of trichuriasis in the world, source WHO, 2002. Areas with an incidence of 50-60 cases per 100,000 of the population are marked in red, with an incidence of 5-25 cases per 100,000 - in yellow.

  3. Symptoms of trichuriasis

  In one day, one worm can suck up to 0.005 ml of blood. The presence in the body of more than eight hundred individuals leads to hypochromic anemia. Also, pathogenic bacteria can get into the place of attachment of the helminth.

  Usually the disease is asymptomatic or with isolated symptoms. They are observed most often in those patients in whom five thousand or more eggs are found in one gram of feces.

  All symptoms of trichocephalosis can be conditionally divided into syndromes:

  1. 1 Dyspeptic syndrome (loss of appetite, nausea, vomiting, weight loss, salivation in children).
  2. 2 Hepatomegaly syndrome (enlarged liver).
  3. 3 Colitis syndrome (paroxysmal pain in the right iliac region, constipation, rarely - diarrhea, painful urge to go to the toilet - tenesmus, blood in the stool, painful bloating).
  4. 4 Astheno-neurotic syndrome ( headache, dizziness, irritability, bouts of short-term loss of consciousness, convulsive seizures, meningeal symptoms, in children - a lag in mental and physical development).
  5. 5 Fever (sometimes there is an increase in temperature up to 38ºС).
  6. 6 Anemia syndrome (manifested by pallor of the skin, muffled heart sounds, shortness of breath with habitual physical activity, cold extremities).

  4. Possible complications

  Complications of trichocephalosis include the development of acute appendicitis when worms enter the appendix, the development of severe hypochromic anemia, intestinal dysbiosis, cachexia (extreme exhaustion of the body), the development of severe amoebiasis, rectal prolapse (usually recorded when more than 20 thousand eggs are found in one gram of feces). Also, whipworm invasion can cause biliary dyskinesia.

  5. Diagnostic methods

  One of the diagnostic methods is a patient survey. It is specified whether he traveled outside the city to the countryside, whether he consumed food products grown in an unfamiliar area.

  

  Figure 5 - Appearance eggs of Trichuris trichiura under microscopy

  The evidence of this method in the diagnosis of trichuriasis is extremely small.

  6. Differential diagnosis

  Trichuriasis must be distinguished from other helminthiases, shigellosis, amoebiasis, as well as ulcerative colitis, acute appendicitis. If a surgical pathology is suspected, a surgeon's consultation is prescribed, if ulcerative colitis is suspected - a proctologist.

  7. Medical treatment

  Treatment of uncomplicated trichuriasis is carried out on an outpatient basis. Patients with severe complications require inpatient monitoring. The patient is prescribed anthelmintic drugs such as albendazole, mebendazole, carbendacim.

  A drug	Efficiency	Dosage	Mode of application
  Albendazole	89,7 %	400 mg
  mebendazole	81 - 92,8 %	100 mg
  Carbendacym	30 – 60 %	10 mg/kg/day.

  Table 1 - Schemes for the use of anthelmintic drugs for trichuriasis

  Albendazole blocks the biochemical processes inside the body of the worm, which contributes to its death. Contraindications are children under two years of age, pregnant women, the period of feeding, hypersensitivity during the previous use of the drug.

  Mebendazole inhibits the absorption of glucose and the formation of energy in worms. The drug is contraindicated in children under two years of age, pregnant women, during breastfeeding, with diseases of the colon (Crohn's disease, ulcerative colitis), allergic reactions to mebendazole, liver failure.

  Carbendacym inhibits the work of the muscle cells of the worms, after which they are not able to fix themselves and are removed from the intestine with feces. Contraindications are pregnancy and allergic manifestations in previous applications of carbendacym.

  When treating with these drugs, neither a special diet nor laxatives are required.

  In cases of persistent invasion, the therapeutic course is repeated after four weeks. A final stool examination is performed three to four weeks after antihelminthic treatment.

  Terms of disability are determined by the presence of complications on an individual basis. Dispensary is not regulated.

  8. Forecast and prevention

  With a small invasion, complications usually do not occur and the patient recovers. With massive - the prognosis is unfavorable. The fight against trichuriasis is based on certain preventive measures. Sanitary and recreational measures include improving the sanitary and hygienic condition of agricultural settlements, protecting the environment from pollution by human feces, and disinfecting sewage suitable for fertilizer.

  A drug	Efficiency	Dosage	Mode of application
  Albendazole	89,7 %	400 mg	Once a day after meals with water for three days
  mebendazole	81 - 92,8 %	100 mg	Twice a day, half an hour after a meal, washed down with water, the course of admission is three days
  Carbendacym	30 – 60 %	10 mg/kg/day.	Once a day after a meal, thoroughly chewed and washed down with water, the course of admission is three to five days