Trichuris dysentery syndrome


Trichuris dysentery syndrome

Description, Causes and Risk Factors:

Abbreviation: TDS.

The whipworm of humans, a species that causes trichuriasis; the body is filiform and slender in the anterior three-fifths, and more robust posteriorly; females are 4 or 5 cm long, males are shorter (with coiled caudal extremity and a single eversible spicule); eggs are barrel-shaped, 50-56 4m by 20-22 4m, with double shell and translucent knobs at each of the two poles; humans are the only susceptible hosts and usually acquire infection by direct finger-to-mouth contact or by ingestion of soil, water, or food that contains larvated eggs (development in the soil takes 3-6 weeks under proper conditions of warmth and moisture, hence distribution is chiefly tropical); larvae escape from eggs in the ileum, mature in approximately a month, and then pass directly into the cecum without undergoing a parenteral migration as occurs with Ascaris lumbricoides; adults may persist for 2-7 years.

Trichuris trichiura is among the most common human parasites in the world. The majority of infected individuals have light infections and are asymptomatic but heavy infection in children can lead to chronic and severe illness. In the majority of individuals with light or moderately intense infection, the worms are relatively few in number and confined to the cecum. The presence of numerous worms throughout the length of the colon from cecum to rectum on the other hand is a typical feature of TDS.

Trichuris trichiura live in the intestine and whipworm eggs are passed in the feces of infected persons. If the infected person defecates outside (near bushes, in a garden, or field), or if the feces of an infected person are used as fertilizer, then eggs are deposited on the soil. They can then mature into a form that is infective. Roundworm infection is caused by ingesting eggs. This can happen when hands or fingers that have contaminated dirt on them are put in the mouth, or by consuming vegetables or fruits that have not been carefully cooked, washed or peeled.

Infection occurs worldwide in warm and humid climates where sanitation and hygiene are poor, including in temperate climates during warmer months. Persons in these areas are at risk if soil contaminated with human feces enters their mouths or if they eat vegetables or fruits that have not been carefully washed, peeled or cooked.

Symptoms:

People with light infections usually have no signs or symptoms. People with heavy infections can experience frequent, painful passage of stool that contains a mixture of mucus, water, and blood. The diarrhea typically has an acrid smell. In severe cases growth retardation can occur. Rectal prolapse can also occur. In children, heavy infection may be associated with growth retardation and impaired cognitive development.

Diagnosis:

The diagnosis of TDS rests on finding worms in the rectum coupled with the clinical syndrome of chronic diarrhoea, anaemia and growth retardation. Clubbing and rectal prolapse are not invariable. Although trichuriasis is common, TDS is said to be uncommon. The often cited morbidity rate from trichuriasis is 0.2 per 1000 population'. Hence trichuriasis has been accorded a low priority in terms of public health importance. However there is evidence to suggest that in areas where the prevalence of Trichuris infection is high, TDS might not be as uncommon as is generally thought.

Children with TDS tend to have growth and nutritional deficits as shown by their consistently short stature and variable amount of wasting'. Cooper and Bundy hypothesised that there is a causative link between trichuris-associate dysentery and growth stunting. This association is further strengthened by the observation of increased growth and improvement in nutritional status after worm expulsions.

The pathogenesis of TDS however remains unclear. Despite the striking similarity of clinical picture to inflammatory bowel disease in children, conventional histology of colonic mucosa in TDS shows little if any inflammation. Immunohistochemistry of the colonic mucosa however has shown increased numbers of tissue infiltrating monocytes and increased local production of tumour necrosis factor a (TNF-alpha). The Trichuris Dysentery Syndrome is a severe condition that causes considerable morbidity but if treated adequately has a favourable outcome. It is imperative for health workers to recognise this condition promptly.

Treatment:

In developing countries, groups at higher risk for soil-transmitted helminth infections (hookworm, Ascaris, and whipworm) are often treated without a prior stool examination. Treating in this way is called preventive treatment (or "preventive chemotherapy"). The high-risk groups identified by the WHO (World Health Organization) are preschool and school-age children, women of childbearing age (including pregnant women in the 2nd and 3rd trimesters and lactating women) and adults in occupations where there is a high risk of heavy infections. School-age children are often treated through school-health programs and preschool children and pregnant women at visits to health clinics.

Fortunately, Trichuris dysentery syndrome can be treated effectively with several different drugs. For humans, Mebendazole is often used to rid the body of the infection. Albendazole may also be used as a means of freeing the body from the presence of Trichuris. A qualified physician can order and evaluate a stool examination in order to both diagnose trichuris trichiura as well as confirm that the parasites have been killed and ejected. Similar medications are available for administration by veterinarians when household pets are diagnosed with a case of whipworms.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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