Trichocephalosis: causes, symptoms, diagnosis, treatment

Trichuriasis (trichuriasis, trichuriasis, lat. trichocephalosis. eng. trichocephaliasis, trichuriasis) is an anthropozoonotic geohelminthiasis, characterized by a chronic course with predominant dysfunction of the gastrointestinal tract.

ICD-10 code

B79. Trichuriasis.

Epidemiology of trichuriasis

Trichuriasis is classified as a geohelminthiasis. The source of environmental contamination is a sick person. Whipworm eggs mature in the soil for 20-25 days. A person becomes infected by swallowing mature eggs with contaminated vegetables, fruits, berries, and water. Whipworm is a ubiquitous parasite. Trichuriasis is common mainly in tropical and subtropical countries, humid regions of a temperate climate. In Russia, helminthiasis is common in the North Caucasus and in the central black earth regions. Children aged 5 to 15 years are mostly affected. In prevention, the central place is occupied by measures to protect the soil from faecal contamination, as well as compliance with personal hygiene rules.

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What causes trichuriasis?

Trichuriasis is caused by the whipworm, Trichocephalus trichiurus, type Nemathelminthes, class Nematoda, order Enoplida, family Trichocephalidae. The anterior part of the helminth's body is thin and hair-like, the tail section is thickened: the ratio of the thread-like part to the thickened part is 2:1 in the female, and 3:2 in the male. The body length of the female is 30-35 mm, and that of the male is 30-45 mm. In females, the posterior end is curved, while in males it has the appearance of a spiral. Whipworm eggs are barrel-shaped, measuring 0.02 x 0.05 mm, with a thick brown shell and colorless plugs at the poles. Adult helminths parasitize in the large intestine, most often in the cecum. Here, females lay up to 3,500 eggs per day. The eggs are excreted into the environment with feces. They must undergo incubation in the soil for 3 weeks or more, after which the larva acquires invasive properties. In the life cycle of Trichocephalus trichiurus there is no migration phase, the parasite has low immunogenicity. When the egg is swallowed, the larva is released in the small intestine, it penetrates the villi, after a few days it moves to the large intestine, where it reaches maturity after 3 months. Among adults, females predominate. The life expectancy of the whipworm is about 5 years.

Pathogenesis of trichocephalosis

In the pathogenesis of trichuriasis, the main role is given to the traumatic effect of the pathogen. Trichuris damage the mucous membrane with a thin head end, penetrating to the submucosal and sometimes muscle layer. With intensive invasion, hemorrhages, erosions and ulcers are observed in the intestine. Trichuris are facultative hematophages. It is believed that infested people lose 0.005 ml of blood per parasite per day, so the presence of more than 800 helminths in the intestines of children causes hypochromic anemia. The sensitizing effect of parasite metabolites on the body also has a certain significance, but is more often limited to intestinal tissues, which contributes to the development of diarrhea. Clinical manifestations of helminthiasis are obvious when a large number of trichuris are parasitized. Symptoms of trichuriasis are observed in people who excrete more than 5,000 eggs of the pathogen in 1 g of feces.

Symptoms of trichuriasis

In most patients with low-intensity invasion, the symptoms of trichuriasis are weak or absent. With moderate invasion, patients complain of loss of appetite, nausea, salivation, diarrhea, and flatulence. Spasmodic abdominal pain localized in the right iliac region is possible. Patients may note such symptoms of trichuriasis as weakness, irritability, dizziness, and headache. With massive invasion, hemorrhagic colitis develops, manifested by pain syndrome, tenesmus, and bloody loose stool. Children with trichuriasis lag behind their peers in physical and mental development. In tropical countries, trichuriasis is considered a factor contributing to the development of intestinal amebiasis and its severe course.

Complications of trichuriasis include rectal prolapse, hypochromic anemia, intestinal dysbiosis, and cachexia. Trichuriasis is a risk factor for appendicitis.

Diagnosis of trichuriasis

Laboratory diagnostics of trichuriasis is based on the detection of helminth eggs in feces using enrichment methods. Adult helminths in the intestine are detected by endoscopy (colonoscopy).

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Differential diagnosis of trichuriasis

Differential diagnostics of trichuriasis is carried out with other intestinal diseases, shigellosis, amoebiasis, ulcerative colitis. If surgical complications are suspected, a surgeon's consultation is indicated; if ulcerative colitis is suspected, a proctologist's consultation is indicated.

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Treatment of trichocephalosis

Antiparasitic treatment of trichuriasis is carried out on an outpatient basis. Patients with severe and complicated course of invasion require hospitalization.

The following medications are used:

• Albendazole - orally after meals, 400 mg once a day for 3 days in a row.
• Mebendazole - orally 100 mg twice a day 20-30 minutes after meals for 3 days.
• Carbendacim - orally after meals, 10 mg/kg per day for 3-5 days.

Antiparasitic treatment of trichuriasis does not require the prescription of a special diet and laxatives. In case of persistent gastrointestinal disorders after etiotropic therapy, enzyme preparations and probiotics are prescribed.

Working capacity is impaired in case of massive invasion. The period of incapacity is determined individually.

In cases of persistent invasion, a repeat course of treatment is carried out after 3-4 weeks.

A follow-up examination of feces is necessary 3-4 weeks after completion of the course of treatment with an anthelmintic drug.

Clinical examination

The disease trichuriasis does not require medical examination.

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Prognosis for trichocephalosis

Trichuriasis usually has a favorable prognosis, but may be complicated by the development of hypochromic anemia and intestinal complications with intensive invasion.