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TrichuriasisSpecies Trichuristrichiura
MeghanBalich
Trichuristrichiura
PhylumNematoda
ClassEnoplea
OrderTrichocephalida
FamilyTrichuridae
Anatomy
• Endoparasites
• Canbefoundinthedigestivetractofthehost
• Onlytheadultseat,• Theyfeedontissuesecretionsofintestinalepithelium
Anatomy• Dioecious• Femalestypicallylargerthanmale.• Malehascurledposteriorend.
• Commonname:Whipworm• Narrowanterioresophagusandathickposterioranus.
• Attachtohostviaslenderanteriorend.
• Sizevariesfrom3to5cm.
• Typicallypink
Reproduction• Eachfemaleproduces2,000-6,000eggsperday.• Lifeexpectancyofawormwithinahostis~1-3years.
• Maleshaveaspiraclesurroundedbyasheathwithanejaculatoryduct
• Femalesmayproduceapheromonetoattractmales.
• Thecurvedportionofthemalecoilsaroundthefemalesgenitalpore.
• Themaleusesspiculestoholdthefemaleinplaceduringcopulation.
Egg Anatomy
• Barrelshaped
• Thickwalled
• Plugateachpole
Transmission
• Childrenarethemosteffectedbywhipworms
• Themainmodeoftransmissionisthroughcontaminatedwater,soil,andfood.• Touchingcontaminatedsoil,typicallyinareaswithpoorsanitation
practices.
Epidemiology
• Mostprevalentintheunderdevelopedcountries.
• Chronicillness,notanacuteillness.
• Effectofthisinfectiononeconomicandeducationburdenisnotquantified.
• Soil-transmittedhelminthesareconsideredaneglectedtropicaldisease,despitetheirprevalence.
• STHprevalenceisgenerallyhigherinruralareasdueto,
• Poorsanitarymeasures
• Inadequatewatersupply
• Overcrowding
Geographic Distribution• TheglobalprevalenceofTrichuristrichiurawas795million(2003)
• 3rd mostcommonroundwormofhumans.
• Mostfrequentinareaswithtropicalweatherandpoorsanitationpractices.
• MostprevalentinequatorialAfricaandSoutheastAsia.
LifecycleEggspassoutofbodyviafeces
Eggshatchinsmallintestine&migratetolargeintestine
Molttobecomeadultsinlargeintestine
Becomeinfectiveafterembryonation
Reproducewithnearby
worms
Trichuriasis• Infects;
• Wild/domesticcanines
• Wild/domesticpigs
• Humans
• Nonhumanprimates
Xie,Y.etal.Geneticcharacterizationandphylogeneticstatusofwhipworms (Trichuris spp.)fromcaptivenon-human primatesinChina, determinedbynuclearandmitochondrial sequencing.
Disease
• Trichuriasis
• Abdominalcolitis
• Trichurisdysenterysyndrome
SymptomsLightInfections
• Asymptomatic
HeavyInfections
• Diarrhea
• Abdominalpain
• Malnutrition(anemia)
• Rectalprolapse
PathologyDiarrhea/Malnutrition• Burrowingofwormheadsintointestinalepitheliumcanresultin
increasedfluidsecretionanddecreasedabsorptionoffluidincolon.
AbdominalPain• Adultsburrowthroughmucosainlargeintestine.• Leadstocelldestructionandimmuneresponse
RectalProlapse• Highnumbersofwormsembeddedintherectumcanleadto
excessfluidinthebody,leadingtorectalprolapse.
Diagnosis• Microscopicallyidentifyingthepresenceofeggsinastoolsample.• Difficulttoidentifyinlightinfections.• Kato-Katztechnique,athicksmearofstoolsampleispreparedpriortosearchingforparasiteeggs.
AdultT.trichiura foundduring colonoscopy.
• Proctoscopy• Examinationofrectalmucosacanoccasionally
demonstrateadultworms.
• Colonoscopy• Identifyadultswormsembeddedincolon
Treatment• Albendazole(egg/larval/adultstages)• Anthelminticagent• Blockseggproductionanddevelopment.• Impairsuptakeofglucosebythelarvalandadultstagesanddepletesglycogenstores.
• Ivermectin• UsedincombinationwithAlbendazole• Interfereswithnervoussystemandmusclefunction
• Mebendazole(larval/adultstages)• Anthelminticagent• Poorlyabsorbedintobloodstream.• Usedaloneinmildtomoderatecases,killsparasitesslowlywithlimitedadversesideeffects.
• Selectivelyandirreversiblyblocksglucoseuptakeandothernutrientsintheintestine.
ReferencesStroehlein,A.J.2017.Whipwormkinomesreflectauniquebiologyandadaptationtothehostanimal.InternationalJournalfor Parasitology.47:13.857-866.
Mohd-Sharharuddin,N.2019.MolecularcharacterizationofTrichurisspeciesisolatedfromhumans,dogs,andcatsinaruralcommunityinPeninsularMalaysia.ActaTropica.190:269-272.
Silber,S.A.2017.EfficacyandSafetyofaSingle-DoseMebendazole500mgChewable,Rapidly-DisintegratingTabletforAscarislumbricoidesandTrichuristrichiura InfectionTreatmentinPediatricPatients:ADouble-Blind,Randomized,Placebo-Controlled,Phase3Study.TheAmericanSocietyofTropicalMedicineandHygiene.97:6.1851-1856.
Silver,Z.,Kaliappan,S.,Samuel,P.,Venugopal,S.,Kang,G.,Sarkar,R.,Ajjampur,S.2018.Geographicaldistributionofsoil transmittedhelminthesandtheeffectsofcommunitytypeinSouthAsiaandSouthEastAsia– Asystematicreview.PLOSNeglectedTropicalDiseases.12:1.
Manz,K.,Clowes,P.,Kroidl,I.,Kowuor,D.,Gledmacher,C.,Ntinginya,N.,Maboko,L.,Hoelscher,M.,Saathoff,E.2017.Trichuristrichiura infectionanditsrelationtoenvironmentalfactorsinMbeyaregion,Tanzania:Across-sectional,population-basedstudy.12:4
Meekums,H.,Hawash,M.,Sparks,A.,Oviedo,Y.,Sandoval,C.,Chico,M.,Stothard,J,.Cooper,P.,Nejsum,P.,Betson,M.2015.AgeneticanalysisofTrichuristrichiura andTrichurissuisfromEcuador.BMCParasitesandVectors.8:168.
Severin,B.,Moldpveanu,A.,Adumitresi,C.,Ilasca,O.2017.ParticulariesRegardingtheEvolutionofTrichinosisinConstantaCounty.ARSMedicalTomitana.22:3.164-168
Panayotova,M.,Muchtarov,M.,Popov,D.,Boeva-Bangyozova,V.2017.Trichinosisinchildhood– currentaspects.MedicalUniversitySofia–CentralMedicalLibrary.53:1.5-12.
Ravasi,D.,O’Riain,M.,Illing,N.2012.PhylogeneticEvidenceThatTwoDistinctTrichurisGenotypesInfectBothHumansandNon-HumanPrimates.PLoSONE.7:8.
Speich,B.,Ame,S.,Keiser,J.2012.EfficacyandSafetyofNitazoxanide,Albendazole,andNitazoxanide-AlbendazoleagainstTrichuristrichiuraInfection:ARandomizedControlledTrial.PloSNeglectedTropicalDisease.6:6.