Whipworm infection (trichuriasis)

Trichuriasis (also known as whipworm) is an intestinal worm infection. Intestinal worms are a type of parasite -- an organism that survives by feeding on other organisms or hosts. Parasites can inhabit the human body or live in soil, water, food or insects. Some parasites exist naturally in the human body, but are usually controlled by the immune system.


Causes/associated factors
Infection with the intestinal worm Trichuris trichiura causes trichuriasis, a common worldwide worm infection. Whipworm is most prevalent in warm moist regions of the world, especially where soil is contaminated by human feces. The infection is less common in the United States. When it does occur, it's most common in the southeastern states due to the favorable climate. Trichuriasis is more common in children than adults.

Transmission
Whipworm infections are more common with inadequate hygiene and sanitation or when human feces are used for fertilizer. Whipworm is not spread from person to person. Instead, infection occurs after ingesting infective whipworm eggs, which may be found in contaminated soil or on contaminated produce that has not been washed. The eggs hatch in the small intestine. Eventually, the larvae (immature worms) develop into mature whipworms about 4 centimeters long which attach themselves to the walls of the colon (the part of the large intestine that extends from the small intestine to the anus). The mature female whipworm produces up to 20,000 eggs a day, which pass out of the body in the feces. After at least 10 days, these eggs become capable of causing infection in someone else. An infected person will begin passing the eggs in his or her stool about two to three months after ingesting the infective eggs.

Signs/symptoms
Most often, whipworm infections cause no symptoms. A heavy infection may cause abdominal discomfort, diarrhea or bloody stools containing mucus. Symptoms are more frequent in children.

Diagnosis
Diagnosis is based on the presence of eggs in a stool sample.

Treatment
Trichuriasis may be treated with the drugs mebendazole or albendazole. The doctor may recommend a repeat stool sample test later.

Complications
Heavy intestinal infections in children can cause rectal prolapse (protrusion of the rectal mucous membranes through the anus), anemia and slowed growth.

Pregnancy-specific information
A variety of medications may be prescribed for various intestinal worm infections, but certain standard medications should not be taken if you're pregnant. Thoroughly discuss your health history with your doctor and review the risks and benefits of any treatment. If you don't have significant symptoms, your doctor may recommend postponing treatment until after delivery.
If you are or may be pregnant, you may want to avoid traveling to areas with poor sanitation, where you're more likely to develop parasitic infection(s). If you do travel to these areas, be sure to follow the preventive measures outlined below.


Senior-specific information
Growing older is not a risk factor for this condition.

Prevention
To prevent intestinal worms of any type, follow these general guidelines:
Practice sanitary hygiene habits, especially when disposing of human waste. Never wipe feces on the ground, and dispose of diapers properly.

Wear shoes in areas where the soil or sand may be contaminated with feces or parasites. Don't sit directly on the ground or handle the soil or sand with your bare hands.

Wash your hands thoroughly with soap and water or an antibacterial handwashing solution before handling food or water and after using the toilet or changing diapers.

Wash, peel or cook raw fruits and vegetables before eating.

Cook meat thoroughly, to at least 160°F. It should no longer be pink in the center. Measure the internal temperature to assure doneness. Keep in mind that curing, smoking, drying or microwaving meat may not kill all worms.

Slabs of pork less than 6 inches thick can be frozen at 5°F (-15°C) for 20 days to kill any worms. Freezing may not be effective for wild game.

If you're traveling abroad, it's wise to avoid uncooked fruits and vegetables, unless you've peeled them yourself; raw or undercooked meat, poultry, fish and eggs; foods prepared in advance that haven't been kept cold or very hot; and foods purchased from street vendors. If you have any doubts about a food's safety, follow this simple rule: Boil it, cook it, peel it or forget it.

If you're unsure of the safety of drinking water (such as in areas where the water isn't chlorinated or hygiene and sanitation are poor), ensure water safety by boiling your water vigorously for one minute, filtering it or treating it with iodine or chlorine. Drink only this water, beverages made from it, canned or bottled carbonated beverages (including water and soft drinks), beer or wine. Wash uncooked fruits or vegatables using treated or filtered water. Avoid using ice cubes and drinking from unclean glasses and wet or dirty cans or bottles. (It's best to drink straight from the can or bottle after wiping it clean and dry.) Don't brush your teeth in tap water, and avoid swallowing water while swimming or bathing.