Trichuriasis (Whipworm)

Transmission is primarily via the fecal-oral route. Eggs are shed in an infected person's feces but require exposure to a warm, moist, soil environment to mature and become infectious. Once the eggs have incubated in soil they can be transmitted via contaminated water, soil, agriculture products, fingers, or other fomites. Human to human transmission of Trichuris species does not occur.

Clinical manifestations of trichuriasis tend to be dependent on the severity of the infection. Minor infections may only result in peripheral blood eosinophilia. Individuals with moderate to severe infections may develop symptoms such as frequent, painful and/or bloody stool, rectal prolapse, or anemia. Children with prolonged or severe anemia may develop significant growth or mental impairment.

The best method for prevention of Trichuriasis is proper disposal of human waste.  Avoiding the use of human waste-based fertilizer (night soil) will also decrease the risk of transmission. Thoroughly washing hands and all produce before cooking and eating is also highly recommended in order to prevent ingestion of parasite eggs.

Trichuriasis is a newly reportable condition as of 2016. Since then, 10 cases have been reported from 2016 through 2020, with an average annual case count of 2.5 cases (ranging between 0-6 cases per year).

 

Report trichuriasis within one week to the local or regional health department or the Texas Department of State Health Services (DSHS), Emerging and Acute Infectious Disease Branch (EAIDB) at 800-252-8239 or 512-776-7676.

Reports from healthcare providers and laboratories may be submitted using the EPI-2 Initial Provider Disease Report Form.
 

• DSHS Epi Case Criteria
• DSHS Laboratory Services
• About Soil-transmitted helminths | Soil-Transmitted Helminths | CDC
• Neglected Tropical Diseases | Neglected Tropical Diseases | CDC
• CDC DPDx – Laboratory Identification of Parasitic Diseases of Public Health Concern

Whipworm (Trichuris trichiura) is an intestinal parasite of humans. The larvae and adult worms live in the intestine of humans and can cause intestinal disease. The name is derived from the worm’s distinctive whip-like shape.

Whipworms 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.

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.

Healthcare providers can diagnose whipworm by taking a stool sample. By using a microscope, providers can look for the presence of whipworm eggs.

• Avoid contact with soil that may be contaminated with human feces, including with human fecal matter ("night soil") used to fertilize crops.
• Wash your hands with soap and warm water before handling food.
• Teach children the importance of washing hands to prevent infection.
• Wash, peel, or cook all raw vegetables and fruits before eating, particularly those that have been grown in soil that has been fertilized with manure.

Transmission of infection to others can be prevented by

• Not defecating outdoors, and by
• Effective sewage disposal systems.

Whipworm infections are generally treated for 1-3 days with medication prescribed by your health care provider. The drugs are effective and appear to have few side effects.

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 World Health Organization are preschool and school-age children, women of childbearing age (including pregnant women in the second and third 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 during a visit to a health clinic.

The soil-transmitted helminths (hookworm, Ascaris, and whipworm) and four other "neglected tropical diseases" (river blindness, lymphatic filariasis, schistosomiasis and trachoma) are sometimes treated through mass drug administrations. Since the drugs used are safe and inexpensive or donated, entire risk groups are offered preventive treatment. Mass drug administrations are conducted periodically (often annually), commonly with drug distributors who go door-to-door. Multiple neglected tropical diseases are often treated simultaneously using MDAs.