Infection with male and female Trichuris trichiura diagnosed in a non-epidemic area
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Manuscript titleInfection with male and femaleTrichuris trichiuradiagnosed in a non-epidemic areaAuthors: Masaki Inoue1, Marin Ishikawa2, Sho Tanaka1, Xinhan Zhang1, Hiromi Okada3, Takuto Miyagishima11 Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan.2 Genomics Unit, Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan.3 Department of Surgical Pathology, Kushiro Rosai Hospital, Kushiro, Japan.Corresponding author: Masaki Inoue, MD, PhD, Department of Gastroenterology, Kushiro Rosai Hospital, 13-23, Nakazonocho, Kushiro, Hokkaido 085-8533, Japan.Tel: +81-154-22-7191E-mail: mokomokomomon@gmail.comConsent statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.Key words: endoscopy, Trichuris trichiura , parasite, whipwormConflict-of-interest statement: We have no financial relationships to disclose.Funding and Acknowledgement details: NoneExplanationA Burmese man in his 20s underwent colonoscopy at our hospital in Japan because of abdominal discomfort. He had come to Japan from Myanmar two years ago and had worked on a pig farm. He had had diarrhea for five months and was taking a drug for controlling intestinal function but had persistent abdominal discomfort. Blood samples showed elevated fractions of eosinophils (white blood cells 7900/μL, eosinophils 15.6%). Colonoscopy (PCF-H290ZI; Olympus, Tokyo, Japan) showed that there were four whipworms including one brown whipworm and three white whipworms in the cecum and ascending colon. The white whipworm was attached to the cecum mucosa ([Fig. 1], [Fig. 2]). The brown one was detected at the ascending colon. Magnified endoscopy and narrow band imaging showed that it had a stripe pattern and that its cranium was burrowing under the colonic mucosa ([Fig. 3]). The whipworms coiled themselves up and wound slowly in response to a stimulus. We removed all of them by using biopsy forceps. Histopathological examination revealed that the brown one was a female whipworm (Trichuris trichiura ) and the three white worms were male ([Fig. 4], [Fig. 5]). The female had a uterus with worm eggs. The egg inspection was negative. After oral administration of Mebendazole, his abdominal discomfort disappeared.T. trichiura infection is prevalent in tropical regions and non-epidemic in Japan. T. trichiura is thought to live for one to eight years as an adult [1]. Therefore, the worms that the patient was infected with in Myanmar could have lived for two years in Japan.T. trichiura parasitizes only humans through fecal-oral transmission. In non-epidemic areas, the frequency of endoscopic identification has been increasing due to the increasing number of immigrants from epidemic countries [2]. To prevent infection, it is important to pay attention to sanitary conditions such as soil and water sources [3].References[1] D.E. ElliotIntestinal wormsM. Feldman, L.S. Friedman, L.J. Brandt (Eds.), Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management (8th ed), Elsevier, Philadelphia (2006), pp. 2435-2457[2] Lorenzetti R, Campo SM, Stella F, Hassan C, Zullo A, Morini S. An unusual endoscopic finding: Trichuris trichiura . Case report and review of the literature. Dig Liver Dis. 2003 Nov;35(11):811-3. doi: 10.1016/s1590-8658(03)00455-9. PMID: 14674673.[3] Kattula D, Sarkar R, Rao Ajjampur SS, Minz S, Levecke B, Muliyil J, Kang G. Prevalence & risk factors for soil transmitted helminth infection among school children in south India. Indian J Med Res. 2014 Jan;139(1):76-82. PMID: 24604041; PMCID: PMC3994744.Figure 1A white whipworm in the cecum. Histopathological examination revealed that it was a male worm. The other two white whipworms were in the ascending colon.Figure 2A brown whipworm in the ascending colon. Histopathological examination revealed that it was a female worm.Figure 3A picture of the female worm obtained by using narrow band imaging showed that its cranium was burrowing under the colonic mucosa.Figure 4Histopathological image of a male whipworm.Figure 5Histopathological image of the female whipworm.Keywords:
Trichuris trichiura
Ascending colon
Trichuriasis
Children with severe Trichuris trichiura infection pose significant social, clinical, and therapeutic problems in Malaysia. Thirty such children were investigated, and mebendazole was found to be safe and effective in the treatment of severe trichuriasis but it had to be given for a longer period than currently recommended. A poor correlation was found between egg load and worm burden in these children. Direct visualization of the rectal and colonic mucosa was the most reliable method of assessing severity in untreated cases, and response to treatment. The eggs of Trichuris that had been exposed to mebendazole were morphologically altered and not viable when incubated. This may be of considerable epidemiological importance.
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Abstract The human whipworm Trichuris trichiura is a parasite that infects around 500 million people globally, with consequences including damage to physical growth and educational performance. Current drugs such as mebendazole have a notable lack of efficacy against whipworm, compared to other soil-transmitted helminths. Mass drug administration programs are therefore unlikely to achieve eradication and new treatments for trichuriasis are desperately needed. All current drug control strategies focus on post-infection eradication, targeting the parasite in vivo . Here we propose developing novel anthelmintics which target the egg stage of the parasite in the soil as an adjunct environmental strategy. As evidence in support of such an approach we describe the actions of a new class of anthelmintic compounds, the 2,4-diaminothieno[3,2- d ]pyrimidines (DATPs). This compound class has found broad utility in medicinal chemistry, but has not previously been described as having anthelmintic activity. Importantly, these compounds show efficacy against not only the adult parasite, but also both the embryonated and unembryonated egg stages and thereby may enable a break in the parasite lifecycle. Author Summary The human whipworm, Trichuris trichiura , infects around 500 million people globally, impacting on their physical growth and educational performance. There are currently huge mass drug administration (MDA) programs aiming to control whipworm, along with the other major soil transmitted helminths, Ascaris and hookworm. However single doses of albendazole and mebendazole, which are used in MDA, have particularly poor effectiveness against whipworm, with cure rates less than 40%. This means that MDA may not be able to control and eliminate whipworm infection, and risks the spread of resistance to albendazole and mebendazole in the parasite population. We are attempting to develop new treatments for parasitic worm infection, particularly focused on whipworm. We report the identification of a class of compounds, diaminothienopyrimidines (DATPs), which have not previously been described as anthelmintics. These compounds are effective against adult stages of whipworm, and also block the development of the model nematode C. elegans . Our DATP compounds reduce the ability of treated eggs to successfully establish infection in a mouse model of human whipworm. These results support a potential environmental spray to control whipworm by targeting the infectious egg stage in environmental hotspots.
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The review argues for a reappraisal of the health significance of the human whipworm, Trichuris trichiura. Infections with this geohelminth are at least as prevalent as Ascaris lumbricoides in many localities, and are associated with significant morbidity. Infection may result in severe trichuriasis syndrome or, more frequently, in a chronic colitis associated with growth stunting. Under-reporting of the chronic manifestations of disease has resulted in a gross under-estimation of the health impact of trichuriasis. Furthermore, estimation of the population dynamical parameters of T. trichiura transmission suggests that whipworm infections are intrinsically more resistant to control than those of other common geohelminths. A major determinant of the transmission dynamics and morbidity characteristics of this helminthiasis is the aggregation of worm burdens in certain predisposed individuals and age groups. It is suggested that improved understanding of the factors generating this distribution of infection intensity is a pre-requisite for effective control of both infection and morbidity.
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Trichuris trichiura commonly referred to as whipworm, has a world-wide distribution, particularly countries with warm, humid climates. This parasite is reported from nearly one quarter of the world population, especially from less developed countries. Poor hygiene conditions are associated with trichuris transmission, usually this infection remains asymptomatic in human but heavy infection can lead to chronic bloody diarrhoea associated with complications like rectal prolapsed, appendicitis, proctitis. Very few cases of extensive trichuriasis have been reported world-wide. Usually, diagnosis is confirmed by detection of eggs in stool sample. This case report deals with a patient of trichuriasis, who was diagnosed by detection of the parasite on colonoscopy. Thus, colonoscopy might be a useful diagnostic tool, especially in symptomatic patients who are infected by only few male worms with no eggs in the stool. Hence cannot be diagnosed by conventional methods.
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Background: Musca domestica is the most common fly species and spreading around the world also act as mechanical vectors various pathogenic agent (virus, bakteri, parasite, one of them is Trichuris trichiura). Human will suffer from Trichuriasis if they ingest food ordrinks contaminating Trichuris trichiura eggs. The prevalence of Trichuriasis is still high and it affects children more often because lack of hygiene. Purpose: to determine the role of Trichuris trichiura eggs on the body surfaces of Musca domestica thatcauses Trichuriasis in humans.Methods: Literature review by retrieving library resources from 39 journals and 2textbooksselected by using the criteria of accredited national journals sintaand reputable international journals and indexed scopus and non-scopus published by 2016.Results: From some experimental studies, Musca domestica carried Trichuris trichiura eggs on the outer body surfaces, as mechanical vectors potential for spreading Trichuriasis.Conclusion: Trichuris trichiura eggs carried by outer body surfaces of Musca domestica can causes serious health problem in humans, has potential cause Trichuriasis disease. Good control and education are needed to prevent Trichuriasis disease
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Abstract Trichuriasis known as whipworm infection caused by Trichuris trichiura , is a highly prevalent soil-transmitted helminthiasis in low- and middle-income countries located in tropical and subtropical areas and affecting approximately 360 million people. Children typically harbour the largest burden of T. trichiura and they are usually co-infected with other soil-transmitted helminth (STH), including Ascaris lumbricoides and hookworm. The consequences of trichuriasis, such as malnutrition and physical and cognitive growth restriction, lead to a massive health burden in endemic regions. Despite the implementation of mass drug administration of anthelminthic treatment to school-age children, T. trichiura infection remains challenging to control due to the low efficacy of current drugs as well as high rates of post-treatment re-infection. Thus, the development of a vaccine that would induce protective immunity and reduce infection rate or community faecal egg output is essential. Hurdles for human whipworm vaccine development include the lack of suitable vaccine antigen targets and animal models for human T. trichiura infection. Instead, rodent whipworm T. muris infected mouse models serve as a major surrogate for testing immunogenicity and efficacy of vaccine candidates. In this review, we summarize recent advances in animal models for T. trichiura antigen discovery and testing of vaccine candidates, while providing an overall view of the current status of T. trichiura vaccine development.
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Recent studies have shown that the efficacy of benzimidazole drugs is influenced by the intensity of trichuriasis. Therefore, the objective of this study was to determine the efficacy of albendazole (ALB) and mebendazole (MBZ) administered randomly for 1 (ALB×1 and MBZ×1) or 2 days (ALB×2 and MBZ×2) to 385 school children with heavy-intensity trichuriasis (mean faecal egg counts (FEC) >1000 eggs per gram of stool (epg)) in Jimma Town, Ethiopia. The efficacies (95% confidence intervals) by means of reduction in faecal egg counts (FECs) were 29·3% (-9·9-56·2), 60·0% (48·5-70·9), 73·5% (64·2-81·3), and 87·1% (81·4-91·2) for ALB×1, MBZ×1, ALB×2, and MBZ×2, respectively. These observations highlight that assessment of the anthelmintic efficacy of existing or new compounds against Trichuris trichiura should be assessed under varying levels of infection intensity.
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Trichuris muris , is the murine parasite and widely deployed model for the human whipworm Trichuris trichiura , a parasite that infects around 500 million people globally. Trichuriasis is a classical disease of poverty with a cycle of re-infection due to the continual exposure of humans, particularly children, to infective eggs, which contaminate the soil in endemic areas. Indeed, modelling studies of trichuriasis have demonstrated that the low efficacy rate of current anthelmintics combined with the high possibility of re-infection from the reservoir of infective eggs within the environment, mean that the elimination of morbidity due to trichuriasis is unlikely to occur. Despite the importance of the infective egg stage in the perpetuation of infections, understanding the biology of the Trichuris ova has been neglected for decades. Here we perform experiments to assess the impact of temperature on the embryonation process of T. muris eggs and describe in detail the stages of larval development within these eggs. In keeping with the early works performed in the early 1900s, we show that the embryonation of T. muris is accelerated by an elevation in temperature, up to 37°C above which eggs do not fully develop and become degenerate. We extend these data to provide a detailed description of T. muris egg development with clear images depicting the various stages of development. To the best of our knowledge we have, for the first time, described the presence of birefringent granules within egg-stage larvae, as well as providing a qualitative and quantitative description of a motile larval stage prior to quiescence within the egg. These experiments are the first step towards a better understanding of the basic biology which underlies the process of egg embryonation. With the threat of elevation in global temperatures, the accelerated embryonation rate we observe at higher temperatures may have important consequences for parasite transmission rates and prospective modelling studies. In addition, a deeper understanding of the Trichuris ova may allow the development of novel control strategies targeting the egg stage of Trichuris in the environment as an adjunct to MDA.
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Trichuris trichiura, commonly referred to as a whipworm, has a worldwide distribution, particularly among countries with warm, humid climates. In Korea, trichuriasis was a highly prevalent soil-transmitted helminthiasis until the 1970s. However, the nationwide prevalence decreased to 0.02% in 2004 as a result of national control activities and improvement in the socioeconomic status of Koreans. Most infected individuals have no distinct symptoms, if lightly infected. The diagnosis is typically confirmed by detection of T. trichiura eggs on examination of a stool sample; few reports have described detection of the parasite during colonoscopy. Recently, we managed 4 patients with trichuriasis who were diagnosed by detection of the parasite on colonoscopy, and we reviewed the literature on the colonoscopic diagnosis of T. trichiura in Korea. We suggest that colonoscopy might be a useful diagnostic tool, especially when infected by only a few male worms with no eggs in the stool. Key words: Trichuris trichiura, trichuriasis, colonoscopy, literature review
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