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(Whipworm Infection; Trichocephaliasis)

By Richard D. Pearson, MD, University of Virginia School of Medicine

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Trichuriasis is infection with Trichuris trichiura. Symptoms may include abdominal pain, diarrhea, and, in heavy infections, anemia and undernutrition. Diagnosis is by finding eggs in stool. Treatment is with mebendazole or albendazole.

Infection is spread via the fecal-oral route. Ingested eggs hatch and enter the crypts of the small bowel as larvae. After maturing for 1 to 3 mo, the worms migrate to the cecum and ascending colon, where they attach to the superficial epithelium, mate, and lay eggs.

Adult worms are estimated to live 1 to 2 yr, although some may live longer.

Trichuriasis is the 3rd most common roundworm infection. An estimated 800 million people are infected worldwide. Trichuris trichiura occurs principally in developing tropical or subtropical areas where human feces is used as fertilizer or where people defecate onto soil, but infections also occur in the southern US. Children are most affected.

Light infections are often asymptomatic. Heavy infections cause abdominal pain, anorexia, and diarrhea and may result in anemia or retarded growth. Very heavy infections may cause weight loss, anemia, and rectal prolapse, particularly in children.


  • Microscopic examination of stool

Diagnosis is made by microscopic examination of stool; the characteristic lemon-shaped eggs with clear opercula at both ends are readily apparent. When colonoscopy is done for other indications, wiggling adult worms may be seen protruding into the bowel lumen. CBC is done to check for anemia.


  • Mebendazole

Mebendazole 100 mg po bid for 3 days or 500 mg as a single dose is recommended. Alternatively, albendazole 400 mg po once/day for 3 days or ivermectin 200 mcg/kg po once/day for 3 days may be used. These drugs should not be used during pregnancy.

Prevention is possible through good sanitation and personal hygiene.

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* This is the Professional Version. *