5-51
Prevention and Hygiene: Avoid improperly cooked pork.
No Improvement/Deterioration: Return for evaluation.
Follow-up Actions
Return evaluation: As needed
Consultation Criteria: Failure to improve. For definitive diagnosis, antibody testing (serology) for Trichinella
is available at reference laboratories.
Zoonotic Disease Considerations
Principal Animal Hosts: Swine, rodents, bears
Clinical Disease in Animals: Asymptomatic
Probable Mode of Transmission: Ingestion of meat containing trichinella worms encysted in striated muscle.
Known Distribution: Worldwide, especially sub-arctic
ID: Trichuriasis (Whipworm)
LTC Glenn Wortmann, MC, USAIntroduction: Whipworm (Trichuris trichiura) is one of the most common human worm infections, with
approximately 800 million cases occurring worldwide. It is spread by fecal-oral transmission or ingesting
vegetables contaminated with whipworm eggs. Infection is generally asymptomatic, but patients with heavy
worm burdens may present with anemia, bloody diarrhea, growth retardation or rectal prolapse. Children
ages 5-15 are most commonly infected.
Subjective: Symptoms
Usually asymptomatic; may have abdominal pain, bloody diarrhea, malaise, and rectal prolapse.
Focused History: Have you experienced bloody diarrhea? Have you had a decrease in your energy level?
(Whipworm can cause bloody diarrhea and iron deciency anemia.)
Objective: Signs
Using Basic Tools: Bloody diarrhea, tender abdomen, rectal prolapse
Using Advanced Tools: Lab: CBC with low HCT; stool for O&P for characteristic lemon-shaped egg (see
Color Plates Picture 29)
Assessment: Epidemic suggests diagnosis, and stool O & P will conrm it.
Differential Diagnosis: Bloody diarrhea/anemia - amebiasis, shigellosis and inammatory bowel disease.
Plan:
Treatment:
Primary: Albendazole 400 mg po for one dose
Alternative: Mebendazole (Vermox) 100mg bid x 3 days
Patient Education
Prevention: Avoid uncooked vegetables in endemic areas.
Medications: For heavy infection, retreatment may be needed.
Zoonotic Disease Considerations
Principal Animal Hosts: Man, canids, and swine
Clinical Disease in Animals: Usually asymptomatic; can see melena, anemia, anorexia, unthriftiness in