Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Trichuriasis 1447

contaminated food, water, or soil, hatch and mature in intestine,

and the head of the worm lodges in mucosa of cecum. Females pass

fertilized eggs.

Signs & Symptoms

■Light infections: none

■Medium infections: mild diarrhea

■Heavy infections: more diarrhea, abdominal discomfort, blood in

stool, and rectal prolapse (in children).

tests

■Basic tests: blood: sometimes eosinophilia is seen

■Basic tests: urine: normal

■Specific tests: Stool exam for O&P shows diagnostic eggs. Charcot-

Leydon crystals may be seen.

■Other tests: Worms can be seen on sigmoidoscopy.

differential diagnosis

■Almost anything that causes diarrhea can suggest moderate to heavy

trichuriasis. Stool exam is specific.

management

What to Do First

■Assess severity of infection. In heavy infection fluid and electrolyte

replacement may be needed. Anemia rarely needs transfusion.

General Measures

■Find source of infection.

specific therapy

Indications

■Any patient with symptoms. Treatment of light infections is optional.

Treatment Options

■Mebendazole for 3 days

■Albendazole for 1–3 days depending on intensity of infection.

Side Effects & Complications

■Mebendazole – almost none, perhaps mild intestinal complaints

■Albendazole – rare in this dosage. Possibly mild intestinal com-

plaints.