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Chapter 17

Trichuriasis (Whipworm Infection)

It is one of the paradoxes of modern medicine that considerable attention is often focused on rare and untreatable entities while common and curable diseases receive remarkably little notice, at least in the radiological literature. Nowhere is this more true than in the case of tropical diseases. For example, in 1947, the whipworm Trichuris trichiura was estimated to infect 355 million people throughout the world, chiefly in the tropics. Yet it was not until 1968 that the radiological manifestations of the disease were described for the first time. Now the infection is even more widespread.


Trichuriasis. Whipworm infection. Trichocephaliasis. Trichocephalosis. Sp: Tricuriasis. Fr: Trichuriose. Ger: Peitschenwurmbefall.


Trichuriasis is infection of the human cecum, appendix, colon and rectum by the whipworm, Trichuris trichiura.

Geographic Distribution

This nematode thrives chiefly in warm, moist tropical countries, but is found throughout the world (Fig. 17. 1). In some hyperendemic areas, 90% of the population is infected. It had been previously estimated in 1947 that 227 million persons were infected in Asia, 27 million in Russia, 34 million in Europe, 28 million in Africa, and 38 million in the tropical areas of the Americas. More recent estimates in 1988 suggested that between 500 and 800 million persons worldwide harbored the parasite. The WHO-World Health Report 1998, states the number of infected persons to be one billion. In the United States, where 2 to 3 million persons are infected, trichuriasis has a spotty distribution, being prevalent chiefly in the southern Appalachian Mountains and in rural Louisiana, where fecal pollution, dense shade near the house, and heavy rainfall favor its propagation. In Brazil, it is the commonest parasite in the large cities (with an incidence of up to 40%). In Costa Rica, it is found in 25% of persons without diarrhea and in 50% of patients with acute diarrhea, but in those with chronic diarrhea the incidence is almost 100%. (This does not necessarily indicate a causative role, however.)

Fig. 17.1 Geographic distribution of trichuriasis.

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