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Laboratory Diagnosis

The diagnosis depends on finding Trichuris eggs on stool concentration tests, or by identification of the adult worms, usually by sigmoidoscopy. The dysenteric exudate may at times contain numerous Charcot-Leyden crystals and eosinophils. The characteristic double-shelled, bile-stained eggs with bipolar mucoid plugs can be detected in direct fecal smears or by formalin ethyl acetate concentration sedimentation methods. In clinically apparent infections, eggs are usually plentiful in direct smears, using a modified Kato technique. If there are only a few eggs on direct smear in a patient with diarrhea, it is likely that trichuriasis is a coincidental finding, and another cause for the patient's intestinal symptoms should be sought. Serological tests, including ELISA, have been used experimentally to measure antibodies, but are not used for routine diagnosis.

Eosinophilia (up to 25%, but usually 15% or less) is common in patients with heavy whipworm burdens, and a hypochromic microcytic iron-deficiency anemia is often present as a result of chronic blood loss from the friable colonic mucosa. A patient with 800 worms loses about 4 cc of blood per day. Boon and Hoh found hemoglobin values below 8.8 gm per 100 ml in 10 of 20 cases of severe whipworm infections in Singapore children.

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