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\begin{document}

\title{Infection with male and female Trichuris trichiura diagnosed in a
non-epidemic area}



\author[1]{Masaki Inoue}%
\author[2]{Marin Ishikawa}%
\author[1]{Sho Tanaka}%
\author[1]{Xinhan Zhang}%
\author[1]{Hiromi Okada}%
\author[3]{Takuto Miyagishima}%
\affil[1]{Kushiro Rosai Hospital}%
\affil[2]{Keio University Hospital Cancer Center}%
\affil[3]{Kushiro rosai hospital}%


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  \date{May 20, 2024}


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Manuscript title

Infection with male and female\emph{Trichuris trichiura}diagnosed in a
non-epidemic area

Authors: Masaki Inoue\textsuperscript{1}, Marin
Ishikawa\textsuperscript{2}, Sho Tanaka\textsuperscript{1}, Xinhan
Zhang\textsuperscript{1}, Hiromi Okada\textsuperscript{3}, Takuto
Miyagishima\textsuperscript{1}

1 Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro,
Japan.

2 Genomics Unit, Keio Cancer Center, Keio University School of Medicine,
Tokyo, Japan.

3 Department of Surgical Pathology, Kushiro Rosai Hospital, Kushiro,
Japan.

Corresponding author: Masaki Inoue, MD, PhD, Department of
Gastroenterology, Kushiro Rosai Hospital, 13-23, Nakazonocho, Kushiro,
Hokkaido 085-8533, Japan.

Tel: +81-154-22-7191

E-mail: mokomokomomon@gmail.com

Consent statement: Written informed consent was obtained from the
patient to publish this report in accordance with the journal's patient
consent policy.

Key words: endoscopy, \emph{Trichuris trichiura} , parasite, whipworm

Conflict-of-interest statement: We have no financial relationships to
disclose.

Funding and Acknowledgement details: None

Explanation

A Burmese man in his 20s underwent colonoscopy at our hospital in Japan
because of abdominal discomfort. He had come to Japan from Myanmar two
years ago and had worked on a pig farm. He had had diarrhea for five
months and was taking a drug for controlling intestinal function but had
persistent abdominal discomfort. Blood samples showed elevated fractions
of eosinophils (white blood cells 7900/\selectlanguage{greek}μ\selectlanguage{english}L, eosinophils 15.6\%).
Colonoscopy (PCF-H290ZI; Olympus, Tokyo, Japan) showed that there were
four whipworms including one brown whipworm and three white whipworms in
the cecum and ascending colon. The white whipworm was attached to the
cecum mucosa ({[}Fig. 1{]}, {[}Fig. 2{]}). The brown one was detected at
the ascending colon. Magnified endoscopy and narrow band imaging showed
that it had a stripe pattern and that its cranium was burrowing under
the colonic mucosa ({[}Fig. 3{]}). The whipworms coiled themselves up
and wound slowly in response to a stimulus. We removed all of them by
using biopsy forceps. Histopathological examination revealed that the
brown one was a female whipworm (\emph{Trichuris trichiura} ) and the
three white worms were male ({[}Fig. 4{]}, {[}Fig. 5{]}). The female had
a uterus with worm eggs. The egg inspection was negative. After oral
administration of Mebendazole, his abdominal discomfort disappeared.

\emph{T. trichiura} \begin{CJK}{UTF8}{gbsn}　\end{CJK}\selectlanguage{english}infection is prevalent in tropical regions and
non-epidemic in Japan. \emph{T. trichiura} is thought to live for one to
eight years as an adult {[}1{]}. Therefore, the worms that the patient
was infected with in Myanmar could have lived for two years in
Japan.\emph{T. trichiura} parasitizes only humans through fecal-oral
transmission. In non-epidemic areas, the frequency of endoscopic
identification has been increasing due to the increasing number of
immigrants from epidemic countries {[}2{]}. To prevent infection, it is
important to pay attention to sanitary conditions such as soil and water
sources {[}3{]}.

References

{[}1{]} D.E. Elliot

Intestinal worms

M. Feldman, L.S. Friedman, L.J. Brandt (Eds.), Sleisenger and Fordtran's
gastrointestinal and liver disease: pathophysiology/diagnosis/management
(8th ed), Elsevier, Philadelphia (2006), pp. 2435-2457

{[}2{]} Lorenzetti R, Campo SM, Stella F, Hassan C, Zullo A, Morini S.
An unusual endoscopic finding: \emph{Trichuris trichiura} . Case report
and review of the literature. Dig Liver Dis. 2003 Nov;35(11):811-3. doi:
10.1016/s1590-8658(03)00455-9. PMID: 14674673.

{[}3{]} Kattula D, Sarkar R, Rao Ajjampur SS, Minz S, Levecke B, Muliyil
J, Kang G. Prevalence \& risk factors for soil transmitted helminth
infection among school children in south India. Indian J Med Res. 2014
Jan;139(1):76-82. PMID: 24604041; PMCID: PMC3994744.

Figure 1

A white whipworm in the cecum. Histopathological examination revealed
that it was a male worm. The other two white whipworms were in the
ascending colon.

Figure 2

A brown whipworm in the ascending colon. Histopathological examination
revealed that it was a female worm.

Figure 3

A picture of the female worm obtained by using narrow band imaging
showed that its cranium was burrowing under the colonic mucosa.

Figure 4

Histopathological image of a male whipworm.

Figure 5

Histopathological image of the female whipworm.\selectlanguage{english}
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