Manuscript title

Infection with male and femaleTrichuris trichiuradiagnosed in a non-epidemic area

Authors: Masaki Inoue¹, Marin Ishikawa², Sho Tanaka¹, Xinhan Zhang¹, Hiromi Okada³, Takuto Miyagishima¹

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, 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/μL, 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 (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.

T. trichiura 　infection is prevalent in tropical regions and non-epidemic in Japan. 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.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: 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.