Trichocephalosis in children: causes, symptoms, diagnosis, treatment

Trichuriasis in children is a chronic helminthiasis caused by a roundworm, the whipworm, with predominant damage to the gastrointestinal tract, anemia and asthenia.

ICD-10 code

B79 Trichuriasis.

Read also: Trichuriasis in adults

Epidemiology of trichuriasis

Trichuriasis is widespread in all climate zones of the globe, excluding deserts and permafrost zones. The incidence of the population of the humid tropics and subtropics is especially high, where the invasion is detected in 40-50% of cases. In the temperate climate zone in rural areas, up to 16-36% of the child population is affected, mainly at the age of 10-15 years.

The source of the invasion is a person who releases parasite eggs into the environment with feces. Egg development occurs in the soil at a temperature of 15 to 35 °C with sufficient humidity. At a temperature of 26-28 °C, the development of invasive eggs is completed within 20-24 days. The eggs are resistant to low temperatures, but quickly die when dried out or exposed to sunlight. Infection occurs when mature eggs are brought into the mouth with contaminated hands, as well as fruits, vegetables, and water.

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Causes of trichuriasis

The causative agent of trichuriasis Trichocephalis trichiuris is a thin nematode of a brownish color. The anterior part of the body is filiform, the posterior part is short and thick. The length of the female is 3.25-5 cm, the male - 3-4.5 cm. The tail end of the male is spirally coiled, while that of the female is cone-shaped. The eggs are barrel-shaped, with "plugs" at the poles. The female releases up to 1000-14,000 eggs per day. Trichuris live mainly in the cecum, and in case of intensive invasion - throughout the entire length of the large intestine, including the rectum. With the anterior hair-like part of the body, the parasite penetrates the superficial layers of the intestinal mucosa, sometimes to the submucosal and muscular layers. The posterior part of the parasite hangs down into the lumen of the intestine. The life expectancy of the trichuris is 5-7 years.

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Pathogenesis of trichocephalosis

In the small intestine, larvae emerge from the invasive eggs and penetrate the mucous membrane, where they develop. After 5-10 days, they again emerge into the intestinal lumen and descend into the large intestine. Maturation into adult individuals occurs within 1-2 months. The introduction of the head of the whipworm into the intestinal mucous membrane, the release of enzymes and metabolites by the larval stage of the parasite cause a pronounced local and relatively limited general inflammatory reaction. Whipworm antigens have low immunogenicity, but in the early period of the disease, a moderate eosinophilic reaction is observed, with intense invasion - an increase in ESR, the content of alpha and beta globulins in the serum.

Symptoms of trichuriasis in children

With moderate invasion without repeated infections, trichuriasis often proceeds subclinically or manifests itself as rare, periodically occurring stabbing or spastic abdominal pains with predominant localization in the right iliac region, epigastrium, sometimes along the entire colon. With massive invasion and repeated infections, nausea, loss of appetite, salivation, unstable stool, headaches, and increased fatigue are common in children. Young children may lag behind in physical development, and develop anemia and hypoalbuminemia.

The invasion is divided into acute (early) and chronic stages, the disease is divided into subclinical, compensated, manifest and severe, complicated forms.

In the temperate climate zone, trichuriasis is often combined with ascariasis. In this case, the pain is spread throughout the abdomen, accompanied by nausea, vomiting, unstable stool, loss of appetite, and weight loss. In young children, physical and even mental development may lag. The invasion is especially severe in combination with amoebiasis and acute intestinal infections: with bloody stool, tenesmus, prolapse of the rectal mucosa, rapid anemia, and weight loss. Trichuriasis complicates the course of acute intestinal infections, contributing to a protracted convalescence, which often cannot be achieved without eliminating the invasion. Trichuriasis mainly affects children of active age, invasion in newborns is casuistry, in children of the 1st year of life, trichuriasis is rare, it proceeds erased in the absence of complicating factors. Congenital trichuriasis does not exist.

Diagnosis of trichuriasis

Trichuriasis is diagnosed based on the epidemiological history, characteristic clinical picture and detection of whipworm eggs in the feces. Recto-colonoscopy reveals moderate swelling and hyperemia of the mucous membrane; with intensive invasion - superficial erosions, pinpoint hemorrhages. Severe swelling of the mucous membrane, ulcers, hemorrhages are detected when parasites spread throughout the colon and when invasion is combined with protozoal and/or bacterial infection, when parasites hanging into the lumen can be seen in the sigmoid colon and even in the rectum.

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Treatment of trichocephalosis

Trichuriasis is treated with carbamate-benzimidazole derivatives: medamin, vermox (mebendazole), albendazole, and a pyrimidine derivative, oxantel. Medamin is prescribed at a dose of 10 mg/kg per day, in 3 doses after meals for 3 days, vermox at a dose of 2.5 mg/kg per day according to the same scheme. The diet is normal, without a large amount of coarse fiber or fat; if fresh milk is poorly tolerated, it is excluded from the diet. A control study of feces is carried out after 2-3 weeks, three times. If eggs are found after 2-3 months, the treatment can be repeated.

How to prevent trichuriasis in children?

Prevention of infection with trichuriasis consists of instilling hygiene skills in children, protecting water sources from sewage, improving the communal services of villages, and using feces to fertilize gardens and vegetable gardens only after they have been composted.