Whip Worm

Birdie birdies at ix.netcom.com
Sun Nov 2 17:23:23 EST 1997


William Reeder wrote:

> > BirdieDear Birdie - I cannot answer your question but can offer some
> observations.  The first deals with the peach.  Each Trichuris egg
> ingested results in one adult worm.  Of course not all eggs ingested will
> hatch and not all hatched larvae will survive to adulthood. The worms do
> not multiply in the body, each must come from an ingested egg.  

Ok, so something is amiss here. She elimanates eggs. I sent her a photo
of a whip worm egg - cut in half, which is posted on the web from the 
Korean Institute of Parasitology and she postively indentified it
"That's
IT!". Now, this would be the Asian version. Yet how much the look of the
worms and eggs vary b'tween the US garden variety and the Asian strain,
we don't know as that requires photo's good enough to do comparison
studies.

I'm going to go to the beverly hills library and/or UCLA - as I can only 
get so far on the web. If anyone knows of good medical books on
parasites,
let me know.

If the worms do not multiply in the body...then, where are the eggs 
coming from? She can't be ingesting them, again and again. Is it
that the eggs are sterile if produced in the body?

The CDC did get an early sample and identified it as whip worm, and
said she was the *only* case. They were pretty amazed by it.

The latin name I gave her was Trichocephalus Trichiurus, and she
said that was it.

However, her MD at one point thought that they were Pin worms.

I do not think this one MD is an expert, and, sure, she could
have pin worm and whip worm.

She has eliminated clusters of them, and, again, indentified
them as whip worms.

When she is having what she calls new outbreaks of them, she
has blood in her stools.

Periodically, they flare-up.

The eggs, lately, have gotten smaller.

It sounds like - with the egg production going on and periodic
flare-ups, that they are in fact reproducing - also, they are not
going away.

Are you 100% sure each egg must be ingested? Perhaps the
difference b'tween the Asian strain and the US strain is that
the Asian ones can and do reproduce in the body, as that would 
certainly explain why they are harder to get rid of, and are a
nastier version.

I need to find this out as that could explain why the treatment
has failed. 

If eggs can develope into eventually worms in the body, then,
they will be harder to eradicate.  You have to be able to kill all
the eggs and/or elimanate them. Harder to do than with adults.
Adults eat things (medicine laced) and can't hide as well.


>The type
> of symptoms you describe would require a heavy worm burden
> meaning a massive or repeated innoculum of eggs. Your peach would not be
> able collect such an abundance of eggs from irrigation water or hands.
> Also the eggs cannot survive exposure to direct sunlight.

Ok, so, I picked her brain. Her ex-husband got very very sick in
Costa Rica several years ago, and she has traveled there as well, but
this is a few years before she was symptomatic. Her current boyfriend
had several Asian girlfriends, and there is a vacation house she has
stayed
at, a few times,where the owners dogs crapped on the porch...which was
dusty.

So, the peach is taking the back seat. Thanks!

> This infection is not uncommon in the United States, in 1976 its
> incidence was reported as 2.7%, most infections occur in the South due to
> warmer temperatures and high humidity which favor survival and develpment
> of the eggs in the soil.  In the past incidences of infection in some
> areas of the South reached 25%.  Most infections occur in children
> because they are much more likely to ingest soil then adults.  Also
> humans can become infected with the dog trichuriid T. vulpis, however it
> should be suseptible to the same drugs as T. trichuria.

This looks like the most likely cause, however, the boyfriend does
have another type of parasite that got in his eye and caused some
damage, and, there is an Asian connection with him with past girl
friends. The doctors put him on medication now as well, in case he
is the cause of re-infection.


> I cannot find any mention of treatment failures with the common
> antiheminthics, so your case is puzzling. 

They have her on Strongylodes now - it's out of France, very strong
stuff. Think it's Ivermectin, made by Merck.

She was on Thiamethol and something else - didnt work.

> Reinfection or misidentification are what I would be concerned about.  There is a
> related species of worm found in the Philippines and Thailand which is
> much more difficult to treat.   It has an egg similar to trichuris which
> could be misidentified by the inexperienced.

She's putting the doctors to the test about this, and did indentify
the egg from the Korean web pages I gave her, 100%. She's also getting
back to the CDC about it, as they had an early sample.

I'm beginning to think she has the asian strain, in fact, from the
reaction from the CDC in the beginning - they were shocked over it,
and if it was the US version, I find it impossible to believe she is
the only case they had reported.

The asian strain would have made them sit up and they would have the
reaction that it was rare.

But, I think her doctors have been treating it the same as the US
version, and this critter didnt respond to the normal drugs for them.

> I hope this information is useful and I hope your friend recovers.

Thank you, it has been useful - except I dont understand about
them not producing eggs in the body....in her, they have been creating
eggs all the way along, and she has been a nazi as far as cleanliness
and keeping tabs on any way she could be reinfected.

She doesnt own any animals.  Washes everything, lysols everything,
uses witch hazel as an anti-septic on her skin, and so on...and the boy
friend is in treatment just in case.

Lower GI endoscopy (sp) was performed and they found nothing, so,
either they are hiding or are in her upper GI tract.

She needs to go in for a complete upper & lower GI endoscopy - 

Meanwhile, it is a bit of a puzzle.

If the latest round (which isnt working so far) of med's - Strongylodes
don't do it (still has a few days to go on them), then, she will be
going
to traditional asian medicine and natural remedies (as well as complete
endoscopy, etc)

The medication she is on now is the most modern of all and hasn't
really been used in this country.

I'll come back after the CDC has been contacted and a re-examination
is made to conclusively determine which strain of whip worm this is.....

I've always been under the impression it was not a US variety.

Cheers,

Birdie




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