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PubMedDate not supplied

Selective primary health care: strategies for control of disease in the developing world. XII. Ascariasis and trichuriasis.

Ascariasis and trichuriasis are the most prevalent and widespread intestinal helminthiases. Transmission of disease occurs by ingestion or inhalation of Ascaris and Trichuris eggs embryonated in the soil. During the migration of Ascaris to the lungs, pneumonic symptoms may develop. The intestinal stage of the parasite can cause severe symptoms and complications when the worm burden is high. High numbers of Trichuris may cause diarrhea. The poor standard of hygiene, the biology of the parasite (which is such that a high number of very resistant eggs are produced), and the habits of the host (such as the use of night soil) are factors causing a high prevalence of infection in many countries in Asia, Africa, South America, and Europe. The mechanism of the transmission of Ascaris varies in different communities. The peak of infection is among children aged four to 14 years. Worm burden is normally low, and only a small segment of the population harbors a high proportion of the worms present in a community. Control of infections due to Ascaris and Trichuris is feasible by a combination of mass chemotherapy with the effective drugs now available, safe disposal of excreta, destruction of the eggs, and health education.

Adolescent↗
PubMed1975

A clinical evaluation of the efficacy of mebendazole in the treatment of trichuriasis.

In a single-blind clinical study of mebendazole, a new, broadspectrum anthelmintic, 70 patients with light to severe infections of Trichuris trichiura were treated. Ten subjects received placebos, and 60 received 100 mg mebendazole twice a day for three and four days. The drug was well tolerated by the patients, and no toxic side effects were observed. Egg count comparisons using the McMaster method on feces collected before and one month after treatment indicated a cure rate for trichuriasis of 65.6% and 89.3% and a total egg reduction of 69.5% and 95.9% for three- and four-day regimens, respectively. Patients not cleared showed an egg reduction rate of 31.6% and 76.8% on the three- and four-day regimens, respectively.

Adolescent↗
PubMed1978

A review of trichuriasis, its incidence, pathogenicity and treatment.

The incidence and pathogenicity of trichuriasis is reviewed. Reference is made to earlier, largely unsuccessful, treatments, and to mebendazole. Oxantel, the most recent drug shown to be effective against Trichuris is discussed, as is oxantel-pyrantel which promises to be effective against mixed helminthic infections.

Enterobius↗
PubMed1977

Mebendazole in the treatment of severe symptomatic trichuriasis in children.

Mebendazole (methyl-5-benzoylbenzimidazole-2-carbamate), a new broad spectrum anthelmintic, cured 26 (74% out of 35 children) with severe symptomatic trichuriasis. Repeat course of therapy were necessary in some cases. The nine treatment failures all showed large reductions (82-99%) in egg counts. Thus, an overall satisfactory response was obtained in terms of complete parasite eradication in 74%, relief of symptoms in all, and significant reduction in worm load in the failures. In the recommended dosage of 100 mg twice daily for 3 days mebendazole failed to achieve a cure rate of 95% to 100% reported in asymptomatic individuals and those with light infections of Trichuris trichiura. It is probable that measures to control diarrhea before administering mebendazole in an increased, extended, or repreated dosage schedule will achieve a higher cure rate. The drug was well tolerated and completely free from any toxic effects.

Benzimidazoles↗
PubMed1978

Further experience with mebendazole in the treatment of symptomatic trichuriasis in children.

Mebendazole (methyl-5-benzoylbenzimidazole-2-carbamate: Vermox), a broad spectrum anthelmintic, cured 22 (88%) children with symptomatic trichuriasis when given as a single 6-day course in a dosage of 100 mg twice daily. A further 3 (12%) were cured after a repeat 6-day course of therapy. Thus complete parasite eradication was achieved in all. The administration of an antidiarrheal agent, loperamide hydrochloride (Imodium), appeared to enhance the efficacy of mebendazole. Both drugs were well tolerated and completely free of any toxic effects.

Ascariasis↗
PubMed2002

Trichuriasis: localized inflammatory responses in the colon.

Most patients with trichuriasis have light worm burdens. Data regarding the inflammatory response to Trichuris worms in the colon of lightly infected persons are scant. Nine patients whose Trichuris infection was found by colonoscopy had biopsies taken from a site adjacent to visible worms and from a second site some 20 cm distally. The biopsies were studied by routine and immunohistochemical methods. None of the biopsies showed mucosal ulceration, significant congestion, fibrosis, gland distortion or goblet cell mucin depletion. There was no difference between worm and worm-free sites in terms of edema, lymphoid follicles or epithelial slough. Worm sites had higher numbers of eosinophils, neutrophils and total inflammatory cells and lower numbers of plasma cells. However there was no difference in lymphocyte, mast cell, and B- and T-cell counts between the two sites. This suggests that the T. trichiura worm incites a local inflammatory response involving eosinophils and neutrophils, even when the colon has only a light burden of worms.

Adult↗
PubMed1983

Cortisone-induced immunotolerance to nematode infection in CBA/Ca mice. II. A model for human chronic trichuriasis.

Treatment of CBA/Ca mice with cortisone acetate for a short period after infection with Trichuris muris induces a state of immunotolerance which allows the development and survival of a chronic infection. Mice harbouring such infections were found to be less capable of responding to a primary infection with Trichinella spiralis or of producing humoral responses to lipopolysaccharide and sheep red blood cells. Mesenteric lymph node T cells, however, were as responsive to the polyclonal activator phytohaemagglutinin as those from normal mice. Homing to the intestinal tract of activated mesenteric lymph node cells from helminth-infected donors was not impaired in the animals harbouring chronic infections. The results are discussed in terms of antigenic competition and with respect to their relevance to chronic human trichuriasis.

Animals↗
PubMed1991

Helper T-cell subsets in mouse trichuriasis.

The fate of a primary infection with the nematode parasite Trichuris muris varies between different inbred strains of mouse. Most strains are resistant to infection, expelling the parasite before the adult worms develop. However, a few strains are unable to mount a protective immune response and will harbour chronic infections. Mouse trichuriasis thus provides on excellent helminth model in which to dissect the mechanisms of immunity operating during acute versus chronic infection. Here, Kathryn Else and Richard Grencis describe their recent work on the polarization of the helper T-cell response during infection with T. muris giving predominantly T(H)2-type cells in resistant strains of mouse and predominantly T(H)1-type cells in strains of mouse unable to expel the parasite. They also discuss their findings in relation to polarized helper T-cell responses reported for other intestinal nematodes.

Journal Article↗