Parasites,  El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Trichuris Trichuris (whipworm). A female Trichuris has been found in the cecum that is the normal habitat of this worms. Trichuriasis is an intestinal infection found in human beings which is caused by Trichuris trichiura, more commonly known as whipworm because of its whip-like appearance. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. It is prevalent throughout the world, especially in tropical areas. Its diagnosis is usually made by identification of the typical eggs in the stool; adult whipworm is rarely seen during colonoscopy. Colonoscopy can directly diagnose trichuriasis, confirming the threadlike form of worms with an attenuated end. The worms can be overlooked, particularly if colon preparation is imperfect. Attenuated whip-like ends of whipworms, which are embedded in the colonic mucosa, were removed with biopsy forceps.

Video Endoscopic Sequence 1 of 19.

Colonoscopic Findings of a Trichuris Trichuris (whipworm).

 A female Trichuris has been found in the cecum that is the
 normal habitat of this worms.

 Trichuriasis is an intestinal infection found in human beings which
 is caused by Trichuris trichiura, more commonly known as
 whipworm because of its whip-like appearance. It is
 characterized by the invasion of the colonic mucosa by the adult
 Trichuris and produces minor inflammatory changes at the sites
 of localization. It is prevalent throughout the world, especially in
 tropical areas. Its diagnosis is usually made by identification of the
 typical eggs in the stool; adult whipworm is rarely seen during
 colonoscopy. Colonoscopy can directly diagnose trichuriasis,
 confirming the threadlike form of worms with an attenuated end.
 The worms can be overlooked, particularly if colon preparation is
 imperfect. Attenuated whip-like ends of whipworms, which are
 embedded in the colonic mucosa, were removed with biopsy
 forceps.

 Download the video clip by clicking on the endoscopic
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 All endoscopic images shown in this Atlas contains video
 clips. 
                                        Medline.

Trichuris Trichuris (whipworm). This worm seem to be a female, Note : A filariform anterior  part.

Video Endoscopic Sequence 2 of 19.

 This worm seem to be a female, Note: A filariform anterior
 part. See the histopathologic below.

 A whipworm (Trichuris trichiura), which was seen to be
 moving gently in the cecum, was discovered during the
 examination.

 

Adult Trichuris.

Adult Trichuris.

Trichuris Trichuris (whipworm). The worm derives its name (whipworm) from its characteristic whiplike shape; the adult (male - 30-45 mm, female - 35-50 mm) buries its thin, threadlike anterior half into the intestinal mucosa, After 10-14 days in soil, eggs become infective. Soil-containing eggs must be swallowed. no tissue migratory phase occurs. Larvae hatch in the small intestine, where they grow and molt, finally taking up residence in the large intestine. The time from ingestion of eggs to development of mature worms is approximately 3 months. Adult females lay eggs for up to 5 years.

Video Endoscopic Sequence 3 of 19.

 Colonoscopic finding of showing a long slender whitish
 T. trichiura worm in the cecum.

 The worm derives its name (whipworm) from its
 characteristic whiplike shape; the adult (male - 30-45 mm,
 female - 35-50 mm) with males being somewhat smaller
 than females.
 Buries its thin, threadlike anterior half into the intestinal
 mucosa, After 10-14 days in soil, eggs become infective.
 Soil-containing eggs must be swallowed.
 no tissue migratory phase occurs. Larvae hatch in the
 small intestine, where they grow and molt, finally taking up
 residence in the large intestine. The time from ingestion of
 eggs to development of mature worms is approximately 3
 months. Adult females lay eggs for up to 5 years.

More than 700 million people are infected worldwide.   Another trichuris is observed in the appendicular hole. This worm seem to be a male, Note : A filariform anterior part and coiled posterior end. More than 700 million people are infected worldwide.The adult worms (approximately 4 cm in length) live in the cecum and ascending colon. The adult worms are fixed in that location with the anterior portions threaded into the mucosa. Most cases are asymptomatic. Heavy parasite loads cause diarrhea, anemia and pain.

Video Endoscopic Sequence 4 of 19.

 Colonoscopic finding of case 2 showing a whitish worm,
 T .trichiura, with coiled posterior end embedded in the wall
 of the cecum

 Another trichuris is observed in the appendicular hole.
 This worm seem to be a male, Note : A filariform anterior
 part and coiled posterior end.
 More than 700 million people are infected worldwide.
 The adult worms (approximately 4 cm in length) live in the
 cecum and ascending colon. The adult worms are fixed in
 that location with the anterior portions threaded into the
 mucosa. Most cases are asymptomatic. Heavy parasite
 loads cause diarrhea, anemia and pain.

One of the worm was taken with the biopsy forceps, see below the sequences of video clips and pictures of this whipworm.

Video Endoscopic Sequence 5 of 19.

 Endoscopic parasite extraction and medical treatment was
 performed.

 One of the worm was taken with the biopsy forceps, see
 below the sequences of video clips and pictures of this
 whipworm.

 Eosinophilia is uncommon; however, when present, it
 ranges from 5-20%.

 

A video clip and a image of the whipworm.  Macroscopic and histopatologic images are displayed in  this sequence, see below.

Video Endoscopic Sequence 6 of 19.

A video clip and a image of the whipworm.

 Macroscopic and histopathologic images are displayed in
 this sequence, see below.

The posterior end of a female Trichuris. The history of T. Trichuria dates back to the times of prehistoric man; however, the first written record of T. trchiura appeared in 1740 when an Italian scientist by the name of Morgani discovered the residence of adult T. trichiura worms in the colon. In 1761 Roedere, a German physician, gave a report of the exact morphologic description and provided accurate drawings of the parasite. The organism received its taxonomy classification in the 18th C.

Video Endoscopic Sequence 7 of 19.

 Caudal aspect of female Trichuris trichura.
 ( Stereoscopic view).

 The history of T. Trichuria dates back to the times of
 prehistoric man; however, the first written record of T.
 trchiura appeared in 1740 when an Italian scientist by the
 name of Morgani discovered the residence of adult T.
 trichiura worms in the colon. In 1761 Roedere, a German
 physician, gave a report of the exact morphologic
 description and provided accurate drawings of the parasite.
 The organism received its taxonomy classification in the
 18th C.

Cephalic part of the Trichuris trichura separated from the body. To the left there is a portion of caudal part of the parasite.

Video Endoscopic Sequence 8 of 19.

 Cephalic part of the Trichuris trichura separated from the
 body.
 To the left there is a portion of caudal part of the parasite.
 The mouth is a simple opening, lacking lips. The buccal
 cavity is tiny and is provided with a minute spear.

Stereoscopic view of the body of the parasite.

Video Endoscopic Sequence 9 of 19.

Stereoscopic view of the body of the parasite.

 The esophagus is very long, occupying about two thirds of
 the body length and consists of a thin-walled tube
 surrounded by large, unicellular glands, the stitchocytes.

 

This is a longitudinal section of Trichuris trichura, showing eggs in the uterus.  Female worms in the cecum shed between 3,000-20,000 eggs per day.

Video Endoscopic Sequence 10 of 19.

 Sections of the worm, demonstrated a gravid female adult
 nematode with numerous immature ova.

 This is a longitudinal section of Trichuris trichura, showing
 eggs in the uterus.

 Female worms in the cecum shed between 3,000-20,000
 eggs per day.

 

A complete section of the uterus with numerous eggs.   Life cycle of T.trichiura: Eggs, after are discharges with the feces, require between 12 days and several weeks (based on the environment condition) for development of larvae. When infective eggs are ingested, the larvae hatch in the small intestine, and migrate to the lower intestine and colon, and enters the epithelium of the intestine. They become sexually mature in about 3 months. The larvae bore into the mucosa with the slender anterior part of the body .

Video Endoscopic Sequence 11 of 19.

 A complete section of the uterus with numerous eggs.

 Life cycle of T.trichiura:
 Eggs, after are discharges with the feces, require between
 12 days and several weeks (based on the environment
 condition) for development of larvae.
 When infective eggs are ingested, the larvae hatch in the
 small intestine, and migrate to the lower intestine andÇ
 colon, and enters the epithelium of the intestine.
 They become sexually mature in about 3 months. The
 larvae bore into the mucosa with the slender anterior part
 of the body.

Characteristic eggs of Trichuris trichura with typical extremes.

Video Endoscopic Sequence 12 of 19.

 Characteristic eggs of Trichuris trichura with typical
 extremes.

 Each worm causes an estimated 5 mL of blood loss every
 day. Heavy infections are required to cause anemia.

A 10x view of eggs into the uterus.

Video Endoscopic Sequence 13 of 19.

 A female adult T. trichiura, showing the uterine tubules.

A 10x view of eggs into the uterus.

A 4x view of eggs.

Video Endoscopic Sequence 14 of 19.

A 4x view of eggs.

 Whipworm infections transpire as a result of accidental
 ingestion of Trichuris trichiura eggs or embryos. After
 they are swallowed, the eggs move to the host's small
 intestine, where they develop into juveniles. The young
 worms then move to the large intestine and attach their
 anterior ends to the intestinal wall. After approximately
 three months, the parasite becomes a sexually mature
 adult, females producing up to 10,000 eggs per day, which
 are passed out of the host's system with digestive wastes.
 The eggs need a warm moist environment to survive
 outside the body and become infective in about three
 weeks. Since whipworms do not actually multiply inside a
 host, each individual worm represents a separate incident
 of infection.

Colonic mucosa with erosion and chronic inflammatory changes, and hemorrhages, 10x.

Video Endoscopic Sequence 15 of 19.

 Colonic mucosa with erosion and chronic inflammatory
 changes, and hemorrhages, 10x.

Same picture as above at low power, 4x.

Video Endoscopic Sequence 16 of 19.

 The colonia mucosae shows chronic inflamation and
 superficial hemorrage.(Low power 4x).

Low power,4x, of  colonic mucosa with inflamatory changes.

Video Endoscopic Sequence 17 of 19.

 Low power,4x, of colonic mucosa with inflamatory changes.
 There are superficial erosions.

Low power,4x, of  colonic mucosa with inflamatory changes.

Video Endoscopic Sequence 18 of 19.

 Low power, 4x, of colonic mucosa with inflamatory
 changes.

 Same picture of colonic mucosae at 10x.

Video Endoscopic Sequence 19 of 19.

 Same picture of colonic mucosa at 10x.

Schistosoma Mansoni.  Magnification Colonoscope. This 34 year-old male, a routine colonoscopy was performed a Trichuris was found at the cecum.

Video Endoscopic Sequence 1 of 9.

Schistosoma Mansoni in the Cecum

Magnification Colonoscope.

 This 34 year-old male, a routine colonoscopy was
 performed a Schistosoma Mansoni was found at the cecum.

 In the Republic of El Salvador no cases of Schistosoma
 Mansoni have been reported previously, in this atlas we
 presented two cases of Schistosoma Mansoni found them
 at the cecum.

High Magnification Image.     The Schistosome Egg is Responsible For Most of the  Pathology Associated with Schistosomiasis.   Schistosome eggs, which may become lodged within the hosts tissues, are the major cause of pathology in schistosomiasis, which takes a number of forms. Onset of egg laying in humans is sometimes associated with an onset of fever (Katayama fever). This "Acute Schistosomiasis" is not however as important as the chronic forms of the disease. For S. mansoni and S. japonicum these are "Intestinal" and "Hepatic Schistosomiasis", associated with formation of granulomas around trapped eggs lodged in the intestinal wall or in the liver respectively. The hepatic form of the disease is the most important, granulomas here giving rise fibrosis of the liver and hepatosplenomegaly in severe cases.

Video Endoscopic Sequence 2 of 9.

High Magnification Image and Video Clip.

The Schistosome Egg is Responsible For Most of the
Pathology Associated with Schistosomiasis.

 Schistosome eggs, which may become lodged within the
 hosts tissues, are the major cause of pathology in
 schistosomiasis, which takes a number of forms. Onset of
 egg laying in humans is sometimes associated with an
 onset of fever (Katayama fever). This "Acute
 Schistosomiasis" is not however as important as the
 chronic forms of the disease. For S. mansoni and S.
 japonicum these are "Intestinal" and "Hepatic
 Schistosomiasis", associated with formation of granulomas
 around trapped eggs lodged in the intestinal wall or in the
 liver respectively. The hepatic form of the disease is the
 most important, granulomas here giving rise fibrosis of the
 liver and hepatosplenomegaly in severe cases.

Schistosomiasis (ie, bilharziasis) is a human disease syndrome caused by infection from one of several species of parasitic trematodes of the genus Schistosoma. Schistosomiasis is a major source of morbidity and mortality for developing countries in Africa, South America, the Caribbean, the Middle East, and Asia. Tourism to and immigration from endemic areas can result in schistosomiasis cases presenting anywhere in the developed world.

Video Endoscopic Sequence 3 of 9.

 Schistosomiasis (ie, bilharziasis) is a human disease
 syndrome caused by infection from one of several species
 of parasitic trematodes of the genus Schistosoma.
 Schistosomiasis is a major source of morbidity and
 mortality for developing countries in Africa, South
 America, the Caribbean, the Middle East, and Asia.
 Tourism to and immigration from endemic areas can result
 in schistosomiasis cases presenting anywhere in the
 developed world.

Most human schistosomiasis is caused by Schistosoma haematobium, Schistosoma mansoni, or Schistosoma japonicum. Less prevalent species such as Schistosoma mekongi and Schistosoma intercalatum also may cause systemic human disease. Less importantly, other schistosomes with avian or mammalian primary hosts can cause severe dermatitis in humans (eg, swimmer's itch secondary to Trichobilharzia ocellata).

Video Endoscopic Sequence 4 of 9.

 Most human schistosomiasis is caused by Schistosoma
 haematobium, Schistosoma mansoni, or Schistosoma
 japonicum. Less prevalent species such as Schistosoma
 mekongi and Schistosoma intercalatum also may cause
 systemic human disease. Less importantly, other
 schistosomes with avian or mammalian primary hosts can
 cause severe dermatitis in humans (eg, swimmer's itch
 secondary to Trichobilharzia ocellata).

 

After malaria, schistosomiasis is the second most prevalent tropical disease in the world. In some parts of the world, it also is known as bilharzia in honor of Theodore Bilharz. He first identified the etiological agent for Schistosoma hematobium in Egypt in 1851.  The pathophysiology of schistosomiasis is due to the immune response against the schistosome eggs. The clinical manifestations depend on the species of parasite, intensity of worm burden, and immunity of the person to the parasite. Recent World Health Organization (WHO) reports estimate that 500-600 million people in 74 tropical and subtropical countries are at risk for schistosomiasis. Over 200 million people in these countries are infected. Of these, 120 million are symptomatic, with 20 million having severe clinical disease.

Video Endoscopic Sequence 5 of 9.

 After malaria, schistosomiasis is the second most prevalent
 tropical disease in the world. In some parts of the world, it
 also is known as bilharzia in honor of Theodore Bilharz. He
 first identified the etiological agent for Schistosoma
 hematobium in Egypt in 1851.

 The pathophysiology of schistosomiasis is due to the
 immune response against the schistosome eggs. The
 clinical manifestations depend on the species of parasite,
 intensity of worm burden, and immunity of the person to
 the parasite. Recent World Health Organization (WHO)
 reports estimate that 500-600 million people in 74 tropical
 and subtropical countries are at risk for schistosomiasis.
 Over 200 million people in these countries are infected. Of
 these, 120 million are symptomatic, with 20 million having
 severe clinical disease.

Clinical manifestations: The clinical manifestations of trichuriasis vary widely from asymptomatic infection to fatal massive infantile trichuriasis. Factors determining the clinical picture are: the intensity and duration of the infection, age, general health status of the host, including, iron reserves, and concomitant infections with other parasites such as shigellosis, amebiasis, giardiasis, or balantidiasis. Mixed infections with other soil-transmitted nematodes are also common.

Video Endoscopic Sequence 6 of 9.

 The life cycle of the flatworms that cause human
 schistosomiasis involves a sexual stage in the human and
 an asexual stage in the fresh water snail host. The adult
 worms are small, 12-26 mm long and 0.3-0.6 mm wide, and
 vary with the different species. S hematobium lives in the
 venous plexus near the urinary bladder and ureters, S
 mansoni lives in the inferior mesenteric vein, and S
 japonicum lives in the superior mesenteric vein of both the
 large and small intestines.

Adult worms mate and lay eggs. The eggs are nonoperculate, possess a spine, and contain a miracidium. The microscopic appearance of the egg allows diagnostic differentiation of the 5 species. An adult S hematobium produces 20-200 round, terminally spined eggs per day; S mansoni produces 100-300 ovoid, laterally spined eggs per day; and S japonicum produces 500-3500 round, small, laterally spined eggs per day. The eggs of S intercalatum have prominent terminal spines, and S mekongi have small lateral spines.

Video Endoscopic Sequence 7 of 9.

 Adult worms mate and lay eggs. The eggs are
 nonoperculate, possess a spine, and contain a miracidium.
 The microscopic appearance of the egg allows diagnostic
 differentiation of the 5 species. An adult S hematobium
 produces 20-200 round, terminally spined eggs per day; S
 mansoni produces 100-300 ovoid, laterally spined eggs per
 day; and S japonicum produces 500-3500 round, small,
 laterally spined eggs per day. The eggs of S intercalatum
 have prominent terminal spines, and S mekongi have small
 lateral spines.

Pathophysiology: The pathophysiology of infection correlates with the life cycle of the parasite, as follows: Cercariae: Skin penetration of cercariae produces an allergic dermatitis at the site of entry. With prior sensitization, a pruritic papular rash occurs. This also is observed with nonhuman avian schistosomes.  Schistosomula: These are tailless cercariae that are transported through blood or lymphatics to the right side of the heart and lungs. Heavy infection can cause symptoms such as cough and fever. Eosinophilia may be observed. Adult worm: Adult worms do not multiply inside the human body. In the venous blood, adult male and female worms mate, and the female lays eggs 4-6 weeks after cercarial penetration. Adult worms rarely are pathogenic. The female adult worm lives for approximately 3-8 years and lays eggs throughout her life span.

Video Endoscopic Sequence 8 of 9.

 Pathophysiology: The pathophysiology of infection
 correlates with the life cycle of the parasite, as follows.

.Cercariae: Skin penetration of cercariae produces an
 allergic dermatitis at the site of entry. With prior
 sensitization, a pruritic papular rash occurs. This also is
 observed with nonhuman avian schistosomes.

 Schistosomula: These are tailless cercariae that are
 transported through blood or lymphatics to the right side of
 the heart and lungs. Heavy infection can cause symptoms
 such as cough and fever. Eosinophilia may be observed.

 Adult worm: Adult worms do not multiply inside the human
 body. In the venous blood, adult male and female worms
 mate, and the female lays eggs 4-6 weeks after cercarial
 penetration. Adult worms rarely are pathogenic.
 The female adult worm lives for approximately 3-8 years
 and lays eggs throughout her life span.

 Eggs: They cause Katayama fever and schistosomiasis.

  • Katayama fever: The exact pathophysiology is not known. It occurs 4-6 weeks after infection, at the time of the initial egg release. It is reported most commonly with S japonicum but also has been reported with S mansoni. Katayama fever is believed to be due to the high worm and egg antigen stimuli that result from immune complex formation and lead to a serum sickness–like illness. This syndrome is not due to granuloma formation.
  • Schistosomiasis: It is due to immunological reactions to Schistosoma eggs trapped in tissues. Antigens released from the egg stimulate a granulomatous reaction comprised of T cells, macrophages, and eosinophils that results in clinical disease. Symptoms and signs depend on the number and location of eggs trapped in the tissues. Initially, the inflammatory reaction is readily reversible. In the latter stages of the disease, the pathology is associated with collagen deposition and fibrosis, resulting in organ damage
     that may be only partially reversible.
The geographic distribution and pathophysiology of schistosomiasis reflect the unique life cycle of these parasites. Schistosomes infect particular species of susceptible freshwater snails in endemic areas. The infected snails release cercariae, which are fork-tailed free-swimming larvae approximately 1 mm in length. The cercariae survive in freshwater up to 48 hours, during which time they must attach to human skin or to that of another susceptible host mammal or die.  Cercariae attach to human hosts utilizing oral and ventral suckers. They then migrate through intact skin to dermal veins and, over the next several days, to the pulmonary vasculature. During this migration, the cercariae metamorphose, shedding tails and outer glycocalyces while developing double-lipid-bilayer teguments that are highly resistant to host immune responses.

Video Endoscopic Sequence 9 of 9.

 The geographic distribution and pathophysiology of
 schistosomiasis reflect the unique life cycle of these
 parasites. Schistosomes infect particular species of
 susceptible freshwater snails in endemic areas. The
 infected snails release cercariae, which are fork-tailed free
 -swimming larvae approximately 1 mm in length. The
 cercariae survive in freshwater up to 48 hours, during
 which time they must attach to human skin or to that of
 another susceptible host mammal or die.

 Cercariae attach to human hosts utilizing oral and ventral
 suckers. They then migrate through intact skin to dermal
 veins and, over the next several days, to the pulmonary
 vasculature. During this migration, the cercariae
 metamorphose, shedding tails and outer glycocalyces while
 developing double-lipid-bilayer teguments that are highly
 resistant to host immune responses.

Trichuris Trichuris (whipworm). This parasite is prevalent in the tropics, larvae penetrate the intestinal mucosa, and reattach as adults to the mucosa of the cecum wall of the colon. The mucosa becomes edematous and friable. Bleeding from friable mucosa can result in anemia.

Video Endoscopic Sequence 1 of 2.

Trichuris Trichuris (whipworm).

 This parasite is prevalent in the tropics, larvae
 penetrate the intestinal mucosa, and reattach as adults to
 the mucosa of the cecum wall of the colon. The mucosa
 becomes edematous and friable. Bleeding from friable
 mucosa can result in anemia.

 This parasite, which only infect human, found in most parts
 of the world, but mostly in worm and humid areas. The
 infection is mostly found from children and infection rates
 as high as 90% has been reported from many areas.

 

Trichuris Trichuris (whipworm).

Video Endoscopic Sequence 2 of 2.

 Trichuris Trichuris (whip worm) at the cecum.

Colonoscopy revealed a whitish threadlike worm undulating
 or coiled in the cecum.

The adult worm usually reaches 3-5 cm in length and has a lifespan of 1-3 years.

 Humans are the only known host of T trichiura. The
 organism is spread via the fecal-oral route. Potential hosts
 ingest the embryonated (mature) eggs. The eggs hatch in
 the small intestine, and the larvae attach to and penetrate
 the small intestinal mucosa, where they begin to mature.
 After approximately 1 week, the immature worms move
 passively to the large intestine and proximal colon. The
 worms' anterior portions penetrate the mucosal epithelium,
 and the worms can imbed over one half of their length into
 the mucosal surface.  

Melanosis Coli and Trichuris Trichuris.  This 63 year-old female a colonoscopy was performed due to an abdominal pain.

Video Endoscopic Sequence 1 of 9.

Melanosis Coli and Schistosoma Mansoni

This 63 year-old female a colonoscopy was performed due to an abdominal pain.

In spite of to have tried to move the parasite with the pressure of the water spurt, but this action was impossible.

Video Endoscopic Sequence 2 of 9.

In spite of to have tried to move the parasite with the pressure of the water spurt, but this action was impossible.

 

The eggs, which are highly antigenic and can induce an intense granulomatous response, migrate through the bowel or bladder wall to be shed via feces or urine. During this time (approximately 10 d) they begin to mature into miracidia. Eggs that are not shed successfully may remain in the tissues or be swept back to the portal circulation (from the mesenteric vessels) or to the pulmonary circulation (from the vesicular vessels via the inferior vena cava [IVC]). The free-swimming miracidia that are shed into freshwater survive 2-3 weeks, during which time they must infect a susceptible snail to complete the life cycle. Within the infected snail, 2 generations of sporocysts multiply, mature into free-swimming cercariae, and exit the snail to seek a human host and begin a new cycle.

Video Endoscopic Sequence 3 of 9.

 The eggs, which are highly antigenic and can induce an
 intense granulomatous response, migrate through the bowel
 or bladder wall to be shed via feces or urine. During this
 time (approximately 10 d) they begin to mature into
 miracidia. Eggs that are not shed successfully may remain
 in the tissues or be swept back to the portal circulation
 (from the mesenteric vessels) or to the pulmonary
 circulation (from the vesicular vessels via the inferior vena
 cava [IVC]).

 The free-swimming miracidia that are shed into freshwater
 survive 2-3 weeks, during which time they must infect a
 susceptible snail to complete the life cycle. Within the
 infected snail, 2 generations of sporocysts multiply, mature
 into free-swimming cercariae, and exit the snail to seek a
 human host and begin a new cycle.

Acute Schistosomiasis - Also called 'Katayama' fever. This is associated with the onset of the female parasite laying eggs, (approximately 5 weeks after infection), and granuloma formation around eggs trapped in the liver and intestinal wall. It resembles 'serum sickness' (i.e. acute immune complex disease), with hepatosplenomegaly, and leucocytosis with eosinophilia. This phase of the infection is often asymptomatic, but when symptoms do occur they include fever, nausea, headache, an irritating cough and, in extreme cases diarrhoea accompanied with blood, mucus and necrotic material. These symptoms , if present, last from a few weeks, to several months. It is not as commonly associated with S. mansoni infections compared with those of S. japonicum.

Video Endoscopic Sequence 4 of 9.

 Acute Schistosomiasis - Also called 'Katayama' fever. This
 is associated with the onset of the female parasite laying
 eggs, (approximately 5 weeks after infection), and
 granuloma formation around eggs trapped in the liver and
 intestinal wall. It resembles 'serum sickness' (i.e. acute
 immune complex disease), with hepatosplenomegaly, and
 leucocytosis with eosinophilia. This phase of the infection is
 often asymptomatic, but when symptoms do occur they
 include fever, nausea, headache, an irritating cough and, in
 extreme cases diarrhoea accompanied with blood, mucus
 and necrotic material. These symptoms , if present, last
 from a few weeks, to several months. It is not as commonly
 associated with S. mansoni infections compared with those
 of S. japonicum. 

The Chronic Phase of Infection.

Video Endoscopic Sequence 5 of 9.

The Chronic Phase of Infection.

  • This is the more important aspect of Schistosoma mansoni pathology, and may be divided into two areas Intestinal Schistosomiasis - This and the hepatic schistosomiasis detailed below, manifest a number of years after infection. The pathogenic reaction is a cellular, granulomatous inflammation around eggs trapped in the tissues, with subsequent fibrosis. All areas of both the small and large intestine may be involved, with the large intestine showing the most severe lesions, whereas severe pathology in the small intestine is only rarely observed, even though large numbers of eggs may be deposited here. Colonic polyps are also sometimes seen, especially in Egypt (Cheever et al 1978). The reasons for the high prevalence of this aspect of pathology in Egypt are not clear.
 Hepatosplenic Schistosomiasis - Again, this aspect of the disease is only seen a few years after infection. The pathology is similar to that seen in the intestine, with a cellular, granulomatous inflammation around eggs trapped in the liver, leading to fibrosis and hepatosplenic disease. Other organs may more rarely also contain granulomas around eggs, particularly the lungs.

Video Endoscopic Sequence 6 of 9.

 Hepatosplenic Schistosomiasis - Again, this aspect of the
 disease is only seen a few years after infection. The
 pathology is similar to that seen in the intestine, with a
 cellular, granulomatous inflammation around eggs trapped
 in the liver, leading to fibrosis and hepatosplenic disease.
 Other organs may more rarely also contain granulomas
 around eggs, particularly the lungs.

 

Pathology Associated with Infection by Other Species of  Schistosome.  S. japonicum Infection.: The primary cause of pathology here is a granulomatous reaction to egg trapped in the liver, and both the acute and chronic aspects of the disease are similar to that of S. mansoni infections, although the acute disease Katayama fever, is more common here than for S. mansoni . The chronic stage of the disease may also be more severe, owing to the greater egg output and longevity of S. japonicum females compared with those of S. mansoni.

Video Endoscopic Sequence 7 of 9.

 Pathology Associated with Infection by Other Species of
 Schistosome.

S. japonicum Infection

 The primary cause of pathology here is a granulomatous
 reaction to egg trapped in the liver, and both the acute and
 chronic aspects of the disease are similar to that of S.
 mansoni infections, although the acute disease Katayama
 fever, is more common here than for S. mansoni . The
 chronic stage of the disease may also be more severe,
 owing to the greater egg output and longevity of S.
 japonicum females compared with those of S. mansoni.

S. haematobium Infection: Adult parasites are found in small venules around the bladder and ureter, with the majority of egg deposition in the tissues of these organs, as eggs pass through the bladder wall, to leave the body in the urine. The disease cause is chronic in nature, with the most frequently affected organ being the urinary bladder, where calcification of eggs trapped in the tissues often occurs. The disease is characterised by blood in the urine (haematuria ), hence the infection is often refered to as 'Urinary Schistosomiasis '. Cancer of the bladder is an important complication of infection with S. haematobium. Eggs may be deposited in the liver, often in high numbers, and granuloma formation may occur, but this is much less severe than with S. mansoni.

Video Endoscopic Sequence 8 of 9.

Schistosoma Mansoni in the cecum

S. haematobium Infection

 Adult parasites are found in small venules around the
 bladder and ureter, with the majority of egg deposition in
 the tissues of these organs, as eggs pass through the
 bladder wall, to leave the body in the urine. The disease
 cause is chronic in nature, with the most frequently
 affected organ being the urinary bladder, where
 calcification of eggs trapped in the tissues often occurs.
 The disease is characterised by blood in the urine
 (haematuria ), hence the infection is often refered to as
 'Urinary Schistosomiasis '. Cancer of the bladder is an
 important complication of infection with S. haematobium.
 Eggs may be deposited in the liver, often in high numbers,
 and granuloma formation may occur, but this is much less
 severe than with S. mansoni.

Minor species : S. Intercalatum infection.  This is diagnosed by the presence of terminally spined eggs in the faeces, (the other terminally spined schistosome eggs, those of S. haematobium , are only found in the urine). Blood may be seen in the faeces, and diarrhoea may occur. However the portal hypertension . seen in S. mansoni infections has not been reported, and infections are often asymptomatic.    S. mekongi infection.

Video Endoscopic Sequence 9 of 9.

Minor Species

  • S. Intercalatum infection.
  • This is diagnosed by the presence of terminally spined eggs in the faeces, (the other terminally spined schistosome eggs, those of S. haematobium , are only found in the urine). Blood may be seen in the faeces, and diarrhoea may occur. However the portal hypertension . seen in S. mansoni infections has not been reported, and infections are often asymptomatic.
  • S. mekongi infection.
  • This has not been greatly studied, but the pathology appears to be similar to that of S. japonicum.
Tricofrida 1

Video Endoscopic Sequence 1 of 8.

Colonoscopy observing a trichuris in the cecum

 This 65 year-old female, has been presented during 6
 months with diarrheal syndrome, a colonoscopy was
 performed finding this parasite in the cecum, after specific
 treatment the patient, never again suffer from diarrhea.

 Ingested eggs hatch in the small intestine and complete a
 1- to 3-monthmaturation in the large intestine; the cecum
 and colon are the most commonly infected sites. Adult
 females lay 5000 to 7000 eggs per day and can do so for
 up to 5 years. Diagnosis is by detecting in the feces the
 oval, yellowish-brown, thick-shelled eggs that have 2 polar
 plugs. Trichuris eggs can be shed intermittently, so
 repeated fecal testing or proctoscopy (or colonoscopy, as
 in the current case) may be helpful in these cases.

TricoFrida2

Video Endoscopic Sequence 2 of 8.

 Colonoscopy revealed no abnormalities except for a small,
 white, mobile whip-like worm attached to the cecum. Note
 the Appendix hole with the whipworm strongly adhered to
 the mucosa.

TricoFrida3

Video Endoscopic Sequence 3 of 8.

The whipworm in their lengthwise

The parasite was extracted with biopsy forceps and sent to pathologist for their respective review.

The pathologist performed a hematoxylin and eosin staining of the secretion surrounding the parasite, the eggs are  microscopically observed that are characteristic of whipworm.                                                                                       .

Video Endoscopic Sequence 4 of 8.

 The pathologist performed a hematoxylin and eosin
 staining of the secretion surrounding the parasite, the eggs
 are microscopically observed that are characteristic of
 whipworm.

A close up to the eggs.

Video Endoscopic Sequence 5 of 8.

A close up to the eggs

TricoFrida6

Video Endoscopic Sequence 6 of 8.

Multiple eggs are observed

 

Part of the parasite observed under the microscope.

Video Endoscopic Sequence 7 of 8.

Part of the parasite observed under the microscope

 

The whipworm after removal from the cecum.

Video Endoscopic Sequence 8 of 8.

The whipworm after removal from the cecum

 

TricoPortillox1

Video Endoscopic Sequence 1 of 6.

 Trichuris trichiura Infection Diagnosed by Colonoscopy

 This 72 year old male, father of urologist was referred to
 our endoscopic unit due to discharged a primary tumor of
 the digestive system because, had been diagnosed with
 liver metastatic disease and probably a primary kidney
 tumor, however, no tumor was found in the digestive
 system but only this whipworm.

 

TricoPortillox2

Video Endoscopic Sequence 2 of 6.

Another image and video of a whipworm

 The adult T. trichiura invade the mucosa and produce
 minor inflammatory changes at localized sites. In endemic
 areas, most people are colonized by small numbers of
 worms and have no symptoms. Some people harbor
 hundreds or even thousands of worms, and they present
 with anemia, diarrhea, abdominal pain, weight loss,
 malnutrition, appendicitis, colonic obstruction, perforation,
 or intestinal bleeding.

 

TricoPortillox3

Video Endoscopic Sequence 3 of 6.

 Trichuris trichiura Infection Diagnosed during a screening colonoscopy

Frequency

United States

 Whipworm infection is rare overall but is more common in
 the rural Southeast, where 2.2 million people are thought
 to be infected.

International

 Whipworm infection is more common in less-developed
 countries. This parasite is carried by nearly one quarter of
 the world population..

TricoPortillox4

Video Endoscopic Sequence 4 of 6.

 Colonoscopic finding of case 3 showing a movable whitish
 worm, T. trichiura, in the ileocecal valve.

 Most patients are asymptomatic. Clinical symptoms are
 limited to patients with heavy infection, who tend to be
 small children or others with significant exposure.
 Note that there is no pulmonary migration and, thus, no
 pulmonary or extra-gastrointestinal symptoms.
 

  •  Nocturnal loose stools
  • Dysentery can occur in patients with greater than 200 worms.
  • Rectal prolapse
  • Failure to thrive
  • Symptoms of anemia (massive infection only)
  • Vague abdominal discomfort
  • Stunted growth
Tricoporxt5

Video Endoscopic Sequence 5 of 6.

 The video shows the pressure exerted by the forceps
 biopsy removing this parasite which this strongly adhered
 to the mucosa.

 

Tricoporxt6

Video Endoscopic Sequence 6 of 6.

Causes

 Whipworm is caused by consumption of soil or food that
 has been fecally contaminated. (Eggs are infective or
 embryonated about 2-3 weeks after being deposited in the
 soil).

 

Tricocephalusqwe1

Video Endoscopic Sequence 1 of 10.

Trichuris Trichuris (whipworm).

This 57 year-old female underwent a routine colonoscopy finding this parasite in the cecum.

 Trichuriasis is an intestinal infection of human beings
 caused by ingesting embryonated eggs from the
 environment. Colonized eggs hatch and enter the crypts of
 the small intestine as larvae.After 1-3 months of
 maturation, the parasite migrates to the cecum. In the
 cecum, the parasite matures, mates, and lays eggs. Adult
 worms are 3-4 cm in length and have thin, tapered anterior
 regions, and are thus commonly referred to as whipworms.

Tricocephalusqwe2

Video Endoscopic Sequence 2 of 10.

Video Endoscopy of Trichuris Trichuris (whipworm).

 Colonoscopic finding, showing a whitish worm, Trichuris
 trichiura, with coiled posterior end embedded in the wall of
 the cecum.

 Poor hygiene is associated with trichuriasis transmission,
 and children are especially vulnerable because of their
 high exposure risk. This is especially true in developing
 countries, where poor sanitary conditions correlate with
 heavy disease burden and infections.

 

Tricocephalusqwe3

Video Endoscopic Sequence 3 of 10.

Endoscopy Image of Trichuris Trichuris (whipworm).

 Trichuris trichiura, commonly referred to as a whipworm,
 has a worldwide distribution, particularly among countries
 with warm, humid climates.

 The morphology was that of Trichuris trichiura (whipworm).
 In retrospect, the thin head (whip) portion of the worm
 could be seen embedded in the cecal mucosa while the
 thicker portion (whip-handle) was visible within the lumen.

 

Tricocephalusqwe4

Video Endoscopic Sequence 4 of 10.

 Removing this parasite which this strongly adhered
 to the mucosa.

 The parasite was removed, and its attenuated whiplike end
 was gradually extracted from the mucosa by a biopsy
 forceps and sent for parasitologic examination. The worm
 was a female.

 Trichuris dysentery syndrome (TDS) is a combination of
 symptoms, such as mucoid diarrhea and occasional
 bleeding. Rectal prolapse can occur in children with
 extremely high numbers of T. trichiura worms. Treatment
 recommendations are as follows: albendazole.
 (400 mg once daily for 3 days) or mebendazole
 (100 mg twice daily for 3 days).

Tricocephalusqwe5

Video Endoscopic Sequence 5 of 10.

A female adult T. trichiura recovered from the cecum

 On a related and fascinating note, Crohn’s disease is
 uncommon in parts of the world where helminthic
 colonization is widespread. Crohn’s disease involves
 overreactive TH1 pathways and helminths blunt TH1
 responses. Because of this and other protective actions,
 Trichuris suis, the porcine whipworm, has been used
 successfully to treat Crohn’s disease. It may not be that
 the only good helminth is a dead helminth. Sometimes we
 benefit from sharing a meal with someone who sits next to
 us.

Tricocephalusqwe6

Video Endoscopic Sequence 6 of 10.

Female adult trichuris trichiura

 The worms can be overlooked, particularly if colon preparation is imperfect. 

Tricocephalusqwe7

Video Endoscopic Sequence 7 of 10.

 Sections of the worm, demonstrated a gravid female adult
 nematode with numerous immature ova (D, H&E).

 Arrel-shaped eggs of T. trichiura, the body wall consisting
 of the cuticle, epicuticle, and muscle layer (H-E stain).

Image of Female Adult Trichuris Trichiura

Video Endoscopic Sequence 8 of 10.

Image of Female Adult Trichuris Trichiura

 Almost a fourth of the world’s population is infected
 withwhipworm, Trichuris trichiura, which, fortunately, is
 characterized by a relative lack of symptoms; only patients
 with heavy infections become symptomatic. Trichuris eggs
 are unembryonated and not infectious when they are
 excreted. Development to the infectious stage takes at
 least 2 weeks, and the host only becomes infected after
 ingesting embryonated eggs from the environment, usually
 from dirt or possibly contaminated water.

Tricocephalusqwe10

Video Endoscopic Sequence 9 of 10.

 

Tricocephalusqwe11

Video Endoscopic Sequence 10 of 10.

Moderate eosinophilic infiltration in lamina propria

Tricocefalodiminuto

 Another tiny parasite attached to the cecum

 This morphology is different from those presented here, is
 smaller and brown.

 The parasite may be a variant or another whipworm if you
 have any ideas please send us an email.

TricoSigmoides1

Secuencia Video Endoscópica 1 de 3.

Colonoscopy in which there is a whipworm in the sigmoid.

 This is a 80 year-old, male. A colonoscopy was practiced
 becaouse of changes in colonic motility, constipation,
 insomuch that defecated without laxatives, could spend up
 to 20 days without a bowel movement.

 

TricoSigmoides2

Secuencia Video Endoscópica 2 de 3.

 In these videos you can watch this whipworm the suction
 exerted on the colonic mucosa.

TricoSigmoides3

Secuencia Video Endoscópica 3 de 3.

Are observed mucosal lesions apparently caused by the parasite sucking on the mucosa.