Layout

284jumonline.qxp:Layout 1 3/17/09 2:30 PM Page 555 Just Images
Sonographic Whipworm Dance
in Trichuriasis
S. Boopathy Vijayaraghavan, MD, DMRD richuriasis is an intestinal nematode infestationfound in humans caused by Trichuris trichiura. Itis more commonly known as whipworm because Tof its whiplike appearance. It is found worldwide but is most prevalent in warm, humid climates. Infectionoccurs by ingestion of embryonated eggs through con-taminated drinking water and food.1 Trichuris trichiuralives primarily in the human cecum, but it is also found inthe appendix and lower ileum.1,2 Light infections usuallydo not give rise to a recognizable clinical manifestation.
Patients with very heavy chronic trichuriasis infectionhave a characteristic clinical picture consisting of diar-rhea, abdominal pain, nausea, anemia, and weight loss. Itmay rarely cause rectal prolapse. Trichuris may attach tothe mucosa of the appendix and provide an entrance forthe pathogenic bacteria, resulting in acute or subacuteinflammatory processes. The diagnosis of trichuriasis isby seeing the eggs of the worm in the stool of the patient.
Here the motility of the whipworms in a chronicallyinflamed appendix on real-time sonography is reported.
The patient was a 48-year-old man who gave a history of recurrent attacks of frequent small stools and abdomi-nal pain for the past 2 years. He was emaciated and ane-mic. His blood investigations confirmed anemia. He wasreferred for sonography to rule out intra-abdominalmalignancy or tuberculosis. Sonography revealed a thick-walled nontender appendix. It was slightly distendedwith fluid. There was a fecalith in the lumen of theappendix (Figure 1). On real-time imaging, there wascontinuous wriggling movement in the lumen of Received October 9, 2008, from SonoscanUltrasonic Scan Center, Coimbatore, India. Revision appendix suggestive of the “whipworm dance” (Video 1).
requested November 1, 2008. Revised manuscript The same was shown on power Doppler imaging (Figure accepted for publication November 11, 2008. 2). This was diagnostic of trichuriasis of the appendix Address correspondence to S. Boopathy Vijayaraghavan, MD, DMRD, 15 B Venkatachalam with a chronically inflamed appendix containing a Rd, R. S. Puram, Coimbatore 641 002, India. fecalith. A stool examination confirmed trichuriasis. The E-mail: sonoscan@vsnl.com, sboopathy@eth.net patient was treated with mebendazole. He showedremarkable clinical improvement and underwent appen- Video online at www.jultrasoundmed.org 2009 by the American Institute of Ultrasound in Medicine • J Ultrasound Med 2009; 28:555–556 • 0278-4297/09/$3.50 284jumonline.qxp:Layout 1 3/17/09 2:30 PM Page 556 Sonographic Whipworm Dance in Trichuriasis
References
Neva FA, Brown HW. Nematodes. In: Basic ClinicalParasitology. 6th ed. Norwalk, CT: Appleton & Lange;1994:120–123.
Gupta SC, Gupta AK, Keswani NK, Singh PA, Tripathi AKKrishna V. Pathology of tropical appendicitis. J Clin Pathol1989; 42:1169–1172.
Figure 1. Thick-walled fluid-filled appendix with fecalith.
Figure 2. Power Doppler image showing the movement of the worm.

Source: http://sboopathy.com/data/Publication/TRICHURIASIS.pdf