P0570 - Trichuris Trichiura Infection Detected During Screening Colonoscopy

David Restrepo, MD¹, Neil Khoury, MD², Jevin Yabut, DO¹, Courtenay Ryan-Fisher, MBBCh³, Robert Blitzer, MD^4
1University of Connecticut, Farmington, CT; ²UConn Health, West Hartford, CT; ³University of Connecticut, Hartford, CT; ⁴CTGI, Hartford, CT

Introduction: Trichuris trichiura, or whipworm, is a soil-transmitted helminth that primarily affects the gastrointestinal tract. Infection occurs through ingestion of contaminated food or water. It is prevalent in tropical regions, typically in areas of poor hygiene. Infected individuals are often asymptomatic. Symptoms can be present in patients with moderate to heavy infections and include loose stools with mucus and blood and nocturnal stooling. In severe cases with high parasitic count, rectal prolapse can occur due to rectal inflammation.

Case Description/Methods: A 46-year-old female with a past medical history of hypertension, anemia, stage III clear cell renal cell carcinoma, migraines, heart failure with reduced ejection fraction, presented for a routine screening colonoscopy. Of note, she recently moved from Honduras to the United States. She had no complaints at the time of evaluation. Colonoscopy revealed worms at the cecum. Samples were sent to the lab for identification. The parasite was identified as Trichuris trichiura. She was treated with albendazole 400 mg daily for three days. A follow-up series of stool ova and parasites collections consisting of 3 different stools, at least 1 month after treatment, was scheduled. The results were still pending at the time of this submission.

Discussion: There is a diminutive amount of research regarding incidence of Trichuriasis diagnosed by colonoscopy. Interestingly, in a 2009 review of 25 reported cases, only four of the cases were from the United States. They described 13 cases in Korea, out of which only four of the patients were asymptomatic, suggesting that it is especially unique to find a whipworm on a screening colonoscopy in an asymptomatic patient. Of note, the worms are typically found in the cecum, as this is where the parasite migrates to lay eggs and mature. Trichuriasis is a medical condition that is highly prevalent in tropical regions. People who live in these regions and do not have access to basic sanitation are more vulnerable to contracting parasitic infections. With the growing migrant population who arrive in the United States from these regions, healthcare providers should be aware of parasitic infections, especially in immigrants from endemic regions. It is also important to consider cost as generic Albendazole can cost $200-300 per course. Alternative regimens with Pyrantel Pamoate can be considered if cost is prohibitive for adequate treatment.



Disclosures:


David Restrepo, MD¹, Neil Khoury, MD², Jevin Yabut, DO¹, Courtenay Ryan-Fisher, MBBCh³, Robert Blitzer, MD⁴. P0570 - Trichuris Trichiura Infection Detected During Screening Colonoscopy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.