Whipworm infection resulting in eosinophilic colitis with occult intestinal bleeding - 22/08/11
Doi : 10.1016/j.gie.2006.07.005
| Commentary Whipworm infection is estimated to infect 800 million people worldwide, but this brings to mind 3 bits of good news: (1) it is not contagious, because the egg is not infective until it is fully embryonated; (2) most individuals with whipworm infection are colonized by a small number of worms and have no symptoms; and (3) the prevalence of immune disorders, eg, irritable bowel disease, is low in regions of the world where infection with nematodes is common. Symptoms of high worm burdens include rectal prolapse; colon obstruction; and mucoid diarrhea, with occasional bleeding; a symptom complex called “trichuris dysentery.” Diagnosis is usually by finding eggs in the stool, and rarely is colonoscopy needed. Colonoscopic and histopathologic findings usually are only minimal, even with heavy worm burdens. What is most exciting to me, however, is the interaction between this nematode and the immune system: whipworms induce Th2 cytokine release and downregulate Th1 responsiveness, thereby dampening the inflammatory response and explaining the benefit seen when patients with ulcerative and Crohn’s colitis are given a diet supplemented by porcine whipworm (Trichuris suis) eggs. The satirist Ambrose Bierse commented “good to eat, and wholesome to digest, as a worm to a toad, a toad to a snake, a snake to a pig, a pig to a man, and a man to a worm.” I do not think he saw the close interplay of worms, pigs, and men in any but a classic evolutionary role. Despite what you may read, the worm inside a bottle of mescal (not tequila) is a marketing ploy with no therapeutic benefit. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2007
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 65 - N° 4
P. 709-710 - avril 2007 Retour au numéro
Article précédent
- Diffuse luminal ulceration resulting from duodenal plasmacytoma
- Andrew J. Fowell, David N. Poller, Richard D. Ellis
- Pneumatosis coli due to pharmacological constipation
- Cesar Prieto, Ignacio Fernandez-Urien, Bruno Sangro, Jose Carlos Subtil, Miguel Angel Idoate, David Cano, Miguel Muñoz-Navas
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?