Journal List > Korean J Gastroenterol > v.69(4) > 1007637

Kim, Seo, and Moon: Trichuris trichiura Infection in North Korean Defector Resulted in Chronic Abdominal Pain and Growth Retardation


Trichuris trichiura infection is a common helminth infection, which is transmitted via soil, with worldwide distribution, especially in rural areas of developing countries. Occasionally, sporadic cases occur in non-endemic, developed areas due to the widespread of immigration. We experienced a case of Trichuris dysentery syndrome in a young North Korean defector, who had been suffering from chronic abdominal pain for 10 years. He is relatively short and thin compared with his older brother. Unexpectedly, the diagnosis, made by a colonoscopy, revealed numerous, small, white, and gently moving worms at the cecum and ascending colon. After 3 days of albendazole (400 mg once daily) administration, clinical symptoms subsided dramatically. On the follow-up colonoscopy, which was performed two months after the completion of his treatment, complete eradication was identified. Soil-transmitted hel-minths, including Trichuris trichiura, are disappearing becoming less prevalent in South Korea as a result of both national driving force and environmental improvement. However, these diseases should be considered when we meet foreign patients from developing countries, like North Korea, presenting chronic abdominal pain. Moreover, proper treatment of North Korean defectors and performing cohort studies of them would help to prepare for the possible unification era in the field of gastroenterology.


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Fig. 1.
Initial colonoscopy finding. Numerous, small, white, and gently moving worms attached to the cecal and ascending colonic mucosa were noted.
Fig. 2.
(A) Section shows intestine and many eggs in the uterus of the adult female worm of Trichuris trichiura (H&E, ×200). (B) Trichuris trichiura eggs are barrel-shaped and measure 50 to 54 microns by 22 to 23 microns. The egg has a thick shell with brownish tinge and bipolar prominences (H&E, ×400).
Fig. 3.
Follow-up colonoscopy. No parasitic infection signs were found.
Table 1.
Currently Published Case Reports of Trichuris Dysentery Syndrome
Case Age/ sex Chief complaint Duration of symptoms Hemoglobin Eosinophils Short statue Wasted Pallor Colonoscopic finding Treatment
Diniz-Santos et al.11 (2006) 8/M Bloody diarrhea 3 months 7.4 g/dL 1.15 × 109/L Yes Yes Yes Massive population of T. trichiura Albendazole (400 mg/d for 5 days)
Krishnamurthy et al.12 (2009) 6/F Loose stools with blood, mucus 2 years 3.5 g/dL 50% Yes Yes Yes Whipworms (T. trichiura) 1st: albendazole (400 mg/d single)
                    2nd: mebendazole (100 mg bid for 3 days)
Azira and Zeehaida13 (2012) 4/F Loose bloody stools with fever 2 years 6.8 g/dL 4.5% Yes Yes Yes Numerous T. trichiura adult worms 1st: albendazole (400 mg/d for 3 days)
                    2nd: albendazole (400 mg/d for 3 days)
Zanwar et al.14 (2016) 7/F Loose bloody stools with mucus 2 months 3.8 g/dL 10% Yes Yes Yes Numerous small, white, mobile worms Albendazole (400 mg/d for 3 days) s

M, male; F, female; T. trichiura, Trichuris trichiura.

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