Pathophysiology

Trichuris, as with Ascaris lumbricoides, is spread via fecal-oral transmission. Eggs are
deposited in soil through human feces. After 10-14 days in soil, eggs become infective. In
contrast to other parasites, such as A lumbricoides, no tissue migratory phase occurs with
Trichuris organisms, confining infection to the GI tract. 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. During this
time, there may be no shedding of eggs and only limited evidence of infection in stool
samples. Worms may live from 1-5 years, and adult female worms lay eggs for up to 5 years,
shedding up to 20,000 eggs per day.
See the image below.

This is an illustration of the life cycle of Trichuris trichiura, the causal agent of trichuriasis.
Image courtesy of Centers for Disease Control and Prevention, Alexander J. da Silva, PhD,
and Melanie Moser.
Immunologically, cytokines such as interleukin 25 (IL-25) mediate type 2 immunity and are
required for the regulation of inflammation in the gastrointestinal tract.
Recent linkage analyses of a genome-wide scan revealed that 2 quantitative trait loci on
chromosomes 9 and 18 may be responsible for the susceptibility to infection with T trichiura
in some genetically predisposed individuals.[2]