A woman from Vietnam complained of chronic diarrhea: A case report and literature review

Trichuris trichiura is a common parasite in subtropical and tropical regions. The prevalence is approximately 23.1% based on an epidemiology study conducted in Vietnam during 1990 to 2001. It is transmitted by oral‐fecal route and the common symptoms include diarrhea, abdominal pain, bloody stool and weight loss. Antihelminth agents like albendazole and mebendazole are the first‐line treatments, and the outcome is good. A 48‐year‐old female immigrant from Vietnam was referred from local clinic to our hospital for colonoscopy due to persistent diarrhea accompanied by abdominal cramping for 3 months. The frequency of diarrhea was four times per day. The characteristic of stool was pasty, and then became watery. Only lower abdominal tenderness was noticed by physical examination. Serology and stool investigations were negative. Colonoscopy was performed due to refractory symptoms and one whitish worm with whip‐like appearance in the cecum. Trichuris trichiura infection was diagnosed by microscopic morphology. Then, the patient was treated with mebendazole and her symptoms improved. The gold standard for diagnosis is stool microscopic examination, including ova, whipworm, or both. However, it is hard to find eggs in the stool samples from those patients who only have mild infections. Colonoscopy is a helpful tool to uncover the whipworm with negative stool examination and make the diagnosis of trichuriasis.