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We recently saw 5 young girls with the sudden onset of frequency and enuresis secondary to enterobius vermicularis. All children had sterile urine and 4 had been unjustly considered neurotic. Anthelmintic therapy resulted in an immediate cure in all 5 cases. More frequent diagnosis and treatment of this common ailment would do a great service to affected girls and their families.
Various helmintic parasites, most of which are uncommon in economically developed countries, can cause abdominal pain and eosinophilic inflammation of the bowel. A homosexual man presented with severe abdominal pain and haemorrhagic colitis, eosinophilic inflammation of the ileum and colon, and numerous unidentifiable larval nematodes in diarrhoeal stool. His symptoms resolved with anthelmintic treatment alone. Using comparative morphology and molecular cloning of nematode ribosomal RNA genes, we identified the parasites as larvae of the pinworm Enterobius vermicularis, which are rarely observed or associated with disease. Occult enterobiasis is widely prevalent and may be a cause of unexplained eosinophilic enterocolitis.
Infections by the nematodes Enterobius, Trichuris, Capillaria, and hookworm are some of the most widespread gastrointestinal infections worldwide. This article is designed not only to provide an overview of the different parasites in terms of epidemiology, clinical manifestation, and disease but also to highlight particular areas of intensive research activity that are providing new insights into both the biology of the host-parasite relationship and possible new approaches to infection management for the future.
A fatal infection with human pinworms, Enterobius vermicularis, was found in a 26-year-old chimpanzee kept in a zoo. Grossly, the animal was highly emaciated, and had severe enteritis with cecal multifocal nodules and severe cholelithiasis. Histopathologically, a large number of human pinworms were observed in the nodular lesions in the cecum and intestinal wall. These migrating worms were surrounded by an inflammatory cell infiltration which lacked eosinophils. There were areas of multifocal hyperemia and/or hemorrhages in various organs including the entire gastrointestinal tract. Pinworms were also observed in the portal venule and parenchyma of the liver. A light infection with Strongyloides cf. stercoralis was also observed.
The two pinworms parasitic in Man are studied and compared. Enterobius vermicularis (L., 1758) has the larger spicule (100 to 140 micron). E. gregorii Hugot, 1983 has the shorter spicule (70 to 80 micron). The two species can also be differentiated by the cuticular ornamentation associated to the cloacal opening in the males.
A nodule of the liver was incidentally noted during left colectomy for a large villous adenoma in a 74-year-old man. Microscopic examination disclosed a granuloma of the liver containing numerous Enterobius vermicularis ova and a cross-section of the nematode. This is the fourth reported case of hepatic oxyuriasis and the second case reported in North America.
A case of unilateral salpingitis caused by Enterobius vermicularis presenting as a painful adnexal mass in a 28-year-old woman is reported.
Enterobius vermicularis has the broadest geographic range of any helminth and is the most common intestinal parasite seen in the primary care setting. Underappreciated is the fact that it is not always a benign disorder and could even cause life-threatening medical problems. Visualization of the actual worms during endoscopy is probably underappreciated in part because endoscopists have never actually seen the worm and/or are not actively looking for, or anticipating, worms. This report describes a case of worm infection as documented during colonoscopy and confirmed by microscopy. The gross and microscopic appearance of the worm is described. Literature regarding the wide range of gastrointestinal and nongastrointestinal manifestations, including potentially life-threatening illnesses, as well as treatment options, are also reviewed.
Eggs of Enterobius vermicularis (human pinworm) were found in hum coprolites from Hopug and Danger Caves, western Utah. The Caves were inhabitated by man from 10,000 B.C. to A.D. 1400. The oldest coprolite containing dated at 7837 B.C. This represents the earliest known association between man abd this exclusively human parasite.
BACKGROUND: Enterobius vermicularis is known to produce perianal and ischioanal abscesses and invade the peritoneal cavity via the female reproductive system, causing pelvic peritonitis. However, there are only rare case reports on the cytodiagnosis of these parasitic lesions. CASE: A 28-year-old woman was admitted with a tender left iliac fossa mass and greenish vaginal discharge. Ultrasonogram and computed tomography scan confirmed the presence of a mass lesion suggestive of a tuboovarian abscess. Cytologic examination of the pus obtained during left salpingo-oophorectomy revealed the presence of ova of E vermicularis and fragments of the adult worm in an inflammatory exudate consisting predominantly of neutrophils, eosinophils and occasional epithelioid cell granulomas. Paraffin sections of the tuboovarian mass showed necrotizing epithelioid cell granulomas, but neither ova nor any worm section was identified. Although the possibility of tuberculosis was considered histologically, Ziehl-Neelsen (Z-N) stain for acid-fast bacilli was negative. Z-N staining of the smear and mycobacterial culture of the pus also did not yield positive results. CONCLUSION: E vermicularis may cause tuboovarian abscess with necrotizing epithelioid granulomas mimicking tuberculosis. Cytologic examination of the pus is helpful in the diagnosis.
BACKGROUND: Extraintestinal infestation by Enterobius vermicularis is uncommon. It has been reported to occur in the peritoneal cavity, ovary, fallopian tube, endometrium, lung, liver and urinary tract. CASE REPORT: Fine needle aspiration diagnosis was made in a case of enterobiasis presenting with a subcutaneous abscess in the natal cleft. Eggs, as well as fragments of cuticle of the adult worm, were found; the morphology of both was best visualized in Papanicolaou-stained smears. Polarizing microscopy highlighted the equally spaced parallel grooves of the cuticle. CONCLUSION: Fine needle aspiration cytology of subcutaneous abscesses due to enterobiasis can be diagnostic when eggs, or eggs with cuticle, are identified in a suppurative or granulomatous inflammation.
A lacto-phenol cotton blue (LPCB) stain for detecting eggs of Enterobius vermicularis in perianal surface samples was evaluated prospectively. Two hundred children treated in the paediatrics ward and outpatients department of Jipmer Hospital in Pondicherry were studied. From each child two anal surface samples were collected by Scotch cellophane tape method. One cellophane tape containing anal surface samples was pressed against surface of the glass slide containing a drop of LPCB while another cellophane tape was placed on a clean glass slide without adding any LPCB. Both the specimens from each child were examined by microscopy for presence of the eggs of the parasite. The anal samples collected from 50 children were positive for the eggs of E. vermicularis--48 were detected by cellophane tape using LPCB and 36 by cellophane tape method without using any LPCB. Using LPCB stain, naturally transparent and colourless eggs of the parasites were stained deep blue which facilitated their easy detection and accurate identification in routine microscopy. We therefore recommend Scotch cellophane tape using LPCB as a simple, rapid, inexpensive and overall more sensitive method for detecting E. vermicularis eggs in anal surface samples for diagnosis of enterobiasis in children.
This study set out to determine the prevalence of Enterobius vermicularis in surgically removed appendices and to assess the possible relation of the parasite to acute appendicitis. All 624 surgically removed appendices received in the Department of Pathology, BPKIHS, Dharan, Nepal during 2(1/2) years (August 1999-January 2002) were examined. E. vermicularis was identified in nine (1.62%) appendices from the patients with a clinical diagnosis of appendicitis. The parasite was most frequently seen in histologically normal appendices (6/71) and was rarely associated with histological change of acute appendicitis (3/539). No cases of E. vermicularis infestation occurred in appendices showing chronic inflammation or removed during the course of other surgical procedures. E. vermicularis was found more frequently in uninflamed and histologically normal appendices (8.45%) than those which were inflamed with histopathologic changes of acute appendicitis (0.56%). It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.
Enterobius vermicularis eggs were found in human coprolites collected in the archaeological site of Caserones, Tarapaca Valley, Chile, dating from 400 BC to 800 AD. The human pinworm had already been found in other pre-historic archaeological sites in America, and its introduction in this continent is discussed.
A molecular paleoparasitological diagnostic approach was developed for Enterobius vermicularis. Ancient DNA was extracted from 27 coprolites from archaeological sites in Chile and USA. Enzymatic amplification of human mtDNA sequences confirmed the human origin. We designed primers specific to the E. vermicularis 5S ribosomal RNA spacer region and they allowed reproducible polymerase chain reaction identification of ancient material. We suggested that the paleoparasitological microscopic identification could accompany molecular diagnosis, which also opens the possibility of sequence analysis to understand parasite-host evolution.
Effects of repeated treatment with pyrantel pamoate on Enterobius vermicularis infection in chimpanzees were assessed by observing worms discharged in the feces after administration of anthelmintic treatment. Three of 9 chimpanzees reared in a zoological garden in Japan were subjected to fecal worm count and morphometric observation, and all were given oral pyrantel pamoate 6 times at 10-day intervals simultaneously. Following the first and second treatments, more than 30,000 pinworms were discharged from 1 chimpanzee. The number of discharged worms abruptly decreased after the third treatment, and only a few worms were recovered after the fifth treatment, indicating that repeated treatment at short intervals was very effective. Complete eradication was not achieved, however, presumably because of reinfection. The female proportion among discharged worms tended to increase as the treatment was repeated.
A histologic examination was made of all appendices delivered to the Dept. of Pathology, Sundby Hospital, Copenhagen, in 1980-87, to ascertain the incidence of Enterobius vermicularis (pinworm) and the possible relation to acute appendicitis. Altogether 2267 appendices were examined, and E. vermicularis was identified in 4.1%. The highest incidence occurred in the 6- to 15-year age group. Infestation was more frequent in female than in male appendices, with the ratio of 1 male to 1.8 females, except in the 11- to 15-year age group, in which the ratio was 1. There was a highly significant difference in the incidence of E. vermicularis in normal appendices and in inflamed appendices, which may indicate that 1) the presence of E. vermicularis in the appendix can give the symptoms of acute appendicitis, or 2) E. vermicularis leaves or does not enter an inflamed appendix.
A 33-year-old Korean woman, para 2. visited an obstetrics and gynecology clinic, Kumi-shi, Kyongsangbuk-do, due to postcoital spotting and flank pain. She had a tubal ligation 7 years before and demonstrated back pain during menstruation. She revealed a foul smelling discharge without complaint of itching. Enterobius vermicularis eggs were demonstrated during microscopic examination of a smear taken from the posterior fornix of the vagina. On endoscopic examination of her vagina, a live worm was found in the posterior fornix. The worm was removed and identified as a female E. vermicularis based on morphology. This is the first case report of vaginal enterobiasis in Korea.