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The pinworm, Enterobius vermicularis, is the most common intestinal parasite in the primary care setting, regardless of race, socioeconomic or cultural circumstances. This article discusses symptoms, diagnosis, and treatment.
Two Enterobius vermicularis organisms invading a macerated embryo 2 cm in length were found in the tissue from an endometrial curettage performed for missed abortion in a pregnant woman. Ova from the helminths were recovered from the vagina and endometrium of the patient. This most unusual case provides further evidence for the invading capacity of E vermicularis.
From 1971 through 1980, four Papanicolaou smears containing pinworm (Enterobius vermicularis) eggs were found among approximately 220,000 routine smears examined at the University of Texas Medical Branch at Galveston. The highest number of ova counted on one slide was 420. Typical light microscopic features of the eggs included elongated oval shapes with flattening of the ventral sides and double-contoured shells folded at one end. The background in three smears showed massive acute inflammation. A scanning electron microscope study of one case revealed that the ova had a relatively smooth surface with an invaginated area at one end.
The presence of the eggs of Enterobius vermicularis in cytologic gynecological smears is described, as well as the granules of pollens whose presence in cytologic smears is of no significance from the clinical standpoint but they may become a diagnostic problem, because by their size and appearance they may at first sight misleadingly be considered as the eggs of a parasite.
By means of the method of determining the isoelectric point, the same conditions of absorption and stain intensity as in Dientamoeba cultivation forms were determined in cells found in Enterobius vermicularis eggs of Dientamoeba fragilis carried. By that way, identity of both stages, as well as function of pinworms as Dientamoeba fragilis vectors were confirmed.
A case of recurrent perianal abscess caused by Enterobius vermicularis infestation of the anal canal and glands in an 11-year-old boy is reported.
A case of a submucosal foreign body granuloma caused by Enterobius vermicularis in the wall of the anal canal of a 29-year-old man is reported.
Specific aetiological factors are responsible for a significant proportion of cases of perianal sepsis in children. A rarely implicated pathogen is Enterobius vermicularis, an obligate parasite with a ubiquitous presence in children. The authors describe two unequivocal instances of threadworm involvement in perianal sepsis, suggesting a pathophysiological basis.
A case of Enterobius (Oxyuris) vermicularis granulomatous disease of the pelvic peritoneum causing pelvic adhesions and infertility is presented and discussed. Since parasitic diseases are common in the developing countries, the infertility team has to bear in mind that a parasitic disease might be the main cause of infertility.
The literature reports 12 cases of enterobiasis presenting as perianal abscess or granuloma. We describe an additional case of a perianal granuloma containing Enterobius vermicularis eggs in a 5-year-old boy. We suggest routine parasite screening for all children presenting with this condition.
A rare case of epididymitis caused by Enterobius vermicularis, a pinworm, is reported. A 52-year-old man underwent resection of the right epididymis and histological examination confirmed the diagnosis of pinworm infection by discovering parts of the body of the oxyurid in various sections.
Studies of patterns of reinfection with four species of intestinal nematodes (Ascaris, hookworm, Trichuris and Enterobius) in 174 individual patients following chemotherapeutic treatment revealed statistical evidence for predisposition to heavy or light infection (relative to the average level in the overall population). Analyses of associations between the abundances of the four species of nematodes within a combined sample of 525 worm burdens showed significant correlations between 5 out of the 6 possible pair-wise comparisons between species. The relevance of these results to the design of control programmes based on chemotherapeutic application is discussed.
BACKGROUND: The relationship between allergy and parasites has been controversial, especially in non-tropical countries. Enterobius vermicularis (human pinworm) is the most prevalent intestinal parasite in industrialized countries. OBJECTIVE: To examine the association between pinworm infestation and allergy in primary school children. METHOD: Peri-anal tape test for pinworm is routinely performed in Taipei primary schools. We collected data from school records and questionnaires distributed to all children in four primary schools grades 1 through 6 (n = 3107). RESULTS: The prevalence of physician-diagnosed asthma (9.3% vs. 14.1%, P = 0.007) and allergic rhinitis (27.4% vs. 38.3%, P = 0.001) was lower in pinworm-positive compared to uninfested children. Pinworm was not correlated with atopic dermatitis or parent allergy. With logistic regression controlling for sex, parent allergy and lower respiratory infection, current asthma (OR = 0.25, 95% CI 0.10-0.63) and rhinitis (OR = 0.61, 95% CI 0.45-0.84) were negatively associated with pinworm. Among children in grades 3-6 who had no asthma or rhinitis before age 7, those with early infestation (pinworm diagnosis at or before grade 1) had a lower risk of having diagnosis of rhinitis during school years, compared to the uninfected group (5.4% vs. 12.3%, P = 0.03; adjusted OR = 0.47, 95% CI 0.21-1.02). CONCLUSIONS: We identified a negative association between pinworm infestation and allergic airway diseases, which could in part be attributed to protective effect of pinworm infestation on development of allergic symptoms. Other mechanisms of association could not be ruled out.
Intestinal infection due to the pinworm Enterobius vermicularis is the most prevalent helminthiasis in Europe and North America. Humans are the only known reservoir and young children are most often affected. The disease is highly contagious and is transmitted via the faecal-oral route. Insufficient hand hygiene, contaminated bed linens and clothes may play a role in transmission. Clinical symptoms often encompass severe nocturnal anal pruritus, when female worms deposit an abundance of eggs in the perianal region. The infection is diagnosed by applying an adhesive tape on the perianal region, followed by microscopic examination. Serious complications, such as extraintestinal infections, occur only rarely. Infections of the female genital tract and the peritoneum are described in the literature, also in pregnant women. We describe a case of a pregnant patient in the 33 (rd) week of gestation with intense anal pruritus in whom an enteral pinworm infection was diagnosed. The patient was successfully treated with mebendazole, an anthelminthic agent. Analysis of the data currently available for the administration of mebendazole during pregnancy did not show an elevated rate of congenital anomalies. However, further studies still have to be performed.
Inflammatory pelvic disease secondary to infection with Enterobius vermicularis is rare in that pinworms are usually asymptomatic inhabitants of the terminal small bowel and cecum. When these parasites do cause symptoms, however, there is a spectrum of gastrointestinal and genitourinary complaints. A case is presented of a woman with bilateral abdominal pain that was found to be due to a combination of parasitic and bacterial (Bacteroides fragilis) infection. The parasitic fallopian tube infection may have predisposed the fallopian tubes to a microbial tuboovarian abscess.
As surgeons gain more experience with laparoscopy in children, it is becoming apparent that one of the best applications of the technique is for appendicitis. The advantages of laparoscopic appendectomy include a better cosmetic result, particularly in young female patients, a shorter recovery time, and an early return to normal activities. In the differential diagnosis of appendicitis, the association of Enterobius vermicularis (pinworms) inflammation in the pediatric age group is not uncommon. The endo-loop technique for laparoscopic appendectomy is the standard technique used in our department. In three patients with E. vermicularis undergoing appendix removal using this technique, pinworms were found to be set free into the abdomen after dividing the appendix between the loop ligatures. Bipolar coagulating forceps were used carefully to thermally desiccate the worms, which were then removed using a blunt grasper. E. vermicularis being released into the abdomen in children undergoing laparoscopic appendectomy using the endo-loop technique has not been reported. Careful evaluation of the appendix stump and simple but careful thermal desiccation and removal of pinworms, if present, must be considered when using the endo-loop technique.
OBJECTIVES: We observed a cohort of children presenting with rectal bleeding that were identified as having Enterobius vermicularis at colonoscopy and questioned the reliability of conventional diagnostic methods of identifying E. vermicularis. PATIENTS AND METHODS: The study was retrospective in nature and subjects were investigated by colonoscopy between May 1997 and December 1999. Patients were identified as having E. vermicularis infestation by direct visualisation of the adult worms at colonoscopy. Patients were treated with mebendazole and a record of their clinical response documented. RESULTS: A total of 180 colonoscopic examinations were performed during the study period. E. vermicularis was identified macroscopically in 31 cases (17.2%). The symptom profile of patients with E. vermicularis were abdominal pain, 19 of 26 (73%); rectal bleeding, 16 of 26 (62%); chronic diarrhoea, 13 of 26 (50%) and weight loss, 11 of 26 (42%). Ova cysts and parasites were identified in none of the saline swabs analysed in 20 patients. Sellotape testing was performed in only 4 patients and was negative in all. Of the 26 children, 21 (81%) demonstrated histopathological features of nonspecific colitis. There was clinical resolution of symptoms in 19 of 23 patients. CONCLUSIONS: We suggest that in patients with symptoms suggestive of inflammatory bowel disease, E. vermicularis infestation must be excluded as a common cause of nonspecific colitis. We also suggest that diagnostic tests such as saline swabs and Sellotape testing may be lacking in sensitivity.
The occurrence of the enteroparasites was verified in 279 children (0 to 6 years) of four municipal day cares of Botucatu/SP. Three samples of each child's feces were collected and processed by the methods of Hoffman-Pons-Janner, Faust and Ritchie and subsequent coloration of the fecal smear by the methods of Auramina-O and Ziehl-Neelsen modified for diagnosis of Cryptosporidium sp. and Graham method for diagnosis of Enterobius vermicularis. Of the analyzed children we verified a prevalence of intestinal parasitism in 53.40%, and the most frequent parasite was Giardia duodenalis (26.88%). Significant association was verified among enteroparasitosis, family income, maternal education and age; the lowest enteroparasite frequency occurred in children of families with larger income and higher education. It was observed that G. duodenalis is more prevalent in children from 0 to 4 years and E. vermicularis is more frequent in children between three and four years old. The high enteroparasite prevalence in day cares suggests complex structure in its epidemiology, where factors beyond sanitation should be considered.