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Enterobiasis

Enterobiases

Enterobiasis, also known as oxyuriasis or pinworm infection, is a common, contagious helminthic infestation caused by the nematode Enterobius vermicularis that mainly affects children and institutionalized persons. The disease is spread by fecal-oral and air-borne route while reinfection is common. Family members of the affected individuals often become infected, as well.


Presentation

Enterobiasis may be asymptomatic and diagnosed incidentally, with worms being observed in the perineal area. If any, symptoms consist of anal and/or vulvar pruritus, that may be very intense and constitute the main complaint. Scratching may lead to the appearance of excoriations, that sometimes become infected by bacteria. The perineum, anus or genitals may be erythematous or, in more severe cases, eczematous dermatitis may be diagnosed [1]. Furthermore, patients may have severe abdominal pain similar to that found in acute appendicitis [2], may be irritable and have nocturnal enuresis. Sleep is disturbed in this disease primarily because of the pruritus. Girls may present with vaginitis. Children may also develop teeth grinding, with subsequent dental consequences. Other possible symptoms and signs include inappetence, nausea, and vomiting.

If Enterobius vermicularis migrates into the female genital tract, it may cause uterus, ovary, fallopian tubes, or peritoneum granulomas [3]. Dissemination of the disease has also been described in the prostate, perianal tissue [4], epididymis [5], lungs [6], urinary bladder, spleen, liver, and conjunctival sac.

Camping
  • This infection is the first documented case of enterobiasis in the settings of a refugee camp and can highlight the unsanitary living conditions that refugees have to endure in those camps.[ncbi.nlm.nih.gov]
  • Oxyuriasis. ( 29807567 ) Eder TIB...Lipek T 2018 3 A case of enterobiasis presenting as post-traumatic-stress-disorder (PTSD): a curious case of the infection with predominant mental health symptoms, presenting for the first time in the settings of a refugee camp[malacards.org]
Falling
  • Worms can sometimes be seen on the skin near the anus or on underclothing, pajamas, or sheets about 2 to 3 hours after falling asleep. Pinworm eggs can be collected and examined using the “tape test” as soon as the person wakes up.[web.archive.org]
Nightmare
  • Oxyuriasis's symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis.[ncbi.nlm.nih.gov]
Inguinal Hernia
  • We describe a case of extra-intestinal pinworm abscess associated with an inguinal hernia in an adult. A brief review of the literature is given and possible mechanisms of tissue invasion are discussed.[ncbi.nlm.nih.gov]
Hunting
  • This mode of transfer could have been favoured during the time when humans changed their behaviour from a hunting-gathering to a more sedentary existence, initially associated with cave habitats.[ncbi.nlm.nih.gov]
Aspiration
  • A nodule that does not need to be excised can be punctured by fine needle aspiration. In endemic areas, appendices excised for various reasons should also be analyzed.[symptoma.com]
  • ( 15333976 ) Fernandez-Flores A....Dajil S. 2004 34 Very high prevalence of enterobiasis among the hilltribal children in rural district "Mae Suk," Thailand. ( 15266232 ) Chaisalee T....Suwansaksri J. 2004 35 Perineal nodule due to enterobiasis: an aspiration[malacards.org]
Rhinitis
  • The prevalence of past episodes of wheezing, current wheezing, asthma, and rhinitis was 31, 14.6, 10.7, and 26.2%, respectively. Parasitosis was present in 49.1%, Enterobius vermicularis (23.3%), being the most common.[ncbi.nlm.nih.gov]
Abdominal Pain
  • In most cases the infection is asymptomatic, but there are also cases described in which peritoneal enterobiasis can cause abdominal pain. A case report and review of the pertinent literature.[ncbi.nlm.nih.gov]
  • In a female patient: the pain is not associated with menstruation, can complain of right-sided pain with intercourse.[2] This is due to infestation of the appendix with Enterobius vermicularis. [2] Intestinal complications: acute abdominal pain in the[explainmedicine.com]
  • Furthermore, patients may have severe abdominal pain similar to that found in acute appendicitis, may be irritable and have nocturnal enuresis. Sleep is disturbed in this disease primarily because of the pruritus. Girls may present with vaginitis.[symptoma.com]
  • Your child has severe abdominal pain. When should I contact my child's healthcare provider? Your child has a decreased appetite. Your child has a fever. Your child has diarrhea. Your child has trouble sleeping.[drugs.com]
Diarrhea
  • Oxyuriasis's symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis.[ncbi.nlm.nih.gov]
  • Thailand 10160 Bentham Science Publishers Bovornkitti caused Chulalongkorn University Citation Index conjunctivitis outbreak contamination in hot cryptosporidiosis Cryptosporidium cysticercosis days rhinocerebral dengue infection detected diagnosis diarrhea[books.google.com]
  • There is no relationship between detection of enterobiasis and CD4 status [ 4 ] or presentation of diarrhea [ 4, 10 ].[hiv.imedpub.com]
  • Your child has diarrhea. Your child has trouble sleeping. Your child's anus becomes red and painful. You have questions or concerns about your child's condition or care. Care Agreement You have the right to help plan your child's care.[drugs.com]
  • There are no constitutional symptoms, diarrhea, bloody stools, nor eosinophilia.[pedclerk.bsd.uchicago.edu]
Worms in Stool
  • The most common signs and symptoms of Enterobiasis include the following: Severe itching and red rashes around the rectum Evidence of blood or worms in stool Lower abdominal pain, in rare cases It is important to note that the presence of a sign or symptom[dovemed.com]
Pelvic Mass
  • She was referred to the Asan Medical Center, Seoul where transvaginal ultrasonography confirmed a pelvic mass exceeding 10 cm in diameter.[ncbi.nlm.nih.gov]
Eczema
  • Perianal itch, however, may be a consequence of hemorrhoids, persistent constipation, proctitis and sincerita, contact dermatitis, psoriasis, neurodermite and eczema perianal area, colon cancer, Trichomonas vaginitis, menopause, candidiasis, diabetes[medicalency.com]
  • Complications Some case reports have suggested that severe pinworm infection may be associated with an increased risk of appendicitis. [1] Scratching the itchy area may cause eczema or a bacterial infection around the rectum.[emedicine.medscape.com]
  • Differential diagnosis Perianal itching may be due to irritation by deodorants, tight nylon underclothes, haemorrhoids, or perianal eczema. Deodorants and haemorrhoids are rather more a problem of adults than of children.[patient.info]
Excoriation
  • Scratching may lead to the appearance of excoriations, that sometimes become infected by bacteria. The perineum, anus or genitals may be erythematous or, in more severe cases, eczematous dermatitis may be diagnosed.[symptoma.com]
  • Neurotic excoriation. In some cases the possibility of sexual abuse must be considered but if this possibility is seriously entertained, the doctor's skills are greatly taxed.[patient.info]
Insomnia
  • The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability.[ncbi.nlm.nih.gov]
  • Other symptoms include weight loss, loss of appetite, insomnia and restlessness. Enterobiasis is one of the most common worm infestations in humans.[biology-online.org]
Pruritus Vulvae
  • This causes vaginal discharge and pruritus vulvae, i.e., itchiness of the vulva. The pinworms can also enter the urethra, and presumably, they carry intestinal bacteria with them.[monsterologist.blogspot.com]
  • Presentation The presenting feature is often pruritus ani or pruritus vulvae, especially at night. Loss of sleep can cause behavioural problems.[patient.info]
Scrotal Pain
  • J‐J Sinikumpu and W Serlo, Persistent scrotal pain and suspected orchido‐epididymitis of a young boy during pinworm (Enterobius vermicularis) infection in the bowel, Acta Paediatrica, 100, 8, (e89-e90), (2011).[doi.org]

Workup

Parents may report seeing parasites on the child's perineum or on the surface of the feces. Female parasites are thin, white, about 10 mm long, while male parasites are half that size. Eggs can be found on the patient's perineum in the morning and can be captured if the transparent tape is placed on the area before the child bathes [7]. The next step is to observe them under a microscope. Eggs are described as ovoid and flat on one side. Samples should be obtained on three to five consecutive mornings [8]. Less reliable diagnostic methods are analyzing samples obtained from under the child's fingernails or asking the parent to inspect the perineal area of the child a few hours after he or she has fallen asleep, in order to observe live parasites. Stool samples are not routinely examined because eggs and adult parasites are seldom observed by this method.

In complicated cases, when granulomas are formed and need to be excised, they also can be studied. A histological analysis reveals inflammatory infiltrates, giant cells, lymphocytes, and numerous eosinophils. All these elements, in addition to fibrous tissue and necrotic material, are present around calcified parasite eggs [9]. A nodule that does not need to be excised can be punctured by fine needle aspiration [10]. In endemic areas, appendices excised for various reasons should also be analyzed [11]. Blood workup is usually noncontributory in uncomplicated cases, as eosinophilia is absent.

Enterobiasis is thought to be underreported, therefore its morbidity is difficult to be established [12].

Pyuria
  • There was no significant difference among patients with monosymptomatic bacteriuria and pyuria either. Enterobiasis thus seems to play no pathogenic role in urinary tract infections of girls.[ncbi.nlm.nih.gov]

Treatment

  • During this treatment time and two weeks after final treatment, it is a good idea to avoid co-bathing and the reuse or sharing of washcloths. Showering may be preferred to avoid possible contamination of bath water.[web.archive.org]
  • The treated subjects were re-assessed post-treatment to ascertain whether they were cured and also to determine their enuretic status (for the enuretics).[ncbi.nlm.nih.gov]

Prognosis

  • (Outcomes/Resolutions) The prognosis of Enterobiasis is typically good, since the infection is asymptomatic in most cases.[dovemed.com]
  • Prognosis Pinworms cause little damage and can be easily eradicated with proper treatment. Full recovery is expected. KEY TERMS Anus — The opening through which feces are eliminated.[encyclopedia.com]
  • Prognosis Pinworm infection does not cause severe morbidity unless ectopic infection occurs. This rare complication occurs in individuals with conditions that compromise the integrity of the bowel wall (eg, inflammatory bowel disease).[emedicine.medscape.com]

Etiology

  • Reports indicate that the parasitic infection constitutes a percentage of the etiologies in appendicitis and fecalitos are the most common trigger, some parasites (Enterobius vermicularis) may be involved in its formation, although this percentage is[ncbi.nlm.nih.gov]
  • Treatment should be directed at the underlying etiology. Once these have been excluded, both general and specific measures must be initiated.[doi.org]
  • Pathophysiology and Etiology The primary symptoms of pinworm infection include pruritus or a prickling sensation in the perianal area, which is produced when a gravid female pinworm migrates to the anal area and inserts her tail pin into the mucosa for[emedicine.medscape.com]

Epidemiology

  • Our results add further knowledge to the epidemiology of intestinal parasites in day care centers.[ncbi.nlm.nih.gov]
  • Epidemiology Pinworm infections are more common within families with school-aged children, in primary caregivers of infected children, and in institutionalized children.[cdc.gov]
  • RØNNINGEN, Enterobius vermicularis and allergic conditions in Norwegian children, Epidemiology and Infection, 10.1017/S0950268813003154, 142, 10, (2114-2120), (2013).[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology and Etiology The primary symptoms of pinworm infection include pruritus or a prickling sensation in the perianal area, which is produced when a gravid female pinworm migrates to the anal area and inserts her tail pin into the mucosa for[emedicine.medscape.com]
  • Pathophysiology: Usually, no symptoms occur when pinworms inhabit the caecum and adjacent areas. Diarrhea can occur during acute infection because of inflammation of the bowel wall.[lecturesofmedicine.blogspot.com]

Prevention

  • How can pinworm infection and reinfection be prevented? Strict observance of good hand hygiene is the most effective means of preventing pinworm infection.[web.archive.org]
  • The study therefore showed that educating high risk individuals played a key role in the prevention of enterobiasis.[ncbi.nlm.nih.gov]
  • Teach children the importance of washing hands to prevent infection.[barnstablecountyhealth.org]

References

Article

  1. St Georgiev V. Chemotherapy of enterobiasis (oxyuriasis). Expert Opin Pharmacother.2001;2:267-275.
  2. Ariyarathenam A, Nachimuthu S, Tang T, et al. Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review. Int J Surg. 2010;8(6):466-469.
  3. Smolyakov R, Talalay B, Yanai-Inbar I, et al. Enterobius vermicularis infection of female genital tract: a report of three cases and review of literature. Eur J Obstet Gynecol Reprod Biol. 2003;107:220–222.
  4. Mahomed A, MacKenzie R, Carson l, et al. Enterobius vermicularis and perianal sepsis in children. Pediatr Surg Intl. 2003;11(19):740–741.
  5. Kollias G, Kyriakopoulos M, Tiniakos G. Epididymitis from Enterobius vermicularis: case report. J Urol. 1992;147(4):1114–1116.
  6. Sinniah B, Leopairut J, Neafie R, et al. Enterobiasis: a histopathological study of 259 patients. Ann Trop Med Parasitol. 1991;85(6):625–635.
  7. Snow M. Pinning down pinworms. Nursing. 2006;36(5):17.
  8. Cho S, Kang S. Significance of scotch-tape anal swab technique in diagnosis of Enterobius vermicularis infection. Kisaengchunghak Chapchi. 1975;13:102-114.
  9. Arora V, Singh N, Chaturvedi S, et al. Fine needle aspiration diagnosis of a subcutaneous abscess from Enterobius vermicularis infestation: a case report. Acta Cytologica. 1997;41(6):1845–1847.
  10. Kumar N, Sharma P, Sachveda R, et al. Perianal nodule due to enterobiasis: an aspiration cytologic diagnosis. Diagnos Cytopathol. 2003;28(1):58–60.
  11. Aydin O. Incidental parasitic infestations in surgically removed appendices: a retrospective analysis. Diagn Pathol. 2007;2:16.
  12. Knopp S, Steinmann P, Keiser J, et al. Nematode infections: soil-transmitted helminths and Trichinella . Infect Dis Clin North Am. 2012;26(2):341-358.

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Last updated: 2019-07-11 22:21