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.
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 . 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. 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 . Dissemination of the disease has also been described in the prostate, perianal tissue , epididymis , lungs , urinary bladder, spleen, liver, and conjunctival sac.
Entire Body System
- 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. This is due to infestation of the appendix with Enterobius vermicularis.  Intestinal complications: acute abdominal pain in the [explainmedicine.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]
The patient was treated with albendazole, and the abdominal pain resolved. Pain is uncommon but can occur in patients with E. vermicularis infections. The more common symptom of anal pruritus is seen in only 33 percent of patients. [doi.org]
- Pruritus Ani
One common symptom is intense pruritus ani that in some patients can lead to insomnia, restlessness and irritability. [ncbi.nlm.nih.gov]
Pruritus Ani which occurs usually at night At night, the female of the Enterobius vermicularis species that lives in the colon migrates out of the anus and deposits her eggs on the perianal skin. Eggs become infective within hours. [explainmedicine.com]
Common symptoms of enterobiasis are intense pruritus ani and perineal pruritus that result when the female migrates to the anal area to lay eggs especially at night. Other symptoms include weight loss, loss of appetite, insomnia and restlessness. [biology-online.org]
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]
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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]
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]
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 . 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 . 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 . 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 . 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 .
- St Georgiev V. Chemotherapy of enterobiasis (oxyuriasis). Expert Opin Pharmacother.2001;2:267-275.
- 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.
- 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.
- Mahomed A, MacKenzie R, Carson l, et al. Enterobius vermicularis and perianal sepsis in children. Pediatr Surg Intl. 2003;11(19):740–741.
- Kollias G, Kyriakopoulos M, Tiniakos G. Epididymitis from Enterobius vermicularis: case report. J Urol. 1992;147(4):1114–1116.
- Sinniah B, Leopairut J, Neafie R, et al. Enterobiasis: a histopathological study of 259 patients. Ann Trop Med Parasitol. 1991;85(6):625–635.
- Snow M. Pinning down pinworms. Nursing. 2006;36(5):17.
- Cho S, Kang S. Significance of scotch-tape anal swab technique in diagnosis of Enterobius vermicularis infection. Kisaengchunghak Chapchi. 1975;13:102-114.
- 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.
- Kumar N, Sharma P, Sachveda R, et al. Perianal nodule due to enterobiasis: an aspiration cytologic diagnosis. Diagnos Cytopathol. 2003;28(1):58–60.
- Aydin O. Incidental parasitic infestations in surgically removed appendices: a retrospective analysis. Diagn Pathol. 2007;2:16.
- 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.