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Enterobiasis - Causes, Symptoms and Treatment

What is Enterobiasis?

Enterobiasis (also called pinworm, seatworm, or threadworm infection, or oxyuriasis) is a benign intestinal disease caused by the nematode Enterobius vermicularis. Found worldwide, even in temperate regions with good sanitation, it's the most prevalent helminthic infection in the United States.

Enterobiasis infection and re-infection occur most often in children between ages 5 and 14 and in certain institutionalized groups because of poor hygiene and frequent hand-to-mouth activity. Crowded living conditions increase the likelihood of its spreading to family members.

What are the Causes of Enterobiasis?

Adult pinworms live in the intestine; female worms migrate to the perianal region to deposit their ova. Direct transmission occurs when the patient's hands transfer infective eggs from the anus to the mouth. Indirect transmission occurs when the patient comes in contact with contaminated articles, such as linens and clothing.

What are the Signs and Symptoms of Enterobiasis?

Asymptomatic enterobiasis is commonly overlooked. However, intense perianal pruritus may occur, especially at night, when the female worm leaves the anus to deposit ova. Pruritus causes irritability, scratching, skin irritation and, sometimes, vaginitis. Enuresis and insomnia may also result because of the night activity. Rarely, complications include appendicitis, salpingitis, and pelvic granuloma.

Diagnosis for Enterobiasis

A history of anal pruritus suggests enterobiasis; identification of Enterobius ova recovered from the perianal area with a cellophane tape swab confirms it.

This test must be repeated three times and is done before the patient bathes and defecates in the morning. A stool sample is usually ova- and worm-free because the worms deposit ova outside the intestine and die after return to the anus.

Treatment for Enterobiasis

Drug therapy with pyrantel, piperazine, or mebendazole destroys the causative parasites. Effective eradication requires simultaneous treatment of family members and, in institutions, other patients.

Special Considerations and Prevention Tips for Enterobiasis

  • If the patient receives pyrantel, tell him and his family that this drug colors the stool bright red and may cause vomiting (vomitus will also be red). The tablet form of this drug is coated with aspirin and shouldn't be given to aspirin-sensitive patients.
  • Before giving piperazine, obtain a history of seizure disorders; this drug is contraindicated in patients with such a history.
  • Tell parents to bathe children daily (showers are preferable to tub baths) and to change underwear and bed linens daily.
  • Educate children to remain in proper personal hygiene, and stress the need for hand washing after defecation and before handling food.
  • Discourage nail biting. If the child can't stop, suggest that he wear gloves until the infection clears.
  • Report all outbreaks of enterobiasis to school authorities.
  • Tell parents to strictly adhere to the prescribed drug dosage as directed by a doctor.

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