Enterobiasis - Symptoms, Causes, Treatment

Disease Overview

Enterobiasis or pinworm infection is a common, contagious, parasitic infestation found mainly in children. The disorder is spread by swallowing or inhaling the tiny eggs of the pinworm. Enterobiasis rarely causes any serious physical problems except for the main symptom, which is severe rectal itching.

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Synonyms

Oxyuriasis
Pinworm Infection
Seatworm Infection

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Signs & Symptoms

The major symptom of enterobiasis is itching in the anal area. There may also be restlessness and difficulty sleeping. Secondary bacterial infections may develop in the areas that are constantly scratched and, very infrequently, the vagin* may become involved in young girls. Very rarely, enterobiasis may lead to appendicitis or inflammation of the fallopian tubes in females.

Many children with enterobiasis show no symptoms (asymptomatic). In rare cases, nausea, loss of appetite, vomiting, involuntary discharge of urine at night (enuresis) or stomach pain may occur. The disorder is usually first identified when live, thin, white pinworms, (females are about 10 mm in length and males are 4-5 mm in length) are noticed in the feces.

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Causes

Enterobiasis is contracted by ingesting the eggs of pinworms, which may be carried on fingernails, clothing, toys or bedding. The eggs may also be inhaled in dust. The infection may be transmitted to others by hand-to-mouth contact with contaminated food or objects.

The female worm, residing in the rectum, usually crawls out through the anus at night and deposits her eggs in the surrounding (perianal) area. The sticky, gelatinous substance in which the eggs are deposited and the movements of the female worm usually cause intense rectal itching. The adult female worm dies after laying the eggs. However, the eggs may survive for as long as three weeks. As the child scratches the area, the tiny eggs become imbedded under the fingernails. These eggs may be swallowed, continuing the parasites’ lifecycle. The parasites reach maturity in the large intestine within two to six weeks.

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Affected populations

Enterobiasis is a common disorder affecting both sexes in equal numbers. It most frequently occurs in children during nursery school or kindergarten years. An entire classroom of children may be affected very quickly as the infection is spread from one child to the next.

In the United States, it is thought that about 10% of the general population is infested but that the number is declining.

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Disorders with Similar Symptoms

Symptoms of the following disorders can be similar to those of Enterobiasis. Comparisons may be useful for a differential diagnosis:

Roundworms (Ascariasis) are found in tropical areas. Young children are most commonly affected. Roundworm eggs are passed to the soil through the feces and may remain in the soil for months or years. They are transmitted to humans by hand-to-mouth contact. Symptoms may include fever, cough, wheezing, stomach cramps, and intestinal obstruction. Treatment is usually with such drugs as pyrantel pamoate or mebendazole.

Hookworms are contracted primarily by walking barefooted through contaminated soil. They are most commonly found in temperate and warm, moist climates. The worms penetrate the skin and travel to the small intestine where they attach themselves to the mucosa and suck blood. The most common symptom is abdominal pain. Anemia may also occur.

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Standard Therapies

Enterobiasis usually is self-limiting if good hygiene is followed. However, most individuals prefer some type of treatment, and the drug pyrantel pamoate is usually prescribed. One dose of pyrantel pamoate, repeated in two weeks, usually stops the infestation. Reinfestation is likely since eggs deposited as long as one week after therapy may survive, and eggs deposited before therapy may survive for up to three weeks. The entire family is usually treated. Petroleum jelly may be applied topically to relieve itching.

Treatment to prevent reinfection includes careful attention to personal hygiene, especially the washing of hands and fingernails, clothing and bed linens.

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Clinical Trials and Studies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

References

TEXTBOOKS

Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:2363.

Berkow R., ed. The Merck Manual-Home Edition, 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 1997:.

Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone Inc. New York, NY; 1995:2528, 479-80.

REVIEW ARTICLES

St Georgiev V. Chemotherapy of enterobiasis (oxyuriasis). Expert Opin Pharmacother. 2001;2:267-75.

JOURNAL ARTICLES

Tandan T, Pollard AJ, Money DM, et al. Pelvic inflammatory disease associated with Enterobius vermicularis. Arch Dis Child. 2002;86:439-40.

Olivares JL, Fernandez R, Fleta J et al. Vitamin B12 and folic acid in children with intestinal parasitic infection. J Am Coll Nutr. 2002;21:109-13.

Ibarra J. Threadworms: a starting point for family hygiene. Br J Community Nurs. 2001;6:414-20.

Parija SC, Sheeladevi C, Shivaprakash MR, et al. Evaluation of lactophenol cotton blue stain for detection of eggs of Enterobius vermicularis in perianal surface samples. Trop Doct. 2001;31:214-15.

Matsush*ta M, Takakuwa H, Nishio A, et al. Pinworm Infection. Gastrointest Endosc. 2001;53:210.

Birbeek GL The benefits of screening must outweigh the risks and costs. West J Med. 2000;172:308-09.

Lohiya GS, Tan-Figueroa L, Crinella FM, et al. Epidemiology and control of enterobiasis in a development center. West J Med. 2000;172:305-08.

FROM THE INTERNET

Fact Sheet: Pinworm Infection. CDC Division of Parasitic Diseases. Last reviewed August 15, 1999. 3pp.

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