ENTEROBIUS VERMICULARIS

Pinworm infection is caused by a small, thin, white roundworm called Enterobius vermicularis. Although pinworom infection can affect all people, it most commonly occurs among children, institutionalized persons, and household members of persons with pinworm infection. Pinworm infection is treatable with over-the-counter or prescription medication, but reinfection, which occurs easily, should be prevented.

FAQS

What is a pinworm?

A pinworm ("threadworm") is a small, thin, white roundworm (nematode) called Enterobius vermicularis that sometimes lives in the colon and rectum of humans. Pinworms are about the length of a staple. While an infected person sleeps, female pinworms leave the intestine through the anus and deposit their eggs on the surrounding skin.

What are the symptoms of a pinworm infection?

Pinworm infection (called enterobiasis or oxyuriasis) causes itching around the anus which can lead to difficulty sleeping and restlessness. Symptoms are caused by the female pinworm laying her eggs. Symptoms of pinworm infection usually are mild and some infected people have no symptoms.

Who is at risk for pinworm infection?

Pinworm infection occurs worldwide and affects persons of all ages and socioeconomic levels. It is the most common worm infection in the United States. Pinworm infection occurs most commonly among:

  • school-aged and preschool-aged children,
  • institutionalized persons, and
  • household members and caretakers of persons with pinworm infection.

Pinworm infection often occurs in more than one person in household and institutional settings. Child care centers often are the site of cases of pinworm infection.

How is pinworm infection spread?

Pinworm infection is spread by the fecal-oral route, that is by the transfer of infective pinworm eggs from the anus to someone’s mouth, either directly by hand or indirectly through contaminated clothing, bedding, food, or other articles.

Pinworm eggs become infective within a few hours after being deposited on the skin around the anus and can survive for 2 to 3 weeks on clothing, bedding, or other objects. People become infected, usually unknowingly, by swallowing (ingesting) infective pinworm eggs that are on fingers, under fingernails, or on clothing, bedding, and other contaminated objects and surfaces. Because of their small size, pinworm eggs sometimes can become airborne and ingested while breathing.

Can my family become infected with pinworms from swimming pools?

Pinworm infections are rarely spread through the use of swimming pools. Pinworm infections occur when a person swallows pinworm eggs picked up from contaminated surfaces or fingers. Although chlorine levels found in pools are not high enough to kill pinworm eggs, the presence of a small number of pinworm eggs in thousands of gallons of water (the amount typically found in pools) makes the chance of infection unlikely.

My little kids like to co-bathe, could this be how they are becoming infected?

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. Careful handling and frequent changing of underclothing, night clothes, towels, and bedding can help reduce infection, reinfection, and environmental contamination with pinworm eggs. These items should be laundered in hot water, especially after each treatment of the infected person and after each usage of washcloths until infection is cleared.

Did my pets give me pinworms / can I give pinworms to my pets?

No. Humans are considered to be the only hosts of E. vermicularis which is also known as the human pinworm.

How is pinworm infection diagnosed?

Itching during the night in a childs perianal area strongly suggests pinworm infection. Diagnosis is made by identifying the worm or its eggs. Worms can sometimes be seen on the skin near the anus or on underclothing, pyjamas, 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. This is done by firmly pressing the adhesive side of clear, transparent cellophane tape to the skin around the anus. The eggs stick to the tape and the tape can be placed on a slide and looked at under a microscope. Because washing/bathing or having a bowel movement can remove eggs from the skin, this test should be done as soon as the person wakes up in the morning before they wash, bathe, go to the toilet, or get dressed. The “tape test? should be done on three consecutive mornings to increase the chance of finding pinworm eggs.

Because itching and scratching of the anal area is common in pinworm infection, samples taken from under the fingernails may also contain eggs. Pinworm eggs rarely are found in routine stool or urine samples.

How is pinworm infection treated?

Pinworm can be treated with either prescription or over-the-counter medications. A health care provider should be consulted before treating a suspected case of pinworm infection.

Treatment involves two doses of medication with the second dose being given 2 weeks after the first dose. All household contacts and caretakers of the infected person should be treated at the same time. Reinfection can occur easily so strict observance of good hand hygiene is essential (e.g. proper handwashing, maintaining clean short fingernails, avoiding nail biting, avoiding scratching the perianal area).

Daily morning bathing and daily changing of underwear helps removes a large proportion of eggs. Showering may be preferred to avoid possible contamination of bath water. Careful handling and frequent changing of underclothing, night clothes, towels, and bedding can help reduce infection, reinfection, and environmental contamination with pinworm eggs. These items should be laundered in hot water, especially after each treatment of the infected person and after each usage of washcloths until infection is cleared.

Should family and other close contacts of someone with pinworm also be treated for pinworm?

Yes. The infected person and all household contacts and caretakers of the infected person should be treated at the same time.

What should be done if the pinworm infection occurs again?

Reinfection occurs easily. Prevention always should be discussed at the time of treatment. Good hand hygiene is the most effective means of prevention. If pinworm infection occurs again, the infected person should be retreated with the same two-dose treatment. The infected person’s household contacts and caretakers also should be treated. If pinworm infection continues to occur, the source of the infection should be sought and treated. Playmates, schoolmates, close contacts outside the home, and household members should be considered possible sources of infection. Each infected person should receive the recommended two-dose treatment.

How can pinworm infection and reinfection be prevented?

Strict observance of good hand hygiene is the most effective means of preventing pinworm infection. This includes washing hands with soap and warm water after using the toilet, changing diapers, and before handling food. Keep fingernails clean and short, avoid fingernail-biting, and avoid scratching the skin in the perianal area. Teach children the importance of washing hands to prevent infection.

Daily morning bathing and changing of underclothes helps remove a large proportion of pinworm eggs and can help prevent infection and reinfection. Showering may be preferred to avoid possible contamination of bath water. Careful handling (avoid shaking) and frequent laundering of underclothes, night clothes, towels, and bed sheets using hot water also helps reduce the chance of infection and reinfection by reducing environmental contamination with eggs.

Control can be difficult in child care centers and schools because the rate of reinfection is high. In institutions, mass and simultaneous treatment, repeated in 2 weeks, can be effective. Hand hygiene is the most effective method of prevention. Trimming and scrubbing the fingernails and bathing after treatment is important to help prevent reinfection and spread of pinworms.

EPIDEMIOLOGY & RISK FACTORS

Pinworm infections are more common within families with school-aged children, in primary caregivers of infected children, and in institutionalized children.

A person is infected with pinworms by ingesting pinworm eggs either directly or indirectly. These eggs are deposited around the anus by the worm and can be carried to common surfaces such as hands, toys, bedding, clothing, and toilet seats. By putting anyones contaminated hands (including ones own) around the mouth area or putting ones mouth on common contaminated surfaces, a person can ingest pinworm eggs and become infected with the pinworm parasite. Since pinworm eggs are so small, it is possible to ingest them while breathing.

Once someone has ingested pinworm eggs, there is an incubation period of 1 to 2 months or longer for the adult gravid female to mature in the small intestine. Once mature, the adult female worm migrates to the colon and lays eggs around the anus at night, when many of their hosts are asleep. People who are infected with pinworm can transfer the parasite to others for as long as there is a female pinworm depositing eggs on the perianal skin. A person can also re-infect themselves, or be re-infected by eggs from another person.

The people most likely to be infected with pinworm are children under 18, people who take care of infected children and people who are institutionalized. In these groups, the prevalence can reach 50%.

Pinworm is the most common worm infection in the United States. Humans are the only species that can transfer this parasite. Household pets like dogs and cats cannot become infected with human pinworms. Pinworm eggs can survive in the indoor environment for 2 to 3 weeks.

BIOLOGY

Causal Agent:

The nematode (roundworm) Enterobius vermicularis (previously Oxyuris vermicularis) also called human pinworm. (Adult females: 8 to 13 mm, adult male: 2 to 5 mm. ) Humans are considered to be the only hosts of E. vermicularis. A second species, Enterobius gregorii, has been described and reported from Europe, Africa, and Asia. For all practical purposes, the morphology, life cycle, clinical presentation, and treatment of E. gregorii is identical to E. vermicularis.

Life Cycle:

Life Cycle of Enterobius vermicularis

Eggs are deposited on perianal folds. Self-infection occurs by transferring infective eggs to the mouth with hands that have scratched the perianal area. Person-to-person transmission can also occur through handling of contaminated clothes or bed linens. Enterobiasis may also be acquired through surfaces in the environment that are contaminated with pinworm eggs (e.g. , curtains, carpeting). Some small number of eggs may become airborne and inhaled. These would be swallowed and follow the same development as ingested eggs. Following ingestion of infective eggs, the larvae hatch in the small intestine and the adults establish themselves in the colon. The time interval from ingestion of infective eggs to oviposition by the adult females is about one month. The life span of the adults is about two months. Gravid females migrate nocturnally outside the anus and oviposit while crawling on the skin of the perianal area. The larvae contained inside the eggs develop (the eggs become infective) in 4 to 6 hours under optimal conditions. Retroinfection, or the migration of newly hatched larvae from the anal skin back into the rectum, may occur but the frequency with which this happens is unknown.

Life cycle image and information courtesy of DPDx.

DISEASE

The most common clinical manifestation of a pinworm infection is an itchy anal region. When the infection is heavy, there can be a secondary bacterial infection due to the irritation and scratching of the anal area. Often the patient will complain of teeth grinding, and insomnia due to disturbed sleep, or even abdominal pain or appendicitis. Infection of the female genital tract has been well reported.

DIAGNOSIS

A person infected with pinworm is often asymptomatic, but itching around the anus is a common symptom. Diagnosis of pinworm can be reached from three simple techniques. The first option is to look for the worms in the perianal reqion 2 to 3 hours after the infected person is asleep. The second option is to touch the perianal skin with transparent tape to collect possible pinworm eggs around the anus first thing in the morning. If a person is infected, the eggs on the tape will be visible under a microscope. The tape method should be conducted on 3 consecutive mornings right after the infected person wakes up and before he/she does any washing. Since anal itching is a common symptom of pinworm, the third option for diagnosis is analyzing samples from under fingernails under a microscope. An infected person who has scratched the anal area may have picked up some pinworm eggs under the nails that could be used for diagnosis.

Since pinworm eggs and worms are often sparse in stool, examining stool samples is not recommended. Serologic tests are not available for diagnosing pinworm infections.

PREVENTION AND CONTROL

Washing your hands with soap and warm water after using the toilet, changing diapers, and before handling food is the most successful way to prevent pinworm infection. In order to stop the spread of pinworm and possible re-infection, people who are infected should bathe every morning to help remove a large amount of the eggs on the skin. Showering is a better method than taking a bath, because showering avoids potentially contaminating the bath water with pinworm eggs. Infected people should not co-bathe with others during their time of infection.

Also, infected people should comply with good hygiene practices such as washing their hands with soap and warm water after using the toilet, changing diapers, and before handling food. They should also cut fingernails regularly, and avoid biting the nails and scratching around the anus. Frequent changing of underclothes and bed linens first thing in the morning is a great way to prevent possible transmission of eggs in the environment and risk of reinfection. These items should not be shaken and carefully placed into a washer and laundered in hot water followed by a hot dryer to kill any eggs that may be there.

In institutions, day care centers, and schools, control of pinworm can be difficult, but mass drug administration during an outbreak can be successful. Teach children the importance of washing hands to prevent infection.

For more information view the source:Center for Disease Control

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