Enterobiasis

Infectious diseases

Clinicals - History

Fact Explanation
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. If a human ingests these eggs they hatch and become adult worms in weeks. , This causes intense itching and irritation. 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. If a human ingests these eggs they hatch and become adult worms in weeks. , This causes intense itching and irritation.
Disturbed sleep Nocturnal itch keeps the patients awake so they complain poor sleep. Disturbed sleep
Nocturnal itch keeps the patients awake so they complain poor sleep.
Irritability and agitation Pruritus ani is a psychologically irritating symptom so people some people become irritable. Irritability and agitation
Pruritus ani is a psychologically irritating symptom so people some people become irritable.
Secondary bacterial infections in the perianal region (painful pustules) Intense itching causes abrasions. Barrier effect of the skin is lost so secondary bacterial infections can occur. Secondary bacterial infections in the perianal region (painful pustules)
Intense itching causes abrasions. Barrier effect of the skin is lost so secondary bacterial infections can occur.
Urinary complications( irritative voiding symptoms sush as Dysuria and Frequency) This can be a very rare incidence of bladder infestation by Enterobius vermicularis. Autoinoculation is the commonest mode of infestation. In some patients prostate or ureters can become infestated. Urinary complications( irritative voiding symptoms sush as Dysuria and Frequency)
This can be a very rare incidence of bladder infestation by Enterobius vermicularis. Autoinoculation is the commonest mode of infestation. In some patients prostate or ureters can become infestated.
Genital complications causing pelvic pain In women, adult female pinworms can migrate to the genital tract, causing granulomas in the uterus, ovary, and the fallopian tubes, and pelvic peritoneum. , Genital complications causing pelvic pain
In women, adult female pinworms can migrate to the genital tract, causing granulomas in the uterus, ovary, and the fallopian tubes, and pelvic peritoneum. ,
Genital complications: menorrhagia This occurs due to granuloma formation in the genital tract. Genital complications: menorrhagia
This occurs due to granuloma formation in the genital tract.
Genital complications: vulval itch This is due to vulvovaginitis caused by Enterobius vermicularis. , Genital complications: vulval itch
This is due to vulvovaginitis caused by Enterobius vermicularis. ,
Intestinal complications: chronic abdominal pain Chronic intermittent, abdominopelvic pain, commonly on the right side can be present.
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: chronic abdominal pain
Chronic intermittent, abdominopelvic pain, commonly on the right side can be present.
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 right iliac fossa Enterobius vermicularis is the most commonly encountered nematode that obstructs the lumen of the appendix and can cause acute appendicitis. Intestinal complications: acute abdominal pain in the right iliac fossa
Enterobius vermicularis is the most commonly encountered nematode that obstructs the lumen of the appendix and can cause acute appendicitis.
Symptoms of anemia such as dyspnoea, fatigue and lethargy This is found in some patients. This is due to chronic infestations. Symptoms of anemia such as dyspnoea, fatigue and lethargy
This is found in some patients. This is due to chronic infestations.
Past history of pruritus ani Autoinfection by feco-oral transmission is a possibility, because ingestion of eggs is the mode of transmission. Past history of pruritus ani
Autoinfection by feco-oral transmission is a possibility, because ingestion of eggs is the mode of transmission.
Close contacts or family members with similar complaints. This nematode is transmitted directly from person to person. , . The methods of infection are: via dust, food, hands,.
Overcrowding, sharing linen, beds, food handling can increase the rate of person -to- person transmission. It is common worldwide but is more commonly encountered in temperate regions.
Close contacts or family members with similar complaints.
This nematode is transmitted directly from person to person. , . The methods of infection are: via dust, food, hands,.
Overcrowding, sharing linen, beds, food handling can increase the rate of person -to- person transmission. It is common worldwide but is more commonly encountered in temperate regions.
Drinking contaminated water Drinking water contaminated with eggs can also cause transmission. Drinking contaminated water
Drinking water contaminated with eggs can also cause transmission.

Clinicals - Examination

Fact Explanation
Visualization of the worm (perianal, perineal and very rarely in urine) Small males measure 2 to 5 mm, and the females measure 8 to 13 mm. They are whitish worms and can be rarely seen during clinical examination. Visualization of the worm (perianal, perineal and very rarely in urine)
Small males measure 2 to 5 mm, and the females measure 8 to 13 mm. They are whitish worms and can be rarely seen during clinical examination.
Painful perianal pustules, abrasion marks and abscesses Intense itching causes abrasions. Barrier effect of the skin is lost so secondary bacterial infections can occur. Painful perianal pustules, abrasion marks and abscesses
Intense itching causes abrasions. Barrier effect of the skin is lost so secondary bacterial infections can occur.
Pallor Pallor is present in some patients . As chronic infestation can cause anemia. Pallor
Pallor is present in some patients . As chronic infestation can cause anemia.
Fever, tachycardia, hypotension and right iliac fossa tenderness, rebound tenderness These features are present in acute appendicitis due to Enterobius vermicularis. Fever, tachycardia, hypotension and right iliac fossa tenderness, rebound tenderness
These features are present in acute appendicitis due to Enterobius vermicularis.
Abdominal tenderness This is due to inflammation of intra abdominal viscera such as appendix, ovaries etc. Abdominal tenderness
This is due to inflammation of intra abdominal viscera such as appendix, ovaries etc.

Investigations - Diagnosis

Fact Explanation
Adhesive-tape method and microscopy This is done for the detection of ova, segments or intact worms. The eggs are stained with lactophenol cotton blue. The threadlike, white adult worms with a long, sharply pointed tail can be identified. Adhesive-tape method and microscopy
This is done for the detection of ova, segments or intact worms. The eggs are stained with lactophenol cotton blue. The threadlike, white adult worms with a long, sharply pointed tail can be identified.
A complete blood count This is done in complicated cases, presenting as different disease entities (such as appendicitis. Differential count can indicate eosinophilia in nematode infestation. , A complete blood count
This is done in complicated cases, presenting as different disease entities (such as appendicitis. Differential count can indicate eosinophilia in nematode infestation. ,
A urinalysis This is to exclude differential diagnosis for complicated cases for acute abdomen such as urinary calculi where there can be haematuria and in pyelonephritis there can be pus cells and granular casts. A urinalysis
This is to exclude differential diagnosis for complicated cases for acute abdomen such as urinary calculi where there can be haematuria and in pyelonephritis there can be pus cells and granular casts.
Urine beta hCG This is to exclude differential diagnosis for complicated cases for acute abdomen because ruptured ectopic pregnancy is a differential diagnosis considered in acute abdomen. Urine beta hCG
This is to exclude differential diagnosis for complicated cases for acute abdomen because ruptured ectopic pregnancy is a differential diagnosis considered in acute abdomen.
Trans abdominal/ transvaginal ultrasonography This is to exclude differential diagnosis for complicated cases for acute abdomen. Trans abdominal/ transvaginal ultrasonography
This is to exclude differential diagnosis for complicated cases for acute abdomen.
X-ray abdomen This is to exclude differential diagnosis for complicated cases for acute abdomen. Important features such as gas under diaphragm in a ruptured viscus or urinary calculi can be identified. X-ray abdomen
This is to exclude differential diagnosis for complicated cases for acute abdomen. Important features such as gas under diaphragm in a ruptured viscus or urinary calculi can be identified.
Contrast enhanced CT scan This is to exclude differential diagnosis for complicated cases for acute abdomen. Contrast enhanced CT scan
This is to exclude differential diagnosis for complicated cases for acute abdomen.

Management - Supportive

Fact Explanation
Improve Individual hygiene: by encouraging hand washing (with soap and warm water) after going to toilet, before handling food etc. Washing hands (with soap and warm water) ,, destroys and washes off infective eggs and prevents feco-oral transmission. Improve Individual hygiene: by encouraging hand washing (with soap and warm water) after going to toilet, before handling food etc.
Washing hands (with soap and warm water) ,, destroys and washes off infective eggs and prevents feco-oral transmission.
Improve Individual hygiene: cut fingernails short. Cutting finger nails short , prevents feco-oral transmission Improve Individual hygiene: cut fingernails short.
Cutting finger nails short , prevents feco-oral transmission
Improve Individual hygiene: avoid nail biting Avoiding nail biting prevents feco-oral transmission. Improve Individual hygiene: avoid nail biting
Avoiding nail biting prevents feco-oral transmission.
Improve Individual hygiene: clean perianal area with soap and regular showers Cleaning perianal area with soap and showering regularly washes the eggs away. Improve Individual hygiene: clean perianal area with soap and regular showers
Cleaning perianal area with soap and showering regularly washes the eggs away.
Improve household hygiene: regular cleaning of underwear, bed linen and towels Regular cleaning of underwear, bed linen and towels ,, prevents person to person transmission. Improve household hygiene: regular cleaning of underwear, bed linen and towels
Regular cleaning of underwear, bed linen and towels ,, prevents person to person transmission.
Improve household hygiene: advise not to share beds or bedlinen This prevents person to person transmission. Improve household hygiene: advise not to share beds or bedlinen
This prevents person to person transmission.

Management - Specific

Fact Explanation
Albendazole and Mebendazole These drugs prevent glucose uptake in nematodes and is effective in Enterobiasis. This is given as a single oral doses and repeated after 1 week for the treatment of re-infection.
Family members are also treated because they are usually also infected with Enterobius vermicularis. These drugs can be used to treat endometrial and urinary infections as well.
Albendazole and Mebendazole
These drugs prevent glucose uptake in nematodes and is effective in Enterobiasis. This is given as a single oral doses and repeated after 1 week for the treatment of re-infection.
Family members are also treated because they are usually also infected with Enterobius vermicularis. These drugs can be used to treat endometrial and urinary infections as well.
Pyrantel pamoate It depolarizes the neuromuscular junctions of the nematodes and expels them in feces. Pyrantel pamoate is given as a single dose and should be repeated in one week to prevent re-infection. , Pyrantel pamoate
It depolarizes the neuromuscular junctions of the nematodes and expels them in feces. Pyrantel pamoate is given as a single dose and should be repeated in one week to prevent re-infection. ,
Management of acute complications Surgical management should be considered in acute appendicitis or any other surgical/gynecological complication. Management of acute complications
Surgical management should be considered in acute appendicitis or any other surgical/gynecological complication.

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