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Pinworm Workup

  • Author: Sun Huh, MD, PhD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 06, 2015
 

Approach Considerations

Glass slide microscopic analysis for Enterobius vermicularis may be performed looking for ova and female pinworms. A specimen is best obtained by dabbing the stretched, unwashed perianal folds in the early morning with cellophane tape and affixing the specimen onto a slide. A negative test for 5 consecutive mornings effectively rules out the diagnosis.

Microscopic examination shows the elongated ovoid egg distinctly compressed laterally and flattened on one side. The egg measures 50-60 µm X 20-30 µm and contains larva.

In areas where pinworms are endemic, consider analyzing any removed appendiceal stump for infestation.[7]

Patients with recurrent episodes of perianal itching should have a stool sample sent to the laboratory for analysis because different parasites, which require different treatment, may appear similar to E vermicularis using the cellophane-tape test.[8]

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Cellophane-tape Examination

A perianal cellophane swab or cellophane-tape examination should be used to detect Enterobius vermicularis eggs (see the image below). Egg detection is associated with false-positive rate of 5-11% and a false-negative rate of 70-95%.[9] One report found that a single cellophane-tape examination yielded a sensitivity of 50%, 3 examinations yielded a sensitivity of 90%, and 5 examinations yielded a sensitivity of 99%.

Microscopic view of Enterobius vermiculariseggs at Microscopic view of Enterobius vermiculariseggs attached to cellophane tape after a perianal swab from a child in kindergarten in Seoul, Korea. Egg size was 50-60 μm X 20-30 μm. The eggs are elongated and ovoid, distinctly compressed laterally, and flattened on one side.
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Contributor Information and Disclosures
Author

Sun Huh, MD, PhD Chairman, Professor, Department of Parasitology, College of Medicine, Hallym University, Korea

Disclosure: Nothing to disclose.

Coauthor(s)

Soo-Ung Lee, PhD Manager, Research and Development, Chuncheon Bioindustry Foundation, Korea

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Joseph J Bocka, MD Director of Shelby Emergency Department, Attending Emergency Physician at Mansfield Hospital, Med Central Health System (Mansfield and Shelby, Ohio); Emergency Medical Service Medical Director for several services

Joseph J Bocka, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose

Mary D Nettleman, MD, MS, MACP Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

David A Peak, MD Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Gordon L Woods, MD Consulting Staff, Department of Internal Medicine, University Medical Center

Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine

Disclosure: Nothing to disclose.

References
  1. Centers for Disease Control and Prevention. Parasites - Enterobiasis (also known as Pinworm Infection). Parasitic Diseases Information. Available at http://www.cdc.gov/parasites/pinworm/index.html. Accessed: July 7, 2012.

  2. Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health. January 2007. 38:20-3. [Medline].

  3. Bøås H, Tapia G, Sødahl JA, Rasmussen T, Rønningen KS. Enterobius vermicularis and Risk Factors in Healthy Norwegian Children. Pediatr Infect Dis J. 2012 Sep. 31(9):927-30. [Medline].

  4. Tsibouris P, Galeas T, Moussia M, et al. Two cases of eosinophilic gastroenteritis and malabsorption due to Enterobious vermicularis. Dig Dis Sci. December 2005. 60:2389-92. [Medline]. [Full Text].

  5. Craggs B, De Waele E, De Vogelaere K, Wybo I, Laubach M, Hoorens A, et al. Enterobius vermicularis infection with tuboovarian abscess and peritonitis occurring during pregnancy. Surg Infect (Larchmt). 2009 Dec. 10(6):545-7. [Medline].

  6. Erian M, McLaren G. Unexpected causes of gynecological pelvic pain. JSLS. 2004 Oct-Dec. 8(4):380-3. [Medline]. [Full Text].

  7. Aydin O. Incidental parasitic infestations in surgically removed appendices: a retrospective analysis. Diagn Pathol. 2007 May 24. 2:16. [Medline]. [Full Text].

  8. Samkari A, Kiska DL, Riddell SW, Wilson K, Weiner LB, Domachowske JB. Dipylidium caninum mimicking recurrent enterobius vermicularis (pinworm) infection. Clin Pediatr (Phila). 2008 May. 47(4):397-9. [Medline].

  9. Cho SY, Kang SY. Significance of scotch-tape anal swab technique in diagnosis of Enterobius vermicularis infection. Kisaengchunghak Chapchi. December 1975. 13:102-14. [Medline]. [Full Text].

  10. Cho SY, Kang SY, Kim SI, et al. Effect of anthelmintics on the early stage of Enterobius vermicularis. Kisaengchunghak Chapchi. June 1985. 23:7-17. [Medline]. [Full Text].

  11. Hong ST, Cho SY, Seo BS et al. Chemotherapeutic control of Enterobius vermicularis infection in orphanages. Kisaengchunghak Chapchi. June 1980. 18:37-44. [Medline]. [Full Text].

  12. Patsantara GG, Piperaki ET, Tzoumaka-Bakoula C, Kanariou MG. Immune responses in children infected with the pinworm Enterobius vermicularis in central Greece. J Helminthol. 2015 May 20. 1-5. [Medline].

 
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Adult female worms of Enterobius vermicularis collected from a 2-year-old girl in a Korean orphanage after treatment with pyrantel pamoate 10 mg/kg.
Microscopic view of Enterobius vermiculariseggs attached to cellophane tape after a perianal swab from a child in kindergarten in Seoul, Korea. Egg size was 50-60 μm X 20-30 μm. The eggs are elongated and ovoid, distinctly compressed laterally, and flattened on one side.
Pinworms in a young patient.
 
 
 
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