eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Enterobiasis: Follow-up

Author: Wayne Wolfram, MD, MPH,
Coauthor(s): Jennifer L Curry, DO, Resident Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center
Contributor Information and Disclosures

Updated: Nov 9, 2009

Follow-up

Inpatient & Outpatient Medications

  • An antihelminthic medication should be prescribed to patients with enterobiasis .
  • Application of an antipruritic ointment or albendazole may help control scratching.3

Deterrence/Prevention

  • Thorough handwashing can deter transmission.

Complications

  • Beware of skin infection from vigorous scratching to relieve pruritus.
  • Pinworms have been associated with appendicitis.5,6 However, small and large intestine ulcerations, perianal abscesses, intestinal pain, transient synovitis, or enuresis is believed to be coincidental and not causal.7
  • If a patient with enterobiasis is refractory to treatment, consider the possibility of an infestation with Dipylidium caninum, which is a common tapeworm that infects domestic cats and dogs.8

Prognosis

  • Prognosis is excellent, but reinfestation is common.

Patient Education

  • Inform families that dogs and cats do not harbor E vermicularis.
  • Inform families that infestation may occur in spite of proper child and household hygiene.
  • Counsel families to avoid overreaction through aggressive sanitary measures. Because infectious eggs may be in bedclothes and dust and remain infectious for 20 days, wet-mopping floors or vacuuming carpets and washing bedclothes are prudent precautions.
  • Reassuring families that pinworms are not a sexually transmitted disease and are not evidence of child abuse may be helpful.
  • Keeping the patient's fingernails trimmed to prevent excoriations is helpful.
  • Avoid scratching the area and nail biting because this is a cause of autoinfection.
  • Encourage the patient to bathe in the morning, this significantly reduces the number of eggs.
  • Children may return to school once they have received a dose of medication, bathed, and have nails trimmed.
  • Bed linens should be washed in hot, soapy water.

Miscellaneous

Medicolegal Pitfalls

  • Pinworms are rarely invasive. Attributing elevated serum immunoglobulin E (IgE) levels or eosinophilia to pinworms is unwise.
 


More on Enterobiasis

Overview: Enterobiasis
Differential Diagnoses & Workup: Enterobiasis
Treatment & Medication: Enterobiasis
Follow-up: Enterobiasis
Multimedia: Enterobiasis
References
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References

  1. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Vaginitis. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2006 May. 12 p. (ACOG practice bulletin; no. 72). [Full Text].

  2. Snow M. Pinning down pinworms. Nursing. May 2006;36(5):17. [Medline].

  3. Singh SP, Panda C, Rout N, Mishra AP. Anal Albendazole application for pruritus ani in threadworm infestation. J Trop Pediatr. Dec 2005;51(6):386. [Medline].

  4. Wen LY, Yan XL, Sun FH, Fang YY, Yang MJ, Lou LJ. A randomized, double-blind, multicenter clinical trial on the efficacy of ivermectin against intestinal nematode infections in China. Acta Trop. Jun 2008;106(3):190-4. [Medline].

  5. Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health. Jan 2007;38(1):20-3. [Medline].

  6. Sodergren MH, Jethwa P, Wilkinson S, Kerwat R. Presenting features of Enterobius vermicularis in the vermiform appendix. Scand J Gastroenterol. 2009;44(4):457-61. [Medline].

  7. Arca MJ, Gates RL, Groner JI, Hammond S, Caniano DA. Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature. Pediatr Surg Int. May 2004;20(5):372-5. [Medline].

  8. Samkari A, Kiska DL, Riddell SW, et al. Dipylidium caninum mimicking recurrent enterobius vermicularis (pinworm) infection. Clin Pediatr (Phila). May 2008;47(4):397-9. [Medline].

  9. American Academy of Pediatrics. Pinworm Infection (Enterobius vermicularis). Report of the committee on infectious disease. 2009;519-20.

  10. Hoekelman RA. Pinworm Infestation. In: Merck Manual of Diagnosis and Therapy. 15th ed. 1987.

  11. Kucik CJ, MartinGL, Sortor BV. Common Intestinal Parasites. Am Fam Physician. Mar 2004;69(5):11621-8.

  12. Lormans JA, Wesel AJ, Vanprus OF. Mebendazole in enterobiasis. A clinical trial in mental retardates. Chemotherapy. 1975;21:255.

  13. Otu-Bassey IB, Ejezie GC, Epoke J, Useh. Enterobiasis and its relationship with anal itching and enuresis among school-age children in Calabar, Nigeria. Ann Trop Med Parasitol. Sep 2005;99(6):611-6.

  14. Song HJ, Cho CH, Kim JS, et al. Prevalence and risk factors for enterobiasis among preschool children in a metropolitan city in Korea. Parasitol Res. Sep 2003;91(1):46-50. [Medline].

  15. Symmers WS. Pathology of oxyuriasis; with special reference to granulomas due to the presence of Oxyuris vermicularis (Enterobius vermicularis) and its ova in the tissues. AMA Arch Pathol. Oct 1950;50(4):475-516. [Medline].

  16. Weller TH, Sorenson CW. Enterobiasis: Its incidence and symptomatology in a group of 505 children. NEJM. 1941;224:143.

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Further Reading

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Keywords

enterobiasis, pinworms, oxyuriasis, human pinworm, pinworm infection, pruritus ani, pruritus vulvae, vaginitis, enuresis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Wayne Wolfram, MD, MPH, 
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer L Curry, DO, Resident Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center
Jennifer L Curry, DO is a member of the following medical societies: American College of Emergency Physicians, American Osteopathic Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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