History and Physical Examination

The patient history of pinworm infection, also called enterobiasis, includes itching or prickling pain in the anal area (usually at nighttime or in the early morning), intense anal itching, restless sleep or difficulty sleeping, and, rarely, abdominal discomfort or loss of appetite.^[8]Other symptoms include irritability and, in females, vaginal itching. Most patients, however, are asymptomatic.^{[1, 2]}

Although a hospital-based study of children aged 2-12 years found that perianal itching was not significantly more common in children who are infected than in children who are uninfected, persons who are Enterobius egg–positive typically visit a physician because of perianal itching.^{[1, 2]}

The pale-colored female pinworm (10 mm) may be seen in the perianal region with the naked eye. The worm's appearance is easily confused with bits of cotton thread. Eggs (30 μm X 50-60 μm) usually are not seen without a microscope. Perianal excoriations secondary to scratching may be found.^{[1, 2]}

Differential Diagnoses

Rawla P, Sharma S. Enterobius Vermicularis. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
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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.
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Erian M, McLaren G. Unexpected causes of gynecological pelvic pain. JSLS. 2004 Oct-Dec. 8(4):380-3. [QxMD MEDLINE Link]. [Full Text].
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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. [QxMD MEDLINE Link].
Cho SY, Kang SY. Significance of scotch-tape anal swab technique in diagnosis of Enterobius vermicularis infection. Kisaengchunghak Chapchi. December 1975. 13:102-14. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
CDC. Parasites - Enterobiasis (also known as Pinworm Infection). Available at https://www.cdc.gov/parasites/pinworm/treatment.html. August 30, 2016; Accessed: August 14, 2017.
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. [QxMD MEDLINE Link].

Media Gallery

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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Author

Sun Huh, MD, PhD Chairman, Professor, Department of Parasitology, College of Medicine, Hallym University, Republic of 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; Fellow of the Royal College of Physicians, London

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

Disclosure: Nothing to disclose.

Additional Contributors

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

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