Approach Considerations
Anthelmintics, such as mebendazole, pyrantel pamoate, and albendazole, are active against Enterobius vermicularis. Itching, irritation, and excoriation should be treated symptomatically. Reinfection with E vermicularis immediately after the completion of drug therapy is common. Additionally, young pinworms may be resistant to drugs. [12] Successful eradication of pinworm infection, also called enterobiasis, requires two doses of medication - an initial dose followed by a subsequent dose 2 weeks later. [1, 2, 13]
All family members or classmates who are infected must be treated simultaneously. In addition, personal and group hygiene must be improved, individuals must wash their hands before eating, and children should be discouraged from activities such as finger-sucking. [2]
If large numbers of children attending the same school test positive for pinworm eggs, all classmates and family members of the children who are infected should be treated 2 times at 2-week intervals. If less than 30% of class members test positive for pinworm eggs, treating only the children who have positive test results reduces the positive rate for eggs in that class. Follow-up is recommended if the pinworm symptoms persist longer than 2 weeks or if signs of bacterial superinfection occur. [1, 2]
If a general physician is unsure how to care for persons with pinworm infection, a parasitologist should be consulted. If no parasitologist is available, a pediatrician or infectious disease specialist should be consulted instead.
Long-Term Monitoring
Patients with pinworm infection must undergo follow-up examination to evaluate for reinfection after anthelmintic treatment is completed.
Although the first single examination may be negative for Enterobius eggs, a follow-up perianal swab is necessary if perianal itching or prickling pain persists.
Deterrence/Prevention
To prevent reinfection, patient and family hygiene must be improved, and individuals must be certain to wash their hands before eating. At-risk individuals should bathe upon waking to help reduce the possibility of egg contamination. Children should be discouraged from activities such as sucking their fingers and scratching bare anal areas. [1, 2]
The entire household should be treated simultaneously. Treatment is much more effective if the child's family and classmates are treated at the same time. Washing sheets, clothes, and towels in a washing machine using regular laundry soap can eliminate pinworm eggs. [1]
For clinicians treating infected patients, strict handwashing is required after contact with the patient, patient’s clothing, and stretcher. All bedding and gowns should be cleaned. In addition, stretchers should be washed before further patient use.
Prevention
Because pinworm eggs may become airborne, it is difficult to prevent the infection if it occurs in a group such as kindergartens, primary schools, and orphanages. Furthermore, the family members can be infected easily if any one member is infected. Thefore, treatment of the group or family is necessary for the prevention of further transmission. Personal hygiene, including hand-washing after the defecation and before meals is the best personal preventive method. Frequent cleaning of the space is the best way to prevent the transmission of E vermicularis egg in a group environment. [1]
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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.
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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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Pinworms in a young patient.
