History

Patients with enterobiasis are often asymptomatic. Worms may be incidentally discovered when they are seen in the perineal region.

If patients are symptomatic, pruritus ani and pruritus vulvae are common presenting symptoms.

Restlessness during sleep is noted by the parents of many patients.

Enuresis may be a symptom in children with pinworms.

Physical Examination

Patients often have excoriation or erythema of the perineum, vulvae, or both, but infestation can occur without these signs.

Visual sighting of a worm by a reliable source (eg, a parent) is usually accepted as evidence of infestation and grounds for treatment.

Worms can be found in stools or on the patient's perineum before bathing in the morning.

Occasionally, the gravid female worm may aberrantly migrate into the female genitalia and produce vaginitis.^[13] Incidental recovery at necropsy or surgery of small granulomatous lesions surrounding the worm, larvae, or eggs in the salpinx and peritoneum demonstrates the worm's ability to ascend the female genital tract.

Abdominal pain may sometimes be severe and can mimic acute appendicitis.^[14]

Differential Diagnoses

Centers for Disease Control and Prevention. Enterobiasis (also known as Pinworm Infection). Available at https://www.cdc.gov/parasites/pinworm/index.html. 2020 Sep 28; Accessed: November 23, 2021.
Singh SP, Panda C, Rout N, Mishra AP. Anal Albendazole application for pruritus ani in threadworm infestation. J Trop Pediatr. 2005 Dec. 51(6):386. [QxMD MEDLINE Link].
Salim N, Schindler T, Abdul U, Rothen J, Genton B, Lweno O, et al. Enterobiasis and strongyloidiasis and associated co-infections and morbidity markers in infants, preschool- and school-aged children from rural coastal Tanzania: a cross-sectional study. BMC Infect Dis. 2014 Dec 9. 14:644. [QxMD MEDLINE Link].
Fan CK, Chuang TW, Huang YC, et al. Enterobius vermicularis infection: prevalence and risk factors among preschool children in kindergarten in the capital area, Republic of the Marshall Islands. BMC Infect Dis. 2019 Jun 18. 19 (1):536. [QxMD MEDLINE Link]. [Full Text].
Song HJ, Cho CH, Kim JS, Choi MH, Hong ST. Prevalence and risk factors for enterobiasis among preschool children in a metropolitan city in Korea. Parasitol Res. 2003 Sep. 91(1):46-50. [QxMD MEDLINE Link].
Kim DH, Son HM, Kim JY, Cho MK, Park MK, Kang SY, et al. Parents' knowledge about enterobiasis might be one of the most important risk factors for enterobiasis in children. Korean J Parasitol. 2010 Jun. 48(2):121-6. [QxMD MEDLINE Link].
Fontanet AL, Sahlu T, Rinke de Wit T, et al. Epidemiology of infections with intestinal parasites and human immunodeficiency virus (HIV) among sugar-estate residents in Ethiopia. Ann Trop Med Parasitol. 2000 Apr. 94(3):269-78. [QxMD MEDLINE Link].
Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health. 2007 Jan. 38(1):20-3. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Vose L. Pinworm in pregnancy. J Midwifery Womens Health. 2012 Mar-Apr. 57(2):184-7. [QxMD MEDLINE Link].
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. 2004 May. 20(5):372-5. [QxMD MEDLINE Link].
Samkari A, Kiska DL, Riddell SW, et al. Dipylidium caninum mimicking recurrent enterobius vermicularis (pinworm) infection. Clin Pediatr (Phila). 2008 May. 47(4):397-9. [QxMD MEDLINE Link].
[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].
Ariyarathenam AV, Nachimuthu S, Tang TY, et al. Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review. Int J Surg. 2010. 8(6):466-9. [QxMD MEDLINE Link].
Snow M. Pinning down pinworms. Nursing. 2006 May. 36(5):17. [QxMD MEDLINE Link].
American Academy of Pediatrics. Pinworm Infection (Enterobius vermicularis). Report of the committee on infectious disease. 2015. 621-22.
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. 2008 Jun. 106(3):190-4. [QxMD MEDLINE Link].

Media Gallery

Because of the short incubation time until the ova are infectious, eggs that are deposited under the fingernails during scratching and then placed in the mouth may be a mode of reinfestation.
Pinworms in a young patient.

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Author

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Lukuman Olumide Afuwape, MD Resident Physician, Department of Emergency Medicine, Mercy St Vincent Medical Center

Lukuman Olumide Afuwape, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Steven Indra, DO Emergency Medicine Physician, Mercy Health System

Steven Indra, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Michael D Nissen, MBBS 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 is a member of the following medical societies: American Academy of Pediatrics, Royal College of Pathologists of Australasia, Royal Australasian College of Physicians, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Jennifer A Curry, MD, MPH Attending Physician, Infectious Disease Clinic, Naval Medical Center Portsmouth; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Jennifer A Curry, MD, MPH is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Sections Enterobiasis (Pinworm Infestation)
Overview
Presentation
DDx
Workup
Treatment
Medication
Media Gallery
References

Enterobiasis (Pinworm Infestation) Clinical Presentation

History

Physical Examination

References

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Contributor Information and Disclosures

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