ABSTRACT
Enterobius vermicularis is the most common helminthic infection in the United States, infecting an estimated 40 million persons. A rare complication of E. vermicularis infestation is appendicitis. The diagnosis must be considered during pathologic examination to ensure appropriate treatment with anti-helminthic therapy.
Subject(s)
Appendicitis , Appendix , Enterobiasis , Animals , Humans , Enterobius , Appendicitis/diagnosis , Appendicitis/complications , Appendectomy , Enterobiasis/complications , Enterobiasis/diagnosis , Enterobiasis/drug therapyABSTRACT
BACKGROUND: Intestinal parasitic infections are common in humans, especially among young children. These conditions are often asymptomatic and self-limiting, and diagnosis is mainly based on the search for ova and parasites in the stools since serology may be biased due to cross reactivity between parasites. Pinworm is common in children and is not usually associated with hypereosinophilia; adhesive-tape test is the gold standard testing for the microscopic detection of Enterobious vermicularis (Ev) eggs. CASE PRESENTATION: A 13-year-old boy was referred due to a self-resolving episode of vomiting and palpebral oedema after dinner, together with a history of chronic rhinitis, chronic cough, absolute IgA deficiency and Hashimoto's thyroiditis and hypereosinophilia (higher value = 3140/µl). On evaluation we detected only palpable thyroid and hypertrophic nasal turbinates. Food allergy was excluded, but skin prick tests showed sensitization to house dust mites and cat epithelium and spirometry showed a marked obstructive pattern with positive bronchodilation test prompting the diagnosis of asthma for which maintenance inhaled treatment was started. Chest x-ray and abdomen ultrasound were negative. Further blood testing showed positive IgG anti-Echinococcus spp. and Strongyloides stercoralis and positive IgE for Ascaris, while Ev were detected both by the adhesive tape test and stool examination, so that we made a final diagnosis of pinworm infection. Three months after adequate treatment with pyrantel pamoate the adhesive-tape test turned out negative and blood testing showed a normal eosinophil count. The child later developed also type 1 diabetes. CONCLUSIONS: We suggest the need to investigate for enterobiasis in children with hypereosinophilia and to consider autoimmunity as a potential confounding factor when interpreting serology for helminths.
Subject(s)
Asthma , Enterobiasis , Eosinophilia , Parasites , Male , Animals , Humans , Child , Child, Preschool , Adolescent , Enterobius , Enterobiasis/complications , Enterobiasis/diagnosis , Enterobiasis/drug therapy , Eosinophilia/etiology , Eosinophilia/complications , Asthma/complicationsABSTRACT
Enterobius vermicularis, also known as pinworm, is a helminth that commonly causes intestinal parasitic infestation. E. vermicularis can also cause extraintestinal infestations. We report a case of lower abdominal pain and intermittent vaginal bleeding in a 45-year-old woman who was referred to our gynaecology department. On investigation, a transvaginal ultrasound showed a multilocular cyst in the left ovary, along with elevated levels of cancer antigen 125. Consequently, a laparoscopic salpingo-oophorectomy was performed. A biopsy of atypical peritoneal lesions revealed remains of E. vermicularis Peritoneal lesions are a rare complication of enterobiasis, and the diagnosis of this complication is usually delayed by limitations in diagnostic options. Although extraintestinal enterobiasis does not require treatment because it is the last stage of the parasitic cycle, primary intestinal infestation requires treatment with mebendazole.
Subject(s)
Enterobiasis , Intestinal Diseases, Parasitic , Ovarian Neoplasms , Peritoneal Diseases , Animals , Enterobiasis/diagnosis , Enterobiasis/drug therapy , Enterobius , Female , Humans , Middle AgedSubject(s)
Colonoscopy/methods , Enterobiasis/diagnosis , Eosinophilia/blood , Feces/parasitology , Animals , Antinematodal Agents/therapeutic use , Enterobiasis/drug therapy , Enterobiasis/immunology , Enterobiasis/parasitology , Enterobius/isolation & purification , Eosinophilia/etiology , Humans , Male , Mebendazole/therapeutic use , Middle Aged , Occult BloodABSTRACT
The report presents a case with Enterobius vermicularis infections in Guiyang City, Guizhou Province, aiming to strengthen the attention to parasitic infections.
Subject(s)
Enterobiasis , Animals , China , Cities , Enterobiasis/diagnosis , Enterobiasis/drug therapy , Enterobiasis/parasitology , Enterobius , Humans , PrevalenceSubject(s)
Albendazole/therapeutic use , Anthelmintics/therapeutic use , Enterobiasis/diagnosis , Enterobius/isolation & purification , Granulation Tissue/parasitology , Ivermectin/therapeutic use , Adult , Animals , Emperipolesis , Enterobiasis/drug therapy , Enterobiasis/parasitology , Enterobiasis/pathology , Female , Granulation Tissue/pathology , Humans , Larva , Lymphocytes/pathology , Macrophages/physiology , Neutrophils/physiology , Plasma Cells/physiology , Rectum/parasitology , Rectum/pathology , Treatment OutcomeABSTRACT
The efficacy of pyrantel pamoate, pyrvinium pamoate, ivermectin, and piperazine citrate against pinworm in cockroach was evaluated. Laboratory-reared German cockroaches naturally infected with Blatticola blattae were treated with the anthelmintics and necropsied at 3 to 35 days after treatment. Ivermectin at over 5 ppm and piperazine citrate at over 2000 ppm killed all the treated cockroaches. Pinworms were still detected in cockroaches given lower concentration of the aforementioned drugs. Administration of pyrantel pamoate (100-1000 ppm) and pyrvinium pamoate (2000 ppm) did not kill the cockroaches, and no pinworms were detected at 3 and 17 days after treatment. Thus, pyrantel pamoate and pyrvinium pamoate were found to be effective for deworming B. blattae in the German cockroaches, without causing mortality for the host. Our results showed that anthelmintics selection is essential for eradication of pinworms in cockroaches because of the toxicity for the host such as ivermectin or piperazine citrate. This is the first report of piperazine citrate toxicity in cockroaches.
Subject(s)
Anthelmintics/pharmacology , Cockroaches/parasitology , Enterobiasis/parasitology , Enterobius/drug effects , Animals , Drug Evaluation, Preclinical , Enterobiasis/drug therapy , Enterobius/physiology , Humans , Ivermectin/pharmacology , Piperazines/pharmacology , Pyrantel Pamoate/pharmacologyABSTRACT
Genital tract bleeding in prepubertal girls is a rare clinical condition, which can occur for multiple reasons. It frequently generates anxiety in the family and in health care professionals. A thorough anamnesis and careful genital inspection can give important diagnostic hints; however, there are cases in which the cause remains doubtful and a complete gynecological evaluation (including cultures and vaginoscopy) is necessary. Therefore, the attending physician should always consider less frequent diagnoses in order to perform the necessary studies in a sequential and rational manner. We present the case of a preschool girl with vaginal bleeding due to pinworm endometritis, which, to our knowledge, has never been reported before as a cause of genital bleeding in prepubertal girls.
Subject(s)
Endometritis/diagnosis , Enterobiasis/diagnosis , Enterobius/isolation & purification , Uterine Hemorrhage/etiology , Albendazole/administration & dosage , Animals , Anthelmintics/administration & dosage , Child, Preschool , Endometritis/complications , Enterobiasis/drug therapy , Female , Gynecological Examination , Humans , Laparoscopy/adverse effects , Uterine Hemorrhage/diagnostic imagingABSTRACT
Enterobiasis is the most common parasite infestation in children; it is often asymptomatic and may rarely be a cause of skin eruption. We present the case of a 7-year-old boy with sudden onset of pruritic erythemato-squamous confluent papules and plaques on UV-exposed skin, caused by proven enterobiasis. To our understanding, this is the first case of photodermatosis-like dermatitis caused by enterobiasis reported in the literature.
Subject(s)
Enterobiasis , Skin Diseases, Parasitic , Child , Enterobiasis/diagnosis , Enterobiasis/drug therapy , Humans , Male , Skin/radiation effects , Skin Diseases, Parasitic/diagnosis , Skin Diseases, Parasitic/drug therapy , Ultraviolet RaysABSTRACT
BACKGROUND: Symptomatic infection with pinworm (Enterobius vermicularis), a human pathogen, is clinically relevant in Germany, with an estimated prevalence in childhood of 2-20%. Enterobiasis can cause major mental distress. There is little systematically verified knowledge on the treatment of this condition, and there is no corresponding German guideline. This review is, therefore, intended as a summary of the current state of knowledge. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed for literature appearing from 1 January 1990 to 5 February 2019 and containing the search terms "enterobiasis," "oxyuriasis," "Enterobius vermicula- ris," "pinworm," and "threadworm." RESULTS: More than one billion people worldwide are thought to be infected with pinworm. Estimates of its prevalence among kindergarten and primary-school pupils in Europe are generally near 20%. Infants (<2 years of age), adolescents (>14 years of age), and adults are only sporadically affected. The main risk factors are age 4-11 years, uncontrolled anus-finger-mouth contact, nail-biting (onychophagia/peri- onychophagia), unsupervised body hygiene, and poor compliance with basic hand hygiene. No large-scale, randomized, controlled trials of treatment are available. The approved antihelminthic agents are mebendazole, pyrantel embonate, and pyrvinium embonate (success rates up to >90%). For recurrent infections, prolonged treatment for up to 16 weeks (a "pulse scheme") is recommended. CONCLUSION: In nearly all cases, antihelminthic treatment along with attention to hygienic measures can successfully eradicate pinworm infection and prevent recurrence and autoinfection. The involvement of all persons living in the patient's house- hold, including sexual partners, is a prerequisite to the lasting success of treatment.
Subject(s)
Enterobiasis , Adolescent , Animals , Child , Child, Preschool , Enterobiasis/diagnosis , Enterobiasis/drug therapy , Enterobius , Europe , Germany , Humans , Hygiene , InfantSubject(s)
Enterobiasis/complications , Enterobius/isolation & purification , Sweet Syndrome/etiology , Animals , Anthelmintics/therapeutic use , Biopsy , Colon/diagnostic imaging , Colon/parasitology , Colonoscopy , Drug Therapy, Combination , Enterobiasis/diagnostic imaging , Enterobiasis/drug therapy , Enterobiasis/parasitology , Female , Glucocorticoids/therapeutic use , Humans , Middle Aged , Skin/pathology , Sweet Syndrome/diagnosis , Sweet Syndrome/drug therapy , Sweet Syndrome/pathology , Treatment OutcomeABSTRACT
Enterobius vermicularis, the common pinworm, is well known in North America as a parasitic infection, mainly affecting children. It is a very contagious organism, and it is responsible for a high number of infections in the United States each year. A rise in eosinophilia is linked to most parasitic infections. However, the correlation between eosinophilia and enterobiasis infections is not well documented in the literature. In this article, we present 3 cases involving patients seen for pediatric gastroenterology consultation with concern for inflammatory bowel disease. As part of their evaluation, each patient was found to have eosinophilia of unknown significance with an ultimate diagnosis of pinworm infections made by endoscopy. Their illness presentation did not include classic enterobiasis symptoms such as rectal pruritus or nighttime irritability. These cases support a link between eosinophilia and enterobiasis that may be instructive for pediatric providers seeing patients with eosinophilia for which there is no readily apparent underlying cause.
Subject(s)
Enterobiasis/complications , Enterobius , Eosinophilia/parasitology , Adolescent , Albendazole/therapeutic use , Animals , Anthelmintics/therapeutic use , Child , Enterobiasis/diagnosis , Enterobiasis/drug therapy , Female , Humans , MaleSubject(s)
Enterobiasis/diagnosis , Enterobius/isolation & purification , Strongyloidiasis/diagnosis , Animals , Anthelmintics/therapeutic use , Colon/parasitology , Colon/pathology , Enterobiasis/drug therapy , Enterobiasis/parasitology , Enterobiasis/pathology , Feces/parasitology , Female , Humans , Middle Aged , Strongyloidiasis/drug therapy , Strongyloidiasis/parasitology , Strongyloidiasis/pathology , Treatment OutcomeABSTRACT
Enterobiasis is an easily recognizable and treatable disease with higher incidence among children. Based on these facts, its clinical importance is usually underestimated. This infection also occurs during adulthood and without treatment, it can cause severe complications in some rare cases. Unnoticed subclinical infection in women can lead to infertility and even to life-threatening conditions. It is also emphasized in this paper that the treatment of identified enterobiasis during pregnancy needs caution. After reviewing the current scientific literature, two gynecological cases are presented here.
Subject(s)
Enterobiasis/complications , Enterobiasis/epidemiology , Enterobius/isolation & purification , Infertility, Female/epidemiology , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/epidemiology , Animals , Anthelmintics/therapeutic use , Enterobiasis/drug therapy , Fallopian Tubes/parasitology , Fallopian Tubes/pathology , Female , Histocytochemistry , Humans , Incidence , Infertility, Female/etiology , Mebendazole/therapeutic use , Microscopy , PregnancyABSTRACT
Subacute cutaneous lupus erythematosus is a clinically distinct form of cutaneous lupus erythematosus, with age of onset typically in the second to fifth decades. Eleven cases have been reported in childhood, and we present the first known case of subacute cutaneous lupus erythematosus in identical twins. Although flares are typically photo-induced, we present an annular eruption typical of subacute cutaneous lupus erythematosus with concurrent pinworm infestation, with recurrence of disease with cutaneous larva migrans. The patient's identical twin had a similar eruption with pinworm infection. This case highlights the possibility of parasitic infestation as a trigger for subacute cutaneous lupus erythematosus in genetically susceptible individuals.
Subject(s)
Enterobiasis/complications , Lupus Erythematosus, Cutaneous/diagnosis , Administration, Topical , Anthelmintics/therapeutic use , Child , Enterobiasis/drug therapy , Glucocorticoids/therapeutic use , Humans , Lupus Erythematosus, Cutaneous/drug therapy , Lupus Erythematosus, Cutaneous/etiology , Male , Skin/pathology , Twins, MonozygoticABSTRACT
Acute appendicitis is the most common surgical emergency worldwide. However, it can still present a challenging diagnosis especially in the young, elderly and those individuals of reproductive age, thus encompassing a wide spectrum of varied clinical presentations. Parasitic infections of the appendix are a rare cause of acute appendicitis. However, they must be considered in children presenting with abdominal pain. We report a case of Enterobius vermicularis infestation mimicking the features of acute appendicitis in a 10-year-old girl. This case is a cautionary reminder of the importance of considering E. vermicularis infestation in children presenting with abdominal pain, but who do not have a significantly raised white cell count or high Alvarado scores. A history of anal pruritus is the most characteristic symptom, but the parasites can cause severe abdominal pain mimicking appendicitis. Prompt recognition and a high clinical index of suspicion are required to prevent an unnecessary appendicectomy. Caution is advised when performing a laparoscopic appendectomy, as in our case, to prevent contamination of the peritoneum. This infestation is easily treatable with mebendazole.
Subject(s)
Appendicitis/parasitology , Enterobiasis/complications , Acute Disease , Animals , Antinematodal Agents/therapeutic use , Appendectomy/adverse effects , Appendicitis/drug therapy , Appendix/parasitology , Child , Enterobiasis/drug therapy , Enterobius , Female , Humans , Mebendazole/therapeutic useABSTRACT
BACKGROUND: Previous studies on the association of enterobiasis and chronic inflammatory diseases have revealed contradictory results. The interaction of Enterobius vermicularis infection in particular with gut microbiota and induced immune responses has never been thoroughly examined. METHODOLOGY/FINDINGS: In order to answer the question of whether exposure to pinworm and mebendazole can shift the intestinal microbial composition and immune responses, we recruited 109 (30 pinworm-negative, 79 pinworm-infected) first and fourth grade primary school children in Taichung, Taiwan, for a gut microbiome study and an intestinal cytokine and SIgA analysis. In the pinworm-infected individuals, fecal samples were collected again at 2 weeks after administration of 100 mg mebendazole. Gut microbiota diversity increased after Enterobius infection, and it peaked after administration of mebendazole. At the phylum level, pinworm infection and mebendazole deworming were associated with a decreased relative abundance of Fusobacteria and an increased proportion of Actinobacteria. At the genus level, the relative abundance of the probiotic Bifidobacterium increased after enterobiasis and mebendazole treatment. The intestinal SIgA level was found to be lower in the pinworm-infected group, and was elevated in half of the mebendazole-treated group. A higher proportion of pre-treatment Salmonella spp. was associated with a non-increase in SIgA after mebendazole deworming treatment. CONCLUSIONS/SIGNIFICANCE: Childhood exposure to pinworm plus mebendazole is associated with increased bacterial diversity, an increased abundance of Actinobacteria including the probiotic Bifidobacterium, and a decreased proportion of Fusobacteria. The gut SIgA level was lower in the pinworm-infected group, and was increased in half of the individuals after mebendazole deworming treatment.
Subject(s)
Cytokines/immunology , Enterobiasis/drug therapy , Enterobiasis/immunology , Enterobius/drug effects , Gastrointestinal Microbiome/drug effects , Mebendazole/therapeutic use , Animals , Bifidobacterium/drug effects , Bifidobacterium/genetics , Bifidobacterium/growth & development , Bifidobacterium/isolation & purification , Child , Child, Preschool , Computational Biology , Cytokines/biosynthesis , Enterobiasis/microbiology , Enterobiasis/parasitology , Enterobius/genetics , Enterobius/immunology , Feces/parasitology , Female , Fusobacteria/drug effects , Fusobacteria/genetics , Fusobacteria/growth & development , Fusobacteria/isolation & purification , Gastrointestinal Microbiome/genetics , Humans , Immunity/drug effects , Immunoglobulin A, Secretory/analysis , Immunoglobulin A, Secretory/immunology , Intestines/drug effects , Intestines/immunology , Intestines/microbiology , Intestines/parasitology , Male , Mebendazole/administration & dosage , Salmonella/drug effects , Salmonella/genetics , Salmonella/growth & development , Salmonella/isolation & purification , Taiwan/epidemiologySubject(s)
Appendix/parasitology , Enterobiasis/diagnosis , Enterobius/isolation & purification , Albendazole/therapeutic use , Animals , Anthelmintics/therapeutic use , Appendectomy/methods , Appendix/surgery , Child , Endoscopy, Gastrointestinal/methods , Enterobiasis/complications , Enterobiasis/drug therapy , Enterobius/drug effects , Female , HumansABSTRACT
Drug resistance in equine gastro-intestinal parasitic nematodes has been reported throughout the world. While the focus is usually put on cyathostomins, observations of macrocylic lactone failure against Oxyuris equi have accumulated over the last decade. Here we report the failure of ivermectin in the control of O. equi in an experimental Welsh pony herd. In a first trial, 6 ponies previously drenched with moxidectin and showing patent O. equi infections were administered ivermectin and subsequently monitored for O. equi egg excretion over one month. This trial demonstrated a failure of ivermectin to control O. equi egg excretion as half of ponies demonstrated recurrent egg excretion in the peri-anal region during 21days after treatment. One year later, six female Welsh ponies drenched with moxidectin demonstrated signs of itching and scratching in their peri-anal region with worms being found transiently in fecal materials three weeks later. Ponies were allocated to three treatment groups, i.e. ivermectin, pyrantel embonate and fenbendazole and monitored for egg excretion over five weeks. Fenbendazole and pyrantel embonate broke ivermectin suboptimal efficacy as soon as 8 and 14days respectively after treatment, while egg excretion remained constant throughout the 41-day long trial in the ivermectin-treated ponies. This is the first report of ivermectin failure against O. equi in France. In the absence of critical efficacy test, it remains unclear whether true resistance is at stake or if these observations confound a constitutive suboptimal efficacy of ivermectin against O. equi.