What is Enterobius Vermicularis (Pinworms)?
Pinworm, also known scientifically as Enterobius vermicularis, is one of the most common worm infections globally. Humans are the only creatures that can get this infection. It often spreads in crowded places and tends to circulate within families. Pinworms are small, thread-like white worms, named after the ‘pin-like’ tail the female worms have on their back ends.
This pinworm infection mainly affects children and spreads through direct contact with items contaminated with pinworms or even through sexual contact. Most of the time, people with this infection don’t show any symptoms. Although the possibility of curing this infection is high, it is common for the infection to come back.
What Causes Enterobius Vermicularis (Pinworms)?
Pinworm infections are most common in children, but anyone can get them. People living in tropical climates and children of school age are at the highest risk. A person gets a pinworm infection by swallowing pinworm eggs. These eggs are often spread by direct contact with feces, such as when a child who has pinworms doesn’t wash their hands properly.
Things that can increase your chances of getting pinworms include not keeping clean, touching things that have pinworm eggs on them and then touching your mouth, or living with someone who already has pinworms.
Risk Factors and Frequency for Enterobius Vermicularis (Pinworms)
The infection tends to affect males twice as often as females. However, interestingly, girls aged between 5 and 14 years are more prone to the infection than their male counterparts. The infection is most common in children under 18 years old and adults who are in close contact with children or those living in institutions. Statistics from the Center for Disease Control and Prevention suggest that about 40 million people in the United States have been infected.
The infection usually spreads through contact with objects like clothes, bedding, personal hygiene products, and furniture that have been contaminated. The most frequent way it spreads is the fecal-oral route, meaning people accidentally swallow the eggs after they’ve touched something that’s contaminated. Another less common way the infection can spread is when someone inhales airborne eggs and then swallows them.
Signs and Symptoms of Enterobius Vermicularis (Pinworms)
Pinworm infestation, caused by Enterobius vermicularis, does not always cause symptoms – about a third of patients don’t have any. However, those who do develop symptoms often experience an uncomfortable itching around the anus. This itching can lead to redness due to constant scratching and, in some cases, even a minor skin infection that causes warmth and more redness. Intense itching can interfere with sleep, sometimes causing insomnia. Some women with pinworms can get genitourinary infections, based on some medical reports. A few patients may also suffer from watery diarrhea. In more serious cases, pinworms can block the appendix or lead to inflammation around it, causing abdominal pain and potentially leading to appendicitis. In some instances, tiny thread-like worms may even be visible to the naked eye in the area around the anus.
Testing for Enterobius Vermicularis (Pinworms)
Doctors can determine if you have an infection from Enterobius (more commonly known as pinworms) through a simple and non-invasive test. This test, called a cellophane tape or pinworm paddle test, involves using a type of sticky tape on the skin around the anus. This tape is then looked at under a microscope to check for pinworm eggs or the worms themselves.
The eggs are small, about 50 by 30 microns in size (much smaller than a millimeter), and they have a flat surface on one side. Female worms themselves are about 8 to 13 millimeters long, while male worms are 2 to 5 millimeters long.
The best time for this test is in the morning, as this is when the chances of finding pinworms or their eggs are highest. If no eggs or worms are found for five mornings in a row, it’s safe to say that you don’t have a pinworm infection.
Just so you know, testing your stool isn’t very helpful in diagnosing pinworms, as they aren’t usually present in the stool. However, your doctor might still recommend a stool sample to rule out other possible causes of your symptoms.
Treatment Options for Enterobius Vermicularis (Pinworms)
Treatment of Enterobiasis, a common type of worm infection, often includes the use of specific medications that kill worms. Some common medications are albendazole, mebendazole, and pyrantel pamoate. It’s worth mentioning that pyrantel pamoate can be bought over the counter in the United States.
There are other medications like ivermectin and piperazine that can treat enterobiasis as well, although they can be less effective and might cause more side effects.
Worm infections can easily spread amongst people living in the same household, hence it is often recommended for everyone in the house, whether they have symptoms or not, to undergo treatment. This helps to avoid a recurring cycle of the infection.
When it comes to treating pregnant patients with the infection, the medication should be used only if the person has significant symptoms. Pyrantel pamoate is the preferred choice in these cases, when compared to other medicines.
It’s also important to know that young pinworms are often resistant to treatment. Therefore, two doses of medication, given two weeks apart, are usually recommended. In situations where a child is infected, it is advisable to treat all family members. If several children in a class are infected, then all should be treated twice, with a two-week interval between treatments. Follow-up checks are essential to confirm if the infection has been fully treated.
What else can Enterobius Vermicularis (Pinworms) be?
Doctors often have to rule out a number of health conditions when making an accurate diagnosis. In the case of certain skin conditions, the following might be considered:
- Pruritus ani (anal itching)
- Pruritus vulvae (vaginal itching)
- Atopic dermatitis (commonly known as eczema)
- Perirectal abscess (an abscess near or in the rectum)
- Cellulitis (a skin infection)
What to expect with Enterobius Vermicularis (Pinworms)
The outcome is generally very good after having a pinworm infection. After treatment, it’s important for patients to see their doctors to check if the infection has fully gone away. If symptoms come back, they will need to be tested and treated again.
There have been reports of pinworm infections happening in various parts of the body other than the intestines, such as the vagina, groin area, genitals, the lining of the abdomen (peritoneum), liver, mouth, lungs, and lower abdomen (pelvis). There have even been cases where pinworms have caused appendicitis by blocking the appendix. Death from pinworm infections is exceedingly rare, but getting re-infected is a common occurrence.
Getting rid of pinworms from places like schools or homes is quite a challenge and needs ongoing monitoring. For thorough treatment, everyone in an affected classroom or household needs to be treated.
Possible Complications When Diagnosed with Enterobius Vermicularis (Pinworms)
In some instances, rigorous scratching caused by intense itching around the anus can result in a minor bacterial infection. Other reported complications include infections in the female reproductive and urinary systems, such as inflammation of the vulva and vagina, and bladder infections, particularly in young girls. Long-term pinworm infestation has also been linked to inflammation of the appendix.
These complications might include:
- Surface bacterial infection due to severe itching around the anus
- Female genital and urinary tract infections, e.g., inflammation of the vulva and vagina and bladder infections
- Inflammation of the appendix due to long-term pinworm infestation
Preventing Enterobius Vermicularis (Pinworms)
It’s important for patients to understand the significance of keeping themselves clean and washing their hands regularly. This practice is crucial in preventing the spread of germs or diseases, as well as avoiding getting infected again after treatment.
