Chapter 3Infectious Diseases Related To Travel
Pinworm (Enterobiasis, Oxyuriasis, Threadworm)
The intestinal nematode (roundworm) Enterobius vermicularis causes pinworm infection. Other helminth infections are discussed in the Helminths, Intestinal section earlier in this chapter.
MODE OF TRANSMISSION
Fecal-oral ingestion of the egg, direct person-to-person contact, or indirect contact via contaminated hands, dust, food, or objects (such as bedding, clothing, toys, bathwater, toilet seats) are modes of transmission. The incubation period from when the egg is ingested to when the adult worm migrates to the anus is 1–2 months, but may be longer. Eggs can remain infective indoors for 2–3 weeks. Humans are the only known natural host; animal pinworms do not infect humans.
Pinworm infection is found worldwide and is the most frequent worm infection in the United States. Infections cluster in households; are common in school-age and preschool-age children and their household members, caregivers, and playmates; and are common in child care and institutional care settings. Crowded living conditions facilitate transmission. People of all ages are at risk. Risk factors include the following:
- Poor hygiene (including failure to follow proper handwashing practices and poor toilet hygiene)
- Unsanitary or inadequate toilet facilities
- Crowded living conditions or living in same household as infected person
- Close day-to-day contact (living and working) with people, particularly institutionalized people or preschool- and school-age children
Although infections can be asymptomatic, common symptoms include nocturnal perianal and perineal pruritus and restless sleep. Urethritis, vaginitis, salpingitis, hepatitis, or peritonitis may occur if adult worms migrate from the perineum to other sites. Secondary bacterial infection of skin may occur from scratching.
Diagnosis is made by identifying the worm or its eggs by:
- Direct visualization of female adult worms near anus or on sheets or underclothing or pajamas at night, about 2–3 hours after patient falls asleep.
- Microscopic identification of worm eggs by using the “scotch tape test” on 3 consecutive mornings. The adhesive side of clear transparent—not translucent—cellophane tape is pressed to the skin around the anus when patient first awakens, before washing or bathing. The tape is then directly affixed to a microscope slide and examined under low power for eggs.
- Eosinophilia is unusual (because of absence of tissue invasion); serologic testing is not useful or widely available.
- Eggs and worms are rarely found in routine stool samples.
Administer an antihelminthic as a single oral dose; repeat in 2 weeks. Drugs of choice are mebendazole, albendazole, or pyrantel pamoate. Treat all household contacts and caretakers at the same time as the patient. Daily morning bathing removes a large proportion of eggs; change underclothing and bedding frequently and launder in hot water. Reinfection occurs easily; instruction about prevention is mandatory to eliminate continued infection and spread.
PREVENTIVE MEASURES FOR TRAVELERS
Strict observance of good hand hygiene is essential (proper handwashing; maintaining clean, short fingernails; avoiding or preventing nail biting and scratching the perianal and perineal region). Daily morning bathing, as well as careful handling and frequent changing and laundering of underclothing and bedding with hot water, can help reduce infection and prevent reinfection and environmental contamination with eggs.
- American Academy of Pediatrics. Pinworm infection (Enterobius vermicularis). In: Pickering LK, Baker CJ, Long SS, McMillan JA, editors. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006. p. 520–2.
- American Public Health Association. Enterobiasis. In: Heyman DL, editor. Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association; 2004. p. 194–6.
- Kucik CJ, Martin GL, Sortor BV. Common intestinal parasites. Am Fam Physician. 2004 Mar 1;69(5): 1161–8.
- Meinking TL, Burkhart CN, Burkhart CG. Changing paradigms in parasitic infections: common dermatological helminthic infections and cutaneous myiasis. Clin Dermatol. 2003 Sep–Oct;21(5):407–16.
- St Georgiev V. Chemotherapy of enterobiasis (oxyuriasis). Expert Opin Pharmacother. 2001 Feb;2(2):267–75.
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