Pinworms. Symptoms, Diagnosis And Treatment Methods

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Pinworms. Symptoms, Diagnosis And Treatment Methods
Pinworms. Symptoms, Diagnosis And Treatment Methods

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Pinworms. Symptoms, diagnosis and treatment Pinworms are a helminth disease that is widespread among children and adults. The causative agent of enterobiasis is pinworms, which are small white worms. A person can get enterobiasis at any age, since the susceptibility to invasion is universal, but the main "risk group" is, nevertheless, children of preschool and primary school age. It is clear that at this age, the child actively learns the world around him, communicates with peers, using common toys or household items. But bad habits multiply the risk of infection with worms: an increased interest in trying everything on the tongue, sucking fingers, biting nails, and also violating the rules of personal hygiene. Pinworms - pathogens of enterobiasis enter the human body only through the mouth, …

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Pinworms are a helminth disease that is widespread among children and adults. The causative agent of enterobiasis is pinworms, which are small white worms. A person can get enterobiasis at any age, since the susceptibility to invasion is universal, but the main "risk group" is, nevertheless, children of preschool and primary school age. It is clear that at this age, the child actively learns the world around him, communicates with peers, using common toys or household items. But bad habits multiply the risk of infection with worms: an increased interest in trying everything on the tongue, sucking fingers, biting nails, and also violating the rules of personal hygiene. Pinworms - the causative agents of enterobiasis enter the human body only through the mouth, and the source of the disease is only a person sick with enterobiasis.

The content of the article:

  • 1 Causes of enterobiasis
  • 2 Pathogenesis of the disease
  • 3 Pinworm close-up
  • 4 Way of transmission of pinworms
  • 5 Symptoms of Enterobiasis
  • 6 Complications of enterobiasis
  • 7 Diagnosis of pinworms
  • 8 Treatment of enterobiasis
  • 9 Additional treatment measures
  • 10 Hygiene measures

    10.1 What to do

The causes of enterobiasis

Pinworms
Pinworms

The causative agent of enterobiasis is the pinworm - Enterobius vermicularus (Linnaeus, 1758; Leach, 1853).

The name Enterobius comes from the Greek enteron - intestines and bios - life, vermicularis - reduced from Latin - a worm, a worm living in the intestine.

Pinworm is a small spindle-shaped nematode of white milk, the cuticle of which has a transverse striated.

The length of the adult female reaches 9-12 mm, of the male 3 - 5 mm, in the female the tail end is pointed, in the male it is blunt and hook-shaped. Sharp lateral keels, running along the length of the helminth's body, form head vesicles at the anterior end. The digestive system of the helminth is represented by the mouth opening, limited by three lips, a cylindrical esophagus with a bulbous expansion, passing into the intestine and ending in the anus in the back of the body.

The bulbus of the esophagus and vesicles form a suction apparatus, which provides fixation of adult helminths to the intestinal wall.

The female reproductive system consists of a paired ovary, the uterus, which passes into the vagina, and ends with the vulva. The vagina has muscle pulp, which in the anoxic environment of the human intestine is in a spasmodic state. Therefore, parasitic females, being in the intestinal lumen, do not emit eggs. The male reproductive system is represented by a testes, which ends in a long spicule.

Pinworms
Pinworms

Pinworm eggs have an oblong, somewhat asymmetrical shape, one side is flatter. Egg size - 50 - 60 x 20 - 30 microns. They are covered with a thin double-contour colorless smooth shell.

Adult helminths live in the lower part of the small intestine, in the cecum and in the upper part of the large intestine. As a rule, only females parasitize, males after copulation are excreted with feces. Helminths feed on the contents of the intestines and are facultative hematophages. The number of individuals parasitizing in the intestine varies widely from several tens to hundreds and thousands. K. I. Skryabin, V. P. Pod'yapolskaya and R. S. Shultz described a case when 2750 parasites were found in the intestines during an autopsy of a child's corpse. Intense invasions are associated with repeated self-infestations.

Human infection with enterobiasis occurs by swallowing mature pinworm eggs, which contain mobile larvae. Under the action of the digestive enzymes of the small intestine, the larvae are released from the eggs, descending into its lower sections, 2-3 molts pass. Here, the copulation process ends, and the males passively leave the intestines. And young female pinworms attach to the mucous membrane with the help of head vesicles and the suction action of the esophageal bulb. In the uterus of a fertilized female, eggs form and accumulate, the number of which reaches 5-17 thousand.

The stretched enlarged uterus compresses the esophageal bulb, displaces it, as a result of which the helminth loses its ability to adhere to the mucous membrane and, under the action of peristalsis, descends into the lower part of the large intestine. Further, during the active migration of the helminth in the rectum, the eggs in the uterus ripen to the stage of a tadpole-like larva.

Overcoming the resistance of the rectal sphincter, the female crawls out onto the perianal folds and the skin of the invaded perineum. The presence of oxygen in the air relaxes the genital tract of the helminth, as a result of which the crawling female secretes eggs, which reach invasiveness directly on the host's body. In the course of the movement of the female, heaps of eggs, 100 - 300 in each, remain on the skin of the infested.

Pinworms crawl out more often at night, when falling asleep and during sleep, when the muscles of the sphincter of the anus are somewhat weakened.

With significant moisture and untidiness around the anus, oviposition is delayed, and pinworms continue to wander, sometimes crawling along the perineum not only into the vagina, but even through the uterus and fallopian tubes into the pelvic cavity, where they were found encapsulated on the peritoneum.

Pathogenesis of the disease

The life cycle of the parasite directly depends on the sanitary conditions of a person's home, and his observance of the rules of personal hygiene. A person infected with pinworms poses a great danger to others, since only he is the source of infection. Dirty hands of an infected person can leave eggs of worms anywhere, both in public places and on money, food, school supplies, etc. In addition, flies are very often carriers of helminth eggs.

Stability in the external environment, especially in conditions with optimal temperature and humidity, allows pinworm eggs to retain active invasive properties for up to three weeks. But increased dryness and solar radiation have a detrimental effect on them. Currently, the effect of pinworm infestation on the human body has been widely studied.

  1. Mechanical effect on the mucous membrane of the human intestine underlies the pathogenesis of pinworm infestation. As a result of adhesion to the surface of the intestinal mucosa, as well as penetration into it more deeply, pinworms violate its integrity, which is dangerous by the addition of a secondary infection and the emergence of foci of inflammation. Often, pinworms are completely immersed in the thickness of the intestinal mucosa, while granulomas form around them, cases of peritonitis have been described, as a result of pinworms perforation (perforation) of the wall of the small intestine and their exit into the abdominal cavity. The mechanical effect of parasites irritates the intestinal receptors, which is the cause of reflex disturbances of the motor and secretory functions of the digestive tract with the subsequent development of enteritis, gastroduodenitis and other diseases.Pinworms disrupt the normal composition of the microbial flora of the human intestine, which inevitably leads to dysbiosis.
  2. Statistics indicate that often pinworms are the cause of appendicitis, introducing an intestinal infection when crawling into the appendicular process. In the same way, pinworms are the cause of many gynecological diseases, both in women and girls (for example, vulvovaginitis), as well as diseases of the urinary tract (cystitis). As a result of excruciating itching on the skin in the area of ​​the anus, perineum, genitals, numerous scratches appear, which, in the event of a secondary infection, become inflamed, complicated by dermatitis, eczema.
  3. By releasing metabolic products (toxins), pinworms can cause intoxication of the body, which is especially often manifested in children, and in women during pregnancy - the cause of severe toxicosis.
  4. The influence of parasites on the human nervous system is well known, since the lack of a full night's rest negatively affects his general well-being, performance, activity, and mood.
  5. The presence of parasites reduces the body's immune forces, resulting in an increase in the incidence of viral and bacterial diseases among those infested with pinworms.
  6. As a result of numerous observations in recent years, the immunosuppressive effect of pinworms on the child's body has been established, that is, parasites are able to suppress the development of post-vaccination immunity against diphtheria. According to statistics, in 18% of children vaccinated three times with the DPT vaccine, anti-diphtheria antibodies are simply absent, and in another 14% antibodies are present in very low titers.

Pinworm close up

The look of the pinworm is not at all frightening, unlike, say, the liver fluke: it is a nondescript white worm about 1 cm long (female) or 3-4 mm (male). The front end (mouth) of the helminth has a slight thickening for attachment to the intestinal wall. The back end of the female pinworm is pointed (sorry for the involuntary pun), and the male is rounded.

The pinworm lives for about 4 weeks, passing during this period a number of important milestones of its existence. Fertilization of the female takes place in the usual environment for the pinworm - in the large intestine, after which the male dies, and the female, at the call of her nature, rushes to the exit from the rectum.

Then comes the stage of laying eggs, which, in order not to go far, the female lays around the anus, in the fold under the buttocks or in the perineum. This usually happens at night: the eggs are attached to the surface of the skin with a special adhesive that causes itching and irritation. Having given a start in life to future offspring, the female also dies. What next…

Pinworm transmission route

Pinworms
Pinworms

After the egg is born, the larva matures in it for some time - about 5 hours, after which it is ready to continue the parasitic lifestyle of its ancestors. As mentioned a little above, the process of laying eggs is accompanied by severe itching, forcing a person to scratch the itchy area.

This is exactly what pinworms are waiting for: through hands contaminated with the parasite's eggs, they spread further: under the nails, onto bedding, dishes, common items and, most importantly, into the oral cavity, then they are swallowed and returned to their native land (i.e. to colon). Once in the intestines, pinworms emerge from the eggs and begin to grow. In two weeks they are ready for further procreation. Thus, the route of transmission of pinworms is fecal-oral. He can be prevented by observing the rules of personal hygiene.

Symptoms of Enterobiasis

The clinical manifestations of enterobiasis are varied and depend on the intensity of infection, the frequency of reinvasions and the individual response of the infected person. In addition, numerous observations confirm the importance of age, namely, a more severe, often complicated reaction of the child's body.

The observations of a parasitologist A.S. Kozlov (1985), who conducted a self-experiment, repeating pinworm infections seven times over the course of two years, are of indisputable interest. Achieving practical reliability, he swallowed different doses of eggs - 4 re-invasions and 2 super-invasions - from 1000 to 10 000. As a result, the author had reason to conclude that in the clinical course of enterobiasis, like other helminthiasis, there are two phases - acute and chronic …

With primary invasion, according to these data, the clinical incubation is two days, the acute phase is 5-7. Parasitological incubation - the beginning of the isolation of females, which actually determines the duration of the chronic phase of one infection, is 35 - 75 days.

The main clinical symptoms of the acute phase of enterobiasis are abdominal pain, morning intestinal discomfort, nausea, and frequent bowel movements up to 4 times a day. These phenomena last up to 5 - 7 days, the stool remains speeded up until the end of the invasion.

The nature of clinical manifestations in the chronic phase is ambiguous. In some of the infected, enterobiasis proceeds without complaints, in the absence of clinical symptoms. The intensity of symptoms in the chronic phase of enterobiasis depends primarily on the intensity of invasion and the frequency of super- and reinvasion.

With a weak invasion, the main complaint is perianal itching, which occurs more often in the evening before bedtime, when falling asleep, and sometimes abdominal pain. After 2-3 days, all these symptoms disappear and, as a rule, recur every 3-4 weeks. This periodicity is associated with the completion of the development of a new generation of helminths as a result of reinvasion.

Pinworms
Pinworms

With mild invasion, the main complaint is perianal itching, which occurs more often in the evening before bedtime, when falling asleep, sometimes abdominal pain

With a more intense and prolonged invasion, perianal itching disturbs the invader not only in the evening and night hours, but also during the day. Abdominal pain intensifies, more often in the right ileocecal region, reminiscent of pain in appendicitis, tenesmus, flatulence, and loose stools occur. Unbearable itching disrupts sleep, becomes the cause of nocturia, masturbation. On the part of the hemogram, moderate leukocytosis is noted, eosinophilia of peripheral blood, which gradually increases in the early phase, reaches a maximum (23%) by 16 days, then gradually decreases by the end of the invasion to 4 - 5%.

As a rule, neurological symptoms are expressed, such as headache, dizziness, memory loss. Children often suffer, they become capricious, whiny, get tired quickly, and do not perceive useful skills well. The instability of attention, inability to concentrate reduces academic performance, in adults - the ability to work.

Enterobiasis has a reliably negative effect on behavioral reactions and neuropsychic development of preschool children. Cases of fainting and epileptiform seizures in children, causally associated with enterobiasis, have been described.

Severe complications of enterobiasis include appendicopathies and appendicitis, proctitis and paraproctitis, dermatitis and eczema of the perianal region with their characteristic symptoms.

The indisputable cause of painful vulvitis and vulvovaginitis in girls is often chronic enterobiasis.

M.G. Makarova found that enterobiasis causes a significant decrease in nonspecific immunity: the activity of saliva lysozyme (1.5 times) and the content of alpha-interferon (to a level less than 2 units / ml), at the same time does not affect the content gamma interferon. These data are of particular interest in terms of establishing the causes of immunosuppression, which is especially common in children.

The prognosis in the absence of complications with enterobiasis is favorable.

In conclusion, it is necessary to pay attention to the polymorphism of clinical manifestations causally associated with enterobiasis, but characteristic of the most diverse organ pathology. This is what leads to the inevitable appeal of the invasive to doctors of different specialties: gastroenterologists, obstetricians-gynecologists, neuropathologists, allergists, dermatologists, urologists, surgeons, etc. And only the correct orientation of such a specialist on the need to exclude enterobiotic invasion provides qualified assistance to the patient.

Complications of enterobiasis

The severity of the symptoms and the possibility of complications will depend on the number of infected helminths, on the place of their attachment in the intestine and on the body's response (with a hypertensive type of response, the symptoms will be more pronounced). The most common complications include: from the stomach and intestines - appendicitis, dysbiosis. On the part of the female reproductive system - vaginitis, endometritis, salpingitis.

Pinworm diagnostics

Pinworms
Pinworms

Complete blood count (CBC) - increased E (eosinophils) - an allergic response to the introduction of helminth. Perhaps the blood picture will show inflammation, but this will only speak of a complicated course from the gastrointestinal tract.

The main diagnostic method is microscopy of the perianal scraping (it is done in the morning or in the evening, before washing, with an interval of 3 days), the same study is repeated after 3 weeks to assess the effectiveness of the treatment. It is possible to use scatological research, but the chances of detecting pinworms will be minimized, because they are in an unfixed state only at the time of egg laying, otherwise they may not even be detected.

The adhesive tape method is also practiced - using plastic tape on the perianal area, after which the results are examined under a microscope directly on the tape.

Enterobiasis treatment

A necessary condition for the successful treatment of a patient with enterobiasis is the simultaneous implementation of the entire complex of preventive measures to prevent reinvasion. This is, first of all, strict adherence to the personal hygienic regime not only for patients, but also for all contacts in the outbreak. Taking into account the high contagiousness of the invasion before the treatment of the revealed invasive, all contacts are subject to examination for enterobiasis - children by scraping, adults - by questioning. All identified infested in the outbreak, the family are subject to simultaneous deworming.

The main recommendations for a sanitary and hygienic regime in family foci of enterrebiosis include the following:

  1. Pinworms
    Pinworms

    Enterobiasis - a disease of dirty hands enterobiasis - a disease of dirty hands, therefore, cleanliness of hands and nails, the fight against the bad habit of biting nails, taking fingers in the mouth, washing hands with soap before eating is the basis of successful treatment;

  2. infested should sleep in closed shorts, that is, with elastic bands not only around the waist, but also around the legs, change them daily;
  3. obligatory washing of the perianal area with soap and water at night and in the morning after sleep;
  4. in the presence of itching in the perianal region before bedtime, a soda cleansing enema is recommended; it is designed only for mechanical removal of worms from the rectum; calculation of baking soda - for an enema: 1/2 teaspoon per 1 cup of boiled room temperature water (garlic, milk-garlic, vinegar enemas are not recommended, since they irritate the rectal mucosa);
  5. daily body washing, bathing in the shower;
  6. daily change of bed linen and ironing it with a hot iron is effective, but difficult to do and, if all the above recommendations are followed, is not necessary.

In the presence of invasion in young children, it is recommended, after washing in the evening at night, to lay a small cotton swab smeared with vaseline ointment in the anus. This prevents the creeping of female pinworms, relieves the child from itching, in women and girls it prevents pinworms from crawling into the vagina.

According to A.V. Markin, even the appointment of only a cotton swab to a patient leads to a decrease in invasion by 1.5 - 6.1 times, while one drug treatment is only 1.9 times.

With the unconditional and high-quality implementation of these recommendations, the patient can get rid of the invasion without drug treatment.

However, as experience has shown, the recovery of the infested is carried out faster and more reliably if the complex is observed: drug treatment against the background of a sanitary and hygienic regime.

With a weak infestation by parasites, the implementation of these measures is sufficient for self-healing. The expediency of prescribing drug therapy is determined only by a doctor. In cases of massive invasion, the scheme has proven to be effective; drug therapy and strict compliance with the sanitary and hygienic regime. For the purpose of deworming, drugs are prescribed:

  • pyrantel pamoat (combantrin) 5-10mg / kg orally, once after breakfast;
  • mebendazole (vermox) 10 mg orally, once. In case of re-invasion, the treatment is repeated after two and four weeks;
  • albendazole (400 mg) by mouth, once;
  • carbendacim (10 mg) by mouth, three doses within one day;
  • piperazine (the daily dose is 3 grams) is taken in three doses half an hour before meals for five days. If necessary, the course of drug treatment is repeated after ten days.

When treating children, the dosage of antihelminthic drugs is prescribed taking into account the weight and age of the child. Do not forget about the danger of self-medication. When prescribing drug treatment, the doctor takes into account the presence of concomitant diseases or severe complications in the patient, as well as the interaction of antihelminthic drugs with other drugs, for example, Vermox reduces the need for insulin, which is important for a patient with diabetes mellitus. In addition, there are a number of contraindications to the use of antihelminthic drugs: pregnancy, lactation, individual sensitivity, age (for example, it is not recommended to prescribe Vermox to children under two years of age), liver failure, ulcerative colitis. Medicines for the patient should be prescribed only by a doctor. The prognosis for enterobiasis is favorable.

Additional therapeutic measures

Pinworms
Pinworms

In severe forms of enterobiasis, antihelminthic treatment should be combined with the use of drugs, the action of which is aimed at eliminating complications.

Against itching, patients are advised to take antihistamines orally (loratadine, cytirizine, etc.) in age-specific dosages.

If the itching is unbearable, an evening enema helps: adults - 4-5, children 1-3 glasses of water, adding half a teaspoon of soda to each glass (at the same time, female pinworms are washed out of the lower part of the large intestine, ready to lay eggs, which prevents itching around the anus, scratching and contamination of the body, clothing and bedding of a patient with parasite eggs).

So that after the mass death of helminths the toxicosis of the body with the decay products of helminths does not occur, enterosorbents can be taken (12 hours a day after taking anthelmintic drugs - depending on the rate of excretion of drugs from the body: you can not take anthelmintic drugs and enterosorbents at the same time - this can lead to the fact that the drug is also absorbed and will not work).

Hygiene measures

  • should be carried out by all family members (after drug therapy is also given to all family members)
  • timing - 2-3 weeks

What needs to be done

  • Pinworms
    Pinworms

    Hygiene of nails is an important measure for the prevention of pinworms to cut long nails (to exclude the accumulation of pinworm eggs under them)

  • wash hands thoroughly with antibacterial soap (especially under the nails) in the morning, after using the toilet, before eating
  • do not comb itchy areas
  • during the entire period of hygiene measures, the patient should sleep in shorts that fit tightly to the body (the possibility of scratching decreases), children can wear gloves on their hands at night (the spaces under the nails are not contaminated)
  • underwear and bed linen must be boiled and ironed (pay special attention to the seams)
  • it is necessary to carry out daily wet cleaning (to reduce the amount of dust in which helminth eggs can be located)

The better you conduct hygienic measures, the more likely a complete cure from enterobiasis is.

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