ENTEROBIASIS
Dr N Nayak,MBBS,MD
Professor
Department of Microbiology
ENTEROBIASIS
Caused by Enterobius vermicularis
Enterobius gregori
Also called threadworm, pinworm
Life cycle clinical presentation treatment identical in both
Cosmopolitan in distribution, more common in
temperate climate
Humans ,the only host, common in children
Female nematodes may be
divided as follows
• Oviparous- laying eggs
-Unsegmented eggs-Ascaris lumbricoides, Trichuris trichiura
-Segmented eggs-Ankylostoma duodenale, Necator americanus
-Eggs containing larvae-Enterobius vermicularis
• Viviparous-laying larvae
-Dracunculus medinensis, Wuchereria bancrofti, Brugia malayi,
Trichinella spiralis
• Ovo-viviparous- laying eggs containing larvae which are immediately
hatched out- Strongyloides stercoralis
About the parasite
• Cosmopolitan-temperate climate
• Habitat-Adult worm in the caecum
vermiform appendix [ mucosal
surface, occasionally
in sub-mucosa ( coiled )]
• Male 2-4 mm
• Female 8-12 mm
• Eggs- 50-60 u, colorless, non-bile stained,
planoconvex, contains coiled larva
• Life span- males 6-7 weeks; females-14 wks
Life cycle
Mode of transmission
Infective stage –embryonated egg
Route-ingestion of embryonated
egg
Common age group-children
Source- contaminated food, drink
Other modes-close association
Autoinfection from fingers
Retrograde infection
Beds, night clothes and linens
Door knobs,table tops
Aerosols(inhaled then swallowed)
Clinical features of
Enterobiasis
• Pruritus periani et perinei
• Nocturnal enuresis
• Secondary infection at the site of itching
• Abdominal discomfort weight loss in heavy parasitic
burden
• Those due to migrating female in urogenital tract causing
inflammation
• Salpingitis
• Appendicitis
Laboratory Diagnosis
• Detection of adult worms
-Perianal region (at the time of itching)
on the surface of the stool (patient himself/herself or by
parents of children)
-Appendix during appendicectomy
-Colonoscopy
Laboratory Diagnosis
• Detection of eggs- eggs not discharged into the faeces,
oviposition in bowel exceptional ?
direct smear/[Link] rarely +ve
Eggs found in large numbers in perianal and
perineal regions;
From finger nails
Scraping perianal area with NIH swab in the
morning, before the child goes for a wash
Collection of
scraping(perianal,perineal
region) by NIH (National
Institute of Health) swab
Treatment of Enterobiasis
• Piperazine citrate 50-75 mg/kg body wt for 7
successive days
• Piperazine single dose therapy
-piperazine phosphate with senna (flavored granules)
-40 grains (a teaspoonful)= 1 gm of piperazine plus
7 mg of sennoside
4 teaspoonful > 6 yrs, 3 teaspoonful < 6 yrs
Treatment of Enterobiasis
• Pyrantel pamoate 11mg/kg body weight, maximum 1
gm, repeat after 2 weeks
• Mebendazole single dose 100 mg, repeat after 2
weeks
• Albendazole single dose 400 mg, repeat after 2 weeks
• Treatment of the group (all affected members in the
family)
Prevention
• Finger nails to be short
• Wash and scrub after defaecation and before meals
• Change bed cloths, sleeping garments, towels daily
• Children may wear gloves during sleep
• Do not shake cloths
• Food to be covered
• Treatment of all members in family
Questions
• Name the helminthic eggs which are non-bile
stained
• Name the helminthic eggs which are bile stained
• Name the helminthic eggs which float in
saturated salt solution
Answers
• Mnemonics
-Non-bile stained eggs
- A HEN laid non-bile stained eggs
-Bile stained eggs
-TAT
-Eggs which float in saturated salt solution
-FEATHer floats
Home work
•Why some helminthic eggs are bile
stained, why some are not ?
•Why the adult female worm of
Enterobius vermicularis lays eggs in
the perianal region?
