Enterobiasis history and symptoms

Template:PinwormEditor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The symptoms may include painful itching around the anus, restless sleep, poor appetite, and failure to gain weight.

History and Symptoms

One third of individuals with pinworm infection are totally asymptomatic. The main symptoms are pruritus ani and perineal pruritus, i.e., itching in and around the anus and around the perineum. The itching occurs mainly during the night, and is caused by the female pinworms migrating to lay eggs around the anus. Both the migrating females and the clumps of eggs are irritating, but the mechanisms causing the intense pruritus have not been explained. The intensity of the itching varies, and it can be described as tickling, crawling sensations, or even acute pain. The itching leads to continuously scratching the area around the anus, which can further result in tearing of the skin and complications such as secondary bacterial infections, including bacterial dermatitis (i.e., skin inflammation) and folliculitis (i.e., hair follicle inflammation). General symptoms are insomnia (i.e., persistent difficulties to sleep) and restlessness. A considerable proportion of children suffer from anorexia (i.e., loss of appetite), weight loss, irritability, emotional instability, and enuresis (i.e., inability to control urination).

Symptoms are caused by the female pinworm laying her eggs. Symptoms of pinworm infection usually are mild and some infected people have no symptoms.

• Difficulty sleeping and restlessness due to the itching that occurs during the night.
• Intense itching around the anus.
• Irritability due to itching and interrupted sleep.
• Irritated or infected skin around the anus, from constant scratching.
• Irritation or discomfort of the vagina in young girls (if an adult worm enters the vagina rather than the anus).
• Loss of appetite and weight (uncommon, but can occur in severe infections).

The most common clinical manifestation of a pinworm infection is an itchy anal region. When the infection is heavy, there can be a secondary bacterial infection due to the irritation and scratching of the anal area. Often the patient will complain of teeth grinding, and insomnia due to disturbed sleep, or even abdominal pain or appendicitis. Infection of the female genital tract has been well reported.

Pinworms cannot damage the skin, and they do not normally migrate through tissues. However, in women they may move onto the vulva and into the vagina, from there moving to external orifice of the uterus, and onwards to the uterine cavity, fallopian tubes, ovaries, and peritoneal cavity. This can cause vulvovaginitis, i.e. an inflammation of the vulva and vagina. This causes vaginal discharge and pruritus vulvae, i.e., itchiness of the vulva. The pinworms can also enter the urethra, and presumably, they carry intestinal bacteria with them. According to Gutierrez (2000), a statistically significant correlation between pinworm infection and urinary tract infections has been shown, however Burkhart & Burkhart (2005) maintain that the incidence of pinworms as a cause of urinary tract infections remains unknown. Incidentally, one report indicated that 36% of young girls with urinary tract infection also had pinworms. Dysuria (i.e., painful urination) has been associated with pinworm infection.

The relationship between pinworm infestation and appendicitis has been researched, but there is a lack of clear consensus in the matter: while Gutierres (2005) maintains that there exists a consensus that pinworms do not produce the inflammatory reaction, Cook (1994) states that it is controversial whether pinworms are causatively related to acute appendicitis, and Burkhart & Burkhart (2004) state that pinworm infection causes symptoms of appendicitis to surface.