Enterobius vermicularis live adult worms in the high vagina

Distressing perineal and vaginal pain in prepubescent girls: an aetiology

AIM

To propose an aetiology and treatment for distressing perineal and vaginal pain in a paediatric female population.

METHODS

Between 1997 and 2011, we saw 24 prepubertal girls (mean age of seven years, 11 months) with distressing vaginal pain, both before and after we suspected that pinworms (Enterobius vermicularis) were the cause.

RESULTS

Prior to 2005, two of six girls had resolution of their symptoms, one of whom had repeated courses of mebendazole. After 2005, when pinworms were discovered in one patient, treatment with mebendazole 100 mg weekly for three weeks resolved symptoms in 18 girls. Three girls had a recurrence of symptoms within 2-4 months, and repeat treatment with mebendazole was successful.

CONCLUSIONS

Pinworms should be considered when prepubertal girls present with distressing perineal or vaginal pain, and treatment with weekly mebendazole should be offered.

Parents' knowledge about enterobiasis might be one of the most important risk factors for enterobiasis in children

To know the prevalence of Enterobius vermicularis infection and what are the most important risk factors, we evaluated the incidence and risk factors of enterobiasis among children attended in kindergartens in Busan metropolitan city, Republic of Korea. A total of 1,674 children from 21 kindergartens in 11 of 16 autonomous districts of Busan were evaluated for E. vermicularis infection by the cellotape anal swab technique. The overall egg-positive rate for E. vermicularis was 10.7% (179/1,674), and the prevalence of enterobiasis in each kindergarten ranged between 0% and 32.4%. There was an increasing tendency of the egg positive rate according to the population density; the higher the population density communities had, the higher egg-positive rate for E. vermicularis was detected (P = 0.001). Among personal hygiene factors involving children, thumb-sucking (P = 0.036) and fingernail-trimming (P = 0.024) were highly associated with enterobiasis. In addition, taking anthelmintic medications against E. vermicularis infection was strongly associated with enterobiasis (P = 0.014). Moreover, parents' knowledge of enterobiasis was correlated significantly with the incidence of enterobiasis of their children (P = 0.006). In conclusion, we need to consider not only personal hygiene but also parents' knowledge about enterobiasis as a factor in order to develop new strategies for elimination or to complete reduction of enterobiasis in Korea.

Chemotherapy of enterobiasis (oxyuriasis)

Enterobius vermicularis (syn. Oxyurus vermicularis), also known as pinworm or seatworm, is the causative agent of human enterobiasis (oxyuriasis). The disease is more prevalent in temperate regions and is facilitated by factors such as overcrowding in schools and family groupings, as well as inadequate personal and community hygiene. Although the infection is more likely to occur in lower socioeconomic groups, enterobiasis has been reported to affect virtually every level of the general population and especially children. In the great majority of cases, enterobiasis is asymptomatic. One common symptom is intense pruritus ani that in some patients can lead to insomnia, restlessness and irritability. Scratching may cause skin irritation, and in more serious cases, eczematous dermatitis, haemorrhage or secondary bacterial infections. Ectopic migration of E. vermicularis often results in pinworm infestation of the female genital tract often causing granulomas of the uterus, ovary and the fallopian tubes and pelvic peritoneum. Anthelmintic therapies for enterobiasis are successful and include mebendazole, albendazole and pyrantel pamoate. Mass medication of affected groups reduced symptoms rapidly, progressively and in a cost-effective way.

Live female Enterobius vermicularis in the posterior fornix of the vagina of a Korean woman

A 33-year-old Korean woman, para 2. visited an obstetrics and gynecology clinic, Kumi-shi, Kyongsangbuk-do, due to postcoital spotting and flank pain. She had a tubal ligation 7 years before and demonstrated back pain during menstruation. She revealed a foul smelling discharge without complaint of itching. Enterobius vermicularis eggs were demonstrated during microscopic examination of a smear taken from the posterior fornix of the vagina. On endoscopic examination of her vagina, a live worm was found in the posterior fornix. The worm was removed and identified as a female E. vermicularis based on morphology. This is the first case report of vaginal enterobiasis in Korea.