Enterobius egg granuloma of the vulva and peritoneum: review of the literature

Peritoneal lesions caused by Enterobius vermicularis suspected to be metastases of ovarian malignancy

Enterobius vermicularis, also known as pinworm, is a helminth that commonly causes intestinal parasitic infestation. E. vermicularis can also cause extraintestinal infestations. We report a case of lower abdominal pain and intermittent vaginal bleeding in a 45-year-old woman who was referred to our gynaecology department. On investigation, a transvaginal ultrasound showed a multilocular cyst in the left ovary, along with elevated levels of cancer antigen 125. Consequently, a laparoscopic salpingo-oophorectomy was performed. A biopsy of atypical peritoneal lesions revealed remains of E. vermicularis Peritoneal lesions are a rare complication of enterobiasis, and the diagnosis of this complication is usually delayed by limitations in diagnostic options. Although extraintestinal enterobiasis does not require treatment because it is the last stage of the parasitic cycle, primary intestinal infestation requires treatment with mebendazole.

The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis

Although the main cause of appendicitis is unclear, infection with Enterobius vermicularis is suggested as a neglected risk factor. Since, there is no comprehensive analysis to estimate the prevalence of E. vermicularis in appendicitis; therefore, we conducted a global-scale systematic review and meta-analysis study to estimate the prevalence of E. vermicularis infection in appendicitis cases. PubMed, Scopus, Web of Science and Google Scholar databases were systematically searched for relevant studies published until 15 August 2019. Pooled prevalence of E. vermicularis infection was estimated using the random effects model. Data were classified based on the continents and countries. Moreover, subgroup analyses regarding the gender, the human development index (HDI), and income level of countries were also performed. Fifty-nine studies involving 103195 appendix tissue samples belonging to the individuals of appendicitis were included. The pooled prevalence of E. vermicularis infection was (4%, 95%CI, 2–6%), with the highest prevalence (8%, 95% CI: 0–36%) and lowest prevalence (2%, 95% CI: 1–4%) in Africa and Americas continents, respectively. With respect to countries, the lowest and highest prevalence rates were reported from Venezuela (<1%, 95% CI: 0–1%) and Nigeria (33%, 95% CI: 17–52%), respectively. Indeed, a higher prevalence was observed in females, as well as in countries with lower levels of income and HDI. Our findings indicate the relatively high burden of E. vermicularis infection in appendicitis cases. However, our findings suggest the great need for more epidemiological studies to depth understand overlaps between E. vermicularis infection and appendicitis in countries with lower HDI and income levels.

Successful Resolution of Recurrent Vaginal Pinworm Infection With Intermittent Albendazole Administration

We describe the case of a 7-year-old girl with repeated vaginal Enterobius vermicularis infection, never detected as a digestive tract infection. Two-dose pyrantel pamoate or 2-dose albendazole could not suppress recurrence. Finally, 3-dose albendazole after 2-week intervals was successful in preventing relapse.

Beyond O&P Times Three

Although examination of the stool for ova and parasites times three (O&P ×3) is routinely performed in the United States (US) for the evaluation of persistent and/or chronic diarrhea, the result is almost always negative. This has contributed to the perception that parasitic diseases are nearly non-existent in the country unless there is a history of travel to an endemic area. The increasing number of immigrants from third-world countries, tourists, and students who present with symptoms of parasitic diseases are often misdiagnosed as having irritable bowel syndrome or inflammatory bowel disease. The consequences of such misdiagnosis need no explanation. However, certain parasitic diseases are endemic to the US and other developed nations and affect both immunocompetent and immunocompromised patients. Testing for parasitic diseases either with O&P or with other diagnostic tests, followed by the recommended treatment, is quite rewarding when appropriate. Most parasitic diseases are easily treatable and should not be confused with other chronic gastrointestinal (GI) disorders. In this review, we critically evaluate the symptomatology of luminal parasitic diseases, their differential diagnoses, appropriate diagnostic tests, and management.

Enterobius vermicularis worm granuloma mimicking like a pseudo tumor in the anal canal: An unusual clinical presentation

Enterobius vermicularis is one of the most common intestinal nematode worldwide. Enterobius rarely causes a symptomatic disease. We report here an unusual case of a 60-year old man who came with a polypoidal growth in the anal canal increasing in size for past 20 years. He had pain and intense itching over the mass. The differential diagnosis of squamous papilloma, fibroma and foreign body granuloma were considered. The mass lesion was excised surgically and sent to the pathology laboratory. The mass turned out to be an “E. vermicularis worm granuloma” by histopathologic examination. Thus, timely reporting and surgical resection of such lesion is necessary to prevent further complications. This case is reported here for the unusual presentation of pinworm as a pseudoneoplasm in the anal canal. Incidence of these cases reflected the poor personal hygiene and improper disposal of human excreta in the rural areas. We insist that health education is the only way to control the spread of helminthic infections that causes a heavy disease burden to our country.

[Nonbacterial colitides]

Aside from bacterial infections, viral, fungal, and parasitic infections are important differential diagnoses in inflammatory disorders of the colorectum. In contrast to bacterial infections, in which the causative organism can hardly ever be detected histologically, in non bacterial infections the germs can often be verified by either histology, immunohistochemistry, or at least by molecular pathology. This manuscript will give an overview of the spectrum of pathogenic germs, the clinical symptoms, and pathological findings of the most important infections.

Enterobious vermicularis (pinworm) infestation of the vulva: report of 2 cases of a pseudoneoplastic lesion mimicking squamous carcinoma

Enterobious Vermicularis (pinworm) infestation outside the gastrointestinal tract is rare. We report 2 patients with vulval involvement, one of whom presented with a clinically suspicious, rapidly growing mass. The histology of both lesions showed similar features of epidermal proliferation in the form of hyperkeratosis, acanthosis, and papillomatosis; this pseudoepitheliomatous hyperplasia raised the possibility of a well-differentiated squamous carcinoma. There was associated inflammation in both cases, including large numbers of eosinophils in 1 case. On the surface or within the keratin layer, structures with the morphology of enterobious vermicularis eggs were identified. In reporting this unusual pseudoneoplastic phenomenon, we stress the necessity for the pathologist to consider and look for parasites in proliferative squamous lesions of the vulva, especially when there is an associated inflammatory infiltrate rich in eosinophils.

Enterobiasis in ectopic locations mimicking tumor-like lesions

Both the clinical and the histopathological diagnostic difficulties of oxyuriasis in unusual sites and their importance from a clinical point of view are pointed out. The authors report two ectoptic cases of enterobiasis observed in Northern Italy, one located in a fallopian tube of a 57-year-old woman and the other in a perianal subcutaneous tissue of a 59-year-old man, mimicking tumor-like lesions. The authors take advantage of the occasion to focus the attention of the medical world on this subject, lamenting the scarce importance given to this parasitosis in university courses of medical schools and in medical textbooks as it is incorrectly considered “out-of-fashion.”

Intestinal myiasis caused by larvae of Telmatoscopus albipunctatus in a Taiwanese man

Here we reported the first case in Taiwan of human intestinal myiasis caused by larvae of Telmatoscopus albipunctatus. The 21-year-old male patient experienced gastroenteritis and anal itching. During the patient's first hospital visit the doctor suspected Enterobius infection. After treatment with anthelmintic mebendazole, 5 live larvae were passed out in the feces. Symptoms were resolved a few days later. The larvae were brown and slender, measuring approximately 10 mm in length. The worms were located in the intestine. Subsequent examination showed that the cause was an infestation of larvae of T. albipunctatus. The patient was likely infected by ingestion of eggs or early-stage larvae in contaminated food.

Pelvic pain caused by intraperitoneal Enterobius vermicularis (threadworm) ova with an associated systemic autoimmune reaction

AIM

The aim of this paper, based on a case study was two-fold; firstly to review the sites and gynecologic complications of ectopic Enterobius vermicularis and secondly study the autoimmune accompaniments of parasitic infestations.

METHODS

A case of intraperitoneal ectopic Enterobius vermicularis, with accompanying autoimmune signs and symptoms, is presented and its response to surgical and medical treatment described. A medical literature search was carried out into the subject of ectopic Enterobius vermicularis, particularly from the gynecologic perspective along with a study of autoimmune activation associated with parasitic infestation.

RESULTS

Pelvic pain was found to be caused by chronic inflammation from ectopic Enterobius vermicularis. This was treated both surgically and medically, with the surgical treatment proving to be inadequate but with a good response to immune modification. In the literature ectopic Enterobius vermicularis was found to be treatable surgically.

CONCLUSION

Ectopic Enterobius vermicularis was found to create symptomatic inflammatory lesions that could be treated surgically and an associated autoimmune response treatable by immune modification.

Enterobius vermicularis and perianal sepsis in children

Specific aetiological factors are responsible for a significant proportion of cases of perianal sepsis in children. A rarely implicated pathogen is Enterobius vermicularis, an obligate parasite with a ubiquitous presence in children. The authors describe two unequivocal instances of threadworm involvement in perianal sepsis, suggesting a pathophysiological basis.

[Granulomatous nodule with Enterobius vermicularis in epiploon simulating metastasis of ovarian cancer]

The authors describe a case of peritoneal enterobiasis presenting as necrotizing granuloma, in a adolescent with tumor of the ovarian endodermic sinus. The diagnosis was established through biopsy of peritoneal nodule, during laparotomy for staging system of ovarian cancer. Granulomatous nodules due to parasites could simulate metastasis, and cause confusion in the staging system for cancer.

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.

Unilateral salpingitis due to enterobius vermicularis

A case of unilateral salpingitis caused by Enterobius vermicularis presenting as a painful adnexal mass in a 28-year-old woman is reported.