Disease: Pinworms
(Pinworm Infection in Children and Adults, Enterobiasis)

    Pinworms facts

    • Pinworm infections are caused by worm-like parasites that infect humans' intestines and rectal/anal areas.
    • Young children and their household members are at risk for pinworm infections.
    • Pinworms are visible. They range in size from 2-13 mm, are white, and resemble a worm but the pinworm eggs are small, transparent and can be seen only with a microscope.
    • Pinworm infections are spread person-to-person by ingesting pinworm eggs that have contaminated fingers, bedding, clothing or other items.
    • The symptoms of pinworm infection are discomfort and itching in the anal/rectal area. Children especially will scratch the rectal/anal area, get eggs on their fingers or underneath their fingernails and transport the infective eggs to bedding, toys, other humans, or back to themselves. The eggs hatch into larval forms in the small intestines and then progress to the large intestine where they mature, mate, and progress to the rectal/anal area where females deposit about 10 to 15 thousand eggs.

    What is pinworm infection in humans?

    Pinworm infection is an infection of the large intestine and anal area by a small, white parasite that resembles a "worm." The medical name for the parasite is Enterobius vermicularis, but it is commonly termed a pinworm in both the lay and medical literature. These parasites are also termed seatworms or threadworms, and the infections is medically termed enterobiasis or helminthiasis. Pinworms and other parasitic worms (which, as a group, are termed helminths) feed off of the host animal by adsorbing nutrients from the host animal. Pinworm infections are the most common helminth infection that occurs in the US.

    Who is at risk for getting pinworms?

    Pinworm is the most common worm infection in the United States, and the majority of pinworm infections worldwide occur in temperate climates.

    Pinworms in children

    School-age children have the highest rates of pinworm infection. They are followed by preschoolers. Institutional settings including day care facilities often harbor cases of pinworm infection. Sometimes, nearly half of the children may be infected.

    Pinworms in adults

    Pinworm infection often occurs in more than one family member. Adults are less likely to have pinworm infection, except for mothers of infected children. However, adult sexual partners can transfer the eggs to each other.

    What do pinworms look like (pinworm pictures)?

    The pinworms are white, can be seen with the naked eye (no magnification) and are about the length of a staple (about 8-13 mm for female and 2-5mm for male worms). The eggs that are laid by the female worms are not visible as they are about 55 micrometers in diameter and are translucent (see Figure 1).

    The male and female worms live for the most part within the rectum of humans but have a life cycle in humans that involves rectal/oral transmission (see Figure 2).

    While an infected person is asleep, female pinworms leave the intestines through the anus and deposit eggs on the skin around the anus. This causes itching and irritation of the surrounding area; children especially will scratch the rectal/anal area, get eggs on their fingers or underneath their fingernails and transport the infective eggs to bedding, toys, other humans, or back to themselves. The eggs hatch into larval forms in the small intestines and then progress to the large intestine where they mature, mate, and progress to the rectal/anal area where females deposit about 10 to 15 thousand eggs.

    Figure 1, picture of pinworm and pinworm eggs (magnified); (image courtesy of CDC.gov)

    Picture of pinworms Picture of the life cycle of a pinworm

    How is pinworm infection spread?

    Pinworm infection is spread person-to-person. Within a few hours of being deposited on the skin around the anus, pinworm eggs become infective (capable of infecting another person). They can survive up to two weeks on clothing, bedding, or other objects. Infection is acquired when these eggs are accidentally swallowed, usually due to inadequate hand washing by the parents and children. However, eggs on bedding or other objects that are touched while the eggs are still viable can cause infection or reinfection of people.

    What are the symptoms of pinworms?

    Intense itching around the anus and/or vagina are the classic symptoms of pinworms. Less common symptoms range from upset stomach to loss of appetite, irritability, restlessness, and insomnia.

    The symptoms of pinworm infection are caused by the female pinworm laying her eggs.

    Most infected individuals have few or no symptoms but, if the infection is heavy, the symptoms can be correspondingly more severe.

    How is pinworm infection diagnosed?

    If pinworms are suspected, transparent adhesive tape or a pinworm paddle (supplied by your health care professional) are applied to the anal region. The eggs (and sometimes the parasites themselves) adhere to the sticky tape or paddle and are identified by examination under a microscope. The test is sometimes referred to as "the Scotch Tape test."

    The test should be done as soon the affected individual wakes up in the morning (because bathing or having a bowel movement may remove most eggs and parasites). The exam may require several samples for diagnosis. Samples taken from under the fingernails may also contain eggs (since scratching of the anal area is common by affected individuals).

    At night, the adult worms can sometimes be seen directly in bedclothes or around the anal area: this is another good time to detect the parasites with the transparent adhesive tape method.

    What is the treatment of pinworms, and is there a home treatment?

    Pinworm medications
    • Usually, a single tablet of mebendazole (Vermox) is used for treatment. This can sometimes be repeated a week later or, if infection persists, the medication is given again three weeks later. Some clinicians recommend a treatment protocol of a drug dose every 3 weeks, 3 times, so that the person has effective drug treatment for about 9 weeks total. Vermox has been discontinued in the US, but stocks are still available in some pharmacies.
    • Another effective medication is albendazole (Albenza) but it may require other medications to reduce the inflammation of the central nervous system, a side effect of the drug. Albendazole is well tolerated with minimal side effects due to minimal systemic absorption.
    • Pyrantel pamoate (Pin-Rid, Pin-X) is available over-the-counter for pinworm after confirmation of the diagnosis by a licensed healthcare practitioner. Drugs available over-the-counter vary from country to country.  Pyrantel is the treatment of choice for pregnant women.
    • To treat pinworms affecting urinary and genital organs, combination therapy with oral mebendazole (Vermox) and ivermectin (Stromectol) for the worms as well as topical therapy for the eggs may be required.

    Learn more about: Vermox | Albenza | Stromectol

    Most pinworm infections are treated at home with the above medications. However, reinfection is fairly common. To both reduce the chances for reinfection and to help prevent others from getting pinworms, see the prevention section.

    Who is at risk for getting pinworms?

    Pinworm is the most common worm infection in the United States, and the majority of pinworm infections worldwide occur in temperate climates.

    Pinworms in children

    School-age children have the highest rates of pinworm infection. They are followed by preschoolers. Institutional settings including day care facilities often harbor cases of pinworm infection. Sometimes, nearly half of the children may be infected.

    Pinworms in adults

    Pinworm infection often occurs in more than one family member. Adults are less likely to have pinworm infection, except for mothers of infected children. However, adult sexual partners can transfer the eggs to each other.

    What do pinworms look like (pinworm pictures)?

    The pinworms are white, can be seen with the naked eye (no magnification) and are about the length of a staple (about 8-13 mm for female and 2-5mm for male worms). The eggs that are laid by the female worms are not visible as they are about 55 micrometers in diameter and are translucent (see Figure 1).

    The male and female worms live for the most part within the rectum of humans but have a life cycle in humans that involves rectal/oral transmission (see Figure 2).

    While an infected person is asleep, female pinworms leave the intestines through the anus and deposit eggs on the skin around the anus. This causes itching and irritation of the surrounding area; children especially will scratch the rectal/anal area, get eggs on their fingers or underneath their fingernails and transport the infective eggs to bedding, toys, other humans, or back to themselves. The eggs hatch into larval forms in the small intestines and then progress to the large intestine where they mature, mate, and progress to the rectal/anal area where females deposit about 10 to 15 thousand eggs.

    Figure 1, picture of pinworm and pinworm eggs (magnified); (image courtesy of CDC.gov)

    Picture of pinworms Picture of the life cycle of a pinworm

    How is pinworm infection spread?

    Pinworm infection is spread person-to-person. Within a few hours of being deposited on the skin around the anus, pinworm eggs become infective (capable of infecting another person). They can survive up to two weeks on clothing, bedding, or other objects. Infection is acquired when these eggs are accidentally swallowed, usually due to inadequate hand washing by the parents and children. However, eggs on bedding or other objects that are touched while the eggs are still viable can cause infection or reinfection of people.

    What are the symptoms of pinworms?

    Intense itching around the anus and/or vagina are the classic symptoms of pinworms. Less common symptoms range from upset stomach to loss of appetite, irritability, restlessness, and insomnia.

    The symptoms of pinworm infection are caused by the female pinworm laying her eggs.

    Most infected individuals have few or no symptoms but, if the infection is heavy, the symptoms can be correspondingly more severe.

    How is pinworm infection diagnosed?

    If pinworms are suspected, transparent adhesive tape or a pinworm paddle (supplied by your health care professional) are applied to the anal region. The eggs (and sometimes the parasites themselves) adhere to the sticky tape or paddle and are identified by examination under a microscope. The test is sometimes referred to as "the Scotch Tape test."

    The test should be done as soon the affected individual wakes up in the morning (because bathing or having a bowel movement may remove most eggs and parasites). The exam may require several samples for diagnosis. Samples taken from under the fingernails may also contain eggs (since scratching of the anal area is common by affected individuals).

    At night, the adult worms can sometimes be seen directly in bedclothes or around the anal area: this is another good time to detect the parasites with the transparent adhesive tape method.

    What is the treatment of pinworms, and is there a home treatment?

    Pinworm medications
    • Usually, a single tablet of mebendazole (Vermox) is used for treatment. This can sometimes be repeated a week later or, if infection persists, the medication is given again three weeks later. Some clinicians recommend a treatment protocol of a drug dose every 3 weeks, 3 times, so that the person has effective drug treatment for about 9 weeks total. Vermox has been discontinued in the US, but stocks are still available in some pharmacies.
    • Another effective medication is albendazole (Albenza) but it may require other medications to reduce the inflammation of the central nervous system, a side effect of the drug. Albendazole is well tolerated with minimal side effects due to minimal systemic absorption.
    • Pyrantel pamoate (Pin-Rid, Pin-X) is available over-the-counter for pinworm after confirmation of the diagnosis by a licensed healthcare practitioner. Drugs available over-the-counter vary from country to country.  Pyrantel is the treatment of choice for pregnant women.
    • To treat pinworms affecting urinary and genital organs, combination therapy with oral mebendazole (Vermox) and ivermectin (Stromectol) for the worms as well as topical therapy for the eggs may be required.

    Learn more about: Vermox | Albenza | Stromectol

    Most pinworm infections are treated at home with the above medications. However, reinfection is fairly common. To both reduce the chances for reinfection and to help prevent others from getting pinworms, see the prevention section.

    Source: http://www.rxlist.com

    Learn more about: Vermox | Albenza | Stromectol

    Most pinworm infections are treated at home with the above medications. However, reinfection is fairly common. To both reduce the chances for reinfection and to help prevent others from getting pinworms, see the prevention section.

    Source: http://www.rxlist.com

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