Enterobiosis is a widespread species helminthiasisincluded in the group of parasitic diseases. The disease is characterized by disorders of the intestines, disorders of the nervous system, skin itching and allergic manifestations. Called by a nematode (roundworm - pinworm). In accordance with the biological development of the parasitic worm, enterobiosis refers to contact helminths, a characteristic feature of which is a specific development cycle of the parasite:
- The development of the parasite occurs without intermediate hosts.
- Regular release of fully / partially matured eggs from the host.
- Continued development after the parasite leaves the intestines on the human body or on surrounding objects, in underwear.
- Oral route of infection through contact with a patient / objects contaminated with eggs.
In areas with a temperate climate (including countries with high economic development), parasitosis is dominant, the specific gravity of which reaches 70-95% among all helminthiases, due to the independence of pinworm life cycle from environmental conditions. In the territory of the Russian Federation, the specific gravity of enterobiosis is almost 60% of the recorded helminthiases and about 200 thousand new cases are registered annually. At the same time, the share of children under the age of 17 years accounts for 96% of cases. The most susceptible to enterobiosis are children from 7 to 14 years old (about 50% of cases) and 3-6 years old (39% of cases).
Why are pinworms dangerous? The presence of pinworms in the body of an invasive person has a pronounced negative effect on the body of both adults and especially children. Among infested children, there is often a delay in physical / mental and development, a decrease immunity, which contributes to increased infectious and somatic morbidity (ARI, dysbiosis, intestinal infections) with the development of pathomorphological changes in tissues / organs with a negative effect on the hormonal, enzymatic functions of the body.
The leading pathogenetic factors are: mechanical and toxic, as a result of which an inflammatory process is formed in various parts of the intestinal mucosa. Due to the tight fit of the head parasite vesicle on the mucous membrane and the penetration of pinworms into the tissues in different parts of the intestine, defects occur in the form of semilunar depressions. The severity of the pathological process determines the intensity of the invasion, since pinworms parasitize in large quantities. As a result of irritation of the chemo / mechanoreceptors of the intestine, a reflex violation of the motor / secretory function of the gastrointestinal tract develops, which provokes the development enteritis, gastritis, gastroduodenitis.
Pinworm metabolic products cause sensitization of the body with the subsequent development of allergic reactions. The immunosuppressive effect of pinworms has been established, which contributes to the development of intestinal infections and dermatoses. Pinworms adversely affect the general condition, the nervous system, especially in children, their intelligence, behavior, causing increased distraction, irritability, and poor memory. The presence of pinworms contributes to the disruption of the microbial landscape of the normal intestinal flora with frequent development of pronounced dysbiosis. Enterobiosis negatively affects the course of pregnancy and is often the cause of toxicosis and other pathologies.
To date, a clinical classification of enterobiosis has not been developed.
The causative agent of enterobiosis pinworm (lat. Enterobius vermicularis) is a dioecious round worm of milky white color with a transversely striated cuticle, the dimensions of which in an adult state are an adult female of 9-12 mm (female) and 2-5 mm of a male. What pinworms look like is shown in the photo below.
The overall structure of the female and male pinworms is shown in the figure below.
Pinworm eggs secreted by the female into the external environment have a size of 50 × 30 μm and an oblong-asymmetric shape, covered with a colorless smooth shell. Parasites are resistant to many chemicals (a solution of lysol, formalin), but are extremely sensitive to solar radiation and drying. Pinworms feed on intestinal contents. Parasitize in the lower part of the small intestine, cecum and in the upper part of the large intestine.
A suction device present allows adults to be fixed to the intestinal wall. Mostly females parasitize in the intestines, because after copulation the males die and quickly stand out with feces. The number of parasitic individuals varies from several tens to hundreds and thousands.
Mature females gradually moving into the rectum, actively exit the anus and lay on the skin in the folds of the perianal region of the egg, which acquire invasive properties (the ability to become infected) after 4-6 hours. The life span of the female does not exceed 30 days.
Pinworm life cycle
Enterobiosis occurs when a person swallows mature pinworm eggs containing larvae. Once in the small intestine, pinworm larvae under the action of digestive enzymes leave the eggs and gradually descend into the lower sections, where after two weeks they turn into mature individuals. After copulation with the help of head vesicles, young females attach to the intestinal mucosa, and the males die and leave the intestines with feces.
In a fertilized female, eggs form and gradually accumulate in the uterus, the number of which can reach several thousand. Under the influence of an enlarged uterus, females lose their ability to hold tightly on the mucosa and fall into the lower part of the large intestine. During the period of active migration in the rectum, the eggs in the female uterus mature to the stage of a tadpole-like larva. Then, the female overcomes the resistance of the anus sphincter with active worm-shaped movements and crawls out onto the perineal skin and the ductal folds of the invaded one. Under the influence of atmospheric oxygen, the genital tract of the helminth relaxes, which allows it to creep out eggs in the ductal folds and on the genitals with heaps of 100-300 pieces, which reach invasive maturity directly on the host’s body (Fig. Below).
The process of egg isolation lasts 15-45 minutes, after which the females die immediately. Pinworms creep out more often during a night's sleep. With untidiness around the anus and humidity, egg laying can linger and pinworms, in search of better conditions, continue to migrate, sometimes crawling along the perineum into the vagina, uterus and fallopian tubes, into the pelvic cavity.
How many eggs live outside of man. The duration of their survival in the external environment is determined by the microclimate in their locations. The invasive properties of the egg acquire after 4-6 hours when they are on the skin of the perineum at high humidity and a temperature of 34-36 C, and in this state, when combing itchy areas of the skin, they fall under the fingernail.
The maturity of eggs slows down when the temperature drops to 22 degrees. Under favorable conditions (18-20 ° C and humidity of about 70%) pinworm eggs survive for 35 days and can withstand drying for 3 weeks. When the air temperature rises to 40-50 degrees, they die, as well as under the influence of a solution lysol and carbolic acid. Accordingly, during the act of defecation, pinworms and their eggs can enter the feces. The pinworms and pinworm eggs are shown below (photo in feces in humans).
The source of infection is a person infected with helminths. The allocation of pinworm eggs to patients in the external environment begins on average 12-14 days after infection, (parasitological incubation) and their selection subsequently continues throughout the entire period of the disease. The transmission mechanism is fecal-oral. How are helminths transmitted? The main transmission routes are:
- Food (if swallowed invasive eggs with food and water).
- Household (when eggs get into the mouth from fingers or contaminated household items, toys, bedding).
- Inhalation route of transmission - when cleaning and shaking linen with dust. It is much less common.
The process of auto (re) invasion is widespread during enterobiasis, which helps to maintain a long state of infection and a high epidemic risk of such patients. The main factors of invasion transmission, i.e., infection with enterobiasis, are most often possible through contaminated hands and household items (baby pots, bedding, toys, linen, dishes, school desks, tables, door handles, etc.) and food products. Thus, the main causes of infection are non-compliance with personal hygiene rules.
Significantly affects the spread of enterobiasis the sanitary condition of homes / institutions and especially personal hygiene skills. The prevalence of enterobiosis is facilitated by the overcrowding of schools / kindergartens, and overpopulation of apartments. Susceptibility to enterobiasis in adults and especially in children is very high. Especially susceptible are children in the range from 1 to 9 years, and from 10 years of age, susceptibility decreases. After transferred enterobiosis is formed immunity, but it is insufficient to prevent re-infections.
Many people mistakenly believe that pets, namely cats, are the reason why pinworms appear. This is not true. You can really get infected from cats, but these animals have a different kind of roundworm - feline roundworm and if they are found in feces, then the animal must be treated urgently, since there is a danger of infection through feces and development toxocariasis.
Symptoms of pinworms in adults
The incubation period varies between 2-4 weeks. Symptoms and treatment of pinworms in adults are diverse and are determined primarily by the intensity of the invasion and the severity of the individual response of the host.
Adults in most cases with minor parasite invasion tolerate enterobiosis subclinically or almost asymptomatically. The main signs: burning in the anus and perianal itching, more often at night. Skin irritation of the perianal zone and perineal region is possible. In a number of individuals, pinworm symptoms may additionally manifest as weakness, sleep disturbance, fatigue, decreased ability to work, and headaches.
In cases of more intense invasion, parasites creep out more often both in the evening and during the day. Patients complain of diffuse or less often localized pain in various parts of the intestine (most often in the appendix area), with pain on palpation. Excessive loose stools may occur, dizziness, headacheloss appetite, nausea...; nausea; nasis;.; napiness;.. nausea; nosiness and nach., naso;. nasal system;.;; nausea., nausea.... Nasal., nauseas;.;;. nachiness, nausea; and nauseous; nosiness; nauseous; appetizing., nausea.;.; nausea); nausea; appendix; numbness. appetite; nausea, loss of craving. Nausea. Ameliation of nore. Nose. Lack of appetite; nauseus, nauseous; nauseus;., loss of appetite., nausea; a nosy;...; nosy,; nosy; a;.; nause.; nausea,.,;, nausea), nauseas, and nosy..;; nauseous; amelia, nauseas, and nosiness; a. lax; aph.; naso; n ;. n. c. aa. a. l. n. an aphp;; aph.,; nausea..
As a result of frequent scratching, deep and painful cracks may appear on the skin in the perineum and perianal zone, and constant toxic / mechanical irritation with pinworms of this zone contributes to the appearance of a different type of rash, eczema and abscesses.
Significantly less common in adults enterobiosis proceeds with severe damage to the nervous system, which manifests itself insomnia, a decrease in cognitive functions and a decrease in working capacity. In women, the disease can manifest as enterobiotic vulvovaginitis - when pinworms enter the vagina in massive quantities, causing toxic irritation and itching, as well as the introduction of intestinal microflora from the rectum. In a blood test - persistent eosinophilia.
Tests and diagnostics
The leading clinical criteria for diagnosing the disease include: severe perianal itching syndrome with the formation of scratches and the formation of abrasions, pyoderma, cracks, eczematous inflammatory process; abdominal pain in the hypogastric region, dyspeptic syndrome (nausea, frequent stools, decreased appetite, flatulence); astheno-neurotic syndrome (dizziness, headaches, fatigue, irritability, sleep disturbances, frequent fainting, nocturnal enuresis); persistent eosinophilia in peripheral blood.
To clarify the diagnosis, pinworm analysis is performed - a microscopic examination of scraping. Scraping is carried out from the perianal folds using adhesive tape, spatula, tampon or imprint using glass eye sticks with glue according to Rabinovich. How to pass scraping on pinworm eggs? The procedure is not difficult. It is carried out with a cotton swab dipped in glycerin / special adhesive tape in the morning before defecation and hygiene procedures of the perineum. Procedure Algorithm:
- moisten a cotton swab in glycerin or use a special adhesive tape;
- gently pushing the buttocks and rotating the stick to make scraping around the anus directly from the surface of the folds or apply adhesive tape;
- place the stick / tape in a test tube / plastic container with a tight lid;
- before being sent to the laboratory (within 2 hours) they are stored in the refrigerator at a temperature of +4 degrees;
- the procedure is repeated 3 days.
Sometimes adult helminths are found on the surface of feces. If necessary, a vaginal smear is taken.
Pinworm treatment in adults
How to treat pinworms in adults?
Treatment of enterobiasis in adults depends on the severity of clinical manifestations, the severity of the course, the presence of complications and includes drugs of etiotropic (pathogenetic) therapy, that is, drugs against pinworms; symptomatic therapy; intestinal recovery microbiocenosis, as well as methods of non-drug therapy, including diet, regimen, physiotherapy methods, hygiene measures. Treatment should be aimed not only at removing pinworms, their eggs and larvae from the body, but also at stopping the effects of their vital functions (allergic reactions, anemia, asthenic manifestations, etc.). Uncomplicated enterobiosisAs a rule, it is treated on an outpatient basis (treatment at home).
Derivatives are most commonly prescribed for the etiotropic treatment of enterobiosis. carbamatebenzimidazole (Medamine, Nemozole, Albendazole, Vermox, Mebendazole, Carbendacim) and tetrahydropyrimidine (Pyrantel) Any drug from this group is an effective remedy that affects both sexually mature forms of pinworms and has high ovicidal (effect on eggs) and larvicidal (effect on larvae) activity.
Pinworm tablets in these farm adults. groups inhibit the transport of glucose in helminths and disrupt oxidative processes, and also have a negative effect on the muscles of intestinal helminths by blocking the action cholinesterase and depolarization of the neuromuscular junction of the parasite.
It is important to understand that medications in adults should be prescribed by a specialist, and not choose what to treat on their own, looking for the best remedy, visiting one or another special forum, since drugs in the wrong dosage are not effective, which does not allow to cure the patient in time, and sometimes even dangerous. So, many patients begin to take Decarisby reading information that it is effective against helminthiases caused by roundworms while it is prescribed for ascariasis. The course of treatment is repeated after 14 days.
It is impossible to give a general unambiguous answer "which drugs are better for treating pinworms or how to get rid of pinworms at home". In principle, the effectiveness of modern drugs used to treat enterobiasis is quite high (about 90%), however, that none of them can guarantee a complete cure after passing one course. For a complete cure, regardless of the drug used, repeated courses are required and all hygiene procedures are followed.
It is also important to understand that deworming at home must be carried out simultaneously by all family members. Before treatment, thorough wet cleaning of the room should be performed, patients should wash themselves and put on a clean, tight-fitting underwear, and in the morning, underwear / bedding should be changed. During treatment, you should cut your nails briefly and avoid scratching itchy places.
With severe intolerant itching / onset of dermatitis, antihistamines are indicated: syrup / tablets Erius, Desloratidine, Fenistil, Allergosan etc. When small abscesses appear at the site of scratching caused by the introduction of a secondary infection into the wound surface, zinc ointment can be prescribed or local antibacterial ointments are used: Levomekol, Oflokain and etc.
For stopping allergic manifestations - Ketotifen. With diarrhea and severe intoxication, enterosorbents are prescribed (Sorbex, Diosorb, Activated carbon, Sorbentogel, Enterosgel and etc.).
In order to restore intestinal microbiocenosis, it is recommended to prescribe such drugs as Lactobacterin, Linex, Bifidumbacterin, Bifikol, Normoflorin and others in various dosage forms (candles, capsules).
Many patients are looking for how dangerous worms are and how to get rid of pinworms without taking medications. It should be said that the treatment of pinworms without drugs of pathogenetic therapy is quite complicated and, unfortunately, it will not be possible to quickly get rid of pinworms with folk remedies. As you know, there are medicinal plants and food products that can be used to treat enterobiasis and prevention. The general anthelmintic effect is exerted by garlic, carrots / carrot juice, walnuts, pumpkin seeds, leaves of wild strawberries, wormwood, pomegranate (pomegranate juice), lovage, elecampane, St. John's wort perforated, which are used in the form of infusions, decoctions and tea.
Garlic is most often used both for oral administration and as a garlic enema. At the same time, an enema with garlic should be placed for at least three consecutive days. However, the effectiveness of folk remedies in the treatment of enterobiasis is low. Nevertheless, the introduction of phytopreparations and foods with a common anthelmintic effect into the diet enhances the effect of medications. And they can be used both in complex treatment, and with the goal of preventing the disease.
The doctorsSpecialization: Parasitologist / Pediatrician
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- Etiotropic drugs for the treatment of enterobiosis (Medamine, Nemozole, Albendazole, Vermox, Mebendazole, Carbendacim, Pyrantel.
- Antihistamines (Erius, Desloratidine, Fenistil, Allergosan).
- Local antibacterial ointments (Zinc maz, Levomekol, Oflokain).
- Enterosorbents (Sorbex, Diosorb, Activated carbon, Sorbentogel, Enterosgel).
- Preparations for the pharmacological regulation of intestinal biocenosis (Lactobacterin, Linex, Bifidumbacterin, Bifikol, Normoflorin).
Procedures and operations
With the aim of leaching pinworms from the lower parts of the colon, cleansing enemas are shown in the evening with the addition of baking soda.
Pinworms in children: treatment and symptoms
As already noted, the contingent of children is the most sensitive to enterobiasis and its pinworm prevalence is significantly higher than that of the adult population, therefore, Dr. Komarovsky (video) - //www.youtube.com/watch?v=OsxlzByUs90 advises parents to periodically examine children for enterobiosis, especially if there is a symptomatology. He also advises to regularly examine the baby's feces, and especially in infants on the subject whether pinworm eggs are present in it. On the Internet you can find many examples of pinworm photos of children in the feces.
Symptoms and treatment of pinworms in children do not fundamentally differ, however, in most invasive children, the proportion of lactonegative intestinal flora increases and the number of Escherichia coli decreases. An increase in the activity of alkaline phosphatase and enterokinase in feces is noted. And since the intestinal microflora is the most important factor in maintaining the activity of intestinal enzymes, with enterobiosis due to impaired digestion / absorption of nutrients, there are signs of weight loss, growth retardation and physical development of the child.
Also, in children, symptoms of damage to the nervous system are more pronounced. Children become naughty, distracted, moody, school performance is sharply reduced. If the process is started or the pinworms in the child cannot be quickly cured, recurrent perianal itching leads to depletion of the NS and to the formation of asthenoneurotic syndrome and neurasthenia.
Another point that pinworms are dangerous in girls is a complication in the form of vulvovaginitis followed by the attachment of a bacterial infection. It usually develops with a high intensity of invasion if it is not possible to get rid of the parasite quickly. Symptoms of pinworms in children, especially in girls, can also manifest with the symptoms of urinary tract infections, since enterobiosis is a factor contributing to the development of complications of this kind.
How to remove pinworms from a child and what to do when they are detected?
As already mentioned, pinworms in adults (symptoms and treatment) have no fundamental differences from enterobiosis in children, and drugs for treating pinworms in children are identical to drugs prescribed by adults. However, all drugs in any form - tablets, capsules, syrups are prescribed taking into account the age dosage, and some of them (Vermox, Mebendazole, Nemozole) are allowed for children over 2 years old.
Also, if necessary, other drugs are prescribed that are identical to those in adults, however, any drug and drugs for removing pinworms can have a side effect and this must be taken into account.
How to treat enterobiotic vulvovaginitis in children?
In addition to the general treatment of enterobiasis in the treatment of enterobiotic vulvovaginitis in girls, it is necessary to conduct a thorough toilet of the external genital organs, especially in the anus, daily for 7 days, rinse the vagina and introduce candles with an antibiotic (Kanamycin etc.), to which pathogenic flora is sensitive.
Almost all pinworm medicines for children are quite effective, but in order to completely cure a child, it is important not only to take anthelmintic tablets for children to cleanse the body of the parasite, but also to prevent re-infection, which is achieved by observing strict sanitary and hygiene rules and personal hygiene child at home and be sure to conduct another course of treatment after some time.
It is extremely undesirable to use exclusively folk remedies, as they give advice on the question “how to bring pinworms out of a child” on some web resources, since all of them are not effective enough, and the presence of pinworms in the child’s body has a pronounced negative effect on the growth, physical and mental state of the child’s body .
Pinworms during pregnancy can not affect the development of the fetus, but their presence can contribute to the development of vaginal infection, which is extremely undesirable during pregnancy. Treatment in pregnant women is complicated by the fact that during pregnancy up to 12 weeks of gestation, etiotropic therapy is contraindicated.
What to treat during pregnancy during this period? The best option is to use traditional medicine and strict personal hygiene. At later stages of pregnancy with severe invasion, the question of the appointment of anthelmintic drugs is decided by the obstetrician individually.
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Specific prevention of enterobiasis has not yet been developed. Nonspecific prevention includes:
- Patient isolation. A patient with enterobiosis should be isolated at home until complete clinical recovery (1-2 weeks on average).
- Careful observance of personal hygiene (nail cutting, washing hands and perineum with disinfectant solutions, washing clothes and ironing all things with a hot iron, daily linen change, refraining from combing itchy places).
- Daily wet cleaning with disinfectants throughout the treatment of the patient, providing the patient with individual care items and separate dishes.
Consequences and Complications
With severe invasion and migration of female pinworms - development vulvovaginitis, vulvita, salpingitis and enterobiotic endometritis. Mechanical / chemical (pinworm secretion stimulation of the perianal region contributes to the appearance of abrasions, cracks, neurodermatitis, and with the addition of a bacterial infection - development pyoderma/eczematous rashes. Prolonged parasite infestation forms (especially often in children) astheno-neurotic syndrome. Against the background of enterobiosis, it often develops dysbiosis and increases the risk of AKI. In children - growth retardation, physical and mental state.
In cases of uncomplicated enterobiosis, the prognosis for life and health is favorable.
List of sources
- Medical parasitology: textbook / G.I. Myandina, E.V. Tarasenko. M: Practical medicine. 2013.256 s.
- Avdyukhina T.I., Konstantinova T.N. et al. Enterobiosis. Clinic, diagnosis, treatment, epidemiology, prevention: Textbook. allowance for doctors. M., 2003.56 s.
- Epidemiological characteristics and the basics of the prevention of contact helminthiases: educational and methodological. allowance / I.N. Valchuk, T.E. Doroshenko, G.N. Chistenko. - Minsk: BSMU, 2017. -40 p.
- Schreiner E.V. Helminthiasis in the clinical practice of a pediatrician: issues of diagnosis, therapy, prevention. Rus honey. journal 2013.
- Bronstein A.M., Malyshev N.A., Luchshev V.I., Davydova I.V. Socio-epidemiological problems and the main issues of the pathology and chemotherapy of helminthiasis of the digestive system. Grew up. honey. journal 2007; 2: 33-6.