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Threadworm
(pinworm) (Complications (Poor sleep
Due to itching,…
Threadworm
(pinworm)
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Epidemiology
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Mostly children <18y, household contacts, institutions
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Pathophysiology
Transmission
Foecal-oral (eggs, can survive 2wk)
Life cycle
Ingestion of worm eggs
Larvae hatch and mature to adults in intestine in 1-2m
Adult female migrates through anus and lays eggs on perianal skin (typically at night)
Adults last 6 weeks, infection maintained by swallowing fresh eggs
Agent
White, thread like Enterobius vermicularis worm
Clinical
presentation
Perianal itching
Intense, worse at night
Worms in stool
Small, white, thread-like
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Diagnosis
Examination
Genital/perineal examination
Excoriations, localised secondary bacterial infection
Worms on skin (unlikely)
Investigations
Bedside
Only if diagnosis is uncertain
Adhesive tape test: tape to perianal skin first thing in the morning before wiping/bathing, put in specimen container
microscopy shows worms/eggs; need 3 consecutive AM samples
History
PMH
Immunocompromised, known medical conditions
DH
Current meds, allergies
SH
Living arrangements, school/nursery
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PC/HPC
Iching: perianal, intensely itchy, worse at night
Associated symptoms: insomnia/poor sleep
Any worms seen in stools/toilet paper
Affected contacts
Management
Conservative
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Hygeine measures
Thorough handwashing with soap/water
Avoid scratching, cut fingernails regularly
Change bed linen and nightwear daily
Wash clothes/linen on hot cycle to kill eggs
Thoroughly clean bathrooms ansd bedrooms
Referral
Frequent recurrences, unclear diagnosis
Medical
Anti-helminth
Indication: all patients except children <6m and pregnant/breastfeeding women
E.g. mebendazole PO single dose
CI: children <6m, pregnancy/breastfeeding
Complications
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Ectopic worm infection
Female genitals (vulvitis, vaginitis, salpingitis)
Male genitals (urethritis)
Colon
Colitis, abscesses, granuloma
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