Materiały źródłowe

• #1 The Diagnosis and Treatment of Pinworm Infection (29.03.2019)

  https://di.aerzteblatt.de/int/archive/article/206305/The-diagnosis-and-treatment-of-pinworm-infection

  Enterobius (syn. Oxyuris) vermicularis is a human-pathogenic intestinal parasite belonging to the nematodes (Nematoda). Synonyms include threadworm and seatworm. Symptomatic pinworm infection is referred to as enterobiasis (older term: oxyuriasis). The first description of the typically configured worm eggs by the Swedish natural scientist, Carl von Linn, dates back 1758. One can assume that E. vermicularis has been successfully established as a parasite in the host organism since the evolution of human hominids. Fossil findings confirm that their co-existence stretches back over many thousands of years. The distinguishing feature of these worms is their eponymous thread-like appearance. The females are 9-12 mm long with a diameter of approximately 0.5 mm, while the males are shorter (3-5 mm) but visible to the naked eye. Striking whitish-beige in color, they are typically round in shape and move with a vigorous worm-like crawling motion. The head section is rounded and contains a muscular esophagus and bulb; in females, the tail section is narrow and sharply tapered. The extensive uterine reproductive system of the fertilized female worm is often completely filled with eggs (10,000/worm). Like all nematodes, E. vermicularis has a thick outer protective covering (cuticle). The double-layered, elongate-oval eggs are 50-60 x 25 m in size, translucent, and asymmetrical in shape (slice of bread shape). The first larval stage in the egg can often be well visualized. The parasite eggs are able to survive for a number of days outside the body (tenacity).

• #1 The Diagnosis and Treatment of Pinworm Infection (29.03.2019)

  https://di.aerzteblatt.de/int/archive/article/206305/The-diagnosis-and-treatment-of-pinworm-infection

  E. vermicularis has a simple direct life cycle, which takes place in the gastrointestinal lumen. Infection occurs via oral ingestion of infective eggs; the larvae contained in the eggs become infective within as little as 4-6 hours following oviposition. Once in the digestive system of the host organism, the external membrane of the eggs softens. After passing through the pylorus, the pinworm larvae hatch in the small intestine. After molting twice, the worms copulate and then migrate downwards to the large intestine, where they can be found in large numbers particularly in the cecum, appendix, or ascending colon. The males die soon after copulation; the gravid females, on the other hand, have an overall life span of up to 100 days, reaching the anal canal by means of active migration. The time interval between ingestion of infective eggs and oviposition by the adult female pinworm is 2-6 weeks. Oviposition occurs primarily while the host is resting, i.e., predominantly at night while they sleep. It involves the females leaving the anus and fixing their eggs to tissue in the perianal area with an adhesive matrix. The migratory movements of the worms during this process often cause uncomfortable pruritus, as a result of which children in particular tend to relieve the itching by using their fingers to scratch the perianal region. The disintegration of the worm cuticle caused by fingers and fingernails leads to a massive release and spreading of eggs into underwear and the surrounding area. The contaminated hands of the host play an important role in maintaining the chain of infection (autoinfection). The already-hatched larvae can also enter the anus retrogradely, thereby causing renewed infection (retrograde infection). Very rarely, incidental involvement of other organs occurs (an estimated 18-20%). The eggs always need suitable conditions outside the gastrointestinal tract (low temperatures, high oxygen concentration) in order to mature. No intraluminal propagation occurs.

• #2 Enterobiasis – Nursing Care Planning and Management – Nurseslabs

  https://nurseslabs.com/enterobiasis/

  E. vermicularis is an obligate parasite; humans are the only natural host. […] Fecal-oral contamination via hand-mouth contact or via fomites (toys, clothes) are common methods of infestation. […] After ingestion, eggs usually hatch in the duodenum within 6 hours. […] Worms mature in as little as 2 weeks and have a lifespan of approximately 2 months. […] Adult worms normally inhabit the terminal ileum, cecum, vermiform appendix, and proximal ascending colon; the worms live free in the intestinal lumen. […] The female worm migrates to the rectum after copulation and, if not expelled during defecation, migrates to the perineum (often at night) where an average of 11,000 eggs are released. […] Eggs become infectious within 6-8 hours and, under optimum conditions, remain infectious in the environment for as long as 3 weeks.

• #3 Enterobiasis (Pinworm Infestation): Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/997814-overview

  E vermicularis is an obligate parasite; humans are the only natural host. Fecal-oral contamination via hand-mouth contact or via fomites (toys, clothes) are common methods of infestation. After ingestion, eggs usually hatch in the duodenum within 6 hours. Worms mature in as little as 2 weeks and have a life span of approximately 2 months. […] Little evidence supports invasion of healthy tissue under normal conditions. The female worm migrates to the rectum after copulation and, if not expelled during defecation, migrates to the perineum (often at night) where an average of 11,000 eggs are released. Eggs become infectious within 6-8 hours and, under optimum conditions, remain infectious in the environment for as long as 3 weeks. […] Because of the short incubation time until the ova are infectious, eggs that are deposited under the fingernails during scratching and then placed in the mouth may be a mode of reinfestation.

• #4 Enterobius Vermicularis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK536974/

  Enterobius vermicularis is an organism that primarily lives in the ileum and cecum. Once E. vermicularis eggs are ingested, they take about 1 to 2 months to develop into adult worms which happens in the small intestine. These do not usually cause any symptoms when confined to the ileocecal area. The female adult worms and ova migrate to the anal area mostly at night time and deposit thousands of eggs in the perianal area. This migration causes pruritus. Eggs hatch near the anal area causing perianal pruritus. This leads to contamination of the fingers and results in ingestion of the eggs (autoinfection) and restarting of the life cycle of the worm. Occasionally, the larvae migrate back into the rectum and to the small intestine and begin the life cycle (retro infection). […] Infection is caused by the ingestion of the pinworm eggs. Transmission is most commonly through the fecal-oral route. […] Risk factors for pinworms include poor hygiene, eating after touching contaminated items and living with an individual who is identified as egg positive.

• #5 Enterobius vermicularis | PPT

  https://www.slideshare.net/slideshow/enterobius-vermicularis-97748116/97748116

  The irritation caused by pruritis ani can result in nocturnal enuresis, chronic salpingitis, cervicitis, peritonitis, and urinary tract infections (UTI). […] Enterobius vermicularis is monoxenous, passing its entire life cycle in the human host. […] The mode of transmission is through contaminated hands, food, water, clothing, and dust. […] Autoinfection occurs due to scratching of the perianal area with fingers, which is most common in children. […] Retroinfection occurs when the egg laid on the perianal skin immediately hatches into the infective stage larva and migrates through the anus to develop into the adult worm in the colon.

• #6 Enterobius/Enterobiasis | Concise Medical Knowledge

  https://www.lecturio.com/concepts/enterobius-enterobiasis/

  Humans are the primary hosts of E. vermicularis. […] The entire life cycle of E. vermicularis takes place in the human GI tract and lasts 28 weeks. […] Inflammatory reaction to worms and eggs on skin intense pruritus. […] Autoinfection occurs by patients transferring the eggs to the mouth with contaminated hands after scratching the affected region. […] Environmental contamination may also occur via the consumption of contaminated foods or contact with surfaces that are contaminated with eggs.

• #7 Pinworm (Enterobiasis): Practice Essentials, Etiology, Transmission

  https://emedicine.medscape.com/article/225652-overview

  Pinworm infection, caused by the nematode Enterobius vermicularis, is prevalent in temperate regions worldwide. It primarily affects children, with transmission often occurring to parents via their children. In the US, general prevalence in children ranges from 0.2-20%, whereas in institutional settings, it can be as high as 50-100%. […] Pinworm infection, also called enterobiasis, is caused by Enterobius vermicularis, a white slender nematode with a pointed tail. In humans, they reside in the cecum, appendix, and ascending colon. Female pinworms are 8-13 mm long, and males are 2-5 mm long. […] Pinworms reside in the cecum, appendix, and ascending colon. Unlike other parasites, they do not lay eggs within the intestines. Instead, female worms accumulate around 10,000 eggs in their uterus. At night, gravid female worms migrate to the anus, lay eggs on the perianal skin, and then die. Within 4-6 hours, the larvae develop inside the eggs, becoming infectious. The movement of the female and the ova cause intense local itching. Ova may survive for up to 3 weeks before hatching.

• #7 Pinworm (Enterobiasis): Practice Essentials, Etiology, Transmission

  https://emedicine.medscape.com/article/225652-overview

  Eggs can be transmitted via contaminated surfaces or hands, and once ingested, the larvae hatch in the small intestine, migrate to the cecum, and mature. The entire cycle, from infection to egg release, takes about 3-4 weeks. […] Unlike other intestinal nematodes such as roundworm, hookworm, and whipworm, which often involve a life cycle requiring feces-soil-oral transmission, pinworms are transmitted via direct contact with contaminated surfaces (furniture, bedding, clothing, etc.), autoinfection (scratching the anus and ingesting eggs), or through sexual contact. […] Pinworm infection does not cause severe morbidity unless ectopic infection occurs. This rare complication occurs in individuals with conditions that compromise the integrity of the bowel wall (eg, inflammatory bowel disease). Parasites migrate through the bowel wall and are found in extracolonic sites. Ectopic enterobiases have been described in various locations, including the vagina, salpinx, inguinal area, genital area, pelvic peritoneum, omentum, liver, salivary glands, male genital tract, and even the lungs. […] A 28% to 68% increased risk for appendicitis is associated with pinworm infestation.

• #8 The Diagnosis and Treatment of Pinworm Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6522669/

  The considerable potential for E. vermicularis transmission is explained by the tenacity and adhesive property of the eggs, which adhere particularly well to hands and under fingernails, thereby easily maintaining the chain of infection (continuous exposure, contact infection, autoinfection). […] Approximately 40% of affected individuals are oligo- or asymptomatic. If autoinfection does not occur, pinworm infection is self-limiting due to the short life span of adult worms. […] The role of E. vermicularis in relation to the pathogenesis of some cases of acute appendicitis has been the subject of controversy for many years, despite the fact that no causality has been reliably demonstrated. […] The anthelmintic efficacy of benzimidazole is based on binding to -tubulin, which inhibits tubulin polymerization and depletes the worms glycogen reserves.

• #9 Threadworm Infection (Strongyloidosis) | Iowa State University

  https://vetmed.iastate.edu/vdpam/about/focus-areas/swine/swine-disease-manual/index-diseases/threadworm-infection

  Adults that develop in the small intestine irritate the intestine, with the severity depending upon the number of parasites. The parasites cause a blunting and atrophy of intestinal villi. […] These alterations result in leakage of proteins into the gut and failure of the intestine to effectively absorb nutrients and fluids. The alterations lead to anemia, diarrhea, dehydration and emaciation. […] Migration of larvae through the lungs causes small hemorrhages as well as thickening and inflammation of alveolar septa that impair respiration.

• #10 Clinical features and complications – GPnotebook

  https://gpnotebook.com/pages/general-information/threadworm/clinical-features-and-complications

  Threadworms may cause symptoms by mechanical stimulation and irritation, allergic action, and migration to parts of the body where they create a pathogenic response (2) […] In the vast majority of threadworm infections there is no significant damage to the intestine or host. […] Occasionally, threadworm infections have been associated with extrintestinal infections which results in atypical presentations: […] threadworm migrations may result in the formation of nodules or granulomas that have been mistaken for tuberculosis, schistosomiasis, and carcinomatosis.

• #11 Threadworm Infection (Strongyloidosis) | Iowa State University

  https://vdl.iastate.edu/vdpam/about/focus-areas/swine/swine-disease-manual/index-diseases/threadworm-infection

  Adults that develop in the small intestine irritate the intestine, with the severity depending upon the number of parasites. The parasites cause a blunting and atrophy of intestinal villi. […] These alterations result in leakage of proteins into the gut and failure of the intestine to effectively absorb nutrients and fluids. The alterations lead to anemia, diarrhea, dehydration and emaciation. Migration of larvae through the lungs causes small hemorrhages as well as thickening and inflammation of alveolar septa that impair respiration.

• #12 enterobiusvermicularis.pptx

  https://www.slideshare.net/slideshow/enterobiusvermicularispptx/261569040

  Enterobius vermicularis, also known as the pinworm or threadworm, is a parasitic nematode that infects the large intestine of humans. The adult worm produces little pathological changes in the intestine. Less frequently, it may cause mild catarrhal inflammation of intestinal mucosa and their sites of attachment. Occasionally, minute ulcers may develop in the caecum and appendix. In sensitized persons, absorption of metabolites secreted by the worm gives rise to allergic manifestations. […] Significant pathological lesions are caused by the eggs. The eggs adhere well to the surface of the skin and by their mucoid secretions cause irritation and characteristic nocturnal perianal or perineal itching. […] All these symptoms are caused by female worms laying eggs on the anal area. In children with severe infection, behavioral changes such as sleep disturbances, neurosis, nail biting, and grinding teeth at night can occur. Adult worms also cause appendicitis.

• #13 Pinworms – Knowledge and References – Taylor & Francis

  https://taylorandfrancis.com/knowledge/Medicine_and_healthcare/Infectious_diseases/Pinworms/

  Pinworm infestation (Enterobius vermicularis) is the most common helminth infection in the United States. […] Adult worms lay eggs on perianal skin at night causing inflammation. […] A high worm burden can cause abdominal pain, nausea, and vomiting. […] Pinworms should be part of the differential for vulvovaginitis in prepubescent females. […] The diagnosis can be confirmed by an adhesive pad or tape pressed to the perianal area at night or in the early morning pre-bathing. […] Pinworms can be treated with antihelminthics such as mebendazole or albendazole: Two doses given 2 weeks apart. […] Reinfection is common and can be reduced by treating the entire household, washing all clothes and bed linens, good hand hygiene, daily bathing, and frequent nail clipping. […] Several studies have claimed that helminths may have a role in CD pathogenesis.

• #13 Pinworms – Knowledge and References – Taylor & Francis

  https://taylorandfrancis.com/knowledge/Medicine_and_healthcare/Infectious_diseases/Pinworms/

  These infestations, mostly determined by pinworms (Enterobius vermicularis) and roundworms (Ascaris lumbricoides), may cause a TH2-response in the immune system and prevent an autoimmune reaction by increasing the number of regulatory T-cells. […] Paradoxically, the reduced rate of chronic helminth infections among children of Western countries may have resulted in an abnormal maturation of the immune system in infancy, and possibly in increased susceptibility to autoimmune disorders including CD.

• #14 Enterobiasis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Enterobiasis_pathophysiology

  It is postulated that Enterobius vermicularis triggers an inflammatory response which is associated with the low-grade eosinophilia. […] Allergic response to the worm protein is considered the cause of pruritus; usually pruritus ani (perianal pruritus).

• #15

  https://link.springer.com/article/10.1007/s00384-015-2239-1

  Ileocolitis due to Enterobius vermicularis has been reported in the literature as early as 1919, but it is not widely recognized as a cause of intestinal inflammatory disease. […] The pathophysiology of Enterobius ileocolitis is not well understood. Controversy exists as to whether the worm is responsible for mucosal ulceration or merely takes up residence in preexisting ulcerated mucosa. […] Some investigators have hypothesized that an immediate hypersensitivity reaction to parasite secretions or surface antigens accounts for the eosinophilic infiltrate. […] Enterobius ileocolitis should be included on the list of diseases that can cause bowel wall thickening due to eosinophilic infiltrates. Awareness of this entity is important because Enterobius ileocolitis is easily curable with proper treatment.

• #16 Pinworm Infestation – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/nematodes-roundworms/pinworm-infestation

  Pinworm ova become infective within a few hours of reaching the perineum. Infestation usually results from transfer of ova from the perianal area to fomites (clothing, bedding, furniture, rugs, toys, toilet seats), from which the ova are picked up by the new host, transmitted to the mouth, and swallowed. […] The female worm migrates out of the anus to the perianal region (usually at night) to deposit ova. The sticky, gelatinous substance in which the ova are deposited and the movements of the female worm cause perianal pruritus. […] Pinworms reach maturity in the lower gastrointestinal tract within 2 to 6 weeks.

• #17 Pinworms: Structure and Pathogenesis (With Diagram)

  https://www.biologydiscussion.com/invertebrate-zoology/phylum-nemathelminthes/pinworms-structure-and-pathogenesis-with-diagram/34329

  The infection of pinworm is called Enterobiasis. The person infected may experience intense itching in the anal region. […] In women and girls, pinworm may crawl into the genital opening and cause inflammation and irritation. Lesions in colon and appendix are also associated with pinworm infection.

• #18 Vaginal Pinworms: Symptoms & Treatment

  https://myvagina.com/vaginal-pinworms/

  Pinworms or threadworms can also colonise the mucous membranes of the vagina and urinary tract. These worms are much harder to get to and kill, since most worming treatments are designed to work in the digestive tract, not the vagina. […] In fact, most antiparasitic drugs are not well absorbed into the bloodstream, so cant get to the mucous membranes of the vagina or urinary tract. This poses a huge problem when trying to treat vaginal or urethral worms. […] Typical medical treatments for intestinal worms are mebendazole, albendazole, or pyrantel pamoate. Mebendazole is poorly absorbed into the bloodstream, so it should be avoided in vaginal worm infections; however, albendazole is reported to have successfully eradicated vaginal pinworm infestations. […] Mebendazole and albendazole block the worms ability to absorb glucose, which starves them of their energy source within days. […] These medicines do not kill the eggs, just larvae and adult worms, so repeat treatment is required.

• #19 Threadworm | intestinal, parasitic, infection | Britannica

  https://www.britannica.com/animal/threadworm

  threadworm, (Strongyloides stercoralis), worm of the phylum Nematoda that is parasitic in the human intestine but is able to live freely and breed in the soil. It is especially common in the moist tropics. […] Larvae are passed out of the hosts body in the feces. They usually reenter through the skin of the hosts feet and are carried by the bloodstream to the region of the lungs. They break through the tracheal passages, migrate into the digestive tract, and become localized in the large intestine, maturing and producing eggs there.

• #20 Strongyloides stercoralis (threadworm) Mnemonic for USMLE

  https://pixorize.com/view/6181

  Also known as a threadworm. […] Pathogenesis and Presentation: Strongyloidiasis […] Skin irritation at site of skin invasion. […] After entering the foot, migrate via blood to the lungs. […] Early pneumonitis. […] Pulmonary signs of worm infection known as Loeffler syndrome. […] Larvae migrate through trachea and are swallowed. […] Mature larvae may reinvade intestinal walls, causing autoinfection. […] Larvae may migrate subcutaneously from perianal region. […] Raised pruritic skin streaks along lower trunk, thighs, buttocks. […] Eosinophilia. […] Immunodeficient patients prone to developing hyperinfection (multiorgan damage and sepsis).

• #21 Strongyloides stercoralis: morphology, life cycle, pathogenesis,diseases, diagnosis and treatment – Online Biology Notes

  https://www.onlinebiologynotes.com/strongyloides-stercoralis-morphology-life-cycle-pathogenesisdiseases-diagnosis-and-treatment/

  Both the larva and adults are pathogenic […] Infective filariform larva at the site of invasion produce macules and papules. […] In the host sensitized earlier to strongyloides antigens, the larva causes allergic reaction such as urticaria and pruritus. […] In the lungs, larva produces a considerable degree of tissue damage and injury to the alveoli and bronchial epithelium, thereby producing bronchopneumonia or full blown pneumonitis. […] It produces inflammatory exudates of macrophages, epithelial cells and minimal hemorrhage. […] In the intestinal mucosa of the duodenum and jejunum the adult worms produce mild to moderate degree of oedema, cellular infiltration and partial villous atrophy. […] In severe infection ulcers and long standing infectious fibrosis is found occasionally. […] In autoinfection and hyperinfection syndrome, the mucosal inflammation is severe. The sigmoidal colon and rectum frequently becomes thickened and oedematous. The cellular reactions around the larvae are typically absent.

• #22 What is Pyrantel Pamoate used for?

  https://synapse.patsnap.com/article/what-is-pyrantel-pamoate-used-for

  Pyrantel Pamoate operates through a unique mechanism of action that disrupts the neuromuscular system of susceptible parasites. Specifically, the drug functions as a depolarizing neuromuscular blocking agent. It mimics the action of the neurotransmitter acetylcholine, binding to the nicotinic receptors on the muscle cells of the parasites. This binding leads to an influx of ions, causing continuous depolarization of the muscle cells. As a result, the affected worms become paralyzed, lose their grip on the intestinal walls, and are subsequently expelled from the host’s body through normal peristaltic movements of the intestine. […] This mechanism is highly effective against nematodes but has little to no impact on the host, making Pyrantel Pamoate a safe and selective antiparasitic agent. The drug is minimally absorbed from the gastrointestinal tract, which further enhances its safety profile by limiting systemic exposure and associated side effects.

• #23 Wonder drug for worms: A review of three decades of ivermectin use in dermatology – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/wonder-drug-for-worms-a-review-of-three-decades-of-ivermectin-use-in-dermatology/

  Ivermectin is an endectocide, which selectively binds to glutamate-gated chloride channels in invertebrates. This causes hyperpolarization of parasite neurons and muscles by increasing chloride ion influx, ultimately resulting in death of the parasite. It acts on endoparasites and ectoparasites by suppressing the nerve impulse conduction in intermediary neurons or in nerve-muscle synapses, respectively.[6],[7] […] Due to the localization of these channels in the central nervous system and inability of ivermectin to cross the bloodbrain barrier, humans are not affected except those with a history of undergoing shunt surgeries. 6 […] Resistance to ivermectin has been reported in nematodes of horses, sheep, and other animals after 20 years of use.[3] An increasing trend of tolerance of scabies mite to ivermectin has been noted in endemic areas recently. Resistance is also noted in patients with crusted scabies who require repeated doses of ivermectin. The possible reasons could be the following: Mutation in GluCl channel receptors which reduces the sensivity of ivermectin [3] […] Mutation of ABCA1 gene resulting in alteration of P-glycoprotein [3] […] Reduced efficacy of single-dose ivermectin, due to lack of ovicidal action.[3]

• #24

  https://www.parasite.org.au/para-site/text/enterobius-text.html

  While many infections remain asymptomatic, worm burdens may increase with time resulting in damage to the intestines by adult worms and/or damage to the perineum resulting from egg deposition. […] Adult worms attach to the mucosa and feed on intestinal content, bacteria and possibly epithelial cells, causing minute ulcerations which may lead to mild catarrhal inflammation with diarrhoea, eosinophilia and bacterial infection. […] More commonly, however, infections are characterized by intense perianal itching (pruritis ani) caused by host sensations and reactions to female worms depositing sticky eggs on the skin. […] Heavy infections in children may cause restlessness, irritability, anorexia, insomnia, nightmares, bed-wetting, nausea and vomiting. […] Occasionally, wandering worms have been associated with appendicitis, vaginitis, and rarely, extra-intestinal granulomas in ectopic sites.

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