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The Informed Parent

The Many Faces of Pinworm

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jun. 30, 2003

Kara is a well-adjusted seven-year-old who is finishing the first grade. She is one of the brightest students in her class and, according to her mom, she just loves school. Kara is quite a gymnast and swimmer, and seems to thrive on competition. Mom brought her to the office because over the past two weeks something seems different. Kara does her homework, visits with her family, gets ready for bed and reads a book before turning out the lights...just like she has done all throughout the school year. But, in eight of the past fourteen nights, about an hour after she falls asleep, her parents are startled by her intense crying. At times the screaming is as if she was possessed. Rushing to her side they find her sitting up, dazed and unable to say what is wrong. The next morning Kara is fine, as if nothing had happened the night before. Her parents are concerned that she might be stressed or is being pushed too much. Is this a cry for help?

Mike is a burley three-year-old who just began pre-school a few weeks ago. He seems to love it, and his parents are pleased since it gives him a chance to play with other children and “burn off some of his extra energy”. Recently, however, his parents became concerned when he was seen constantly scratching his bottom. It was quite noticeable and embarrassing. They didn’t pay too much attention to this until yesterday when he complained that his bottom “hurt”. As mom was giving him a bath she observed that the area around his anus was red. This frightened her, making her wonder if something nefarious had been going on at the pre-school.

Ellie is a two-year-old child brought to the office because mom thought she might have a urinary tract infection. Some redness around the vaginal area was noticed which was nothing out of the ordinary for Ellie. But the concern was the fact that every time Ellie urinated she grabbed herself and said it hurt. She also had been potty trained for almost two months. But she was now wetting the bed at night.

Three different patients; three totally different scenarios, yet all three have the same problem. They all have pinworms. The pinworm is a parasite, enterobius vermiculairs, which is a small worm that is 1/8-1/4 inch in length. It is usually brown-to-gray in color, and is visible to the naked eye if one is looking for it. This parasite is very common worldwide, and can affect anybody. In the United States, it is most prevalent in pre-schools and elementary schools, and in families of children in these age groups.

The life cycle of the worm helps explain the high incidence in young children, as well as the symptoms described above. A person inadvertently ingests the eggs of the worm. These are swallowed, passing to the stomach and intestines where they are hatched into the adult form of the worm. They ultimately migrate to the large intestine where they quietly reside, causing no problems. Since they ARE parasites it would not be in their best interest to cause problems which would allow them to be discovered. At night, and ONLY at nighttime, the adult female worm crawls out onto the perianal area to deposit her eggs. She then crawls back into the anus, or dies. This causes perianal irritation and itching. The affected host scratches his/her bottom, picking up the eggs on fingers or under fingernails. These eggs can then be spread to food, utensils, toys, etc. An unsuspecting person can ingest these eggs and becomes infected. It is no surprise that a pre-school setting would be optimal for this method of spread.

The nighttime migration of the female worms can cause a very strange sensation. It is not painful but can wake a soundly sleeping child, causing her to react as if she was having a night terror. Such was the case with Kara. The irritation to the perianal area from the presence of the worms and eggs can cause significant redness. This was seen in Mike’s case. The migrating adult female worms can make their way to the vaginal area causing vaginitis, or even cystitis, a true bladder infection. In Ellie’s case, her urinalysis and culture were negative. She merely had a vaginitis that was easily remedied with local measures. Other symptoms from pinworm infestations can include grinding of teeth and bedwetting.

The easiest way to diagnose pinworms is having the parents look for them. The child goes to sleep as he usually does. An hour after he has fallen asleep the perianal area should be inspected carefully with a flashlight. The tiny worms, which are less than a quarter of an inch in length, should be seen. They should be obvious when looked for, but would be easily missed if given only a cursory glance.

When a diagnosis of pinworms is made, the treatment is simple. The affected person takes one chewable tablet of an anti-parasite drug on day one, taking another tablet two weeks later. The first tablet will kill the adult worms; the second will kill the eggs that have hatched since the first tablet was taken. It is wise to treat all family members when a child is diagnosed having pinworms, making sure to break any possible cycle of re-infection.

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