Pinworm infestation in humans is called oxyurosis. The pinworms hatch and mature in the intestine. The female worms reach full maturity about two weeks after fertilization and lay several thousand eggs outside the anus before they perish themselves. The pinworm does not need an intermediate host and usually does not cause any serious symptoms.
What is oxyurosis?
Oxyuriasis refers to the infestation of a person with the so-called pinworm, a white roundworm (female) about eight to thirteen millimeters long, whose eggs are ingested orally and cause the infestation. The pinworm goes through about three instars in the intestine, but does not need an intermediate host. It is an unusually simple route of development and infection. See gradinmath for What is Horner Syndrome.
The pinworm passes through two to three larval stages in the intestine within two to three weeks and, after reaching sexual maturity and fertilization, settles in the area of the cecum for another two weeks until the eggs reach their maturity stage. The female worm then migrates towards the anus and leaves the anus mainly at night to lay its 5,000 to over 11,000 eggs. Then the female worm perishes.
The male pinworm dies after mating and is excreted in the stool. The eggs are coated with a special protein that not only sticks the eggs to the skin near the anus, but also causes an itch that causes the sufferer to scratch, especially while sleeping. As a result, some of the eggs are picked up with the fingers and can thus cause new infections or infections in other people.
The pinworm, a roundworm classified as a nematode with the Latin name Oxyuris vermicularis or Enterobius vermicularis, probably affects only humans. This means that only people infected with oxyuriasis or the excreted eggs of the pinworm come into question as a source of infection. The male worms perish after mating and are excreted. The female worms also die outside the anus after laying their eggs, which is why the organism becomes worm-free by itself if eggs are not repeatedly ingested.
Since egg laying occurs mainly at night and is associated with severe itching in the anus, scratching often occurs unconsciously during sleep, so that the fingers and fingernails are contaminated with the tiny worm eggs. Another route of infection is contamination of food with worm eggs or by spraying contaminated aerosols. Under favorable environmental conditions, the worm eggs remain viable and infectious for up to three weeks.
Symptoms, Ailments & Signs
Oxyuriasis is initially accompanied by few symptoms. The most noticeable symptom is the nocturnal itching on the anus, which is triggered by special proteins in which the worm eggs are “packaged” and with which the eggs practically adhere to the skin. Symptoms such as decreased appetite and facial pallor, weight loss, reduced performance and abdominal pain, similar to those of appendicitis, can occur with a longer-lasting worm infestation.
In extreme cases, chronic diarrhea and rectal bleeding can occur. Although the pinworm does not penetrate other tissues or blood vessels, in very rare cases the worm can infect the genital tract of girls and women and cause vulvovaginitis.
Diagnosis & course of disease
If nightly itching in the area of the anus gives rise to suspicion of oxyuriasis, a good way of diagnosing it is to use a transparent adhesive strip to take up possible eggs of the worm in the anus in the morning and examine them under the light microscope. The process can be repeated on several days if the outcome is negative.
Another indication can be worms in the stool that are visible to the naked eye and any dead female worms that may be present in the bed linen or nightwear. The course of the disease is usually unproblematic and hardly goes beyond loss of appetite and, in the worst case, pain reminiscent of appendicitis.
In most cases, oxyuriasis does not initially cause any particular discomfort or other symptoms. However, as the disease progresses, those affected suffer from very severe itching in the anus, which mainly occurs at night. There is also a lack of appetite and thus weight loss and various deficiency symptoms.
A pale face and a significantly reduced resilience of the patient are also associated with this disease. Oxyuriasis thus has a very negative effect on the quality of life of those affected and reduces it enormously. Furthermore, the patients suffer from severe abdominal pain, which can often lead to depression or other psychological problems.
Internal bleeding is not uncommon and can lead to anemia in some cases. In the worst case, it can also lead to appendicitis. This must then be surgically removed. There are no particular complications. With treatment, the symptoms can also be completely reduced. The life expectancy of the patient is not affected.
When should you go to the doctor?
Itching in the intimate area can indicate a pinworm infection. A doctor’s visit is indicated if the symptoms do not go away or get worse quickly. The symptoms usually appear during the night and can therefore be clearly assigned to oxyariasis.
If small worms are noticed in the underwear or in the stool, a doctor must be consulted. Parents who notice behavioral or developmental problems in their child should contact the pediatrician. Sleep disorders or skin changes in the intimate area also indicate an infection that needs to be medically clarified and treated. Affected people should consult a doctor early and have the symptoms clarified.
Otherwise, life-threatening complications can occur. People who have been in contact with potentially infected people are among the risk groups. Children who have put a contaminated pacifier or finger in their mouth are also at risk and should be seen by a doctor if the above symptoms occur. The family doctor, the pediatrician or a specialist in internal diseases can be consulted with the complaints. Other contacts are the gynecologist or the urologist. During the treatment, the patient must be closely monitored by a doctor so that the necessary countermeasures can be taken immediately in the event of any complications.
Treatment & Therapy
Oxyuriasis responds well to a single dose of antihelminthics, but the drugs do not kill the eggs. Due to the risk of auto-infection from existing eggs and due to the development cycle of the pinworm, it is advisable to repeat a treatment 14 and 28 days after the initial treatment. Within a family, the family members should also be treated prophylactically in order to combat a possible initial infection in family members right at the beginning.
Initial infections are usually completely symptom-free in the first 4 to 6 weeks before the first female worms start laying eggs. Antihelminthics contain active ingredients that have a toxic effect on the metabolism of nematodes and flatworms such as tapeworms and flukes, but are harmless to the human metabolism in the prescribed amount.
Before starting treatment with an anthelmintic, it is important to know what type of worms caused the disease so that targeted action can be taken. Some remedies are only effective against nematodes and others only against flatworms.
Outlook & Forecast
In the case of an infestation with pinworms, the prognosis is usually favorable. Oxyuriasis takes a positive course in most cases and only very rarely causes complications. However, there is a high recidivism rate, especially in children. It is not uncommon for them to become infected again after a short time. In small children, the maggot eggs can penetrate directly from the anus into the oral cavity by sucking on the thumb or fingers.
Side effects from the treatment are rarely to be feared. Complications such as an infestation of the female vagina with worm eggs, which develop there, only rarely cloud the favorable prognosis. However, if there are consequences, these are noticeable through inflammation, pain or discharge. In severe cases, there is a risk of impaired bowel function. However, life-threatening intestinal perforations are very rare. The affected persons also suffer from abdominal pain and stool retention. Usually, however, oxyuriasis does not pose a major risk to the patient’s health.
However, the risk of further infection is high. Even with effective treatment, oxyuriasis often returns because other members of the family are often infected with the pinworms as well.
Oxyuriasis will take longer to heal if the pinworm infection is discovered late. In such cases, it is necessary to rehabilitate the affected organs.
Strict hygiene is the primary preventive measure. This is especially true for people within a family when a family member is affected. The hygiene measures consist of changing underwear and, if possible, bed linen every day and washing them in a hot wash cycle to reliably kill any worm eggs and maggots that may be present. Particular attention is paid to the hygiene of the hands, which must be washed with soap after any possible contact and the fingernails must be meticulously worked with a nail brush.
In the case of oxyuriasis, there are usually only a few direct aftercare measures available to those affected. In the case of this disease, a very early and, above all, rapid diagnosis is first and foremost necessary so that there are no further complications or symptoms. Therefore, ideally, the affected person should consult a doctor at the first signs and symptoms.
Most patients depend on taking various medications to relieve these symptoms. The precise instructions of the doctor should always be followed in order to identify and treat any side effects at an early stage. Furthermore, regular check-ups are very important even after successful treatment in order to prevent reinfection of the oxyuriasis.
Most of those affected should ensure a healthy lifestyle with a balanced diet to counteract the symptoms. The person affected should drink a lot to support the body. As a rule, oxyuriasis can be treated relatively well by a doctor, so that follow-up care is no longer necessary. A high standard of hygiene should generally be maintained.
You can do that yourself
Fortunately, once pinworms are diagnosed as the cause of nighttime itch, oxyurosis is easily treated. During treatment, sufferers should be careful not to scratch their anus, even during sleep. So that children can also stick to this, pajamas, such as those offered for children with neurodermatitis, are helpful. They have mittens on the sleeves that the child cannot slip out of. At most, children can scratch fabric on fabric at night and not get worm eggs from their hands to their mouths.
Because the worm eggs are able to survive outside the intestines for a good three weeks, strict hygiene within the family is advisable. Underwear, towels and bed linen should be changed daily and washed on a hot wash cycle. This is the only way to ensure that maggot eggs are not also transmitted via substances.
Personal hygiene is also important, especially in the anal area. PH-neutral detergents and care products are recommended here. If the anus is already scratched, nourishing creams that can be applied to the region once or twice a day will help. Baby creams or wound and healing ointments are the first choice here. Gels containing light-colored sulfonated shale oil are also recommended because they have antimicrobial and wound-healing properties.