Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

530 Enteral and Parenteral Nutrition Enterobiasis (Pinworm)

■short-term enteral/parenteral nutrition supports wound healing

and

➣stabilization until transition back to oral nutrition possible

■if lifelong nutrition support necessary, 100% nutrient needs can be

met with careful technique and monitoring

Enterobiasis (Pinworm)...............................

J. GORDON FRIERSON, MD

history & physical

History

■Life cycle: Eggs of Enterobius vermicularis are laid by females at night

in anal and perianal area, are reingested by original or other host,

hatch and develop in small intestine, mate and mature in colon.

Generally 3–4 weeks to complete cycle.

■Exposure is by fecal-oral route, either auto-infection after scratching

anus, or eggs transmitted by host’s fingers or fomites. Eggs may be

in dust, on sheets, clothing. Found worldwide.

Signs & Symptoms

■Children most often affected. Complaints are anal pruritus, or small

“thread-like” worms coming from anus. In heavy infections may

have irritability, restlessness. Rarely eggs or worms found in fallopian

tubes or appendix, with corresponding pain, inflammation.

tests

■Basic tests: blood: normal

■Basic tests: urine: normal

■Specific tests: Scotch tape test: piece of clear tape pressed against the

anus early in AM before washing or defecation, then placed on slide

and examined. Eggs should be visible. Kits available as “pinworm

kits.”

➣Seeing or capturing adult worm, thin, white, 0.8 to 1.3 cm, is

diagnostic. Occasionally seen on sigmoidoscopy.

■Other tests: Stool O&P examination often negative, not recom-

mended

differential diagnosis

■Other causes of pruritus ani, such as anal pruritus, candidiasis, hem-

orrhoids, and strongyloidiasis