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Pruritus Ani with White Threads in a School-Aged Girl

2013; Elsevier BV; Volume: 163; Issue: 3 Linguagem: Inglês

10.1016/j.jpeds.2013.03.082

1097-6833

Wei‐Te Lei, Hung‐Yang Chang, Chi-Hone Lien, Hung‐Chang Lee, Te-Lung Tsai, Chien‐Yu Lin,

Urticaria and Related Conditions

A 7-year-old girl presented to the emergency department complaining of pruritus ani at night. She reported no fever, weight loss, enuresis, grinding of the teeth at night, or hematochezia. Physical examination revealed a threadlike moving worm in the perianal area (Figure 1 and Video 1 [Video 1; available at www.jpeds.com]). The worm was removed and identified as Enterobius vermicularis (Figure 2). Transparent adhesive tape was applied to the patient's perianal area, and embryonated eggs with moving larvae inside were visualized under a low-power microscope (Video 2; available at www.jpeds.com).Figure 2Microscopic examination of the worm revealed a gravid female pinworm, identified as E vermicularis, filled with eggs (arrows).View Large Image Figure ViewerDownload Hi-res image Download (PPT) The patient demonstrated complete recovery after treatment with the antihelminthic agent mebendazole as a single dose repeated 2 weeks later. All of her family members were treated as well. Intestinal nematode infection remains a public health concern in many parts of the world. Taiwan was once an area endemic for nematodes in children, with an overall prevalence of 73%.1Taiwan Parasite Control Association Statistics of parasite infection among school children 1976-1995. Taiwan Parasite Control Association, Taipei, Taiwan1997Google Scholar The prevalence was reduced dramatically after health education and a population-based parasitic control project by the Taiwan Provincial Health Department in the 1970s. Pinworm is now the predominant parasite, with a prevalence of enterobiasis in school-aged children of ∼2.4% in the large-scale survey.2Wang C.C. Lee Y.F. Chang C.C. Lee N.S. Chen P.Y. Huang F.L. et al.Current status of Enterobius vermicularis infection in primary schoolchildren in Miaoli County and Taichung County, Taiwan.J Microbiol Immunol Infect. 2009; 42: 420-426PubMed Google Scholar, 3Wang L.C. Hwang K.P. Chen E.R. Enterobius vermicularis infection in schoolchildren: a large-scale survey 6 years after a population-based control.Epidemiol Infect. 2010; 138: 28-36Crossref PubMed Scopus (13) Google Scholar E vermicularis is a nematode with characteristic life cycle and clinical manifestations. It is transmitted by the fecal-oral route, and reinfection is common. Although severe complications are rare in children with enterobiasis, it may cause malnutrition, sleep disturbances, and reduced quality of life.4Avolio L. Avoltini V. Ceffa F. Bragheri R. Perianal granuloma caused by Enterobius vermicularis: report of a new observation and review of the literature.J Pediatr. 1998; 132: 1055-1056Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar Infection with E vermicularis is easily neglected in developed countries, and the importance of personal hygiene and high alertness of pinworm infection need to be reinforced.5Sung F.C. Lin R.S. Huang K.C. Wang S.Y. Lu Y.J. Pinworm control and risk factors of pinworm infection among primary-school children in Taiwan.Am J Trop Med Hyg. 2001; 65: 558-562PubMed Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4ZDA1YzdlZTE2NDIyNGQ0MzFhYjliMDUxODZkOTAxOCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjk5Nzk5Mzc0fQ.IAUTkj7IxXIQ7aFGopGM7Zb4Kx6MGGvOQFGtex-qKbVM5w1FKBWwZAzTHToGXREz74oP4MzjQ2aKqA0tJPRy0AbqFWmjB6LppbsswzVA-zH9Yj_MInAxB0FwwrRwH6X0HAOK27JnxKOLYrxEIaz0mdajPo0yU2D_laeFuStab6C5VfhtdW6Xh1hczjjO4ngrnX7x5xNMN2FfRZMIygGMJIHQHiE6HXpAlGegv8opO2Ch1XAUiWcBusNyCZIoRUubYh0iSJndDzddeZ7oDUbdr7-KV6Jr2T-LPM4-sr-DVQ4TIlsb6jKs2u7oiN56cSiWCJCRVB1csLCi-MR2DytkHg Download .mp4 (1.09 MB) Help with .mp4 files Video 1A threadlike moving worm was visualized in the perianal area. The parasite was removed and identified as E vermicularis.eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI2YWNiMzE4YjlmMDcwNzhjZWQyYzkzMmUxYTExMDM4ZiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjk5Nzk5Mzc0fQ.UOc8KUIOqCvobUG-r0hXwxaTVXkG_hNFOlfxP46jWC0ZiQxP12V3QTi7cnFrwH3Lu3Xpi9Bhy02VyijmRjdPr7fFVH1lpYxtxKya0hQtLa-86x66EYuGBdX70cXhP2tYNQ-N_Gm8bqEGY6EMJjafz-xNEUV1JNqx1a9MPPyKJLmtrmoRIead7ofXYneJoVLRFH4TGDkvJMOXTt3wWu81uMMDPK8symf7WKj-Ic_yx_XI7J_yzPbIcilVXUlqo7UtLOELIK7bnhDviyzQajO4qzXfYSTyq4pPt-U0vocuqgBYI70bnFf9hoDM_MAgI168fWbCdyQfn-tu9-uvbrjcKA Download .mp4 (1.38 MB) Help with .mp4 files Video 2Under low-power microscopy, multiple embryonated eggs are seen with larvae moving inside.