Oxyuriasis is the term used to describe a pinworm infestation in humans. The pinworms hatch and mature in the intestines. The female worms reach full maturity about two weeks after fertilization and lay several thousand eggs outside the anus before perishing themselves. The pinworm does not require an intermediate host and usually does not cause serious symptoms.
What is oxyuriasis?
Oxyuriasis refers to a person’s infestation with what is known as pinworm, a white threadworm (female) about eight to thirteen millimeters long whose eggs are ingested orally and cause the infestation. The pinworm passes through about three maggot stages in the intestine, but does not require an intermediate host. It is an unusually simple development and infection pathway. 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 appendix area for another two weeks until the eggs reach their mature 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. The female worm then perishes. The male pinworm dies already after mating and is excreted with the stool. The eggs are surrounded by a special protein which, on the one hand, causes the eggs to stick to the skin near the anus and, on the other hand, triggers an itching sensation that causes the affected person to scratch himself – especially during sleep. As a result, some of the eggs are picked up by the fingers and can cause new infections or infections in other people again.
Causes
The pinworm, a nematode classified as a threadworm with the Latin name Oxyuris vermicularis or Enterobius vermicularis, probably affects only humans. This means that only humans infected with oxyuriasis or the excreted eggs of the pinworm are possible sources of infection. The male worms perish after the mating act and are excreted. The female worms also die after laying their eggs outside the anus, 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 the intense itching at the anus, scratching often occurs unconsciously during sleep, so that the fingers and fingernails become contaminated with the tiny worm eggs. Another route of infection is through contamination of food with worm eggs or by spraying contaminated aerosol. The worm eggs remain viable and infectious for up to three weeks under favorable environmental conditions.
Symptoms, complaints, and signs
Oxyuriasis is initially accompanied by few symptoms. The most noticeable symptom is nocturnal itching at the anus, which is triggered by special proteins in which the worm eggs are “packed” and with which the eggs practically adhere to the skin. Prolonged worm infestation may result in symptoms such as decreased appetite and facial pallor, weight loss, decreased performance, and abdominal pain similar to that of appendicitis. In extreme cases, chronic diarrhea and rectal bleeding may develop. The pinworm does not invade other tissues or blood vessels, but in very rare cases, the worm can infect the genital tract of girls and women and cause vulvovaginitis.
Diagnosis and course of the disease
If nightly itching around the anus raises suspicion of oxyuriasis, a good diagnostic option is to use a transparent adhesive strip to pick up possible eggs of the worm at the anus in the morning and examine them under a light microscope. The procedure can be repeated on several days if the result is negative. Another indication can be worms in the stool, which are visible to the naked eye, and any dead female worms in the bed or night linen. The course of the disease is usually unproblematic and hardly goes beyond loss of appetite and, at worst, pain reminiscent of appendicitis.
Complications
In most cases, oxyuriasis does not initially cause any particular discomfort or other symptoms. However, as this disease progresses, those affected suffer from very severe itching in the anus, which occurs mainly at night.Likewise, there is a lack of appetite and thus weight loss and various deficiency symptoms. A pallor in the 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 the affected person and reduces it enormously. Furthermore, the patients suffer from severe abdominal pain, which not infrequently can also lead to depression or other psychological complaints. Internal bleeding is also not uncommon and in some cases can lead to anemia. Furthermore, in the worst case, it can also lead to appendicitis. This must then be surgically removed. Special complications do not occur. With treatment, the symptoms can also be completely limited. The life expectancy of the patient is not affected.
When should one go to the doctor?
Itching in the intimate area may indicate an infection with pinworms. A visit to the doctor is indicated if the symptoms do not subside or rapidly become more severe. The symptoms usually occur during the night and can be clearly assigned to oxyuariasis on the basis of this. 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 consult a pediatrician. Sleep disturbances or skin changes in the intimate area also indicate an infection that must be medically clarified and treated. Affected persons should consult a doctor early on and have the symptoms clarified. Otherwise, life-threatening complications may occur. Persons who have come into contact with possibly infected people belong to the risk groups. Children who have put a contaminated pacifier or finger in their mouth are also at risk and should be presented to a doctor if the symptoms mentioned occur. With the complaints, the family doctor, the pediatrician or a specialist for internal diseases can be consulted. Other contacts are the gynecologist or the urologist. During treatment, the patient must be closely monitored by a physician so that the necessary countermeasures can be taken directly in the event of any complications.
Treatment and therapy
Oxyuriasis responds well to a single course of anthelmintics; however, the drugs do not kill the eggs. Because of the risk of autoinfection from existing eggs and because of the developmental cycle of the pinworm, it is recommended that treatment be repeated 14 and 28 days after each initial treatment. Within a family, 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 asymptomatic for the first 4 to 6 weeks before the first female worms begin laying eggs. Antihelminthics contain active ingredients that are toxic specifically to the metabolism of nematodes and flatworms such as tapeworms and flukes, but are harmless to human metabolism in the prescribed amounts. Before treatment with an antihelminthic agent, it should be known which type of worm has caused the disease so that it can be targeted. Some agents are effective only against nematodes and others only against flatworms.
Outlook and prognosis
In cases of pinworm infestation, the prognosis is usually favorable. Thus, in most cases, oxyuriasis takes a positive course and exceedingly rarely causes complications. However, there is a high relapse rate, especially in children. It is not uncommon for them to become infected again after only a short time. In young children, the maggot eggs can penetrate directly from the anus into the oral cavity by sucking the thumb or fingers. Side effects from the treatment are rare. Complications such as infestation of the female vagina with worm eggs, which continue to develop there, also rarely cloud the favorable prognosis. However, if secondary symptoms do occur, they are noticeable in the form of inflammation, pain or discharge. In severe cases, there is a risk of impairment of intestinal functions. However, life-threatening intestinal perforations are very rare. In these cases, affected individuals also suffer from abdominal pain and stool retention. Normally, 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 also frequently infected with pinworms. A longer healing period of oxyuriasis must be expected if the pinworm infection was discovered late. Thus, in such cases, sanitation of the affected organs is necessary.
Prevention
The primary preventive measure is strict hygiene. This is especially true for people within a family if a family member is affected. Hygiene measures consist of changing undergarments and, if possible, bed linens daily and washing them in a boil wash cycle to reliably kill any worm eggs and maggots that may be present. Particular care must be taken in the hygiene of hands, which must be washed with soap after any possible contact and fingernails must be meticulously treated with a nail brush.
Aftercare
In the case of oxyuriasis, only a few measures of direct aftercare are usually available to those affected. In this disease, in the first place, a very early and, above all, rapid diagnosis is necessary to prevent further complications or discomfort. Therefore, the affected person should ideally see a doctor at the first signs and symptoms. Most patients rely on taking various medications to alleviate these symptoms. The doctor’s precise instructions should always be followed in order to detect and treat any side effects at an early stage. Furthermore, even after successful treatment, regular check-ups are very important to prevent re-infection of oxyuriasis. Most sufferers should pay attention to a healthy lifestyle with a balanced diet to counteract the symptoms. At the same time, the affected person should drink plenty of fluids to support the body. As a rule, oxyuriasis can be treated relatively well by a doctor, so that follow-up care measures are no longer necessary. A high standard of hygiene should generally be maintained.
This is what you can do yourself
Fortunately, oxyuriasis can be easily treated once pinworms have been diagnosed as the trigger for nighttime itching. During treatment, sufferers should be careful not to scratch their anus, even at night while sleeping. So that children can also adhere to this, pajamas such as those offered for children with neurodermatitis are helpful. They have mittens at the ends of the sleeves, from which the child cannot slip out himself. This way, children can at most scratch with fabric on fabric at night and not bring worm eggs from their hands to their mouths. Because the worm eggs can survive outside the intestine for a good three weeks, strict hygiene is advised within the family. Underwear, towels and bed linen should definitely be changed daily and washed with a boil wash cycle. This is the only way to ensure that maggot eggs are not also transmitted via fabrics. Body hygiene is also important, especially in the anal area. PH-neutral washing and care products are recommended here. If the anus is already scratched open, nourishing creams with which the region can be creamed once or twice a day will help. Baby creams or wound and healing ointments are products of first choice here. Gels containing light sulfonated shale oil are also recommended because they are antimicrobial and promote wound healing.
