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Presentation
An 8 year-old girl presented to a pediatric infectious disease telemedicine consult with her mother for burning and itching around her anus and in the vaginal area. The mother stated small, white wiggling worms around the patient’s anus. Each time, the patient was treated with over-the-counter Reese’s Pinworm Medicine (pyrantel pamoate) by her mother.
 
Lab Testing
Primary diagnostic testing for infection with Enterobius vermicularis is the Scotch tape test. Sample is best collected at nighttime or early morning, when the adult female worm migrates from the colon to deposit eggs around the anus. Microscopic evaluation is performed using Gram’s iodine for contrast. Enterobius vermicularis ova were observed.
 
Cause of Symptoms
The most common clinical manifestation of Enterobius vermicularis is pruritis ani. Patients report of restlessness due to loss of sleep from itchiness, which occurs when the female worm deposits her eggs in the perianal folds. Abdominal pain, diarrhea, and intestinal blockages are rare, but may occur. Other rare complications include secondary bacterial infection due to scratching of infected area and formation of abscess and fistula.
 
Treatment
Patient received antiparasitic treatment Albendazole 200mg followed by another dose of Albendazole 200mg, two weeks later to catch the worm in all stages. Albendazole is first line treatment for pinworm and other helminthic infections.

Contact Information

Nicole Jackson, njackson@asmusa.org