Diagnosis incidence and treatment of enterobius vericularis in North America

Abstract

The adult male pinworm measures from 2 to 5 millimeters in length, and has its terminal and curved ventrad. The female pinworm is more than twice as large as the male, 8-13 millimeters in length, and has its tail portion decidedly attenuate. Pinworm ova is characteristically flattened on one side, and measures 55 by 30 micrometers. Examination of the feces show only a small percentage of the actual number of cases infected with pinworms. D'Antoni and Sawitz (1940) reported diagnosing less than 1 per cent of the true incidence using direct fecal films, and less than 25 per cent using fecal concentration techniques. The use of swabs is the present accepted means for diagnosing pinworm infections. Many swabs have been devised, but only two are in general use (1) the NIH swab, and (2) the Graham swab. These two swabs require a total of 7 consecutive swabs before an individual is considered to be negative. Serological testing seems to be of little value in diagnosing the presence of Enterobius. The reactions encountered upon injection of various sorts of extracts of pinworm individuals are not specific and therefore of little diagnostic value. The incidence of Enterobius in North America can be regarded as high, probably infecting half the people of North America. Central America and Mexico seems to be the most heavily infected area of continent. According to Sandground (1933) and Mazzotti and his associated (1940) and (1943), the majority of central americans and mexicans are probably harboring pinworms. In the Canadian-Alaska areas, the incidence of pinworms is high, according to Kuitunen-Ekbaum (1940) and (1943) and Ashburn (1941). The numerous papers presented on the incidence of pinworms in various parts of the United States supports the view that possibly 40 percent or more of the people in the United States are infected with pinworms. The injury that results from infections with Enterobius is slight. Gravid female migrations may set up local irritations in the anal area known as prurtis ani. This latter phenomenon is often used as a basis for diagnosing pinworms. MacArthur (1930) reported that the first and most important case of nocturnal prurtis is the presence of Enterobius. Numerous other complaints are associated with pinworm infections; anorexia, irritability, headaches, gastro-intestinal symptoms and so forth. Anal washes and ointments were once highly favored in treating pinworm infections, but they are, for the most part, no longer used. Wright, Brady, and Bozicevich (1939) reported anal ointments to be of doubtful value in treating cases of enterobiasis since they failed either to destroy females or render the ova non-viable. Santonin was shown by Wright, Brady, and Bozicevich (1939) to be far from effective in treating pinworms infections. Tetrachloroethylene is probably the best single dose drug for the treatment of Enterobius, but in large does it is not well tolerated by the patients especially children. Phenothiazine therapy is the standard treatment for enterobiasis in Europe and appears to be quite effective in ridding individuals of pinworms. With the use of phenothiazine nearly 90 percent cures are effected. Hexylresorcinol is probably the best all around drug available in pinworm therapy. The drug is better tolerated in large doses than most anthelmintics. It has, however, two major disadvantages, (1) it is expensive, and (2) if treatment is to be effective it must proceed for a considerable length of time. Hygienic measures alone will not clear up infections with pinworms. Best results are obtained when medication is coupled with hygienic controls. Thirty-six institutionalized boys, between the ages of 13 and 17, were examined with the use of a modified anal swab. The swab consists of a small test tube having a ring of Scotch tape affixed to its terminal end. The applicator tube when not in use was inserted into a larger, housing test tube. The boys were examined in the morning, 6:30-6:45 AM. For the sake of convenience the boys were divided into three groups, group I-13 boys, group II-13 boys, and group III-10 boys. Of the 36 boys examined on the basis of four swabs, 18 or 50.0 percent were found to be infected with pinworms. The negative fourth swabs were not regarded as evidence for diagnosis of pinworm infections using three consecutive swabs.