Gastrointestinal parasite infections (4.8.2)

Question 1

What are threadworms? Where are they frequent?

Answer 1

Enterobius vermicularis

> Intestinal parasitic worms: 5-13 mm long

> Most common worm infection in Australia

> Humans are the only host

Infestations more frequent in:

• Preschool and school-aged children
• Crowded conditions and temperate climates

Question 2

How to diagnose threadworms (pinworms)

Answer 2

Diagnosis based on symptoms (approx 30% present with nocturnal perianal itch)

• can be confirmed by observing adult worms in the perianal area (parent inspection of child anal area at night –> torch helps worms glow in light); or in the faeces and sometimes on underwear
• Possible to collect eggs from the perianal area but not necessary for diagnosis –> briefly place transparent adhesive tape on the perianal skin in the morning (prior to defecation and washing) and examine the tape for eggs. Eggs can be difficult to see with the naked eye.

Question 3

What are some signs and symptoms of threadworms?

Answer 3

• Itchiness around the vagina (females)
• local anal tickling sensation or acute pain
• day time irritability and sleeplessness, bed wetting
• reduced appetitie, abdominal pain and weight loss
• severe infestation –> acute diarrhoea

Question 4

What is some differential diagnoses of threadworm?

Answer 4

Other types of worm infestations

> check for recent travel abroad or extended time in remote/rural parts of Australia

Contact irritant dermatitis, eczema

> history, signs of itching on other parts of the body

Scabies or fungal infections

> check for other presenting symptoms

Question 5

For threadworms;

A) who is the patient? and family?

B) What are the symptoms

C) How long have the symptoms been present

D) Action taken

E) Medications

F) Medical conditions

G) Allergies

Answer 5

A)

• Very young children*
• Pregnant women*

B)

• Uncertain diagnosis*
• Unusual GI sx*
• Secondary bacterial infection from scratching*

C)

• Frequent recurrence*

D)

• Tx failure*

E)

N/A

F)

N/A

G)

N/A

Suspect other worm infections e.g. recent travel abroad (esp developing countries, northern australia*)

Question 6

Self-care for threadworm?

Answer 6

• Shower at night and the morning after the medication has been administered to wash away eggs laid during the night
• Change underwear, nightwear, sheets and towels frequently; wash them in hot water and iron
• Wash toys in hot water
• Do not shake sheets when taking them off the bed
• Wash hands and scrub nails after going to the toilet or changing nappies and before eating or food preparation
• Discourage scratching of bare skin in the perianal area and trim fingernails short
• Underwear, onesies, and mittens at night
• Vacuum often, to remove any eggs; wipe rather than dust
• Discourage children from putting their hands in their mouths and eating food that has fallen on the floor
• Protective ointment on perianal area
• Clean the toilet regularly
• Exclusion of a child from child care/school etc is not required if treatment has occurred
• No need to worm any pets