Pinworms

What are pinworms?

Pinworms are plasticky, thread-like worms that live in the large intestine of human beings. They are about one-half inch long. Pinworm eggs are small, transparent, and can be seen only with a microscope. When the person sleeps, the female pinworm travels to the anus and lays eggs around the anal region, which along with the wriggling of the female pinworm leads to severe itching.

How is pinworm infection spread?

Pinworm infection or Enterobiasis is spread by the fecal-oral route, that is by the transfer of infective pinworm eggs from the anus to someone’s mouth. This happens either by hand to mouth contact and ingestion of the eggs or indirectly through contaminated food and water, clothing, bedding, food, or other household objects/surfaces. The pinworm eggs can remain on the surfaces or objects around you for up to 3 weeks. You cannot get pinworm from your pets because humans are the only known hosts of the pinworm.

Why is it a continuous cycle?

Once the affected person scratches his/her anal region, the pinworm eggs are transferred to the person’s fingers and remain under the fingernails. It then spreads to the bedding and linen and other objects/surfaces in the house and also remains on the person’s underwear. These pinworm eggs when accidentally ingested by anyone in the house after they touch any of the affected person’s belongings can lead to the cycle being repeated. Retroinfection, or the migration of newly hatched larvae from the anal skin back into the rectum, may occur, but the frequency with which this happens is unknown.

Symptoms of Pinworm Infection

• Itching around the area of the anus, and in women, also around the vagina
• Nervousness
• Insomnia and restlessness
• Loss of appetite
• Abdominal pain
• Weight loss
• Infection of the bladder or ureters, leading to dysuria or bladder comfort.

Sometimes in mild cases of infection, there may be no symptoms of pinworm.

Characteristics of Hosts

Pinworm infection affects people all over the world and across all ages and socioeconomic levels. Pinworm infection is the most common worm infection in the United States. Pinworm infection occurs most commonly among:

• School-aged and preschool-aged children
• Institutionalized Persons
• Household members and caretakers of persons with pinworm infection

Due to the ease with which it spreads, pinworm infection usually affects more than one person in a household or an institution. Childcare centers are major sites of pinworm infection.

Risk Factors for Pinworm Infection

Children aged 5 to 10

Pinworm mostly affects children aged five to ten (kids in preschool or early school). Pinworm rarely affects children below the age of two. It spreads from the children to those who interact with the children, including teachers and caregivers in these institutions and at home.

Overcrowded spaces with poor hygiene

Overcrowded spaces with poor personal and group hygiene are also another risk factor for the spread of infections by pinworms. Here, it is possible to ingest these worm eggs as they spread through the air or through objects which people repeatedly use.

Testing for Pinworm

An adhesive transparent tape is taken and it is stuck around the anal region of the person who has just risen from sleep. As the female adult pinworm lays the eggs around this area, they will get stuck to the tape and will be present there when the person wakes up. Once you take this tape to the doctor, he will confirm the presence of pinworms and begin treatment. For best results, perform the tape tests three days in a row.

Self Management of Pinworms

By making a few changes around your home, you could keep these pinworms away. Some of them are listed below:

• Avoid scratching the perianal area, even if you feel the need to do so.
• Wash your hands regularly.
• Keep your fingernails short, and avoid biting your nails.
• Wear well-fitting underwear.
• Wash your underwear in hot water each day.
• Change your sleepwear regularly.
• Mop or vacuum the floors throughout the house.
• Wash all linens and bedding thoroughly in hot water.

Treatment for Pinworm Infection

To treat pinworm infections, your doctor may recommend over-the-counter medications like pyrantel pamoate (Reese’s Pinworm Medicine) not just to the infected person but to other members of the household as well. The treatment works by paralyzing the worms so that they can leave the body in the person’s stool. Some of the anti-parasite medications used are:

• Mebendazole
• Albendazole (Albenza)

You may have mild gastrointestinal side effects initially and may need two doses at least to be treated completely. The second dose is generally administered two weeks after the first dose.

The doctor may also recommend tap water enemas to help flush out the pinworms and to reduce the symptoms of the infection. Reese’s Pinworm Medicine and piperazine are now rarely used due to their lower efficacy and a higher frequency of side effects when compared with mebendazole and albendazole.

Reinfection after completing drug therapy is common. Also there are drug-resistant strains of pinworms developing every year.

What to do before an appointment

Preparing a list of questions can help you make the most of your time with your doctor. For pinworm infection, some basic questions to ask include:

• What are the other possible causes of my symptoms, if I do not have pinworm?
• Does the whole family need to be treated for pinworms?
• How do I rid my home of pinworms?
• How do I prevent reinfection?

What your doctor may ask you during the consultation

The doctor may ask the following questions during the course of a consultation trying to determine the cause of the symptoms:

• When did the case of itching start?
• Does it itch mostly at night or throughout the day?
• Do any other members in the family experience the same symptoms?
• Do the symptoms get better or worse for some reason?
• Has your or your child had contact with anyone who you know to have pinworms?
• Have you found any dead pinworms in your underwear, pajamas, or bedding?

Tapeworms vs. Pinworms: The difference

Both tapeworms and pinworms are common infections in the United States and around the world. It is easy to confuse them if one doesn’t observe the symptoms carefully. Laboratory testing, of course, will certainly help to identify the cause. But what are the differences between them in relation to cause, the host characteristics, symptoms and treatment? Here are some of the most common differences:

The difference in size and shape

Pinworms are thin and white and about as long as a staple. Tapeworms are flatworms that are ribbon-shaped and grow very long. Adult tapeworms are sometimes known to grow up to 30 feet, the length of a school bus. Infections by such tapeworms are very rare.

Characteristics of the Host

Pinworms affect only human beings whereas tapeworms affect pets also. Dogs commonly get it by ingesting fleas that may carry tapeworm larvae. Some of the symptoms of tapeworm infection in your beloved canine could be an irritation around their bottoms, causing them to scoot across the floor or lick their bottoms a lot. They may also lose a lot of weight quickly because of the tapeworm.

Differences between modes of infection

The infection route for the pinworm has already been described. The tapeworm is found in unhygienic conditions and around livestock, and people who eat raw or uncooked beef or pork are at a high risk of being infected by it. Tapeworms can live outside for months waiting for the host to come along.

Differences in symptoms after infection

Just like the pinworm, some people may have no symptoms at all of a tapeworm infection. Others may have stomach pain, weakness, or diarrhea, which help to distinguish it from pinworms. There is a change in appetite, much like a pinworm infection and the resulting loss of weight.

When you get tapeworms from eating raw pork, the eggs enter into the bloodstream and hatch in your tissues. Once inside the tissues, they form fluid-filled cysts. This process is called cysticercosis. Depending on where the cysts are formed and the extent of inflammation they cause, a range of symptoms have been reported. Some of them are visionary impairments, the formation of lumps on the skin, neurological changes, and seizures.

Differences in treatment methods

Over the counter, medicines are prescribed for pinworm infections and if possible the entire family is treated for pinworm to ensure non-recurrence. Tapeworms on the other hand sometimes just go away without any kind of treatment. In other cases, some medicines may be prescribed that kill the tapeworm or cause it to be removed from the body in your stools. In an infection that is caused by tapeworm cysts, the doctor needs to treat the symptoms that occur as a result of the infection and may also need to perform surgery to remove the cysts.

In a nutshell

Pinworms are a continuous menace if not properly done away with. Treatment is only effective if the means of prevention are just as robust. Children are most at risk of not only contracting the disease but also spreading it.  If proper personal hygiene is maintained by everyone, pinworms can be gotten rid of. The word ‘everyone’ is of most relevance here to prevent the recurrence of the disease.

References
https://www.health.ny.gov/diseases/communicable/pinworm/fact_sheet.htm
http://web.stanford.edu/class/humbio103/ParaSites2006/Enterobius/history.htm
https://www.mayoclinic.org/diseases-conditions/pinworm/diagnosis-treatment/drc-20376386
https://www.cdc.gov/parasites/pinworm/gen_info/faqs.html
https://www.webmd.com/a-to-z-guides/pinworms-infection#1
https://www.ncbi.nlm.nih.gov/pubmed/12435149
https://www.medicinenet.com/pinworm_infection/article.htm#what_are_pinworms
https://www.emedicinehealth.com/pinworms/article_em.htm#can_a_child_or_adult_become_reinfected_with_pinworms