ENTEROBIASIS : CLINICAL ASPECTS
E. vermicularis seldom produces serious disease. The most frequent symptom is pruritusani (anal itching). This symptom is most severe at night and has been attributed to the migration of the gravid female. It may lead to irritability and other minor complaints. In severe infections, the intense itching may lead to scratching, excoriation, and secondary bacterial infection. In female patients, the worm may enter the genital tract, producing vaginitis, granulomatous endometritis, or even salpingitis. It has also been suggested that migrating worms might carry enteric bacteria into the urinary bladder in young women, inducing an acute bacterial infection of the urinary tract. Although this worm is fre-quently found in the lumen of the resected appendix, it is doubtful that it plays a causal role in appendicitis. Perhaps the most serious effect of this common infection is the psy-chic trauma suffered by the economically advantaged when they discover that they, too, are subject to intestinal worm infection.
Eosinophilia is usually absent. The diagnosis is suggested by the clinical manifestations and confirmed by the recovery of the characteristic eggs from the anal mucosa. Identifica-tion is accomplished by applying the sticky side of cellophane tape to the mucocutaneous junction, then transferring the tape to a glass slide and examining the slide under the low-power lens of a microscope. Occasionally, the adult female is seen by a parent of an in-fected child or recovered with the cellophane tape procedure.
Several highly satisfactory agents, including pyrantel pamoate and mebendazole, are available for treatment. Many authorities believe that all members of a family or other cohabiting group should be treated simultaneously. In severe infections, retreatment after 2 weeks is recommended. Although cure rates are high, reinfection is extremely common. It need not be treated in the absence of symptoms.
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