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Davoodi L, Soleymani E, Oladi Z, Azar SS, Parandin F, Mizani A, Mirbadie SR, Hajizadeh F, Fakhar M. Vulvovaginitis due to Enterobius vermicularis in a girl and epidemic enterobiasis in her family. Clin Case Rep 2024; 12:e8902. [PMID: 38725928 PMCID: PMC11079541 DOI: 10.1002/ccr3.8902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
Key Clinical Message Here we present a case of a 4-year-old girl who suffered from vulvovaginitis caused by Enterobius vermicularis. All members of her family were also infected by this helminth. Treatment with mebendazole was administered to all family members and it was found that the entire family had been cured. Abstract Vulvovaginitis, an inflammation of the vulvovaginal mucous membranes, is a common reason for pediatric gynecology consultations. One of the causes of this condition is a parasitic worm known as Enterobius vermicularis (E. vermicularis). In girls, adult worms can infiltrate the vagina and release eggs, leading to the development of vulvovaginitis. Furthermore, these worms have the ability to invade the endometrial cavity too. Here we present a case of a 4-year-old girl who suffered from vulvovaginitis caused by E. vermicularis. All members of her family were also infected by this parasitic helminth. In the vaginal sample, apart from the eggs, the female adult worm was observed under the microscope. Treatment with mebendazole was administered to all family members, and their progress was followed for a period of 3 weeks, during which it was found that the entire family had been cured. This patient experienced significant improvement in symptoms related to severe anxiety, nervousness, vaginal inflammation, itching, and vulvovaginitis caused by E. vermicularis. To prevent infection by E. vermicularis, it is crucial to disinfect underwear and bed sheets. In kindergartens, the spread of this parasite should not be underestimated, and asymptomatic individuals who have been exposed to infected persons should receive treatment to prevent an epidemic. Maintaining cleanliness and hygiene, especially after using the toilet, is of the most importance, particularly for girls who are more susceptible to E. vermicularis infection. Additionally, it is essential for all family members to be aware of the transmission routes of this parasite.
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Affiliation(s)
- Lotfollah Davoodi
- Department of Infectious Diseases, Faculty of MedicineAntimicrobial Resistance Research Center, Mazandaran University of Medical SciencesSariIran
| | - Eissa Soleymani
- Department of Parasitology, Toxoplasmosis Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
| | - Ziaeddin Oladi
- Department of Internal Medicine, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Shadi Shayesteh Azar
- Department of Infectious Diseases, Faculty of MedicineAntimicrobial Resistance Research Center, Mazandaran University of Medical SciencesSariIran
| | - Fatemeh Parandin
- Research Center for Environmental Determinants of Health (RCEDH)Health Institute, Kermanshah University of Medical SciencesKermanshahIran
| | - Azadeh Mizani
- Department of ParasitologyPasteur Institute of IranTehranIran
| | | | - Fatemeh Hajizadeh
- Department of Parasitology, Toxoplasmosis Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
| | - Mahdi Fakhar
- Iranian National Registry Centre for Lophomoniasis and ToxoplasmosisImam Khomeini Hospital, Mazandaran University of Medical SciencesSariIran
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Vanhooren M, Stoefs A, Van Den Broucke S, Van Esbroeck M, Demuyser T, Kindt S. Intestinal helminthic infections: a narrative review to guide the hepatogastroenterologist. Acta Gastroenterol Belg 2023; 86:460-473. [PMID: 37814562 DOI: 10.51821/86.3.11895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Intestinal helminthic infections are not uncommon in Western Europe, mainly due to modern travel, emigration and globalization. Moreover, some helminthic infections are endemic in Western Europe and are part of the everyday clinical practice. The hepatogastroenterologist should therefore recognize and manage these patients or at least refer them to appropriate reference centers. Signs and symptoms are often unspecific or even absent. Discerning the disease at an early stage avoids expensive diagnostic testing, life-threatening complications and in some cases even further spread of the disease. This review article aims to guide the hepatogastroenterologist when suspecting a helminthic infection by addressing the most prevalent symptoms, summarizing the most probable associated helminthic entities, highlighting practical steps in diagnosis and available treatments.
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Affiliation(s)
- M Vanhooren
- Department of Gastroenterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - A Stoefs
- Department of Microbiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - S Van Den Broucke
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp (ITMA), Antwerp, Belgium
| | - M Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp (ITMA), Antwerp, Belgium
| | - T Demuyser
- Department of Microbiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- AIMS lab, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - S Kindt
- Department of Gastroenterology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Ummarino A, Caputo M, Tucci FA, Pezzicoli G, Piepoli A, Gentile A, Latiano T, Panza A, Calà N, Ceglia AP, Pistoio G, Troiano V, Pucatti M, Latiano A, Andriulli A, Tucci A, Palmieri O. A PCR-based method for the diagnosis of Enterobius vermicularis in stool samples, specifically designed for clinical application. Front Microbiol 2022; 13:1028988. [PMID: 36466657 PMCID: PMC9712443 DOI: 10.3389/fmicb.2022.1028988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/31/2022] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Enterobius vermicularis (E. vermicularis) is a nematode that infects up to 200 million people worldwide, despite effective medications being available. Conventional diagnostic tests are hindered by low sensitivity and poor patient compliance. Furthermore, no biomolecular techniques are available for clinical application. The aim of this study was to develop a procedure specifically designed for clinical application to detect E. vermicularis by means of PCR. MATERIALS AND METHODS Two subject groups were taken into account: a group of 27 infected patients and a control group of 27 healthy subjects. A nested-PCR was performed on fecal samples to detect E. vermicularis. Due to the intrinsic difficulties of the fecal matrix, several countermeasures were adopted to ensure the efficient performance of the method: (a) a large amount of feces for the extraction process (20 g instead of 200 mg); (b) a combination of chemical and physical treatments to grind the fecal matrix; (c) an additional purification process for the negative samples after the first nested-PCR; and (d) the selection of a very specific target region for the PCR. RESULTS Due to the lack of overlap with other organisms, a sequence of the 5S ribosomal DNA (rDNA) spacer region including the tract SL1 was chosen to design appropriate external and internal primers. The first nested-PCR detected E.vermicularis in 19/27 samples from infected patients. After further purification, 5/8 of the negative samples resulted positive at the second PCR. Conversely, all the samples from healthy controls resulted negative to both PCRs. Sensitivity and specificity of the method were, respectively, 88.9% and 100%. CONCLUSION The results prove the high diagnostic accuracy of the proposed method, addressing and overcoming the challenges posed by both conventional tests and PCR-based approaches. Therefore, the method can be proposed for clinical application.
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Affiliation(s)
- Aldo Ummarino
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | - Michele Caputo
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | | | | | - Ada Piepoli
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Annamaria Gentile
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Tiziana Latiano
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Anna Panza
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Nicholas Calà
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | | | | | | | - Michela Pucatti
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | - Anna Latiano
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Angelo Andriulli
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
| | - Antonio Tucci
- Agorà Biomedical Sciences, Etromapmacs Pole, Lesina (FG), Italy
| | - Orazio Palmieri
- Gastroenterology Unit, Fondazione IRCCS “Casa Sollievo Della Sofferenza” Hospital, Viale Cappuccini, Italy
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Penberthy K, Mendoza J, Mendoza M, Harrison G, Lancaster L, Belyea B, Zeichner SL. Abdominal Pain and Intermittent Fevers in a 16-Year-Old Girl. Pediatrics 2019; 144:e20190093. [PMID: 31375532 PMCID: PMC6855813 DOI: 10.1542/peds.2019-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/19/2023] Open
Abstract
A 16-year-old girl presented to the emergency department with intermittent fevers and worsening abdominal pain of 5 weeks duration. She had a history of travel to a less developed country and exposure to possible infectious diseases. Abdominal imaging and blood tests revealed diffuse mesenteric lymphadenopathy, elevated transaminases, and elevation of inflammatory markers. Gastroesophageal and colon endoscopies revealed gastric ulcers, and the patient was discharged with a presumptive diagnosis of systemic juvenile idiopathic arthritis given the lymphadenopathy seen on imaging, serositis, sacroiliac joint stiffness noted on physical examination, and pain relief with celecoxib. She presented again 4 days later with worsening abdominal tenderness, elevated transaminases, and new-onset abdominal distention. Tissue biopsy yielded the diagnosis and directed appropriate treatment.
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MESH Headings
- Abdominal Pain/etiology
- Adolescent
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arthritis, Juvenile/diagnosis
- Biomarkers/blood
- Biopsy
- Diagnosis, Differential
- Emergency Service, Hospital
- Endoscopy, Gastrointestinal
- Enterobiasis/diagnosis
- Female
- Fever/etiology
- Humans
- Inflammation/diagnosis
- Lymphadenopathy/diagnosis
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/diagnostic imaging
- Lymphoma, Large-Cell, Anaplastic/drug therapy
- Lymphoma, Large-Cell, Anaplastic/pathology
- Positron Emission Tomography Computed Tomography
- Stomach Ulcer/chemically induced
- Stomach Ulcer/diagnosis
- Tomography, X-Ray Computed
- Transaminases/blood
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Affiliation(s)
- Kristen Penberthy
- Microbiology, Immunology, and Cancer Biology, School of Medicine, University of Virginia, Charlottesville, Virginia
| | | | | | | | | | | | - Steven L Zeichner
- Pediatric Infectious Diseases, Department of Pediatrics and Departments of
- Microbiology, Immunology, and Cancer Biology, School of Medicine, University of Virginia, Charlottesville, Virginia
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Cymerman RM, Kaplan Hoffmann R, Rouhani Schaffer P, Pomeranz MK. Vulvar infections: beyond sexually transmitted infections. Int J Dermatol 2017; 56:361-369. [DOI: 10.1111/ijd.13464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/24/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel M. Cymerman
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Rachel Kaplan Hoffmann
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Panta Rouhani Schaffer
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
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Iguchi S, Hirai Y, Ainoda Y, Isoda N, Miura H, Egawa H, Yamamoto M, Kikuchi K. Incidental diagnosis of oxyuriasis through a colonoscopy. IDCases 2016; 4:38-40. [PMID: 27077026 PMCID: PMC4816899 DOI: 10.1016/j.idcr.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/27/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Shigekazu Iguchi
- Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan
- Corresponding author at: Department of Infectious Diseases, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Tel.: +81 3 3353 8111x38311; fax: +81 3 5269 7003.Department of Infectious Diseases, Tokyo Women's Medical University8-1 Kawada-cho, Shinjuku-kuTokyo162-8666Japan
| | - Yuji Hirai
- Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yusuke Ainoda
- Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Noriko Isoda
- Department of Clinical Laboratory, Tokyo Women's Medical University, Tokyo, Japan
| | - Hitomi Miura
- Department of Clinical Laboratory, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroto Egawa
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Kikuchi
- Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan
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Shetty JB, Kulkarni DV, Prabhu V. Eggs containing larvae of Enterobius vermicularis in vaginal smear. J Cytol 2013; 29:94-6. [PMID: 22438633 PMCID: PMC3307469 DOI: 10.4103/0970-9371.93238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Enterobius vermicularis also known commonly as pinworm is the most common intestinal parasite. It is a nematode that inhabits the human terminal ileum, colon and appendix. The fertilized female migrates to the perianal area where eggs are deposited but occasionally introduces itself into adjacent orifices, most commonly the female genitourinary tract. Thus the eggs can be seen in the vaginal smear as a result of contamination. We report a case wherein the patient presented with signs and symptoms of vulvovaginitis. In her vaginal smear there were eggs of Enterobius vermicularis which showed a coiled larva within it. In the background there were plenty of acute inflammatory cells. This patient responded favorably to antihelminthics. We report this case to highlight the morphology of the parasite and also to emphasize that such findings should not be neglected. Timely reporting and appropriate treatment of such cases will prevent further complications of this parasite including endometritis, salphingitis and peritonitis.
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Affiliation(s)
- Jyothi B Shetty
- Department of Pathology, K. B. Bhabha Hospital and Seth G. S. Medical College, Mumbai, India
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Rohidas MA, Sampatraj JS, Ajit KA, Motilal RP. Massive infestation with pinworms causing chronic diarrhea. J Formos Med Assoc 2013; 114:1011-2. [PMID: 23763862 DOI: 10.1016/j.jfma.2013.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 01/24/2013] [Accepted: 01/25/2013] [Indexed: 10/27/2022] Open
Affiliation(s)
| | | | - Khot Amol Ajit
- Department of Gastroenterology, T.N.M.C, B.Y.L. Nair Hospital, Mumbai, India
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9
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Charpille M, Brière M, Lechiche C, Sotto A, Lachaud L. [Caecal infestation due to Enterobius vermicularis]. Med Mal Infect 2013; 43:90-1. [PMID: 23477937 DOI: 10.1016/j.medmal.2013.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 01/19/2013] [Accepted: 01/28/2013] [Indexed: 11/27/2022]
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10
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Pinworm infestation mimicking crohns' disease. Case Rep Gastrointest Med 2013; 2013:706197. [PMID: 23555063 PMCID: PMC3608265 DOI: 10.1155/2013/706197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 02/13/2013] [Indexed: 01/14/2023] Open
Abstract
We here report a case of a young man who presented to his general practitioner with diarrhea. Inflammatory bowel disease was suspected and a colonoscopy showed aphthous lesions suggestive of Crohns' disease but biopsies revealed eggs of Enterobius vermicularis. When treated for this parasite, his symptoms were alleviated and a followup colonoscopy revealed a normal colon and distal ileum. Enterobius vermicularis is the most common parasite worldwide and has been attributed with many different presentations and pathologies. It is therefore necessary to maintain vigilance, even in high-income countries, in order to diagnose patients with one of the many atypical presentations of pinworms.
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Enterobius vermicularis (oxiuros) en la práctica ginecológica: clínica y citología. Experiencia de 3 casos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2010.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Hirai Y, Ainoda Y, Nakamura-Uchiyama F, Umetani K, Totsuka K. Unusual colonoscopic view of Enterobius vermicularis. Intern Med 2011; 50:657. [PMID: 21422699 DOI: 10.2169/internalmedicine.50.4811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yuji Hirai
- Department of Infectious Diseases, Tokyo Women's Medical University, Japan.
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Chang TK, Liao CW, Huang YC, Chang CC, Chou CM, Tsay HC, Huang A, Guu SF, Kao TC, Fan CK. Prevalence of Enterobius vermicularis Infection among preschool children in kindergartens of Taipei City, Taiwan in 2008. THE KOREAN JOURNAL OF PARASITOLOGY 2009; 47:185-7. [PMID: 19488428 DOI: 10.3347/kjp.2009.47.2.185] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 03/24/2009] [Accepted: 03/31/2009] [Indexed: 11/23/2022]
Abstract
The prevalence of Enterobius vermicularis infection among preschool children was reported to be low based on a 5-year screening program in Taipei City, Taiwan. The Taipei City government intended to terminate the E. vermicularis screening program among preschool children. Thus, we were entrusted with confirming whether pinworm infections among preschool children in Taipei City had truly declined. From each of 12 administrative districts 2-3 kindergartens were randomly selected for investigation. In total, 4,349 children were examined, of which 2,537 were boys and 1,812 were girls. The cellophane tape adhered to a glass slide was used, and all examinations were done by certified medical technologists. Results indicated that the overall prevalence rate of pinworm infections was 0.62% (27/4,349). Although the infection rate was higher among boys (0.67%, 17/2,537) than in girls (0.55%, 10/1,812), no significant difference was found (chi(2) = 0.399, P = 0.62). According to the administrative district, the infection rate ranged from no positive cases of E. vermicularis infection in the Xinyi, Zhongzhen, and Wanhua Districts (0%; 0/299, 0/165, and 0/358, respectively), to 0.26% (1/131) in Songshan District, with the highest rate of 1.88% (7/373) in Wenshan District. Because the overall infection rate (0.62%, 27/4,349) in the present study was unchanged compared to that (0.40%, 197/49,541) previously reported in 2005, we propose that regular pinworm screening and treatment programs should be continued in some parts of Taipei City.
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Affiliation(s)
- Tso-Kang Chang
- Department of Parasitology, Taipei Medical University College of Medicine, Taipei, Taiwan
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