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Al-Shouli ST, Barry M, Binkhamis K, AlHogail N, Alafaleq NO, Dufailu OA, Aljerian K. Fatal Case of a Child Harboring Enterobius vermicularis. Healthcare (Basel) 2023; 11:healthcare11060917. [PMID: 36981574 PMCID: PMC10048790 DOI: 10.3390/healthcare11060917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Enterobius vermicularis is a threadlike parasite also known as "pinworms". It is the most common helminth infection, affecting the gastrointestinal tracts of children worldwide, although it seldom causes any fatalities. Enterobius vermicularis infections are usually asymptomatic and may only cause anal pruritis, with occasional reported cases of ectopic migration into the appendix or the female genital tract by adult pinworms. Here, we report a case of a 15-year-old girl who presented to the emergency department with high-grade fever, vomiting, and vague abdominal pain for three days. She was diagnosed with acute abdominal pain and underwent emergency ileocecectomy, but died the following day. Pathological examination of ileocecal junction showed intraluminal and intramural Enterobius vermicularis, which were attributed as the cause of her death in the absence of any other pathologies. Death due to Enterobius vermicularis is rare; this case calls for clinicians to be vigilant in exploring Enterobius vermicularis infections in patients with undiagnosed acute abdominal pain, since it could be a potential cause of death.
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Affiliation(s)
- Samia T Al-Shouli
- Immunology Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Mazin Barry
- Infectious Disease Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Khalifa Binkhamis
- Medical Microbiology Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Nourah AlHogail
- College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Nouf Omar Alafaleq
- Department of Biochemistry, College of Science, King Saud University, Riyadh 12372, Saudi Arabia
| | - Osman Adamu Dufailu
- Faculty of Engineering and Science, University of Greenwich, Central Avenue, Chatham Maritime, Kent ME4 4TB, UK
| | - Khaldoon Aljerian
- Forensic Medicine Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
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Haghshenas M, Koosha M, Latifi A, Kazemirad E, Dehghan A, Nikmanesh B, Mowlavi G. Detection of Enterobius vermicularis in archived formalin-fixed paraffin-embedded (FFPE) appendectomy blocks: It's potential to compare genetic variations based on mitochondrial DNA (cox1) gene. PLoS One 2023; 18:e0281622. [PMID: 36758053 PMCID: PMC9910638 DOI: 10.1371/journal.pone.0281622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Acute appendicitis represents one of the most common causes of emergency abdominal surgery worldwide. Meanwhile, Enterobius vermicularis has been suggested as one of the probable causes of appendicitis. In this study, the morphological characteristics of the remnant pinworms and pathologic changes were explored in old-archived FFPE tissues of appendectomies. Moreover, we provide the first molecular identification, genetic, and haplotype variation of this nematode from the old-archived FFPE tissue section of appendectomy using the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Seventeen FFPE appendectomies with E. vermicularis infection, stored over 12-22 years, were collected from two different geographical areas of Iran. In the histopathological examination, tissue changes were observed in thirteen cases (76.4%) and inflammation in four blocks (23.5%). After DNA extraction, the cox1 gene was amplified in twelve (70.6%) cases using the nested polymerase chain reaction (PCR). Phylogenetic analysis and a median-joining network of 78 available cox1 sequences of E. vermicularis revealed 59 haplotypes. We identified five haplotypes that fell into type B. All Haplotypes are novel except for two haplotypes, Hap32 and Hap37, identical to E. vermicularis sequences from Iran, Greece, and Germany. The ranges of diversity distance and haplotype diversity within the isolates were 0-1.9% and HD:0.643-0.667, subsequently. Overall, the absence of inflammation or even tissue changes in some sections can suggest the possible non-inflammatory role of E. vermicularis in appendicitis. Although FFPE material suffers from PCR inhibition, we could successfully use nested PCR to characterize E. vermicularis in old-archived appendectomy blocks and suggest this method as a complementary diagnosis technique in pathology. While the predominant type was B in the Middle East and Europe, further studies on a larger sample size from different geographical regions could probably confirm the results obtained in the present study.
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Affiliation(s)
- Maryam Haghshenas
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Koosha
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Latifi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Kazemirad
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail: , (EK); (GM)
| | - Arash Dehghan
- Department of Pathology, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Bahram Nikmanesh
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Mowlavi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
- * E-mail: , (EK); (GM)
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Infections Are a Very Dangerous Affair: Enterobiasis and Death. Healthcare (Basel) 2021; 9:healthcare9121641. [PMID: 34946367 PMCID: PMC8701381 DOI: 10.3390/healthcare9121641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Enterobiasis or oxyuriasis from Enterobius vermicularis is an infection usually localized in the large bowel and cecum. Generally, the symptoms are characterized by anal itching, and intestinal or nervous disorders. Rarely, it is responsible for death. METHODS A forensic autopsy of a 52-year-old white male inmate who died 5 days after hospitalization was performed. Histological and toxicological analyses were also performed. RESULTS The death occurred by localization of Enterobius vermicularis in the duodenum and in the proximal ileum, with intestinal haemorrhage, inflammation, and peritonitis documented by histological examination. CONCLUSION This is a common infectious disease, and can rarely occur with a fatal outcome, even in advanced populations. The lack of knowledge related to the rarity of death from enterobiasis disease can determine a dangerous concern.
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The Incidence of Pinworm ( Enterobius Vermicularis) in Pre-school and School Aged Children in the Eastern Slovakia. Helminthologia 2018; 55:275-280. [PMID: 31662658 PMCID: PMC6662009 DOI: 10.2478/helm-2018-0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/19/2018] [Indexed: 01/27/2023] Open
Abstract
Helminth infections caused by Enterobius vermicularis have a cosmopolitan character and most often affect the paediatric pre-school and school age population. The presented study was conducted to determine the prevalence of E. vermicularis in the analyzed population of children in the Eastern Slovakia. The Graham’s scotch tape method was used to investigate the presence of Enterobius vermicularis eggs in 390 specimens. The analyzed set consisted of 218 girls and 172 boys, divided by age into three groups – aged from 5 months to 2 years, aged from 3 to 6 years, and aged from 7 to 15 years. Investigation of perianal scotch tapes of children for the presence of E. vermicularis eggs revealed the prevalence of E. vermicularis was P = 3.59 %. Depending on the incidence of E. vermicularis infection, we detected no statistically significant difference (p> 0.05). The prevalence of E. vermicularis in boys was P = 4.07 %, and in girls P = 3.21 %. The highest prevalence of E. vermicularis was recorded in the group of children aged from 3 to 6 years (P = 5.03 %). Most of the samples were positive at age 4 and 5. The lowest prevalence was in the group of children aged from 5 months to 2 years (P = 0.97 %), and the prevalence of E. vermicularis in the group of children aged from 7 to 15 was P = 3.91 %. The difference in the incidence of E. vermicularis infection among different age groups of children was not statistically significant (p> 0.05). Enterobius vermicularis nematode infection and enterobiasis currently represents a major public health problem in Slovakia. At the present its occurrence is the most frequent in the paediatric population. Therefore it is important to introduce a targeted hygienic-epidemiological measure in children’s collectives, what also should include proper and effective diagnostics and frequent recurrent therapy.
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Kearns PKA, Casey HA, Leach JP. Hypothesis: Multiple sclerosis is caused by three-hits, strictly in order, in genetically susceptible persons. Mult Scler Relat Disord 2018; 24:157-174. [PMID: 30015080 DOI: 10.1016/j.msard.2018.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/25/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
Multiple Sclerosis is a chronic, progressive and debilitating neurological disease which, despite extensive study for over 100 years, remains of enigmatic aetiology. Drawn from the epidemiological evidence, there exists a consensus that there are environmental (possibly infectious) factors that contribute to disease pathogenesis that have not yet been fully elucidated. Here we propose a three-tiered hypothesis: 1) a clinic-epidemiological model of multiple sclerosis as a rare late complication of two sequential infections (with the temporal sequence of infections being important); 2) a proposal that the first event is helminthic infection with Enterobius Vermicularis, and the second is Epstein Barr Virus infection; and 3) a proposal for a testable biological mechanism, involving T-Cell exhaustion for Epstein-Barr Virus protein LMP2A. We believe that this model satisfies some of the as-yet unexplained features of multiple sclerosis epidemiology, is consistent with the clinical and neuropathological features of the disease and is potentially testable by experiment. This model may be generalizable to other autoimmune diseases.
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Sharma M, Kaul R, Chander B. Enterobius vermicularis infestation leading to Meckel's diverticulitis in an adolescent boy: An extremely rare presentation. J Lab Physicians 2018; 10:106-108. [PMID: 29403216 PMCID: PMC5784279 DOI: 10.4103/jlp.jlp_142_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Enterobius vermicularis is an intestinal nematode commonly affecting children worldwide. Its transmission is by feco-oral route. Meckel's diverticulitis due to E. vermicularis infestation is an extremely rare presentation. An 11-year-old boy presented with acute abdomen. During surgery inflamed Meckel's diverticulum (M.D) was seen. Histopathology examination of specimen revealed E. vermicularis. Till date, only one case of E. vermicularis infestation of M.D is reported around five decades ago. This histopathological confirmation is extremely important as the required treatment (Mebendazole) of the infected case along with household contacts can prevent the spread of infection and may avoid surgery in known contacts.
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Affiliation(s)
- Manupriya Sharma
- Department of Pathology, Dr. RPGMC, Kangra, Tanda, Himachal Pradesh, India
| | - Rashmi Kaul
- Department of Pathology, Dr. RPGMC, Kangra, Tanda, Himachal Pradesh, India
| | - Bal Chander
- Department of Pathology, Dr. RPGMC, Kangra, Tanda, Himachal Pradesh, India
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Efared B, Atsame-Ebang G, Soumana BM, Tahiri L, Hammas N, El Fatemi H, Chbani L. Acute suppurative appendicitis associated with Enterobius vermicularis: an incidental finding or a causative agent? A case report. BMC Res Notes 2017; 10:494. [PMID: 28985767 PMCID: PMC5639576 DOI: 10.1186/s13104-017-2822-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 09/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Histological acute appendicitis patterns associated with Enterobius vermicularis is an extremely rare finding. The exact role of this parasite in acute appendicitis is controversial as usually resected specimens show no evidence of histological inflammation. Case presentation We present herein a case of a 21-year-old male Arabic patient who presented with clinical syndrome of acute appendicitis. Emergency appendectomy was performed and the histopathological examination of the resected specimen showed the presence of E. vermicularis as well as intense acute inflammatory patterns such as mucosal ulceration and suppurative necrosis. The post-operative course was uneventful and the patient was discharged with appropriate anti-helmintic drug prescription. Conclusion Acute appendicitis due to E. vermicularis is a very rare occurrence. The histopathological analysis of resected specimens should pay special attention to search for this parasite for adequate post-operative treatment of patients.
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Affiliation(s)
- Boubacar Efared
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.
| | | | | | - Layla Tahiri
- Department of Pathology, Hassan II University Hospital, Fès, Morocco
| | - Nawal Hammas
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.,Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Hinde El Fatemi
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.,Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Laila Chbani
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.,Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
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Mallick SK, Sengupta R, Banerjee AK. Unusual presentation of Enterobius vermicularis in conjunctival sac. Trop Doct 2014; 45:247-9. [PMID: 25540166 DOI: 10.1177/0049475514562494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report an unusual case of extraintestinal infection with adult Enterobius vermicularis worms in the conjunctival sac of a two-and-a-half year old boy from Alipurduar, West Bengal, India. Only two other similar cases have been reported in the English literature, one from Assam, India in 1976, and the other from Illinois and California in 2011.
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Affiliation(s)
- Sanjay Kumar Mallick
- Assistant Professor, Department of Microbiology, North Bengal Medical College Sushrutanagar, Darjeeling, India
| | | | - Arup Kumar Banerjee
- Assistant Professor, Department of Microbiology, North Bengal Medical College Sushrutanagar, Darjeeling, India
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Abstract
We report an unusual case of extraintestinal infection with adult Enterobius vermicularis worms in the nares and ocular orbit of a 14-year-old girl in Illinois. Only one other similar case has been reported in the English-language literature.
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Serpytis M, Seinin D. Fatal case of ectopic enterobiasis: Enterobius vermicularis in the kidneys. ACTA ACUST UNITED AC 2011; 46:70-2. [PMID: 21879805 DOI: 10.3109/00365599.2011.609834] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Enterobius vermicularis is one of the most common intestinal parasites found in humans. They commonly infest the terminal ileum and large intestine, and are usually considered an innocuous parasite that can be easily eradicated with proper treatment. However, extraintestinal migration of worms, although very rare, may lead to severe health disorders or even death. This article, reports the first fatal case of ectopic enterobiasis known to the authors, which developed in an adult patient with E. vermicularis infection, causing perforation of the large intestine and generalized bacterial peritonitis. Despite emergency laparotomy, the patient died from septic shock on the day after surgery. During pathological examination, worms were found not only in the large intestine, but also in the renal parenchyma; worm eggs were found deposited in the lungs as well.
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Affiliation(s)
- Mindaugas Serpytis
- Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius, Lithuania.
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