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Takač I, Kavalar R, Lovrec MR, Lovrec VG. Concomitant ectopic Enterobius vermicularis infection in uterine cervical cancer. BMC Womens Health 2024; 24:265. [PMID: 38678281 PMCID: PMC11055370 DOI: 10.1186/s12905-024-03073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Enterobius vermicularis (E. vermicularis), also referred to as pinworm, is a widespread human intestinal parasite which predominantly occurs in young children, making their caretakers a population at risk for the transmission of this helminth. It can occasionally affect extraintestinal organs and tissues, including the female genital tract. Infestation can be asymptomatic or manifest as different kinds of gynaecological disorders, such as pelvic inflammation mimicking tumours, abnormal uterine bleeding, or vaginitis. Diagnosis is made by identifying ova in the sample collected from the perineal skin using a transparent adhesive tape or microscopic examination of resected tissue. Mebendazole is the first-line medication and should also be administered to all household members. CASE PRESENTATION We present a case of a patient who had undergone surgery for invasive cervical cancer with an accidental finding of E. vermicularis eggs in the cervix. CONCLUSIONS Although not very common, infestation with E. vermicularis should be considered in differential diagnoses of various gynaecological disorders accompanied by histological findings of granulomatous inflammation.
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Affiliation(s)
- Iztok Takač
- Division for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska ul. 5, Maribor, 2000, Slovenia
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Maribor, Maribor, 2000, Slovenia
| | - Rajko Kavalar
- Department of Pathology, University Medical Centre Maribor, Maribor, 2000, Slovenia
| | - Matija Rudolf Lovrec
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Maribor, Maribor, 2000, Slovenia
| | - Vida Gavrić Lovrec
- Division for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska ul. 5, Maribor, 2000, Slovenia.
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Maribor, Maribor, 2000, Slovenia.
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Enterobius Vermicularis Infection: A Cross-sectional Study in Preschool and School Children in the North-Western Part of Slovenia. Helminthologia 2022; 59:357-363. [PMID: 36875684 PMCID: PMC9979069 DOI: 10.2478/helm-2022-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/15/2022] [Indexed: 02/05/2023] Open
Abstract
Enterobius vermicularis is a prevalent intestinal nematode. The objective of the research was to study enterobiasis prevalence in symptomatic children <15 years of age attending community health center in North - Western part of Slovenia in years 2017 - 2022. Perianal tape tests were performed on three consecutive days. The overall prevalence was 34.2 % (296 out of 864 children included). The mean age of children positive for E. vermicularis was 5.77 (95 % CI: 5.51 - 6.04) and 4.74 (95 % CI: 4.54 - 4.95), p<0.001 for children with negative test results. The positivity rate was not significantly different for boys compared to girls (boys 37.0 %, 95 % CI: 32.4 % - 41.8 %, girls 31.8 %, 95 % CI: 27.6 % - 36.2 %, p=0.107). The number of boys with all three samples positive in a sample set was higher compared to girls (p - value 0.002). Family size affected the positivity rate - the mean number of siblings was higher in positive children. Significant association with E. vermicularis infection was proven by the presence of anal pruritus and absence of abdominal discomfort. High E. vermicularis warrants careful monitoring of trends and public health response. It is necessary to encourage the use of hygiene measures in schools and empower parents to recognize enterobiasis timely.
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Grillo F, Campora M, Carlin L, Cornara L, Parente P, Vanoli A, Remo A, Migliora P, Roberto F, Fassan M, Mastracci L. "Stranger things" in the gut: uncommon items in gastrointestinal specimens. Virchows Arch 2021; 480:231-245. [PMID: 34599376 PMCID: PMC8986674 DOI: 10.1007/s00428-021-03188-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
Organic (such as parasites or vegetable remnants) and inorganic substances may be encountered during routine pathology diagnostic work up of endoscopic gastrointestinal biopsy samples and major resections, causing possible diagnostic conundrums for the young and not so young pathologists. The main aim of this review is the description of the most frequent oddities one can encounter as foreign bodies, in gastrointestinal pathology, on the basis of the current literature and personal experience. The types of encountered substances are divided into four principal categories: parasites (helminths such as Enterobius vermicularis, Strongyloides, Schistosoma, and Anisakis, and protozoa such as Entamoeba, Giardia and some intestinal coccidia); drugs and pharmaceutical fillers (found as deposits and as bystanders, innocent or not); seeds (possibly confused with worms) and plant remnants; pollutants (secondary to post-resection or post-biopsy contamination of the sample). An ample library of images is provided in order to consent easy referencing for diagnostic routine.
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Affiliation(s)
- Federica Grillo
- IRCCS Ospedale Policlinico San Martino, Anatomic Pathology Unit, Genova, Italy
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Michela Campora
- Anatomic Pathology Section, S. Chiara Hospital, Trento, Italy
| | - Luca Carlin
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Laura Cornara
- Department for the Earth, Environment and Life Sciences (DiSTAV), University of Genoa, Genoa, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, and IRCCS San Matteo Hospital, Pavia, Italy
| | - Andrea Remo
- Pathology Unit, Service Department, ULSS9 "Scaligera", Verona, Italy
| | - Paola Migliora
- Clinical Cytopathology Service and Pathology Institute of Locarno, Locarno, Switzerland
| | - Fiocca Roberto
- IRCCS Ospedale Policlinico San Martino, Anatomic Pathology Unit, Genova, Italy
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Luca Mastracci
- IRCCS Ospedale Policlinico San Martino, Anatomic Pathology Unit, Genova, Italy.
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Largo Rosanna Benzi 10, 16132, Genova, Italy.
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Mendos A, Mathison BA, Pritt BS, Lamps LW, Pai SA. Intramural Ova of Enterobius vermicularis in the Appendix-An Egg-Topic Location! Int J Surg Pathol 2021; 30:214-216. [PMID: 34255564 DOI: 10.1177/10668969211032455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report an unusual case of appendicitis in a 9-year-old girl in whom the wall of the appendix contained necrotizing granulomas, as well as eggs of Enterobius vermicularis. Although luminal E vermicularis adult parasites are commonly identified in the appendix and luminal eggs are occasionally seen, intramural worms and eggs are rare. We are unaware of earlier reports of ectopic intramural eggs in the appendix. It is important to and make a correct diagnosis, as both, the patient, as well as the family should be treated for enterobiasis.
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Affiliation(s)
- Angelina Mendos
- 223456Columbia Asia Referral Hospital, Bangalore, Karnataka, India
| | - Blaine A Mathison
- Institute for Clinical and Experimental Pathology, 33294ARUP Laboratories, Salt Lake City, Utah, USA
| | | | | | - Sanjay A Pai
- 223456Columbia Asia Referral Hospital, Bangalore, Karnataka, India
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Croonen B, Oei A, Mol S, Schneeberger P. Peritoneal lesions caused by Enterobius vermicularis suspected to be metastases of ovarian malignancy. BMJ Case Rep 2021; 14:14/7/e238618. [PMID: 34244195 DOI: 10.1136/bcr-2020-238618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Enterobius vermicularis, also known as pinworm, is a helminth that commonly causes intestinal parasitic infestation. E. vermicularis can also cause extraintestinal infestations. We report a case of lower abdominal pain and intermittent vaginal bleeding in a 45-year-old woman who was referred to our gynaecology department. On investigation, a transvaginal ultrasound showed a multilocular cyst in the left ovary, along with elevated levels of cancer antigen 125. Consequently, a laparoscopic salpingo-oophorectomy was performed. A biopsy of atypical peritoneal lesions revealed remains of E. vermicularis Peritoneal lesions are a rare complication of enterobiasis, and the diagnosis of this complication is usually delayed by limitations in diagnostic options. Although extraintestinal enterobiasis does not require treatment because it is the last stage of the parasitic cycle, primary intestinal infestation requires treatment with mebendazole.
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Affiliation(s)
- Britt Croonen
- Gynecology and obstetrics, Bernhoven Hospital, Uden, The Netherlands
| | - Angèle Oei
- Gynecology and obstetrics, Bernhoven Hospital, Uden, The Netherlands
| | - Suzanne Mol
- Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Successful Resolution of Recurrent Vaginal Pinworm Infection With Intermittent Albendazole Administration. Pediatr Infect Dis J 2020; 39:254-255. [PMID: 32032311 DOI: 10.1097/inf.0000000000002546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe the case of a 7-year-old girl with repeated vaginal Enterobius vermicularis infection, never detected as a digestive tract infection. Two-dose pyrantel pamoate or 2-dose albendazole could not suppress recurrence. Finally, 3-dose albendazole after 2-week intervals was successful in preventing relapse.
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Wendt S, Trawinski H, Schubert S, Rodloff AC, Mössner J, Lübbert C. The Diagnosis and Treatment of Pinworm Infection. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:213-219. [PMID: 31064642 DOI: 10.3238/arztebl.2019.0213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 10/29/2018] [Accepted: 02/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Symptomatic infection with pinworm (Enterobius vermicularis), a human pathogen, is clinically relevant in Germany, with an estimated prevalence in childhood of 2-20%. Enterobiasis can cause major mental distress. There is little systematically verified knowledge on the treatment of this condition, and there is no corresponding German guideline. This review is, therefore, intended as a summary of the current state of knowledge. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed for literature appearing from 1 January 1990 to 5 February 2019 and containing the search terms "enterobiasis," "oxyuriasis," "Enterobius vermicula- ris," "pinworm," and "threadworm." RESULTS More than one billion people worldwide are thought to be infected with pinworm. Estimates of its prevalence among kindergarten and primary-school pupils in Europe are generally near 20%. Infants (<2 years of age), adolescents (>14 years of age), and adults are only sporadically affected. The main risk factors are age 4-11 years, uncontrolled anus-finger-mouth contact, nail-biting (onychophagia/peri- onychophagia), unsupervised body hygiene, and poor compliance with basic hand hygiene. No large-scale, randomized, controlled trials of treatment are available. The approved antihelminthic agents are mebendazole, pyrantel embonate, and pyrvinium embonate (success rates up to >90%). For recurrent infections, prolonged treatment for up to 16 weeks (a "pulse scheme") is recommended. CONCLUSION In nearly all cases, antihelminthic treatment along with attention to hygienic measures can successfully eradicate pinworm infection and prevent recurrence and autoinfection. The involvement of all persons living in the patient's house- hold, including sexual partners, is a prerequisite to the lasting success of treatment.
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Affiliation(s)
- Sebastian Wendt
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital; Interdisciplinary Centre for Infectious Diseases (ZINF), Leipzig University Hospital; Department of Gastroenterology, Division of Infectious Diseases and Tropical Medicine, Leipzig University Hospital; Department of Gastroenterology, Leipzig University Hospital
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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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Tsai CY, Junod R, Jacot-Guillarmod M, Beniere C, Ziadi S, Bongiovanni M. VaginalEnterobius vermicularisdiagnosed on liquid-based cytology during Papanicolaou test cervical cancer screening: A report of two cases and a review of the literature. Diagn Cytopathol 2017; 46:179-186. [DOI: 10.1002/dc.23812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Chun-Yi Tsai
- Service of Clinical Pathology; Lausanne University Hospital, Institute of Pathology; Lausanne Switzerland
| | - Rachel Junod
- Department of Obstetrics and Gynecology; Lausanne University Hospital; Switzerland
| | | | - Charles Beniere
- Service of Clinical Pathology; Lausanne University Hospital, Institute of Pathology; Lausanne Switzerland
| | - Sonia Ziadi
- Service of Clinical Pathology; Lausanne University Hospital, Institute of Pathology; Lausanne Switzerland
| | - Massimo Bongiovanni
- Service of Clinical Pathology; Lausanne University Hospital, Institute of Pathology; Lausanne Switzerland
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Raju K, Verappa S, Venkataramappa SM. Enterobius vermicularis infestation masquerading as cervical carcinoma: A cytological diagnosis. J Nat Sci Biol Med 2015; 6:476-9. [PMID: 26283859 PMCID: PMC4518439 DOI: 10.4103/0976-9668.160047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Although prevalence of Enterobius vermicularis (EV) infestation in Intestines ranges from 35% to 70%, its prevalence in female genital tract is not known despite several incidental findings. Acute inflammatory cells in the background of cervical Pap smear indicate infestation and should not be neglected as contamination. A 40-year-woman presented with white vaginal discharge persistent for past 1 year. Local examination showed hypertrophied cervix with eversion of both lips and hard consistency of the anterior lip of cervix. A clinical diagnosis of cervical carcinoma was made. However, cervical Pap smear indicated EV eggs in an inflammatory background, treatment to which resulted in completely recovery.
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Affiliation(s)
- Kalyani Raju
- Department of Pathology, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India
| | - Seema Verappa
- Department of Pathology, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India
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Enterobius vermicularis salpingitis seen in the setting of ectopic pregnancy in a Malaysian patient. J Clin Microbiol 2014; 52:3468-70. [PMID: 24989613 DOI: 10.1128/jcm.01191-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing.
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