Enterobiasis and its relationship with anal itching and enuresis among school-age children in Calabar, Nigeria

Epidemiologic Study of Enterobius vermicularis Infection among Schoolchildren in the Republic of Marshall Islands

The prevalence and risk factors of Enterobius vermicularis (pinworm) infection among primary schoolchildren (PSC) in the Marshall Islands remain unknown; thus, investigation on the status of pinworm infection rate is necessary to establish baseline data. After parents'/guardians' consent, a total of 346 children (179 boys and 167 girls) participated in this study. Individual's perianal area and thumbs were inspected by using the Scotch tape technique and cellophane tape method, respectively. For each child, demographic and risk factor data were collected by a structured questionnaire and statistically analyzed. The overall prevalence of pinworm infection was 12.14% (42/346). Univariate analysis indicated significant differences in PSC who live in an urban area compared to those who live in the rural area (p=0.01). Multivariate analysis still found that PSC who live in the rural area had higher chances to acquire pinworm infection. However, no risk factors were identified to be associated with personal hygiene, sibling number, and parent's educational level or occupation. Nevertheless, a pinworm-like egg was detected on the thumb of one male participant. Children living in the rural area and thumb-sucking behavior are two of the important risk factors of transmitting pinworm infection in the PSC in the Marshall Islands. We suggested an urgent and continuous provision of adequate hygienic sensitization in the school and the community.

Rodloff A, Mössner J, Lübbert C. The Diagnosis and Treatment of Pinworm Infection

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.

Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: part III - convergence toward clinical trials

Rapid scientific and technological advances have allowed for a more detailed understanding of the relevance of intestinal microbiota, and the entire body-wide microbiome, to human health and well-being. Rodent studies have provided suggestive evidence that probiotics (e.g. lactobacillus and bifidobacteria) can influence behavior. More importantly, emerging clinical studies indicate that the administration of beneficial microbes, via supplementation and/or fecal microbial transplant (FMT), can influence end-points related to mood state (glycemic control, oxidative status, uremic toxins), brain function (functional magnetic resonance imaging fMRI), and mental outlook (depression, anxiety). However, despite the advances in the area of gastro-biological psychiatry, it becomes clear that there remains an urgent need to explore the value of beneficial microbes in controlled clinical investigations. With the history explored in this series, it is fair to ask if we are now on the cusp of major clinical breakthroughs, or are we merely in the quicksand of Autointoxication II?

Have worms lost their luster?

Childhood infections with some helminths have been reported to reduce the risk of acquiring some immune-mediated diseases like sensitization to allergens, asthma and inflammatory bowel disease. Denmark keeps a medical registry that collects data on disease prevalence and medication use throughout the country. Mebendazole frequently is used to treat pinworm (Enterobius vermicularis) infection. In this population-based analysis of a cohort of 924,749 children, prescriptions for Mebendazole were used as a surrogate marker for pinworm infection. Children who received this medication were compared to children who did not, for the frequency of asthma, type I diabetes, juvenile arthritis, ulcerative colitis and Crohn’s disease. It was found that Mebendazole use, and by inference pinworm infection, did not appear to reduce the risk for acquiring any of these immune-mediated diseases.

The post-treatment effects of enterobiasis on the occurrence of enuresis among children in Calabar, Nigeria

OBJECTIVE

To investigate the relationship between enterobiasis and enuresis before and after albendazole therapy among 632 children, aged, 5-14 years, in Calabar, Nigeria.

METHODS

The scotch tape (cellotape) technique was used for the detection of eggs of Enterobius vermicularis (E. vermicularis) while questionnaire-based interviews were used for screening for anal itching and/or enuresis among study participants. All subjects found positive for Enterobius infection as confirmed by the presence of eggs and those with persistent anal itching (both enuretic and non-enuretic) were treated with 400 mg of albendazole given as a single dose. The treated subjects were re-assessed post-treatment to ascertain whether they were cured and also to determine their enuretic status (for the enuretics).

RESULTS

The overall prevalences of Enterobius infection, anal itching, and enuresis prior to albendazole therapy were 6.8%, 42.9%, and 35.6% respectively. There was no statistically significant difference in the prevalence of these parameters by the socio-economic class of subjects (P = 0.462, P = 0.647, and P = 0.610, respectively). The pre-treatment prevalences of enuresis among Enterobius and anal itching-positive subjects were 53.5% and 49.8%, respectively versus 34.3% and 24.9%, respectively among their negative counterpart (P = 0.012 and P < 0.001, respectively). Four (20%) out of the 20 enuretic children found Enterobius egg-negative after albendazole therapy were equally cured while 8(40%) had reduction of their enuresis, thus giving a total resolution rate of 60%. Similarly, 64.2% resolution (25% cure and 32.8% reduction) of enuresis was observed amongst 120 anal itching-cured/enuretic children. Enuretic status of the Enterobius-/anal itching-uncured subjects, on the other hand, remained unchanged post-treatment.

CONCLUSIONS

This study is suggestive of the involvement of E. vermicularis in the aetiology of enuresis in Calabar. Children presenting with, especially, uncomplicated enuresis should be screened for enterobiasis.

A randomized, double-blind, multicenter clinical trial on the efficacy of ivermectin against intestinal nematode infections in China

To assess the efficacy of ivermectin against intestinal nematode infections, a randomized, double-blind, multicenter clinical trial was carried out in a total of 816 human individuals infected with different nematodes from three counties in China. The subjects were randomly assigned into experimental and control groups and orally given a single dose of 0.1, 0.2, 0.2 and 0.2mg/kg ivermectin against Ascaris lumbricoides, hookworm, Trichuris trichiura and Enterobius vermicularis, respectively. Parallel control groups to each of the ivermectin groups were given a single oral dose of 6.7 mg/kg albendazole. The cure rates with ivermectin and albendazole were 100% (102/102) and 99.0% (101/102) for Ascaris, and 66.7% (68/102) and 67.7% (69/102) for Trichuris, respectively, with no significant difference (P>0.05) between the two treatments. The parasitological cure rates of albendazole were 69.6% (71/102) for hookworm and 94.1% (96/102) for Enterobius, which were significantly higher than ivermectin (33.3% and 52.9%, respectively, P<0.0001). The expulsion of worm in the feces reached its peak 1-2 days after ivermectin treatment. The study showed that ivermectin, with few side effects, could be used as an additional treatment tool for intestinal nematodes, especially for the treatment of Ascaris and Trichuris infections in China.

A review and meta-analysis of the impact of intestinal worms on child growth and nutrition

More than a half of the world's population are infected with one or more species of intestinal worms of which the nematodes Ascaris lumbricoides, Trichuris trichiura and the hookworms are the most common and important in terms of child health. This paper: (1) introduces the main species of intestinal worms with particular attention to intestinal nematodes; (2) examines how such worms may affect child growth and nutrition; (3) reviews the biological and epidemiological factors that influence the effects that worms can have on the growth and nutrition of children; (4) considers the many factors that can affect the impact of treatment with anthelmintic drugs; (5) presents the results of a meta-analysis of studies of the effect of treating worm infections on child growth and nutrition; (6) discusses the results in terms of what is reasonable to expect that deworming alone can achieve; (7) describes some important characteristics of an ideal study of the effects of deworming; and (8) comments on the implications for programmes of recommendations concerning mass deworming.