Pinworm

Background

Two pinworms next to a ruler: The markings are 1 mm apart.

Enterobius vermicularis

• Enterobius

Clinical Features

• Nocturnal perianal itch

Differential Diagnosis

Helminth infections

Cestodes (Tapeworms)

• Taenia saginata
• Taenia solium (Cysticercosis)
• Diphyllobothrium latum
• Hymenolepis nana
• Echinococcus granulosus

Trematodes (Flukes)

• Fasciola hepatica
• Fasciolopsis buski
• Opistorchis viverrini
• Schistosoma spp
  • Schistosomiasis
• Chlonorchis sinensis
• Paragonimus spp.

Nematodes (Roundworms)

• Ascaris lumbricoides
• Enterobius vermicularis (Pinworm)
• Filarial worms
  • Loa Loa
  • Onchocerciasis
  • Lymphatic filariasis (Elephantiasis)
    • Wuchereria bancrofti
    • Brugia malayi
    • Brugia timori
• Hookworm
  • Necator americanus
  • Ancylostoma duodenale
  • Cutaneous larva migrans (Ancylostoma braziliense)
• Dracunculiasis
• Strongyloides stercoralis
• Trichuris trichiura (Whipworm)
• Anisakis
• Toxocara spp.
• Trichinosis

Workup

• Cellophane tape test to be followed up outpt

Management

Treatment targeted against Enterobius vermicularis; All family members should be treated at the same time

Adult

• Mebendazole 100mg PO once, THEN repeat in 2 weeks OR
  • Okay during breastfeeding
• Albendazole 400mg PO once, THEN repeat in 2 weeks OR
• Pyrantel Pamoate (Pin-x) 11mg/kg (max 1g), THEN repeat in 2 weeks
  • First choice for pregnant patients
    • Treat in pregnancy only if the infection is compromising the pregnancy (i.e. weight loss, sleeplessness); withhold until the 3rd trimester if possible.

Pediatric

• 2 years or older:
  • Mebendazole 100mg PO once, THEN repeat in 2 weeks OR
  • Albendazole 400mg PO once, THEN repeat in 2 weeks OR
• <2 years
  • Albendazole 200 mg PO once, THEN repeat in 2 weeks

Consider treatment for the household.

Disposition

Discharge with oral treatment

See Also

• Parasitic Diseases
• Travel Medicine