Case Study

Helen McDonald

CC: Itchy but

HPI: 6 year old male presents to PCP with

mother and father, 1 week Hx c/o itchy, slightly
reddened rectum, scant bloody smear on toilet
tissue once believed to be from wiping too
hard, using Desitin after baths and BMs with
some relief of symptoms, itching worse at night
PMH: 37 week gestation, uncomplicated
spontaneous vaginal delivery
PSH: Denies

 Meds: Desitin topically QID PRN to rectum

Immunization: Hep A & B, RV, DTaP, Hib, PCV, MMRV,
influenza 2015
Allergies: No known food/drug/dyes/latex allergies
Social Hx: Resides with both parents, no siblings, no
second hand smoke exposure, no developmental delays,
attends kindergarten

Family Hx
Denies family hx cardiovascular, lung diseases, DM,
Stroke, cancer
Father 24 AW, Mother 23 AW, PGF 52 AW, PGM 52 AW,
MGF 42 AW, MGM 41 AW

ROS
General: Denies fevers, change in activity
GI: As per HPI, denies change in appetite, N/V, soft
brown stools 1-2x/day, no blood in stools, denies
straining, abd pain, pressure, bloating, flatulence, diarrhea
Resp: Denies wheezing, cough
Cardiac: Denies heart murmurs
Skin: Denies rash, eruption, sweating,
changes in pigmentation or texture

Physical Exam
General: Nontoxic, well developed, playful 6 year old
VS: T: 98.5, P: 87, RR: 20, Wt: 23 kg, ht: 45
Abd: Symmetrical, no scars, lesions, movement, bowel
sounds present all four quadrants, medium pitch every
15 seconds, tympany, no guarding, pain, organomegaly,
masses, TTP

Physical cont.

Perianal: No rash, redness, discharge

Resp: Breath sounds bilaterally clear
CV: Regular rate, rhythm, no murmurs, S1&S2 intact
Skin: Warm, pink, no rash, edema

Differential Dx

L20.9 Atopic dermatitis

L25.9 Contact dermatitis
L40.9 Psoriasis
B86 Scabies
B80 Eterobiasis

Enterobiasis (Pinworm)

Pinworm

Intestinal Enterobius vermicularis infection

Prevalence:
Most common worm infection in the U.S., 20-42 million
people harbor the parasite
Approximately 30% of children worldwide infected

Epidemiology:
Age 5-14 year olds
Families with school age children
Caregivers

Epidemiology
Transmission
Oral ingestion of eggs directly or indirectly
Egg deposits around the anus transmitted to
hands, toys, clothing, toilet seats then orally
either through direct mouth contact or contact
with hands
Eggs can survive in indoor environments for 23 weeks

Epidemiology cont.
Incubation period: 1-2 month maturation of adult gravid
female in small intestine, then migrates to the colon
Females lay eggs around the anus at night
Transmission occurs as long as a female is available to
deposit eggs on perianal skin
A person can re-infect themselves

Clinical Findings

Many are asymptomatic

Perianal, perineal itching
Vulvovaginitis
Dysuria
Rarely abdominal pain
Insomnia or restless sleep

Diagnostics
Digital rectal exam, saline slide preparation
Stool for ova and parasites (only 10-15% effective)
Adhesive tape test: Transparent tape stuck to perianal
area in the morning before bathing then observed under
a microscope
Need 3 tests to achieve 90% sensitivity

Treatment
Mebendazole (Vermox) 100 mg chewable tablet x 1
dose; use caution children <2 yrs
Albendazole (Albenza) 400mg PO X 1 dose (>2 yrs of
age), repeat 100mg x 1 dose in 7 days for children 2 or
older
Pyrantel pamoate (Pin-X, Reeses Pinworm medicine)
single dose 11mg/kg (>2 yrs of age) max dose 1 g; use
caution children <2 yrs

Treatment cont.
Recommended retreatment after 2 weeks due to high
incidences of reinfection
Refractory cases may require treatment every 2 weeks
for 4-6 cycles
Treat symptomatic family members

Education

Reinfection is common, prevention is important

Hand hygiene with soap and water, frequently
Clip fingernails
Wash bedding and clothing
Do not shake linen before washing

References
Centers for Disease Control and Prevention. (2015).
Parasites: Eterobiasis (also known as pinworm
infection). Retrieved from
http://www.cdc.gov/parasites/pinworm/
Domino, F. J., Baldor, R. A., Golding, J., Grimes, J. A.,
& Taylor, J. S. (2013). The 5-minute clinical consult
2013. Philladelphia, PA: Lipplincott