It is pertinent that primary care providers examine evidence when suspecting and treating

enterobiasis (pinworm) infections. It is important to note that pinworm infestations do not affect
a certain race or socioeconomic class and may not present with itching if it is a first time
infection (Blenkinsopp, A., Paxton, P., Blenkinsopp, J., 2004). It takes some time to become
sensitized to the pinworm and irritant in which eggs are laid in the anal mucosa. Therefore,
patients may often be asymptomatic.
Infestations continue to occur through the fecal oral routine but may also be transmitted
via inhalation of contaminated dust. It has been proven that eggs can remain viable for twenty
days in moist environments (Burkhart, C.N. and Burkhart, C.G., 2004). Hand washing remains
the number one way to prevent the spread of infection however wearing pajamas and underwear
in bed, providing separate towels for each member of the family, and vacuuming and dusting
rooms also helps to prevent recontamination after treatment.
Diagnosis of pinworms remains mostly clinical. Eggs will stain a deep blue with
lactophenol cotton blue if samples are obtained using a tape test (Burkhart, C.N. and Burkhart,
C.G., 2004). Lab tests are irrelevant to diagnosis and remain normal unless advanced, invasive
disease has occurred and then eosinophilia may be present (Burkhart, C.N. and Burkhart, C.G.,
2004). Pinworm infestation may lead to secondary complications and symptoms including
genitourinary infections in females, vulvovaginitis, postmenopausal bleeding, enuresis, and
appendicitis (Burkhart, C.N. and Burkhart, C.G., 2004; Akhigbe, Smith, Adeyemo, Adeyanju,
Condon, and Waldron, 2013). It is estimated that 36% of girls which present with genitourinary
complaints which do not respond to normal therapies may be affected by pinworms (Burkhart,
C.N. and Burkhart, C.G., 2004).
Acute appendicitis can be associated with pinworms and thus this should be ruled out
prior to an appendectomy. Proper treatment has been found to reduce the number of operations
needed for acute appendicitis for this reason. Studies have noted that 0.2-41.8% of acute
appendicitis infections are related to pinworm infestations world-wide (Akhigbe, Smith,
Adeyemo, Adeyanju, Condon, and Waldron, 2013). In a retrospective study, which occurred
over five years a review of 382 appendectomies in adolescents was conducted. This study noted
that of the 382 surgeries 12 cases of pinworms were confirmed (seven males and 5 females) with
an age range of five to fourteen years (Akhigbe, Smith, Adeyemo, Adeyanju, Condon, and
Waldron, 2013). In addition, treatment precautions should be completed prior to an
appendectomy to avoid chronic complications and contaminations during surgery.

After a literature review evidence indicates that the first-line treatment for pinworm
infestations should be with a single dose of mebendazole 100 mg tablets for children older than
two years. There is conflicting literature for the repeat dose. Some studies indicate one week
while others indicate two weeks. It has been confirmed however that mebendazole is over 90%
effective when a repeat dose is given (Burkhart, C.N. and Burkhart, C.G., 2004). Other treatment
options include meticulous hygiene practice for six weeks. This is a non-pharmaceutical method
and is preferred during pregnancy and breastfeeding, as well as for infants less than three months
old (Burkhart, C.N. and Burkhart, C.G., 2004). Children ages three months to two years may
take piperazine with sennosides however there is little evidence on the efficacy of this regimen.
No matter which pharmacologic treatment is preferred it is essential to combine a drug regimen
with proper hygiene and to treat all family members to prevent re-infestation (Burkhart, C.N. and
Burkhart, C.G., 2004). One study does indicate that if the genitourinary system is involved oral
ivermectin should be added for two intervals with one week apart dosing (Akhigbe, Smith,
Adeyemo, Adeyanju, Condon, and Waldron, 2013).