Enterobius vermicularis

History
First described by Linnaeus in 1771.

Geographical Distribution
Worldwide, more common in warm moist regions, it is the
third commonest nematode alter
roundworm and hookworm

Habitat
The adult worm lives in the large intestine-in caecum
and also in vermiform appendix
Morphology
Adult worm
Shape: Pinkish-white, resembles a whip. The anterior three-
fifth is thin, hairlike and coiled.
The posterior two-fifth is thick and stout--resembles the
handle of whip-whip worm
The anterior portion contains a long capillary oesophagus and
the posterior part contains the
intestine and reproductive organs
It lives in intestine for many years
Male worm: 3-4 cm long. The posterior end is coiled and has a
single spicule
Female worm: 8-13 0.3-05 mm. The posterior third of the he
body is long tapering point
tail. It is oviparous-mature female lays eggs and after
oviposition dies in 2 or 3
Eggs (Fig. 10.5b)
Shape: Planoconvex-flattened on ventral side and convex on
dorsal side
Size: 50-60 pix 30
Colour: colourless-non-bile stained
Egg-shell: Transparent
Egg contains Pully developed, a coiled tadpole-like larva
It floats in saturated solution of common salt
Lifecycle
Definitive host: Human beings
Intermediate host: Not required, passes lifecycle in one
host-human beings
Infective form: Mature eggs
Sources: Contaminated hands, food and water
Mode of infection: Ingestion and inhalation
Egg with a tadpole-like larva laid on perianal skin completes
its
development in 24-36 hours and becomes mature

Infection occurs by ingestion of mature eggs through

contaminated food and
water or anus to mouth auto infection

Eggs hatch in intestine to release the larvae

The larvae develop into mature worms

The male worm fertilizes the female worm and dies

The gravid female migrates out of the anus during night and
lays up to 10,000 499 on perianalski
pathogenicity
the disease cause is known as enterobiasis
Common in children. Familial infection is common
Infection occurs by the ingestion of eggs
The eggs deposited on perianal skin contaminatenightclothes
and bed linens of infected person
Infection can also occur by inhalation of eggs that become
air borne during bed making
Reinfection of same host (autoinfection) is also possible,

1. By Hand-to-Mouth
in which fingers get contaminated with eggs because of
scratching of affected itching part around
the anus. These eggs are then either transferred to food
articles and swallowed or transferred
directly from anus to mouth.
2. Retrograde Infection
In which eggs laid on perianal skin hatch out into larvae,
which migrate back through the anus
up to colon and develop into adult worms.

Clinical Features
Perianal pruritus and an eczematous condition round the anus
and perineum
Nocturnal enuresis
Inflammation of the vermiform appendix may also occur
Invasion of female genital tract may occur rarely, causing
vulvovaginitis, salphingitis and pelvic or peritoneal
granulomas
Laboratory Diagnosis
Diagnosis includes:
Demonstration of the adult worms in facces after a purge or
an enema
Demonstration of characteristic eggs in faeces by direct
smear examination or in concentrated faeces, where it may be
negative as eggs are deposited on the perianal skin.
Hence,demonstration of eggs in the scrapings from the
perianal skin by NIH swab or cellophane tape is a better
method
Demonstration of eggs in washings of finger tips, linen and
garments
The worms may be discovered by the patient or parents of the
children
Inspection of perianal region at the commencement of itching
may reveal gravid female
Prophylactic Measures
Health education
Treatment of all infected
Health education on personal and community hygiene
eatment of all infected persons to prevent infection by
contact

Treatment
Mebendazole or pyrantel pamoate