Pinworm Infection

Know the general features, signs/symptoms, and risk factors for pinworm infections

• General features

  • Commonly affects children and caregivers

  • Caused by Enterobius vermicularis

  • Very contagious

  • Spread by fecal-oral route, indirect through fomites (primary)

  • Inhalation (secondary)

• Signs/symptoms

  • Mainly asymptomatic

  • Perianal pruritis (noctural, itching)

  • Psychological trauma (pinworm neurosis)

  • Symptoms of more severe infections – refer!

    • Diarrhea

    • Anorexia

    • Abdominal pain

    • Nausea

    • Insomnia/restlessness

• Risk Factors

  • Poor hygiene, nail biting

  • Anal scratching (fecal-oral transmission)

Identify exclusion criteria for the self-treatment of pinworm infections and when individuals can be self-treated

• Liver disease

• Pregnancy

• Breast feeding

• Vague symptoms and negative visual inspections

• Age < 2 years

• Weight < 25 lbs (treat in collaboration with pediatrician)

• Need for repeat treatment (treat in collaboration with pediatrician)

• Hypersensitivity

Know the available nonprescription medication for the treatment of pinworm infections and know its general mechanism of action, length/duration of use, dosing, max dose, and ADR’s

• Pryantel Pamoate

  • MOA: depolarizing muscular agent that paralyzes the worms, allows them to be passed in stool

  • Dosing/Max dose:

    • 1mg/kg (pyrantel base) x 1 single oral dose

    • Max dose is 1g

    • May repeat in 2 weeks if s/sx persist

  • ADRs: mild, not highly systemically absorbed

    • Nausea and vomiting

    • Anorexia

    • Diarrhea

    • Abdominal cramps

Provide appropriate patient counseling information

• Counseling:

  • Pyrantel dosing (for the whole family)

  • Possible need for repeat dosing

  • Prevention may be difficult:

    • Clean hands (eating, restroom, etc), kids sleep in separate beds, good bathroom hygiene

  • During treatment:

    • Cut/clean fingernails, avoid scratching, keep fingers out of mouth

    • Change underwear BID/wash in warm/soapy water, daily showers

    • Clean toilet seat, disinfect fomites, clean floors with disinfectant

    • Vacuum around bed frequently/dispose of vacuum bag, wash linens with hot water

    • Open window shades/curtains