Enterobiasis. Symptoms in adults and treatment, medications

Enterobiasis occurs in adult men and womenwho do not follow basic sanitary and hygienic rules, eat dirty and poorly washed food, drink raw water, and do not keep their hands clean. In most cases, the development of this disease is manifested by a minimal number of symptoms. Itching in the anal area, insomnia, nausea, and decreased appetite are typical signs of parasitic infestation.

Definition of disease

Enterobiasis is a type of helminthiasis caused by pinworms. These parasites are white to grayish roundworms. The average body length of a female does not exceed 1 cm. The sizes of males are in the range of 5-6 mm.

The back of the body of the female pinworm is distinguished by an awl-shaped shape, and in the male it is twisted towards the abdominal cavity. Helminths of this species parasitize in the colon in adults and children, but they can also migrate into the appendix cavity and vagina. The systematic appearance of itching in the anus and perineum is one of the key symptoms of pinworm infection.

Causes of enterobiasis in adults

According to the WHO conclusion, enterobiasis belongs to the category of neglected parasitic diseases of the human body. The largest number of people infected with pinworms live in underdeveloped countries with a low level of sanitary and epidemiological control.

The following are the most common causes of enterobiasis in adults:

• eating vegetables and fruits that have not been pre-washed;
• the use of common household items, on the surface of which there are pinworm eggs;
• ignoring the elementary rules of washing hands before eating;
• drinking raw water, which contains helminth eggs.

To prevent pinworm infection, it is very important to cut your nails in a timely manner. Patients with enterobiasis experience severe itching in the anus, scratch the skin of this area, as a result of which the eggs of the worms fall on the bundles of the fingers and under the nail plates. When eating with dirty hands, repeated self-infection with pinworms occurs. As a result of this process, the population of helminths in the intestine is increasing at a tremendous rate.

Etiology and epidemiology

Enterobiasis (symptoms in adults appear within 1-2 weeks after infection with pinworms) has a complex etiology of development, which is as follows:

1. In the process of eating, licking fingers or drinking contaminated water, a person swallows nematode eggs.
2. Eggs of helminths enter the duodenal cavity, where young individuals of pinworms hatch from them.
3. From the duodenum, the worms migrate to the large intestine (part of the ascending and cecum), where their further maturation occurs.
4. After reaching puberty, fertilized females move towards the anus of the infected.
5. Female pinworms lay eggs on the skin around the anus.

Pinworm infestation is ubiquitous. Enterobiasis is common in all countries of the world. The main reservoir and distributor of these helminths are people. At risk are men and women who do not follow the norms of personal hygiene.

Pinworm eggs fall into the gastrointestinal tract during a meal if the person did not wash his hands, fresh vegetables, fruits before eating. In the environment, flies and cockroaches carry eggs of nematodes on their paws. The future larvae move in the air along with the dust.

Symptoms of enterobiasis

Enterobiasis (symptoms in adults are felt gradually as the disease progresses) for a long time may not show any pathological signs.

After an increase in the number of pinworms in the gastrointestinal tract, a person begins to complain of the following symptoms:

• itching in the anal area from moderate to severe and unbearable (the manifestation of this symptom becomes most pronounced at night and in the morning);
• loss of appetite;
• nausea (in rare cases, the patient vomits before eating or immediately after eating);
• rumbling in the stomach;
• increased gas formation;
• pulling pain in the intestines;
• irritation of the skin before entering the anus (the appearance of this symptom is associated with unconscious scratching of the skin near the anus at night);
• insomnia;
• irritability and nervousness;
• diarrhea with the release of mushy feces;
• teeth grinding at night;
• excretion of feces with impurities of mucus and blood.

Depending on the number of sexually mature individuals of pinworms in the intestinal cavity, helminths can be released into the environment along with the patient's feces. The severe course of enterobiasis is accompanied by sphincteritis, infection of the tissues of the anus with bacterial microorganisms. There are cases of paraproctitis, provoked by the pathogenic activity of pinworms.

Pathogenesis

Enterobiasis (symptoms in adult men and women are determined by a parasitologist or therapist at the stage of preliminary examination) is a chronic parasitic disease that has the following developmental pathogenesis:

• infection with nematode eggs occurs alimentary (in 80% of cases, infection with this type of helminthiasis is carried out through dirty hands);
• the spread of pinworms is possible by using shared towels, bedding and underwear;
• infection with pinworm eggs occurs in a domestic environment through poorly washed dishes, cutlery, children's toys.

At risk of contracting enterobiasis are adult men and women who work or permanently live in unsatisfactory sanitary and hygienic conditions. Helminthic infestation with pinworms is quite often diagnosed in kindergarten teachers and nannies, boarding schools for orphans and patients with signs of mental retardation. If pinworms are present in at least one of the household members, then in 90% of cases, all other family members fall ill with enterobiasis.

Classification and stages of development

Enterobiasis (symptoms in adults appear in a mild or complicated form) progresses gradually as the number of helminths increases in the large intestine. The table below describes the stages of development of parasitic infestation by pinworms.

Stages of enterobiasis in adults	Characteristics of the pathological process
The initial period of infection with a mild course of the disease	At the initial stage of helminthic invasion, enterobiasis is almost asymptomatic. A sick person periodically feels a slight itching in the perianal region. There are no dyspeptic phenomena in the form of flatulence, nausea, disturbances in the digestive function of the stomach and intestines. A peripheral blood test for eosinophilia is negative. The general state of health of the patient remains satisfactory.
Progression of enterobiasis with a sharp increase in the number of helminths	At this stage of enterobiasis, an infected person has more pronounced attacks of itching of the anus, which appear at night. The onset of this symptom can cause insomnia, or it awakens the patient from even the deepest sleep. The soreness of the abdomen joins, scratching of the skin appears between the buttocks. An infected person complains of recurrent stool disorders, nausea, loss of appetite. At this stage of enterobiasis, complications may develop in the form of inflammation of the gastrointestinal mucosa. In women, helminths can enter the vaginal cavity, causing parasitic vulvovaginitis. Based on the results of a clinical analysis of capillary blood, signs of mild eosinophilia are found.
Complications caused by helminthic invasion	At this stage of enterobiasis, the patient is diagnosed with unbearable itching of epithelial tissues in the perianal region. The manifestation of this symptom is so pronounced that a person's sleep is disturbed, acute dermatitis of the skin around the anus joins. An inflammatory process develops in the intestine, which can cause local tissue suppuration. The patient suffers from chronic stool disorder, loss of appetite, flatulence. The acute symptomatology of enterobiasis leads to mental depletion and astheno-neurotic syndrome.

By the nature of the clinical manifestations, enterobiasis in adults is classified into an uncomplicated and complicated form. In the first case, the patient is diagnosed with symptoms of helminthic infestation with pinworms, which do not cause long-term health disorders. The complicated form of enterobiasis disrupts the work of the entire digestive system, as well as other internal organs of the abdominal cavity.

Complications of enterobiasis

Enterobiasis (symptoms in adults are manifested by a gradual deterioration in general well-being) responds well to drug treatment.

Ignoring the signs of the disease, untimely started therapy leads to the development of the following complications of this disease:

• inflammatory lesion of the abdominal cavity;
• chronic intoxication of the body, which creates additional stress on the kidneys and liver tissue;
• suppuration of the walls of the large intestine (in the presence of this complication, the feces of the patient become frothy, contain mucus or bloody discharge, and are also unpleasant putrid smell);
• paraproctitis;
• acute form of sphincteritis;
• constant swelling of the anal ring;
• headache caused by mental exhaustion;
• appendicitis;
• neurodermatitis of the skin in the perianal region;
• vulvitis and vulvovaginitis in women.

The neglected forms of enterobiasis can lead to the penetration of helminths into the uterine cavity. Women with this complication of helminthic invasion develop acute endometritis, the treatment of which requires a course of antiparasitic therapy.

Diagnosis of enterobiasis

To determine enterobiasis, a comprehensive examination of the patient is required. Compulsory differential diagnosis is performed for the possible presence of hemorrhoidal disease, oncology of the rectum, fungal infection of the mucous membrane of the anus. The table below lists the main research methods that can detect helminthic invasion.

Methods for determining enterobiasis	Characteristics of the diagnostic process
Clinical analysis of peripheral blood	To carry out this diagnosis, capillary blood from a finger is used. In people infected with pinworms, the study shows moderate to severe eosinophilia. In men and women with a complicated form of enterobiasis, the presence of inflammatory lesions digestive tract, reproductive system organs may develop neutrophilic-eosinophilic leukocytosis.
Scraping for the detection of helminth eggs	Scraping from the perianal region of the anus is considered the gold standard for laboratory diagnosis of enterobiasis. The principle of this examination is to collect helminth eggs using adhesive tape, which is fixed on the surface of the patient's skin in the immediate vicinity of the anus. Diagnostics is performed in the morning before washing. If the test is positive, pinworm eggs will be present on the sticky tape.
Visual examination of feces	In the process of visual examination of the patient's feces, the medical worker draws attention to the presence of live females in the feces. The detection of individuals of helminths is an indisputable confirmation of enterobiasis.

PCR diagnostics in determining enterobiasis is practically not used, since it is considered an uninformative method in detecting helminthic invasion. Based on the results of the examination, the attending physician prescribes the patient to take a course of anthelmintic drugs.

Specificity of treatment of enterobiasis, used groups of drugs

Therapy of enterobiasis is carried out with the use of antiparasitic drugs, which are prescribed by the doctor after a comprehensive examination of the patient. The type of medication is selected individually, depending on the general health of the patient, the stage and severity of helminthiasis.

The specificity of the treatment of enterobiasis is that an infected person takes anthelmintic drugs, and also observes the following rules:

• cuts nails as short as possible;
• puts on tight underwear at night;
• carries out daily wet cleaning of the apartment with wiping of household items with soapy water;
• performs evening and morning washing;
• at night, lays a dense swab dipped in petroleum jelly into the anus;
• every morning he changes bed and underwear, washes and ironed it to destroy helminth eggs that could be on the surface of the fabric.

The above actions are aimed at preventing further oviposition by females who are still alive after drug therapy. At the same time, the prevention of repeated self-infection is provided. Throughout the course of treatment of enterobiasis, the patient must undergo at least 3 examinations. Diagnostics for helminth eggs is performed after 14, 25, and also 30 days of antihelminthic therapy.

As the main method of examination, skin scraping in the area of ​​perianal folds is used. Treatment of uncomplicated enterobiasis is carried out on an outpatient basis. Complicated forms of this helminthiasis require hospitalization of the patient in an inpatient department of the hospital. In especially severe cases, surgical debridement of the gastrointestinal tract tissues with signs of purulent inflammation is required.

Drug names and regimens

Antiparasitic drugs for enterobiasis are prescribed by a general practitioner or parasitologist.

Pirantel

Pirantel is an effective anthelmintic drug that comes in the form of tablets and a drinkable suspension. This medication blocks the muscle and nervous system of parasites. Adult patients take Pirantel 3-4 tablets once. The drug is chewed in the mouth and then washed down with a little water. Repeated reception of a similar dose is carried out no earlier than 3 weeks later. The average cost of Pirantel tablets is 32 rubles.

Albendazole

Albendazole is an anthelmintic drug that belongs to the pharmacological group of benzimidazoles. This drug is taken as a single dose of 400 mg (1 tablet). This medication should be chewed thoroughly in the mouth and then washed down with plenty of water. Albendazole is taken with meals. After 2 weeks, it is recommended to take this medication in a similar dosage. The price of Albendazole in pharmacies is 150 rubles.

Vermox

Vermox is an antiparasitic drug that is used to treat enterobiasis. This medication contains the active substance mebendazole at a concentration of 100 mg per 1 tablet. Vermox is taken orally whole or by chewing. The recommended dosage for enterobiasis is 1 tablet, which is taken once. Re-taking the drug Vermox is carried out in 2-4 weeks.

To increase the therapeutic effectiveness of this medication, to prevent the relapse of enterobiasis, it is necessary to treat all family members living with a person who is infected with pinworms. This drug is contraindicated in patients with hepatic impairment, Crohn's disease, lactose intolerance, pregnant women, and breastfeeding. The average cost of Vermox tablets is 92 rubles.

How long does therapy last?

Treatment of enterobiasis is carried out in one continuous course, the duration of which is 2 weeks. In case of detection of a helminthic invasion, the doctor prescribes an anthelmintic drug to the patient. The patient takes this medication in the dosage indicated by the doctor. After 14 days, the patient takes the prescribed medication again, and then undergoes the first follow-up examination. The post-therapeutic detection of pinworm eggs requires continuation of the treatment process.

Can alternative methods be used for treatment and which ones?

To completely get rid of pinworms, it is recommended to use medication therapy in combination with cleansing enemas. In the evening, using a pear, it is necessary to inject 200-300 ml of boiled water into the rectal cavity, which is cooled to room temperature. This procedure is performed 1-2 times a week for 14 days. The use of this folk method will allow you to remove sexually mature female helminths, which are localized in the ampulla of the rectum.

Forecast

In the presence of an uncomplicated form of enterobiasis, the prognosis for complete recovery without dysfunction of internal organs is favorable. The emergence of complications in the form of inflammation of the tissues of the digestive tract and the reproductive system leads to persistent dysfunction of the damaged organs.

In medical practice, there are occasional cases when, in a severe course of enterobiasis, a patient has neuropsychiatric disorders. The uncomplicated form of this disease does not cause death. Enterobiasis, complicated by purulent inflammation of the abdominal cavity, rectum, large intestine, appendix, is life-threatening.

Enterobiasis is a highly contagious parasitic disease caused by pinworms. This type of helminthiasis is equally common in adult men and women of all age categories. At risk are teachers of kindergartens, educational institutions, boarding schools for orphans and mentally ill patients.

The main symptoms of enterobiasis include itching and local skin irritation in the anal area, loss of appetite, nausea, and flatulence. The most common transmission of pinworm eggs is by eating with dirty hands and using household items previously used by an infected person.

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