What are the diagnostic procedures for Enterobius vermicularis (pinworm) infection in a 5-year-old child?

From the Guidelines

To check for pinworms in a 5-year-old child, the 'sellotape test' should be performed by placing the sticky side of sellotape on the perianal skin then examining it under the microscope for ova, as recommended by the study published in the Journal of Infection 1. This method is straightforward and effective for diagnosing pinworm infections, which are common in children worldwide, particularly due to the faeco-oral route of transmission.

• The prepatent period of 2-4 weeks should be considered when evaluating the timing of symptoms and potential exposure.
• Clinical presentation may include intense pruritis ani, weight loss, irritability, diarrhea, abdominal pain, and occasionally colitis with eosinophilia, as noted in the study 1.
• If the diagnosis is confirmed, treatment with a single dose of albendazole 400 mg or mebendazole 100 mg is recommended, according to the study published in the Journal of Infection 1.
• It is essential to consider the potential for pinworms to colonize the female genital tract, causing vaginal discharge, and to take precautions to prevent reinfection, such as good hand hygiene and washing of bedding and clothing.
• Given the contagious nature of pinworms, treating all household members simultaneously and taking preventive measures can help reduce the risk of reinfection.

From the Research

Pinworm Infection in Children

• Pinworm infestation is a common problem in children, especially those between 5 to 10 years old, with a worldwide prevalence of approximately 30% 2.
• The infection is often asymptomatic, but common symptoms include nocturnal pruritus ani 2, 3.
• Children aged 5 to 14 years have the highest prevalence of enterobiasis, with predisposing factors including poor socioeconomic conditions, inadequate sanitation, and poor personal hygiene 2.

Diagnosis of Pinworm Infection

• The diagnosis of pinworm infection is best established by the cellophane tape test, with a sensitivity of around 50% for a single test and up to 90% for tests performed on three different mornings 2.
• Examination of the stool is not recommended, as pinworms and eggs are not usually passed in the stool 2.
• Visualization of a worm in the perianal area or stool can also lead to a definitive diagnosis 2.

Treatment of Pinworm Infection

• The drugs of choice for the treatment of pinworm infestation are mebendazole, pyrantel pamoate, and albendazole, all of which are given in a single dose and repeated in two weeks 2, 4.
• Mebendazole and albendazole are both adulticidal and ovicidal, whereas pyrantel pamoate is only adulticidal 2.
• Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections, to prevent reinfection 2, 5.
• Good personal hygiene, such as frequent handwashing and clipping of fingernails, is also important in preventing pinworm infection 2, 5.

Recurrent Pinworm Infection

• Recurrent pinworm infection can be a problem, even with effective treatment, due to repeated cycles of reinfection 2.
• Prolonged treatment with antihelminthic agents, such as mebendazole or albendazole, may be necessary to prevent recurrence 5, 6.
• A "pulse scheme" of treatment, where the medication is given intermittently, may also be effective in preventing relapse 6.