A school‑age child presents with nocturnal perianal pruritus; how is pinworm infection diagnosed and treated, including recommendations for household members?

Pinworm Infection: Diagnosis and Treatment

Direct Answer

Diagnose pinworm infection using the "sellotape test" (adhesive tape test) performed on three consecutive mornings, and treat with a single dose of albendazole 400 mg or mebendazole 100 mg, repeated after two weeks; all household members should be treated simultaneously, especially those sharing a bed with the infected child. 1, 2, 3

Diagnostic Approach

Clinical Presentation

• Nocturnal perianal pruritus is the hallmark symptom, occurring as female worms migrate to lay eggs at night 1, 2
• Approximately 30-40% of infected patients remain completely asymptomatic 2
• Additional symptoms may include irritability, insomnia, restlessness, weight loss, abdominal pain, and occasionally vaginal discharge in girls 1, 2

Diagnostic Testing

• The "sellotape test" (adhesive tape test) is the diagnostic method of choice 1, 2, 3
• Apply the sticky side of clear tape to the perianal skin in the morning before bathing or defecation, then examine under microscope for ova 1
• A single test has only 50% sensitivity, but performing the test on three consecutive mornings increases sensitivity to approximately 90% 2
• Stool examination is NOT recommended, as pinworms and eggs are rarely passed in feces 2
• Direct visualization of adult worms in the perianal area provides definitive diagnosis 2

Treatment Protocol

First-Line Pharmacotherapy

Three equally effective single-dose options exist: 1, 2, 4, 3

• Albendazole 400 mg (single dose, repeat in 2 weeks)
• Mebendazole 100 mg (single dose, repeat in 2 weeks)
• Pyrantel pamoate 11 mg/kg, maximum 1 g (single dose, repeat in 2 weeks)

Key Treatment Distinctions

• Mebendazole and albendazole are both adulticidal AND ovicidal, making them the preferred agents 2, 4
• Pyrantel pamoate is only adulticidal (does not kill eggs), though still effective 2
• For pregnant women, pyrantel pamoate is preferred over mebendazole or albendazole 2
• The two-week interval between doses is critical to kill newly hatched larvae from eggs that survived the first treatment 2, 3

Household Management Strategy

All household members must be evaluated and treated simultaneously: 2, 3

• Treat all persons with live lice or nits within 1 cm of the scalp 5
• Treat all individuals sharing a bed with the infected child, even if asymptomatic 5, 2
• This approach is essential because reinfection rates are extremely high without simultaneous household treatment 2, 3
• Consider treating all household members if multiple or repeated symptomatic infections occur 2

Managing Recurrent Infections

Common Pitfall

• Recurrence is common and usually represents reinfection (particularly autoinfection) rather than treatment failure, given the short life span of adult pinworms 2, 3
• For persistent recurrent infections, prolonged "pulse scheme" treatment for up to 16 weeks may be necessary 3

Hygiene Measures

Implement strict hygiene protocols to prevent reinfection: 2, 3

• Frequent handwashing, especially after bowel movements and before meals 2
• Clip fingernails short 2
• Discourage nail-biting, finger-sucking, and scratching the anogenital area 2
• Change and wash pillowcases, bedding, and underwear in hot water 5
• Clean hair care items used by the infected individual 5

School Considerations

• Children should NOT be excluded from school due to pinworm infection, as transmission risk in classroom settings is minimal 5
• The child likely has been infected for a month or more by the time of diagnosis 1
• Notify parents confidentially on the day of diagnosis 1
• The child should remain in class but be discouraged from close direct contact with others 1