Pinworms infection presenting with itching and restless sleep
Pinworms infections are commonly seen in young children, school-aged children and even adults. The infection is caused by worm-like parasites known as Enterobius vermicularis that infect the human intestines and rectal/anal area. The size of these pinworms ranges from 2 to 13 mm. They resemble worms but can only be seen with the help of a microscope. The infection can be spread from person-to-person by ingesting the worms through contaminated fingers, nightclothes and bed linen. Common symptoms of the condition include itching and discomfort.
The clinical image shows female pinworms leaving the anus of a 5-year-old child, who presented with symptoms of abdominal pain, restlessness and crying at 11 p.m. The female worms leave the rectum during the night and deposit their eggs on the perianal skin, causing pruritus.
The infection is the most common type of intestinal worm infection in the United States
When the infected person is sleeping, the female pinworms lay eggs in the surrounding skin folds of the anus. Most people present with no symptoms, whereas some complain of anal itching as well as restless sleep. The infection easily spreads from child to child. Treatment includes the use of oral drugs to kill the pinworms with thorough washing of underwear, bedding and pyjamas. It is also recommended to treat the entire family for best results.
In some cases patients may also accidentally swallow the pinworm eggs leading to infection. As mentioned above, the eggs can be carried to the mouth through your fingers or contaminated food and drinks. Once the eggs are swallowed, they hatch in the intestines and mature to adult worms within a few weeks. The eggs laid in the anal area cause itching which when scratched cause the worms to cling to your fingers and get under the fingernails. This way the eggs get transferred to other surfaces, for example, toys, bedding, clothes, toilet seats or even other people. The eggs can survive for 2 to 3 weeks on the surfaces.
Source: NEJM
