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Prof. Walter Jaoko

Department of Medical Microbiology
University of Nairobi
Learning Objectives
At the end of this lesson, the learner should be able to:

• Classify the parasite Enterobius vermicularis
• Outline geographical distribution of E. vermicularis
• Describe morphology of key stages of E. vermicularis
• Describe the life cycle of E. vermicularis
• Describe clinical manifestations of E. vermicularis
• Describe the tests used to diagnose E. vermicularis
• Outline treatment of E. vermicularis
• Describe control of E. vermicularis
1.0 Introduction
• Intestinal nematode, found in the large intestines
• Also known as pinworm
• Worldwide distribution, more in temperate climates
• More common in overcrowding places
– Orphanages, boarding schools etc
• Children most affected – high prevalence & intensity
• Cause disease known as enterobiasis
2.0 Morphology
• Adults
– Females 9-12 mm, Males 2-3 mm
– Thick lips (cervical alae)
• Eggs
– Planocovex in shape
– Transparent wall
– Embryonated

Adult, Enterobius vermucularis

Egg in Iodine stained preparation
Egg in wet saline preparation
3.0 Life cycle
• Adults mate in LI, females get out of anus, lay eggs
• Eggs passed embryonate within a few hours
• Itchiness of perineum, scratching, stick to fingers &
nails, ingested accidentally (self or others), reach SI,
hatch, larvae move to LI, attach to mucosa, adults
• May be transmitted through clothing, beddings, food
etc contaminated with eggs, dustborne by inhalation,
• Life cycle 4-6 weeks

4.0 Clinical presentation
• Light infection mostly asymptomatic
• Clinical presentation includes
– Pruritus ani (scratching the anus) usually at night
– Sleep disturbance
– Irritability & lack of concentration in school
– Poor class performance
– Loss of appetite
• Complications include
– Appendicitis
– Salpingitis in females (rare)
5.0 Laboratory Diagnosis
• Microscopic identification of eggs must be done in the
morning, before defecation and washing by
– Adhesive scotch tape test - Press transparent adhesive
tape on the perianal skin & then examining tape
placed on a slide
– Anal swabs – Press a swab coated with adhesive
material on the perianal skin
– Camel hair brush
• Eggs occasionally found in stool, urine, vaginal smears
• Adult worms may also be found in perianal area

Enterobius vermicularis eggs in a cellophane tape preparation
6.0 Treatment
• Mebendazole
• Albendazole
• Pyrantel Pamoate
* In institutional outbreaks treat all the household
7.0 Prevention & Control
• Proper hygiene
– Daily bathing
– Frequent changing of clothes & beddings
– Keeping short nails etc,
• Avoiding overcrowding, opening of windows for
ventilation etc
• Health education
– Washing of hands before eating of a meal
• Treatment of infected persons with antihelminthes