Enterobius vermicularis

(Enterobius = Pin like/ Thread like. Vermicularis = Vermiform appendix)

Distribution: Cosmopolitan

Habitat: In caecum and appendix. They remain within the mucosa. If they underwent encystation, cysts are seen in
submucosa and this occurs rarely.

Morphology:

- They lack buccal cavity.

- They have a pair of cervical alae.
- They are white, spindle shaped and small.
- The posterior end of oesophagus is dilated into bulb (double bulb esophagus). This is characteristic feature.
- Male: Is shorter and thinner than female. Its posterior end is curved. After fertilizing female, it usually dies. So, it
cannot be seen except when intestine is cleaned with purgative.
- Female: Is longer and thicker than male. Its posterior end is straight. After being fertilized, it migrates from
cecum to anus and lay eggs on the perianal skin.

Egg:

- Egg is planoconvex in shape.

- It is colourless and non-bile staining.
- It contains tadpole like embryo (i.e it is embryonated egg)
- It is covered by a transparent sheet.
- Floats in saturated salt of NaCl.

Life cycle:
 Ingestion of embryonated egg

The shell of egg gets digested in small intestine and release of larva.

Larva reaches to cecum and attains the sexual maturity

Male fertilizes the female worm in cecum and male dies

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 Fertilized female migrates from cecum to anus and at night time, it comes out on to
perianal and perineal skin to lay eggs.

Eggs pass out in stool in very few concentration/amount as egg is not laid in rectum
rather in skin. Ingestion of the eggs initiate the cycle again.

Autoinfection: Due to adult female on perianal skin, there is pruritis and itching. When the patient scratches the area,
fingers get contaminated with eggs. In those with poor hygienic activity, when they eat food with such fingers, egg is
also ingested.

Retrograde infection: In some cases, eggs hatch to release larva within the perianal skin. Those larva undergo retrograde
movement to cause infection.

Clinical findings:

- Pruritis of perianal and perineal area

- Nocturnal enuresis (coz itching disturbs the sleep)
- In female, the worm may enter oviduct, uterus and even into peritoneum. In such cases, salpingitis, peritonitis
also occurs.

Lab diagnosis:

A) Diagnosis of adult worm

B) Diagnosis of egg

Diagnosis of adult worm:

- Adult worms are found in the surface of feces.

- Adult female may be seen on skin at night when they crawl out.
- Male worm isn’t seen usually as it dies just after fertilizing female. In case of use of purgatives, we can even get
male worm.

Diagnosis of egg:

- As the egg concentration is very less in feces, stool sample isn’t used frequently.
- The eggs can be collected by taking swab from perianal skin. We can collect swab by:
 NIH swab method (It has cellophane tape at one end of glass rod and is attached with the rubber band)
 Scotch tape method (it is adhesive cellophane tape)
- Eggs can also be demonstrated within the dirt of fingernails after itching. (Usually in children)