Inadvertent detection of massive Enterobius vermicularis infection in an asymptomatic adult with rectal blowout following barotrauma

Enterobius vermicularis (pin worm) is a common intestinal parasite infection which usually affects children and rarely causes significant illness. However, of the few reports of extra-intestinal E. vermicularis infection reported in the literature, patients can have significant morbidity and mortality, thus stressing the need for appropriate management of pin worm infection. We report a case of massive E. vermicularis infection in a 20-year-old male which was inadvertently discovered during an emergency abdominal surgery. The case emphasizes the need to perform routine ova-parasite screening at periodic intervals to detect intestinal parasitic infections, to promote adequate practices to improve sanitation facilities and to direct appropriate therapeutic measures to eliminate the worm burden in case of infections.

Vaginal Enterobius vermicularis diagnosed on liquid-based cytology during Papanicolaou test cervical cancer screening: A report of two cases and a review of the literature.

Enterobiasis is one of the most common human parasitic infections. It is considered an intestinal parasite, but cases of extra-intestinal affections exist, notably infections of the female genital tract. Enterobius vermicularis (EV) eggs (or ova) have been found in the cervical smears of two patients in our institute during the last 16 years. No gynaecological or gastrointestinal symptoms were reported, and there was no known intestinal infection in these two cases. A review of the available literature revealed rare cases of vaginal enterobiasis, with a wide range of clinical presentations, many patients being asymptomatic. The diagnosis may sometimes be difficult, mainly because of the lack of clinical suspicion. However, cytological identification of EV in cervico-vaginal smears is important, especially when considering the risk of ascending infections of the genital tract associated with severe complications.

Co-infection with Enterobius vermicularis and Taenia saginata mimicking acute appendicitis.

In this report, we describe an unusual case of verminous appendicitis due to Enterobius vermicularis and Taenia saginata in a 29-year-old woman from Iran. The histopathological examinations and parasitological descriptions of both worms found in the appendix lumen are discussed. The removed appendix exhibited the macroscopic and microscopic features of acute appendicitis. Antihelminthic therapy was initiated with single doses of praziquantel for the taeniasis and mebendazole for the enterobiasis, and the patient was discharged.

[Perforation of the appendix and observation of Enterobius vermicularis]. / Perforeret appendicitis med fund af Enterobius vermicularis.

A nine-year-old girl was admitted to the paediatric ward due to fever and lower abdomen pain through a day. Acute laparoscopic exploration showed a large necrotic perforation at the distal end of the appendix. During the appendectomy multiple small, live Enterobius vermicularis (pinworms) were observed. The patient was admitted for three days of observation and received relevant treatment with intravenous antibiotics and antihelminthic treatment. The histology showed numerous pinworms in the lumen of the appendix and invasion of the pinworms of the submucosal layer and the wall of the appendix.

Incidence and outcomes of unexpected pathology findings after appendectomy.

PURPOSE: Pathologic evaluation of the appendix after appendectomy is routine and can identify unexpected findings. We evaluated our experience in children undergoing appendectomy to review the clinical course of patients with unexpected appendiceal pathology. METHODS: After IRB approval, a retrospective review was conducted on patients who underwent appendectomy from January 1, 1995 to March 1, 2011. Patient demographics, diagnosis, pathological findings, disease outcomes, and treatment were collected only on patients with abnormal pathology. RESULTS: 3602 patients underwent appendectomy. 113 patients had normal appendices, and 86 patients had unexpected findings, including carcinoid tumor (n=9), pinworm (n=34), granuloma (n=14), eosinophilic infiltrates (n=18), and other (n=11). All cases of carcinoid tumor were completely resected, with no recurrence or need for reoperation. Of the 34 patients with pinworm infestation, 41.2% underwent antimicrobial therapy, and none had post-operative symptoms. One patient (7%) with an appendiceal granuloma developed Crohn's disease. Three patients (16.7%) with eosinophilia developed symptomatic intestinal eosinophilia. CONCLUSIONS: Pediatric appendiceal carcinoid is an incidental finding; in this series, none required further intervention. Appendiceal granulomas are not commonly associated with developing Crohn's disease in the short term. Routine antibiotics for the treatment of pinworms are adequate. Patients with appendiceal eosinophilia may develop symptomatic intestinal eosinophilia.

Enterobius vermicularis salpingitis seen in the setting of ectopic pregnancy in a Malaysian patient.

We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing.

Enterobius vermicularis: Can it be a possible pathogen in Bartholin gland abscess formation?

The most frequent disorders of the Bartholin glands are cysts or abscesses. Bartholin gland abscesses occur generally as a result of polymicrobial infections or agents that cause sexually transmitted diseases. But as far as we know, no parasite has been previously reported among the infectious agents that are detected from the abscesses of the Bartholin gland. Here, we report a 45-year-old woman, in the Bartholin abscess aspirate of whom Enterobius vermicularis eggs were detected in between the inflammatory infiltrate by cytological examination.

Peritoneal enterobiasis causing endometriosis-like symptoms.

PURPOSE: Enterobiasis is the most common parasitic disease of the temperate zones and infects the human intestinal tract. In rare cases extraintestinal infections with Enterobius vermicularis may occur and can affect the female genital tract and peritoneal cavity. In most cases the infection is asymptomatic, but there are also cases described in which peritoneal enterobiasis can cause abdominal pain. METHODS: A case report and review of the pertinent literature. RESULTS: A 32-year-old patient was admitted with cyclical lower abdominal pain. With suspected endometriosis a diagnostic autofluorescence laparoscopy (DAFE) was performed. At surgery extensive peritoneal deposits were seen. Macroscopically these deposits were not typical for endometriosis. The histological examination showed granuloma caused by E. vermicularis eggs. The patient was treated with mebendazole. After completion of treatment the patient was asymptomatic. At the second-look laparoscopy no more peritoneal changes were detected. CONCLUSION: Enterobius vermicularis may cause symptoms similar to endometriosis. In cases with reasonable suspicion it should therefore be considered in the differential diagnosis.

Oxiuriasis apendicular: estudio de prevalencia y descripción clínico-morfológica / Presence of Enterobius vermicularis in surgical pieces of appendectomies

Background: The frequency of appendicular presence of Enterobius vermicularis varies from 0.2 to 41.8 percent. It is generally a pathological finding. The luminal obstruction by the parasite may unveil an acute appendicitis. Aim: To study the frequency of Enterobius vermicularis presence in surgical pieces of appendectomies. Material and Methods: Analysis of surgical pieces of appendectomies processed at the pathology laboratory of a general hospital, between 1993 and 2010. Results: In 21.038 surgical pieces, the presence of Enterobius vermicularis was found in 322 (1.5 percent). Fifty nine percent were women and 71 percent were younger than 18 years. Acute inflammation was confirmed in 71 percent. A history of previous abdominal pain was present in 40 and 70 percent of patients with and without acute inflammation in the surgical piece. Conclusions: In this series, the frequency of Enterobius vermicularis presence in surgical pieces of appendectomy was 1.5 percent.

Introducción: La frecuencia de Enterobius vermicularis (EB) apendicular varía entre 0,2-41,8 por ciento, siendo generalmente su diagnóstico un hallazgo al estudio histopatológico. La obstrución luminal puede desencadenar un cólico apendicular o evolucionar a una apendicitis aguda, siendo por tanto una causa frecuente de apendicectomía. El objetivo del estudio es determinar la prevalencia de EB en piezas quirúrgicas de apendicectomía junto con describir características clínico-morfológicas. Material y Método: Cohorte retrospectiva de pacientes con oxiuriasis apendicular diagnosticados en el Hospital Hernán Henríquez Aravena entre 1993-2010. Se estudiaron variables clínico-morfológicas, utilizándose estadística descriptiva y analítica, aplicando Chi-cuadrado y test exacto de Fisher para variables categóricas y T-student para variables continuas con un IC de 95 por ciento. Resultados: En 21.038 apendicectomías se verificaron EB en 322 casos (1,53 por ciento). El 59 por ciento eran mujeres y 71 por ciento menor de 18 años. Inflamación aguda fue confirmada en 71 por ciento. En casos con inflamación aguda la temperatura rectal y recuento leucocitario promedio fue 380 C y 12.975 mm³ respectivamente, mientras que en casos sin inflamación 37,80 C y 10.984 mm³ (p = N.S). En el grupo apendicectomizado por sospecha de apendicitis el 40 por ciento tenía historia de dolor abdominal previo, mientras que en aquellos sin inflamación aguda asociada el 72 por ciento (p = 0,005). Conclusiones: La prevalencia de EB apendicular fue 1,53 por ciento, afectando fundamentalmente a niños-jóvenes del sexo femenino. La oxiuriasis apendicular representa una causa de dolor abdominal interpretado como apendicitis aguda, sin asociarse a inflamación en el examen anatomopatológico. La historia de dolor abdominal previo resultó una variable útil para discriminar cólico apendicular de apendicitis aguda.

Enterobious vermicularis (pinworm) infestation of the vulva: report of 2 cases of a pseudoneoplastic lesion mimicking squamous carcinoma.

Enterobious Vermicularis (pinworm) infestation outside the gastrointestinal tract is rare. We report 2 patients with vulval involvement, one of whom presented with a clinically suspicious, rapidly growing mass. The histology of both lesions showed similar features of epidermal proliferation in the form of hyperkeratosis, acanthosis, and papillomatosis; this pseudoepitheliomatous hyperplasia raised the possibility of a well-differentiated squamous carcinoma. There was associated inflammation in both cases, including large numbers of eosinophils in 1 case. On the surface or within the keratin layer, structures with the morphology of enterobious vermicularis eggs were identified. In reporting this unusual pseudoneoplastic phenomenon, we stress the necessity for the pathologist to consider and look for parasites in proliferative squamous lesions of the vulva, especially when there is an associated inflammatory infiltrate rich in eosinophils.

Enterobius vermicularis infection of the fallopian tube in an infertile female.

Enterobius vermicularis (EV) is the most common nematode to infect humans. It inhabits the intestinal lumen, but rare, ectopic infections have been documented. The female genital tract is the most common ectopic site. We present a unique case of an EV infection of the fallopian tube resulting in inflammation, tubal obstruction, and infertility. A 30-year-old woman presented with infertility. Investigations included a laparoscopy with hydrotubation using methylene blue dye. This showed a left fallopian tube obstruction and extensive pelvic adhesions. A left salpingectomy was performed. Microscopic examination of the fallopian tube revealed numerous calcified and non-calcified ova associated with granulomatous reaction. The microscopic features were compatible with EV infection. Ectopic EV infections of the female genital tract result when the gravid female worm migrates from the perianal area to the vagina and ascends through the uterus and fallopian tubes to the peritoneal cavity. Microscopic examination of these ectopic sites can reveal adult worms or ova with granulomata formation, eosinophilic infiltrate, chronic inflammatory reaction, and fibrosis. The ova have a characteristic asymmetric oval configuration with flattening on one side. We postulate that our patient's salpingitis due to EV with accompanying fibrosis is a cause of her infertility.

Enterobius vermicularis infection with tuboovarian abscess and peritonitis occurring during pregnancy.

BACKGROUND: Extraintestinal Enterobius vermicularis infections are rare but may occasionally affect the female genital tract. Although mostly asymptomatic or causing minor clinical problems, they may lead to severe infectious complications. METHODS: Case report and review of the pertinent English language literature. RESULTS: A 31-year-old, 30-week-pregnant female was admitted with a clinical suspicion of appendicitis. At surgery, the appendix appeared normal, but generalized peritonitis of unclear origin was present. Eggs of Enterobius vermicularis were found upon microbiological and pathological examination. Because of persisting infectious disease, the patient underwent an elective caesarean section, and at that time the diagnosis of a right tuboovarian abscess was made, and salpingo-oophorectomy was performed. The pathology report confirmed the diagnosis of an E. vermicularis salpingo-oophoritis. CONCLUSION: This case was extraordinary because of a combination of tuboovarian abscess and generalized peritonitis with E. vermicularis infection occurring during late pregnancy. Ectopic enterobiasis should be considered in the differential diagnosis of pelvic infections of gynecological origin.

Infecções parasitárias do apêndice cecal e suas relações com apendicite aguda / Parasitic infection of the appendix and its possible relationship to acute appendicitis

Investigou-se a prevalência de infecções parasitárias do apêndice cecal e suas relações com a apendicite. Dos 1.600 apêndices estudados 24 (1,5 por cento) apresentaram infecção parasitária. Enterobius vermicularis foi encontrado em 23 casos (95,8 por cento) e Taenia sp em apenas um (4,2 por cento). Dezesseis pacientes (66,7 por cento) eram menores de 10 anos; 15 eram masculinos e 9 femininos. A análise histopatológica demonstrou inflamação aguda supurativa em 12 casos (50 por cento), eosinofilia em 13 (54,2 por cento) e hiperplasia linfóide em 10 (41,7 por cento). Complicações como peritonite ocorreram em 11 e gangrena em 3 casos. As infecções parasitárias do apêndice são causa pouco freqüente de apendicite aguda em crianças e adolescentes.

From 1,600 surgically removed appendices, 24 (1.5 percent) were found to have helminths. Enterobius vermicularis was observed in 23 of the 24 specimens (95.8 percent) and Taenia sp was detected in only 1 (4.2 percent) case. Sixteen patients (66.7 percent) were less than 10 year-old; 15 patients were male and 9 female. Pathologic analysis disclosed acute neutrophilic inflammation in 12 cases and lymphoid hyperplasia in 10 of the 24 appendices. Gangrenous appendicitis was diagnosed in 3 cases and peritonitis was found in 11 of the 24 infested appendices. Parasitic infection of the appendix is an uncommon cause of acute appendicitis in children and adolescents.