The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis.

Although the main cause of appendicitis is unclear, infection with Enterobius vermicularis is suggested as a neglected risk factor. Since, there is no comprehensive analysis to estimate the prevalence of E. vermicularis in appendicitis; therefore, we conducted a global-scale systematic review and meta-analysis study to estimate the prevalence of E. vermicularis infection in appendicitis cases. PubMed, Scopus, Web of Science and Google Scholar databases were systematically searched for relevant studies published until 15 August 2019. Pooled prevalence of E. vermicularis infection was estimated using the random effects model. Data were classified based on the continents and countries. Moreover, subgroup analyses regarding the gender, the human development index (HDI), and income level of countries were also performed. Fifty-nine studies involving 103195 appendix tissue samples belonging to the individuals of appendicitis were included. The pooled prevalence of E. vermicularis infection was (4%, 95%CI, 2-6%), with the highest prevalence (8%, 95% CI: 0-36%) and lowest prevalence (2%, 95% CI: 1-4%) in Africa and Americas continents, respectively. With respect to countries, the lowest and highest prevalence rates were reported from Venezuela (<1%, 95% CI: 0-1%) and Nigeria (33%, 95% CI: 17-52%), respectively. Indeed, a higher prevalence was observed in females, as well as in countries with lower levels of income and HDI. Our findings indicate the relatively high burden of E. vermicularis infection in appendicitis cases. However, our findings suggest the great need for more epidemiological studies to depth understand overlaps between E. vermicularis infection and appendicitis in countries with lower HDI and income levels.

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.

Epidemiological survey of the prevalence of intestinal parasites among schoolchildren in Sari, northern Iran.

Parasitic infection is highly prevalent throughout the developing countries of the world. Research on the prevalence of intestinal parasitic infections in various geographic regions is a prerequisite for the development of appropriate control strategies. A cross-sectional study was conducted to determine the prevalence of intestinal parasitic infections among schoolchildren in public primary and secondary schools in the urban areas of Sari, Mazandaran province, northern Iran. The study was conducted from November 2009 to June 2010. A total of 1100 stool samples from 607 males and 493 females aged 7-14 years were examined by direct wet mounting, formalin-ether concentration, and Ziehl-Neelsen and trichrome permanent staining methods. A parental questionnaire for common risk factors was completed for each participant. Mono- or poly-parasitism was detected in 367 (33.3%) of the children (32.6% of males and 34.2% of females). Various species of protozoan or helminth infections were detected: Blastocystis hominis seemed to be the most prevalent parasite (13.5%) followed by Giardia lamblia (10.6%), Entamoeba coli (7.2%), Endolimax nana (1.5%), Enterobius vermicularis (2.2%), Trichostrongylus sp. (2.1%) and Strongyloides stercoralis (1.6%). The prevalence of intestinal parasite infections in females was slightly higher than in males, though without a statistically significant difference (p=0.56). No age association was detected, and a slightly lower positive association with increasing age was observed (p=0.33). A significant association was observed with parents' educational level, household income and practice of hand washing before meals (p<0.01). Although paediatric pathogenic intestinal parasite infections are not more prevalent in this geographical area than in other regions, improvements in personal hygienic conditions and behavioural characteristics is important to completely control parasitic infections in schoolchildren in northern Iran.

Helminth infection does not reduce risk for chronic inflammatory disease in a population-based cohort study.

BACKGROUND & AIMS: Parasitic helminth infections can suppress symptoms of allergy, type 1 diabetes, arthritis, and inflammatory bowel disease in animal models. We analyzed data from a large, population-based cohort study to determine whether common childhood enterobiasis protects against these diseases. METHODS: We collected information on individual prescriptions filled for the drug mebendazole against Enterobius vermicularis for all children born in Denmark 1995-2008 from the National Register of Medicinal Product Statistics (n = 924,749; age 0-14 years); 132,383 of these children (14%) filled a prescription for mebendazole, 102,482 of the children (11%) had a household peer who was registered with a filled mebendazole prescription, and the remaining 689,884 children (75%) comprised the reference group. Children diagnosed with asthma, type 1 diabetes, juvenile arthritis, ulcerative colitis, or Crohn's disease were identified from the National Patient Registry. We used Poisson regression to estimate confounder-adjusted incidence rate ratios for first in- or outpatient hospital diagnosis of chronic inflammatory disease according to history of mebendazole treatment prescribed to children in the study. RESULTS: Chronic inflammatory disease was diagnosed in 10,352 children during 6.4 million person-years of follow-up. The incidence rate ratios was 1.07 for asthma (95% confidence interval [CI]: 1.00-1.13), 1.05 for type 1 diabetes (95% CI: 0.79-1.12), 1.13 for juvenile arthritis (95% CI: 0.94-1.37), 0.77 for ulcerative colitis (95% CI: 0.41-1.46), and 1.44 for Crohn's disease (95% CI: 0.82-2.53). Results were not modified by number of treatments or age at treatment. CONCLUSIONS: Based on a population-based analysis, enterobiasis does not reduce risk for asthma, type 1 diabetes, arthritis, or inflammatory bowel disease.

Vulvovaginitis infantil / Child vulvovaginitis

La vulvovaginitis es el problema ginecológico más frecuente en las niñas prepúberes, favorecido por la menor protección del introito vaginal a los agentes externos y la presencia de factores anatómicos (proximidad del ano, labios mayores y menores menos desarrollados, etc.) y hormonales (hipoestrogenismo). A esto se suma el efecto de productos irritantes locales y la coexistencia en ocasiones de malos hábitos higiénicos. La mayoría de las vulvovaginitis en las niñas son inespecíficas, aunque en un porcentaje variable pueden aislarse bacterias patógenas específicas (entéricas, respiratorias, o de transmisión sexual), o ser secundarias a otros procesos como oxiurasis o cuerpos extraños intravaginales. En el presente artículo analizaremos la etiología, la patogénesis, la clínica y el manejo de esta entidad en la infancia, y realizaremos algunas consideraciones clínicas y microbiológicas sobre distintos cuadros con etiología específica(AU)

Vulvovaginitis is the most common gynecological problem in prepubertal girls, helped by lower introitus protection to external agents and the presence of anatomical (proximity of anus, minor and major labia less developed,...) and hormonal factors (low estrogen concentration) This is compounded by the effect of local irritants and sometimes co-existence of poor hygiene. Most vulvovaginitis in girls are nonspecific, although specific pathogenic bacteria (enteric, respiratory, or sexually transmitted) can be isolated and they can be also secondary to other causes as oxiurasis, or intravaginal foreign bodies. In this article we will analyze the etiology, pathogenesis, clinical features and management of this disorder in childhood, and we will have some clinical and microbiological considerations of different diseases with specific etiology(AU)

The post-treatment effects of enterobiasis on the occurrence of enuresis among children in Calabar, Nigeria.

OBJECTIVE: To investigate the relationship between enterobiasis and enuresis before and after albendazole therapy among 632 children, aged, 5-14 years, in Calabar, Nigeria. METHODS: The scotch tape (cellotape) technique was used for the detection of eggs of Enterobius vermicularis (E. vermicularis) while questionnaire-based interviews were used for screening for anal itching and/or enuresis among study participants. All subjects found positive for Enterobius infection as confirmed by the presence of eggs and those with persistent anal itching (both enuretic and non-enuretic) were treated with 400 mg of albendazole given as a single dose. The treated subjects were re-assessed post-treatment to ascertain whether they were cured and also to determine their enuretic status (for the enuretics). RESULTS: The overall prevalences of Enterobius infection, anal itching, and enuresis prior to albendazole therapy were 6.8%, 42.9%, and 35.6% respectively. There was no statistically significant difference in the prevalence of these parameters by the socio-economic class of subjects (P = 0.462, P = 0.647, and P = 0.610, respectively). The pre-treatment prevalences of enuresis among Enterobius and anal itching-positive subjects were 53.5% and 49.8%, respectively versus 34.3% and 24.9%, respectively among their negative counterpart (P = 0.012 and P < 0.001, respectively). Four (20%) out of the 20 enuretic children found Enterobius egg-negative after albendazole therapy were equally cured while 8(40%) had reduction of their enuresis, thus giving a total resolution rate of 60%. Similarly, 64.2% resolution (25% cure and 32.8% reduction) of enuresis was observed amongst 120 anal itching-cured/enuretic children. Enuretic status of the Enterobius-/anal itching-uncured subjects, on the other hand, remained unchanged post-treatment. CONCLUSIONS: This study is suggestive of the involvement of E. vermicularis in the aetiology of enuresis in Calabar. Children presenting with, especially, uncomplicated enuresis should be screened for enterobiasis.

Confección por dos filarias (Loa loa y Mansonella perstans) en una paciente proveniente de Guinea / Loa Loa and Mansonella perstans coinfection in a patient from Guinea

Presentamos un caso de una infección mixta por 2filarias (Loa loa y Mansonella perstans). La infección sesospechó, al aparecer, una marcada eosinofilia en unaanalítica de rutina. En la extensión de sangre periféricase observaban microfilarias envainadas y sin envainar,con lo que se estableció un diagnóstico de infecciónmixta por filarias. El diagnóstico definitivo de especiese realizó en el Centro Nacional de Microbiología deMajadahonda. Se instauró un tratamiento con dietilcarbamicinay mebendazol que conllevó la curación de lossíntomas de la paciente y la eliminación de las microfilariasen sangre.La filariasis es todavía endémica en muchos países.Debido al aumento de viajeros a dichas zonas y alos movimientos migratorios desde dichas áreas, no esinfrecuente enfrentarnos a su diagnóstico. La implantaciónde tratamientos masivos contra las filarias en zonasendémicas por parte de la Organización Mundial dela Salud está disminuyendo su transmisión, consiguiendola eliminación de la enfermedad en algunas áreas(AU)

We present a case of mixed infection by two filariae(Loa loa and Mansonella perstans). It seems that theinfection was suspected due to a pronounced eosinophiliain a routine analysis. Sheathed and unsheathedmicrofilariae were observed in the spread of peripheralblood, which enabled a diagnosis to be established ofmixed infection by filariae. The definitive diagnosis ofthe species was carried out at the National Centre ofMicrobiolgy of Majadahonda. A treatment was initiatedwith dietilcarbamazina and mebendazole which resultedin the patient’s being cured and in the elimination ofthe microfilariae in the patient’s blood.Filariasis is still endemic in many countries. Due tothe increase of travellers to such zones and the migratorymovements from such areas it is not unusual forus to come across such a diagnosis. The implantationof massive treatments against filariae in endemic zonesby the World Health Organisation is reducing theirtransmission and is managing to eliminate the diseasein some areas(AU)

Sensitivity of perianal tape impressions to diagnose pinworm (Syphacia spp.) infections in rats (Rattus norvegicus) and mice (Mus musculus).

We determined the sensitivity of perianal tape impressions to detect Syphacia spp. in rats and mice. We evaluated 300 rat and 200 mouse perianal impressions over 9 wk. Pinworm-positive perianal tape impressions from animals with worm burdens at necropsy were considered as true positives. Conversely, pinworm-negative perianal tape impressions from animals with worm burdens were considered false negatives. The sensitivity of perianal tape impressions for detecting Syphacia muris infections in rats was 100%, and for detecting Syphacia obvelata in mice was 85.5%. Intermittent shedding of Syphacia obvelata ova is the most probable explanation for the decreased sensitivity rate we observed in mice. We urge caution in use of perianal tape impressions alone for Syphacia spp. screening in sentinel mice and rats.

Relationship between Enterobius vermicularis and the incidence of acute appendicitis.

The objective of this study was to evaluate the relationship between Enterobius vermicularis and the occurrence of acute appendicitis. Over a ten year period of time, all appendix specimens received by the department of pathology were reviewed for pathologic changes and the existence of E. vermicularis. Logistic regression was carried out to determine the odds ratio (OR) of the relationship between E. vermicularis and acute appendicitis. A total of 5048 specimens were reviewed. E. vermicularis was found in 144 (2.9%) cases. After separating by sex and adjusting for age logistic regression analysis showed the OR of E. vermicularis appendiceal infestation was 1.275 (95% CI = 0.42-3.9) for males and 1.678 (95% CI = 0.61-4.65) for females. Age was an independent risk factor for acute appendicitis in males (OR = 1.01, 95% CI = 1.003-1.017) and females (OR = 1.012, 95% CI = 1.005-1.02).

Enterobíase / Enterobiasis

Os autores fazem uma revisão da enterobíase com uma visão clínica, com maior ênfase no diagnóstico e apresentação de novas opções terapêuticas desta parasitose intestinal

Fatal infection with human pinworm, Enterobius vermicularis, in a captive chimpanzee.

A fatal infection with human pinworms, Enterobius vermicularis, was found in a 26-year-old chimpanzee kept in a zoo. Grossly, the animal was highly emaciated, and had severe enteritis with cecal multifocal nodules and severe cholelithiasis. Histopathologically, a large number of human pinworms were observed in the nodular lesions in the cecum and intestinal wall. These migrating worms were surrounded by an inflammatory cell infiltration which lacked eosinophils. There were areas of multifocal hyperemia and/or hemorrhages in various organs including the entire gastrointestinal tract. Pinworms were also observed in the portal venule and parenchyma of the liver. A light infection with Strongyloides cf. stercoralis was also observed.

Salpingitis bilateral por Enterobius vermicularis / Bilateral salpingitis caused by Enterobius vermicularis

Los casos de diseminación de Enterobius vermicularis (oxiuros) a los órganos internos femeninos apartir de focos primarios digestivos son numerosos en la bibliografía médica. Aportamos un raro caso desalpingitis bilateral ligada a la ascensión del parásito por el tracto genital (AU)

Susceptibility of natural hybrids between house mouse subspecies to Sarcocystis muris.

A previous study showed that the susceptibility of hybrids between two Mus musculus musculus and Mus musculus domesticus did not apply to every parasite. The authors proposed that only parasites which exerted enough constraints would induce the selection of poorly compatible systems of resistance in the subspecies. This study completes the previous work. Experimental infections of mice of the two subspecies and their hybrids with the tissue-dwelling protozoan Sarcocystis muris show that hybrids are more susceptible to the coccidian than M. m. musculus and M. m. domesticus individuals. This result demonstrates that the hybrids are not only susceptible to intestinal helminths, and confirms the 'constraint hypothesis'.