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Pinworm infection: easy to detect and easy to treat

Anal itching at night is highly suggestive of pinworm infection, an intestinal parasitic infection that is very common in children. Several drugs, none of which have serious adverse effects, eradicate the parasites, after two doses, given two weeks apart.

Pinworm infection is an intestinal parasitic disease caused by a roundworm. It is very common in children aged 3 to 10 years and their close contacts (family, school or daycare, etc.). The eggs are laid by the female worms around the host’s anus, mainly at night, which leads to itching. Contamination occurs by swallowing eggs present on the hands, particularly under the fingernails. Eggs remain infectious for 2 to 3 weeks, creating a risk of reinfection or of contamination of close contacts, which makes spontaneous cure unlikely.

Anal itching, without other associated symptoms, is very suggestive of pinworm infection. The diagnosis is confirmed by the presence of eggs or, more rarely, worms  on microscopic examination of an adhesive tape applied to the anal region, three mornings in a row, before bathing.

Careful, regular hand washing before every meal, and after using the toilet, is the key measure to prevent pinworm infection.

For children over 2 years of age and for adults, the benzimidazole drugs albendazole (Zentel° and other brands) and mebendazole (Vermox°), are the treatment of choice, taken as two oral doses, 2 weeks apart. For women who are, or could become, pregnant, pyrantel (Combantrin° and other brands) is preferable.

In women who are breastfeeding, a benzimidazole is preferable, since the extent to which pyrantel passes into breast milk is not known. As a precaution, breastfeeding should be suspended for around two days after taking a benzimidazole.

Given the highly contagious nature of pinworm infection and the relatively few adverse effects of the drugs used, simultaneous treatment of all members of a household is usually recommended.

©Prescrire 1 October 2020

Source: "Pinworm infection. Often easy to treat" Prescrire International 2020; 29 (219): 247-248. Subscribers only.

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