Enterobiasis in adults
What is enterobiasis?
Enterobiasis is a helminthic disease that is provoked by roundworms (pinworms). The invasion is accompanied by severe anal itching, painful sensations in the abdomen, impaired appetite, allergy to the body and other symptoms.
The worms that provoke the development of enterobiasis live in the intestines. They are the most common parasites found in the human body. Although young children most often suffer from enterobiasis, adults are also susceptible to this disease. In the high-risk zone are those adults whose children attend kindergartens, since the eggs of this nematode species are transmitted by contact and everyday life.
As for the structure of the parasites, they all have a fusiform shape, while the female is always larger than the male. Its body can reach 1 cm in length, while the body of the male does not exceed 3 mm. The color of the parasites is white. In adulthood, enterobiasis pathogens parasitize in the lower part of the small intestine and in the large intestine. In order not to go outside with feces, the worms are attached to the intestinal walls using special vesicles located on the head. Each individual can parasitize in the intestines for no more than 2 months, after which it dies for a natural reason - from old age. Nevertheless, the number of worms simultaneously living in the intestines of an adult can reach several thousand.
In the Russian structure of helminthiasis, enterobiasis takes the leading place. This parasitic invasion accounts for up to 70% of all infections. The epidemiological feature of enterobiasis is that it does not need a host change to complete the full development cycle of the parasite.
Content:
- Symptoms of enterobiasis
- Ways of infection with enterobiasis
- Diagnosis of enterobiasis
- Treatment of enterobiasis
- Prevention of enterobiasis
Symptoms of enterobiasis
The symptoms of enterobiasis are very diverse and largely depend on the massiveness of the invasion. The individual reaction of the infected organism influences the severity of the course of the disease. As a rule, in adulthood, enterobiasis proceeds much easier than in children.
The clinical course of enterobiasis should be divided into two main stages: acute and chronic.
Symptoms of the acute stage of enterobiasis
The acute stage of enterobiasis begins two days after the larvae enter the body. It lasts about 5-7 days.
The main symptoms of the acute stage:
- Stomach ache;
- Discomfort in the intestines, which are worse in the morning;
- The stool becomes more frequent, on average it happens 4 times per knocking. Moreover, it is formalized, not liquid.
Symptoms of the chronic stage of enterobiasis
The invasion acquires a chronic course after 35-75 days from the moment of infection. The symptoms at this stage are quite varied. Some patients do not notice any changes in their health at all.
Usually, patients report the following symptoms:
- Perianal itching of varying intensity. It most often occurs in the evening or at night. Itching occurs when female enterobiasis parasites crawl out of the anus to lay eggs. Itching lasts no more than 1-2 days and then subsides for 21-30 days. This frequency is explained by the fact that helminths replace one generation with another as a result of reinvasion;
- The longer a person is sick with enterobiasis, the stronger the itching will be. He begins to disturb the patient not only at night, but also in the daytime. Such pronounced itching leads to serious sleep disturbances, as a result of constant discomfort in the perineal region, a person often begins to urinate;
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Combing the anal area leads to the formation of abrasions, scratches and microcracks. They, in turn, are the gateway for bacteria. Dermatitis and secondary infection significantly aggravate the course of the disease and worsen the quality of life;
- Stomach pains become more intense. They are most often localized in the right ileocecal zone and resemble pain that occurs during inflammation of the appendix (appendicitis);
- Neurological symptoms are manifested in the form of headache, dizziness, and impairment of cognitive abilities. Patients get tired faster, perceive information worse. Attention, memory, thinking suffers. This, in turn, leads to a deterioration in performance;
- Immunity drops. The amount of lysozyme in saliva will decrease 1.5 times, the level of alpha-interferon decreases;
- In women during a long-term current enterobiasis, vulvovaginitis and endometritis often develop, since parasites are able to crawl into the genitals, carrying pathogenic microorganisms;
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Inflammatory reactions in the intestines and in the body as a whole arise as a result of the vital activity of worm larvae. They produce proteolytic enzymes and lectin-like substances. Human immunity reacts to them as a threat and begins to attack its own tissues;
- Enterobiasis leads to impaired absorption and digestion of food. In more than 40% of patients, there is a decrease in the acidity of gastric juice, inhibition of the function of pepsin formation;
- The risk of developing intestinal infections in patients with enterobiasis increases 3 times. In this case, the course of the disease will be more severe;
- Bruxism - teeth grinding at night. This symptom is not supported by scientific evidence, but many doctors consider it to be specific for parasitic infestation;
- Patients who have enterobiasis for a long time will experience symptoms of iron deficiency anemia. It develops due to the fact that parasites actively use iron from food to carry out their life. Iron deficiency and possible vitamin deficiency are aggravated by intestinal dysbiosis;
- Naturally, the lack of vitamins and minerals negatively affects the condition of the skin. She becomes pale, prone to flaking and dryness. Jams appear in the corners of the lips, hair splits and falls out.
There are many clinical manifestations associated with enterobiasis, and most of them are not specific. It is for this reason that many adults have been registered with gastroenterologists, neurologists, neurologists and other narrow specialists for a long time. With a small invasion, the disease can be hidden at all, but this does not mean that parasites do not harm human health.
Ways of infection with enterobiasis
If until recently it was believed that infection requires the entry of helminth eggs into the oral cavity, now it has been proven that this is not entirely true. It has been established that if the eggs are in the perianal region for 6 hours or more, retrograde infection is possible. However, the main route of invasion is fecal-oral.
The main carriers of enterobiasis are preschool children. It is from them that adults, most often family members, become infected. The fecal-oral mechanism of invasion is realized by household and food routes. The eggs of parasites can be transmitted through a handshake, through household items, through door handles, through any things that the patient has touched. Flies and cockroaches most often carry eggs of worms into food, although it is possible that food is contaminated by a sick adult who prepared or sold them. Helminth eggs are found in house dust, in animal hair, on bedding.
The life cycle of worms is absolutely independent of climatic conditions, therefore enterobiasis is widespread throughout the world. To a large extent, the degree of distribution depends on the sanitary conditions in which a person lives and how well his hygiene skills are formed. Equally important is the presence of a preschool child in the family.
An adult becomes infected with enterobiasis by swallowing parasite eggs. Most often, they are brought into the mouth with dirty hands. Therefore, enterobiasis is rightfully called "the disease of dirty hands." With their help, eggs fall on surrounding objects, on clothes, on furniture, etc. As a result, the circle of infected people is constantly expanding.
Once in the external environment, the eggs mature to the invasive stage in just a few hours. A comfortable temperature for them is the human body temperature. However, they will maintain their viability in the range of +23 to +40 ° C Celsius. In favorable conditions for them, eggs will be infectious for 3 weeks, existing even outside the human body. Temperatures below -15 ° C and above +55 ° C are fatal for them.
When a person swallows invasive eggs, they end up in the stomach. Digestive enzymes break down the membrane, and a mobile larva enters the small intestine, which descends into its lower sections. There she lingers for a certain time, going through 2 or 3 molting processes. When the parasites reach puberty, males fertilize females and passively, along with feces, leave the intestines.
Females linger in the intestine, attaching themselves to its walls with the help of the esophageal bulb and head vesicles. At this time, eggs begin to ripen in the fertilized female. Only one helminth can contain up to 17,000 eggs. The uterus stretches more and more, the esophageal bulb loses its ability to hold the female helminth, and it descends into the lower part of the large intestine.
The female crawls through the sphincter onto the perianal folds of a person and lays eggs. Each pile contains about 300 eggs that ripen on the infected person's body. Helminths prefer to crawl out at night, since the sphincter is as relaxed as possible at this time, and it is easier for them to overcome its resistance.
Sometimes helminths continue their journey through the human genitals, crawling not only into the perineum in men, but also into the vagina in women. Science knows cases when worms were found encapsulated in the peritoneum, in the uterus and in the fallopian tubes. However, most often, the female dies after laying the eggs. It dries up and becomes a shapeless lump.
During the laying of eggs, the skin receptors around the anus are irritated, which leads to severe itching. A person scratches itchy places, eggs fall on his hands, under his nails, and spread further.
Thus, the main causes of enterobiasis can be identified:
- Failure to comply with hygiene rules after using the toilet or public places. It is especially important to wash your hands before eating, even if you are planning a small snack;
- The presence of long grown nails that are not properly cared for;
- Poor sanitary and hygienic conditions, the presence of flies, cockroaches and other insects in the house;
- Eating foods contaminated with helminth eggs.
Diagnosis of enterobiasis
Diagnosis of enterobiasis in adulthood is most often not difficult. Permanent anal itching is the basis for suspicion of parasitic invasion. This is a very specific symptom for enterobiasis. However, it should be borne in mind that the skin of the anus can itch for other reasons, including hemorrhoids, diabetes mellitus, Trichomonas colpitis in women, liver disease, etc. Therefore, a parasitologist must confirm the diagnosis. Until that moment, until this happens, you should refrain from taking any medications.
The basic diagnostic method is scraping or imprint on enterobiasis. Naturally, the indisputable confirmation of parasitic invasion is the presence of live parasites in the feces. Moreover, often people can see them on their own, since helminths can reach a length of 1 cm, and a microscope is not needed to detect them. Especially often, worms can be seen in feces with massive infection.
If in childhood for the diagnosis of enterobiasis, the Graham method is used (the print is made on adhesive tape), then scraping for enterobiasis in adults is taken with a spatula or cotton swab. It is pre-moistened in an aqueous solution of glycerin or in a soda solution. After that, the tampon is transferred to the laboratory, where it is rinsed, centrifuged, the separated precipitate is applied to glass and qualitatively examined under a microscope.
It should be borne in mind that up to 5 repeated tests may be required to obtain a reliable result. With a single study, the percentage of detection of helminth eggs does not exceed 50%.
Scatological research methods are often used to detect other helminthiases, but they are not informative in relation to enterobiasis. This is because pinworms do not lay eggs in the intestines.
An indirect sign indicating parasitic invasion is an increase in the level of eosinophils in the blood. With prolonged invasion, patients most often have persistent iron deficiency anemia.
Treatment of enterobiasis
Treatment of enterobiasis in adults involves taking the same drugs that are used to remove parasites in children. However, an important distinguishing feature of therapy is the increase in dosage. Modern medicine has at its disposal not a very large number of drugs that can get rid of enterobiasis.
You should not prescribe medications on your own, as this can be dangerous.
Doctors, as a rule, prescribe the following drugs for enterobiasis to their patients:
- Levamisole-based drug Decaris. In addition to the fact that it has a detrimental effect on parasites, this drug acts as an immunomodulator;
- Pirantel or Helmintox drug based on pyrantel pamoate;
- Preparations Vermox, Vormil, Telmox, Mebex based on mebendazole;
- One of the strongest drugs for getting rid of enterobiasis is Nemozol. However, when choosing it, it should be borne in mind that it has a large number of side effects. In this regard, Nemozol is recommended for admission only in case of polyinvasion, that is, when several types of worms are parasitized in the human body, or there is an infection with protozoal organisms (lamblia). It is possible to use Nemozole for enterobiasis, which is difficult to treat, or with massive invasion;
- Piperazine is a drug used to treat pregnant women, but it is not effective. It is allowed to prescribe it even during lactation.
To increase the effectiveness of the treatment of enterobiasis, you should prepare in advance. To do this, 24 hours before taking the anthelmintic agent, you need to abandon the products that fix the stool. You should not eat heavy or fatty foods before going to bed, dinner on the eve of the upcoming treatment should be light.
Preparations for enterobiasis are taken in the morning. In order to help the body get rid of parasites faster, you should drink a laxative in the evening. Thus, it will be possible to better cleanse the intestines from dead parasites, as well as from those that could retain viability.
An important condition for effective treatment of enterobiasis is repeated administration of anthelmintic drugs after 14 days. The fact is that most of the drugs have a detrimental effect on adults, and the larvae of helminths survive. Therefore, it is so important to repeat the course of treatment in order to surely get rid of parasites.
If a person suffers from pronounced allergic reactions, from severe itching, then an antihistamine can be taken. Effective remedies are Zodak, Tsetrin, Loratadin. In addition, taking antihistamines will help avoid an allergic reaction to the anthelmintic drug. Another argument in favor of their use is the elimination of the possibility of scratching the skin and a decrease in the likelihood of helminth eggs getting on clothes and on the body.
If the patient experiences severe anal itching, then a cleansing enema can be given. To prepare the cleaning composition, dissolve 2 teaspoons of soda in 1000 ml of boiled water. This volume will be enough for the procedure.
It is important to understand that taking medications for enterobiasis is only half of the treatment. Its success largely depends on whether patients adhere to the basic recommendations for the prevention of reinfection. In addition, all family members must follow the doctor's prescriptions, regardless of whether they are diagnosed with enterobiasis or not.
Rules for successfully getting rid of enterobiasis:
- After going outside, after using the restroom, wash your hands before every meal. Moreover, this must be done efficiently, with the obligatory use of soap.
- Always cut your nails short.
- During treatment, you should change your underwear twice a day. This procedure is mandatory in the morning. It is highly advisable to change your underwear before a night's rest. Wearing underwear should be not only clean, but also thoroughly ironed.
- The apartment should be wet cleaned daily. Particular attention should be paid to the toilet, thoroughly disinfecting it.
If at least one of these rules is violated or not fully observed, then the treatment of enterobiasis will be ineffective. The person will become infected again and infect the people around him.
Turning to the methods of traditional medicine, we can recommend only one remedy - this is pumpkin seed. It is believed that a greenish film that covers the surface of the seed itself and is located directly under the peel has antihelminthic properties. Therefore, it is so important to preserve its integrity.
Treatment with pumpkin seeds is as follows:
- For two days, a person is given a morning enema, and in the evening they are given a saline laxative;
- Then a mixture of pumpkin seeds (300 g) and honey (100 g) is prepared. It is offered to the patient on an empty stomach. The mixture must be eaten within an hour. In this case, the stomach should be empty;
- After 4 hours, the person is offered a laxative, and after another half hour, an enema is given;
- When the bowels have been emptied, you can return to your previous lifestyle.
However, no method should be applied on its own and a specialist should be consulted before starting treatment.
Learn more: Broad Spectrum Parasite Medicines
Prevention of enterobiasis
Prevention of enterobiasis is a set of measures aimed at preventing parasitic invasion of the human intestine. To do this, it is necessary to timely identify the infected and prevent the transfer of worm eggs from one person to another.
- It is necessary to routinely identify and examine people who are at risk. First of all, these are the personnel of preschool institutions and schools. This also includes pool employees, people working in the food industry.
- If employees with enterobiasis are identified, they are removed from work until they are completely cured.
- During treatment and for at least 3 days after its completion, you should especially carefully carry out wet cleaning using soda-soap solutions. After surface treatment, rags should be boiled.
- Patients should wash themselves in the morning and evening with the obligatory change of underwear. It should be ironed on both sides.
- All upholstered furniture, rugs, carpet runners should be vacuum cleaned and ironed through the fabric.
- Particular attention should be paid to clean hands. They must be washed before every meal and in between meals. It is best to refuse long nails.
- Hygiene rules should be taught to children from an early age. It is important to forbid them to suck their fingers, to put foreign objects in their mouths. If you do this in a playful way, then the rules will be learned by the child faster.
- It is important to get rid of cockroaches, flies, bedbugs and other insects in the house, as they are carriers of infection.
Enterobiasis is a serious disease, and it is necessary to treat it responsibly. The World Health Organization classifies helminthiasis as a disease especially dangerous to human health. Recent data indicate that the presence of parasites in the body can provoke cancer. Therefore, in order to protect yourself and your loved ones from such problems, you just need to follow the rules for the prevention of enterobiasis, and when the first symptoms of invasion appear, consult a doctor and carry out high-quality diagnostics.
Author of the article: Danilova Tatyana Vyacheslavovna | Infectionist
Education: in 2008 received a diploma in General Medicine (General Medicine) at the Pirogov Russian Research Medical University. Immediately passed an internship and received a diploma of a therapist
