Thread Worm Flashcards
Things to consider with threadworms
Age of child, pregnancy, overseas travel
Other skin conditions, secondary infection, no response to treatment, highly transmissible
Self-care measure taken to prevent transmission
What are threadworms (pinworms)?
Helminthic infection by parasitic worms, alive 5-6 wks in gut and dies
In lower GI near anus, female deposits eggs on perianal skin at night
Symptom = perianal itching
How are threadworms spread?
Faecal-oral route = scratch > eggs on hand > swallowed
Retro-infection = larvae hatch and migrate back
Dust-borne eggs ingested
Who is more susceptible to threadworms?
School-aged children/parents in temperate regions
What are the symptoms of threadworms?
Most asymptomatic, can see worms migrate out of anus at night
Intense perianal itching, worse at night
Itch = restlessness, insomnia, damage to perianal area
Questions to ask to determine threadworm infections
Ask to describe symptoms? How developed? When first notice? When worse?
Have you noticed your child scratching their bottom? Has child complained of itchy bum?
What have you done to manage so far? When?
Any other symptoms?
Sleep patterns? Any other health conditions? Any recent overseas travel?
How often have they experienced this?
Pregnancy/breastfeeding?
What will treatment do to the threadworms?
Kill worms, not eggs or larvae
Eggs can survive 2-3 wks indoors and not spread via animals
When to refer with threadworm presentation?
Younger than 12 months, unclear diagnosis
Sign of infection = weeping skin
No response to treatment
Recent overseas travel or rural/remote Aus
Blood in faeces
Other symptoms = abdominal pain, diarrhoea/vomiting, unexplained weight loss
What are things to consider with threadworm infection?
May be asymptomatic, intense perianal itching (worse at night)
Not spread via animals
There should be no other symptoms
What are some differential diagnoses for threadworms?
Atopic dermatitis = inflammation of perianal area, less common, damage to skin less common
IBS = GI symptoms (diarrhoea, vomiting), symptoms of systemic disease (fever, weight loss)
Perianal itch = diet, excessive sweating, skin irritants, medicines, faecal incontinence
Other worms = hookworms, whipworm, roundworm, strongyloides overseas or NT
Other infections = satellite lesions (fungal), itching elsewhere (Scabies)
Haemorrhoids/anal fissure = pain, swelling, bleeding
Infection or abscess = fever and pain, sign of infection
What is the goal of treating threadworm?
Prevent transmission, infection
treat with anthelminthic therapy
What OTC medicines are used to treat threadworm infections?
Mebendazole = one dose kills worms, initial dose does not eradicate eggs or larvae (req 2nd dose in 2 weeks)
- safe to use in children <2 y/o, safe in breastfeeding
Pyrantel = used in children <12 months, dose by weight, repeated in 2 wks, treatment choice in preg, safe in breastfeeding
Preventative measures for threadworm infections
Hygiene = washing hands (transmission, reinfection)
Discourage from nail biting, finger sucking, and scratching
Keep nails trimmed
wash sheets and clothes (DO NOT SHAKE SHEETS)
What is some useful information to tell the patient about threadworms?
Common infection amongst children, passed on at school or home, inform school or childcare; adopt hygiene measures to prevent transmission
unlikely to cause harm, not a sign of poor hygiene
Effective treatments available, will work if taken properly; no exclusion is needed
Mention some hygiene measures for prevention/treatment of threadworms
Wear tight fitter underwear at night, change after morning shower
Wear clean gloves at night to stop scratching, shower on waking to remove eggs
Keep nails short and discourage nail biting
Wash bedding, soft toys, towels, gloves, in hot water and dry in hot dryer to kill eggs
