A Study On Entrobius Vermicularis Infection In A Appendices Removed By Surgery In Tabriz Hospitals
E Fallah, A Dehgani
Keywords
appendicitis, enterobius vermicularis, oxyuriasis, pinworms
Citation
E Fallah, A Dehgani. A Study On Entrobius Vermicularis Infection In A Appendices Removed By Surgery In Tabriz Hospitals. The Internet Journal of Parasitic Diseases. 2008 Volume 4 Number 1.
Abstract
The association of Enterobius vermicularis infestation with acute appendicitis varies from 0.2– 41.8% worldwide. Our purpose was to determine the significance of Enterobius-associated appendicitis by retrospective review of appendectomies performed during a 8-year period at a major Tabriz hospital. The Surgical Pathology database at Imam Khomeini’s and Alinasab’s Hospital, Tabriz,Iran was reviewed for appendiceal specimens found to have Enterobius infestation. Corresponding patient charts were evaluated for age, gender, presenting symptoms, laboratory data, operative findings, and clinical course. Of the 5981 appendectomies performed from 2005 to 2009, 38 specimens (1.38%) were found to contain Enterobius vermicularis. Twenty-six of the appendectomies were performed for symptoms of acute appendicitis; the remaining twelve were incidental appendectomies in conjunction with other operations. Between that age groups , and between two age groups of 5-10 and 11-16 the highest rate has been shown that among them females infection is more . In 38 cases there are pinworm that %67 present of it relates to females and %33 of it relates to males . Of the 26 symptomatic children, 12 presented with fever >99.0؛F, and 14 had a WBC count >10,000. Intraoperative appearance of the appendix ranged from normal to perforation. Pathologic evaluation showed neutrophil or eosinophil infiltration in 27 of the 38 specimens. Enterobius infestation is an uncommon cause of acute appendicitis in children in the Islamic Republic of Iran. It may be associated with acute appendicitis, ‘‘chronic appendicitis,’’ ruptured appendicitis, or with no significant clinical symptoms.
Introduction
Enterobius vermicularis (pinworm) infections of the gas¬trointestinal tract occur in 4–28% of children worldwide [1, 2, 3, 4, 5]. Although the most common manifestation of pinworms is perianal pruritus, pinworms have been found in multiple other locations, including the appendix [6, 7, 8, 9, 10]. Recent literature regarding appendiceal helminths focuses primarily on the pathologic changes induced by the presence of intraluminal parasites. We reviewed a cohort of children with asymptomatic and symptomatic pinworms of the appendix.
Methods
From 2005–2009, the Surgical Pathology database at Imam-Khomeini and Alinasab Hospitals, Tabriz, Iran, was queried for appendix specimens that had pinworms on histologic analysis. The patients’ medical records were evaluated to determine age, gender, presenting symptoms, presenting vital signs, white blood cell (WBC) count, operative findings, and clinical course. Histologic findings were recorded.
Results
Thirty-eight of 5981 appendectomy patients (1.38%) were noted to have intraluminal pinworms within the appen¬dix specimen (Table 1). In 38 cases there is pinworm that %67 present of it relates to females and %33 of it relates to males .Twenty-six operations were performed for symptoms of abdominal pain. Twelve incidental appendectomies were performed in conjunction with another primary procedure.
Figure 1
Symptomatic patients
Twenty-six patients presented with symptoms of generalized abdominal pain (n=9) or right lower quadrant (RLQ) pain (n=17). Duration of pain symptoms ranged from 12 h–10 days, with an average of 2.5 days. Median duration of symptoms was 2 days. Other symptoms described by the patients are listed in Table 2. Twelve children (47%) had recorded temperatures ‡99؛F. Thirteen children (50%) had a heart rate ‡100/min. On admission, white blood cell (WBC) counts ranged from 5.4–29.7, with 11 children having counts >10,000. The neutrophil counts (segmented neutrophils plus bands) were 32–98%. Table 3 correlates patients’ tem¬peratures, presenting heart rates, WBC counts, and presence of left shift with the microscopic pathologic findings.
Figure 2
Figure 3
Discussion
Gastrointestinal infection due to Enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection [11]. Although seen in all ages and socioeconomic levels, it is most common in children ages 5 to 14. Pinworms have been present for thousands of years. Enterobius ova have been found in human coprolites from 7800 BC [12]. Fabricius Hildanus was the first to describe appendiceal pinworms in 1634 [13]. Since 1899, when the association of Enterobius infestation and appendicitis was first described [9], there have been several case reports and retrospective studies describing this entity. Humans are the only natural hosts of pinworms. Embryonated eggs measure 30–60