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PinWorm and Urinary Tract Infections In Young Girls
Young girls, with or without urinary tract infection, were examined for pinworms to explore a possible relationship between these two problems.
Of the 55 young girls with urinary tract infection, 20 (36.4%) had pinworm eggs in the perianal and perineal region monitored using the cellophane tape method.
While 9 (16.40/0) of 55 young girls who had never previously had a Urinary Tract Infection were found to have Enterobius eggs in at least one of the cellophane tape tests, and the difference was found to be significant (p<0.05).
These results suggested that urinary tract infections may be related to pinworms. When a urinary tract infection is diagnosed in young girls, cellulose tape should be applied to both the Perian- a1 and the perineal regions on at least three consecutive occasions.
Keywords: Enterobius vermicularis; pinworm; urinary tract infection; etiology.
Enterobius vermicularis (pinworm) has a cosmopolitan distribution, being widely found in cool and temperate zones. It is especially prevalent in schoolchildren aged 5-14 years and there is no association with any particular socioeconomic level (4, 8).
The adult worm lives in the cecum and adjacent portions of the large and small intestine. The gravid female migrates onto the perianal and perineal skin, lays her eggs and dies.
Enterobius may be found at ectopic sites. Worms may migrate from the perianal skin over the perineum and into other orifices in the region. The gravid female worm may enter the vagina and from the vagina at all levels of the female genital tract.
Pinworms (or eggs) have been found in routine vaginal and cervical smears (3, 8) and peritoneal granulomas (2, 6, 11) in women. They may cross the urethra into the urinary bladder. A possible relationship between Enterobius Vermicularis infection and secondary enuresis has been reported (1 0). Postmenopausal bleeding (1) and urinary tract infection (7, 12) have also been reported to be related to pinworms.
MATERIALS AND METHODS
Between December 1995 and June 1996, 55 girls admitted to the Department of Pediatrics, the Faculty of Medicine, Celal Bayar University, Manisa, Turkey, with urinary frequency, dysuria and pyuria was diagnosed as having a urinary tract infection.
These patients who were aged between 1 and 13 years (mean? SD=6.7-+ 3.1) comprised the study group.
Another 55 girls admitted to the same clinic with no urinary symptoms and no previous history of urinary tract infection comprised the control group. They were aged between 1 and 14 years (meanZSD= 7.023.9).
The cases in the control group were diagnosed as upper respiratory tract infection, dermatitis, or were healthy girls admitted for vaccination against hepatitis B. All cases were examined for E. Vermicularis eggs using the cellulose tape method on three consecutive mornings, as previously reported (4).
Two cellulose tapes were applied on each occasion, one to the perianal and the other to the perineal region. All patients in the study group were treated with trimethoprim-sulfamethoxazole and nitrofurantoin for urinary tract infection.
All cases positive for E. Vermicularis in both the study group and the control group, and family members older than 2 years, were treated with two doses of 100 mg mebendazole 15 days apart.
Parents of the children in both groups were informed about the study, and their written consent was obtained. Statistical analysis test or Fisher’s exact test. The groups were compared using the Chi-square RESULTS Enterobius eggs were found in 20 of 55 (36%) patients with urinary tract infection and 9 of 55 (16%) control cases.
The difference between the two groups was significant (p=0.03). Results for the different age groups are shown in Table 1. In the study group, only perianal examination of 11 (20%), only perineal examination of 2 YO), and both perianal and perineal examinations of 7 (13%) cases revealed positive results, while the figures for the control group were 5 (9”/0), 1 (2%), and 3 (6%), respectively.
The most frequent symptom of enterobiasis is perianal pruritis. Finger sucking was found to be strongly associated with pinworms in children 410 years old (5). Other symptoms attributed to the infection include nervousness, insomnia, nightmares, and convulsions (4).
A mucoid vaginal discharge may also be seen due to subsequent migration of the worms into the vagina, uterus, or fallopian tubes. A large proportion of pinworm infections are, however, reported to be asymptomatic (4, 5, 8).
Our results indicated a relationship between urinary tract infection and pinworms in young girls. The incidence of pinworm infection was found to be significantly higher (p=0.03) in young girls with urinary tract infection, especially those older than 6 years (p=0.012).
The difference was not significant in girls younger than 7 years (p= 1.0). A live pinworm found in the posterior fornix of a patient during endoscopic examination of the vagina (3) shows that some pinworms may enter the urogenital tract of female patients during their nocturnal migration.
Pinworm infection was also found to be related to introital bacteriology and recurrent urinary tract infection in children (7). In our patients, the urinary tract infection was thought to be related to the passage of female E. Vermicularis carrying bacteria through the urethra.
The finding that 9 of 20 (45%) patients with both enterobiasis and urinary tract infection had pinworm eggs in the perineal region provided good evidence of migration of the parasites. The life span of the pinworm is only a few months and the infection may resolve spontaneously without any drug therapy.
Pinworms may thus disappear after giving rise to the urinary tract infection. Although anal pruritis may suggest a pinworm infection, this symptom may also be related to other conditions such as allergy, mycotic infection or anal fissure, and correct diagnosis therefore depends on demonstrating the eggs or adult worms.
A single examination detects only 50% of the infections (8), and the best time for the examination is in the morning before the patient takes a shower or goes to the bathroom (4). Mebendazole was effective in the treatment of the pinworms; two oral 100 mg doses were given 15 days apart in all cases with or without urinary tract infection. There were no significant side-effects and no recurrence was detected at follow-up.