Recurrent paediatric pinworm infection of the vagina as a potential reservoir for Enterobius vermicularis

Abstract

Enterobius vermicularis infection remains one of the most common parasitic infections, particularly prevalent in children. Enterobiasis, although not usually dangerous, may cause significant morbidity. Elimination of the parasite from a family or an institution often poses problems, either because of an incomplete cure or re-infection. While there have been limited reports of ectopic enterobiasis throughout the world, ours is probably one of the rarest reports of recurrent vaginal E. vermicularis infection in the absence of any gastrointestinal symptoms despite complete treatment. A 4-year-old girl presented with recurrent episodes of vulval itching on 3-4 occasions over 2 years. There was no pruritis ani nor urinary/gastrointestinal complaints. The vulva was inflamed with 4-5 living worms, 6-7 mm in length, emerging from the anterior vaginal fornix, but with no vaginal discharge. Direct microscopic examination of vaginal swabs revealed adult worms of Enterobius but no eggs. Repeated stool samples from the patient, parents and a sibling were negative. The patient was treated orally with 100 mg of mebendazole for 3 days followed by two more courses at 3-week intervals over a period of 3 months. Recurrent vaginal enterobiasis despite complete treatment and in the absence of any gastrointestinal involvement suggests that the vagina is a potential reservoir for E. vermicularis, which supports the theory of rare ectopic enterobiasis through the ascending pathway of the female genital tract.

Vaginal Enterobius vermicularis diagnosed on liquid‐based cytology during Papanicolaou test cervical cancer screening: A report of two cases and a review of the literature

“…There were no gastrointestinal symptoms, and repeated stool samples of the patient and her family were negative. In this case, recurrent vaginal infection by EV despite treatment and in the absence of any signs of gastrointestinal infection suggests that the vagina is a potential reservoir …”

“…The frequency of involvement of the genital tract is unknown because only scarce reports of extraintestinal enterobiasis, in the ovary, vagina, salpinx, and peritoneal cavity can be found in the available literature . Concerning findings of EV in the vagina reported throughout the world, the literature in English contains ∼30 cases of EV, mostly EV eggs, discovered in vaginal or cervical smears, since the 1970 s (Table ) . Interestingly, the majority of the cases reported come from India, even though enterobiasis seems more prevalent in temperate than tropical countries .…”

Vulvar infections: beyond sexually transmitted infections

“…Some patients may be asymptomatic, with reports of ova in vaginal smears in patients without any symptoms until the infestations were severe enough to cause uterine enlargement and pelvic pain . Kashyap et al . reported a case of vulvar itching in a patient with live worms found in the vagina on multiple occasions.…”

“…Some patients may be asymptomatic, with reports of ova in vaginal smears in patients without any symptoms until the infestations were severe enough to cause uterine enlargement and pelvic pain. 62 Kashyap et al 63 reported a case of vulvar itching in a patient with live worms found in the vagina on multiple occasions. This patient experienced no perianal itching, no worms or ova located in the gastrointestinal tract or GI symptoms, and repeated negative tape tests, with authors concluding that the vagina can serve as the sole reservoir for these worms.…”

“…70 For pharmacologic treatment, mebendazole boasts a cure rate of 90-100%, with even higher cure rates for albendazole, which is also better tolerated. 63 Pyrantel pamoate is the most frequent agent prescribed for Enterobius in the United States, with a nearly 100% cure rate when given twice, 2 weeks apart. 71 A choice of one of the following regimens is standard:…”