Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.

Threadworms // Page 1 of 3

Helminthes Infestation: Threadworm / Pinworm

1. Most common worm infestation (strongyloidiasis) is by Enterobius
vermicularis or threadworm.
2. These threadworms:
a. Resemble fine pieces of white cotton. They are about 2-13 mm long. The adult
female threadworms are larger (up to 15mm)
b. Are nematodes - unsegmented cylindrical bodies with a complete digestive
system that taper at both ends. These parasites live in the rectum and are generally harmless
c. Human host specific - will not survive in the intestine of household pets. However, it is still possible to
contract threadworms from eggs stuck to the fur of cats and dogs

Diagnosis and Symptoms

1. 90% without symptoms
2. Intense itchy feeling around the anus, usually at night or early in the morning
3. Restless sleep, grinding your teeth in your sleep and enuresis
4. Irritability
5. Loss of appetite
6. More definitive proof - look for them
a. See if any worms are visible on the surface of faeces after a bowel motion
(20% success rate), or
b. Best done in the morning as soon as the child wakes up. The worms themselves
will be visible to the naked eye. They will "glow" under the torchlight
7. Look for the eggs. A female threadworm can lay up to 16,000 eggs
before dying
a. Deposited around the anus on the perianal skin
b. Best detected at night and look like small white specks
c. Alternatively, Use the "adhesive tape test". In the morning before bathing or going to the toilet, apply a
piece of double-sided cellophane tape to a wooden stick. Press the tape against the anus and remove it.
Any threadworm eggs will appear as tiny white marks on the tape

Infestation

1. There are two main ways you can catch threadworms:
a. DIRECTLY - through contact with an infected person
b. INDIRECTLY - through touching a surface such as a tap, door handle, toilet seat, bedding, toys, pencil,
kitchen bench, clothing, door handles, food or furniture that have been contaminated by an infected person


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Threadworms // Page 2 of 3

2. Very contagious. Both children and adults can be infected, although it is mostly found in
children.
a. Irritation around the anus (caused by the mucus, or "glue", that the female threadworm secretes in order
to attach the eggs to the skin) sufferer will scratch the itching area, collect eggs on the fingers and under
the nails. They easily get transferred to the mouth and some will be swallowed. Thumb sucking and sucking
other fingers is strongly associated with the prevalence of threadworms. Once ingested, the eggs hatch out
as threadworm larvae in the small intestine. After they have swallowed the eggs they hatch inside the small
intestine. The shells of the eggs are dissolved by stomach juices. The juvenile threadworm larvae then
move to the large intestine to grow and mate. It takes about a month, the incubation period taking
anywhere between 2 to 6 weeks, for the swallowed egg to turn into a sexually mature adult worm. An adult
worm lives for approximately two months, although the male threadworm dies after copulation
a. Can also spread rapidly to clothes. They survive for up to three weeks on clothing, bedding, in carpets and
within household dust. Eggs can even survive in swimming pools
b. Children in childcare institutions are easily infected by each other
3. If eggs remain on the perianal skin long enough to hatch then the juveniles will crawl back
into the anus to the intestines to mature into adults. This process is known as retroinfection

Treatment and Prevention of reinfestation

1. In untreated patients, the disease has a high rate of reinfestation caused by worms already
present in the body. This type of disease recurrence is called autoinfection. Because of
autoinfection, threadworms can remain inside humans for as long as 45 years after the initial
infestation
2. Drug treatment
a. Should be combined with hygiene measures
b. Treat whole family at the same time
c. Not intended to be used by pregnant women or children under two years-of-age
d. Albendazole (Zentel) and Mebendazole (Vermox). Inhibits the threadworms' ability to absorb glucose
(sugars) which depletes them of the energy that they need to survive. As a result the threadworm dies
within several days. Avoid food and drinks containing a lot of sugar because treatments containing
mebendazole are trying to starve the worms of glucose
e. Pyrantel (Combantrin) - a "neuro-muscular blocking agent", causes paralysis of the threadworm's nervous
system. The paralysed worms are then expelled in the faeces by the normal actions of the bowel. Eating
high-fibre food will help to prevent constipation and will assist expelling the worms
f. These medicines will not treat the eggs or immature worms and will not protect you or your children from
contracting threadworm if exposed to it again. So it's advisable to check roughly two weeks after the initial
dose
3. Good hygiene is essential to stop the infection being spread
a. Hygiene controls for 6 weeks, breaking the cycle of infection by removing all eggs and allowing the adult
worms to die


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Threadworms // Page 3 of 3

b. Whilst poor hygiene habits can contribute to the spread of threadworms once you have contracted it,
catching threadworms can be as simple as touching an infected surface - it doesn't matter how clean you
are
c. Wash hands and scrub under the nails before eating and after visiting the toilet
d. Finger nails should be short and kept scrubbed clean
e. Until children are toilet trained, take special care when handling their excreta
f. Discourage children from sharing food and from placing objects into their mouths
4. Other measures:
a. Threadworm eggs may be left on common household surfaces, so give your home a thorough clean.
Vacuum carpets and wash floors, clothes and bedding with hot water, to kill any remaining eggs. Don't
forget the favourite teddy or security blanket, and take care not to shake linen when removing bedclothes -
you could be spreading infectious eggs into the air
b. Make sure that everyone in the household using their own towel and facecloth
c. Snug underpants fitted to children at night may make it harder to scratch, therefore reducing the risk of
eggs transferring to fingers
d. Underwear should be changed daily
e. Bed sheets should be changed frequently, especially 7 to 10 days after the treatment
f. Use hot laundry wash cycles for a while in order to kill the remaining eggs
g. Shower rather than bathe for several days after treatment, to dislodge any remaining eggs from the anal
region

Refer

1. Anyone who is pregnant or planning a pregnancy or who is breast feeding a child
2. Children under two years of age
3. Patients who persistently relapse should be seen by the GP and possibly referred to a
parasitologist