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Case (64)

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Dr.Habiib:
 A 5- Year old female child, attended the outpatient clinic of the Pediatric Hospital, accompanied by her mother complaining of nocturnal enuresis, dysuria, itching in perianal region and vulva, restlessness and insomnia. The mother told doctor that her child had previous stool analysis, after the advise of nurse, but the result of this stool analysis was negative for parasites. The doctor described another method of diagnosis, which showed  eggs under the microscope.

1. What is the parasitic infection that may cause the mentioned complain?
2. Why was the stool analysis negative in spite of infection?
3. What is the other method described by the doctor, which helped in the diagnosis of case?
4.What is the reason of: nocturnal enuresis, dysuria and itching in the perianal  region and vulva?
5. Mention the treatment of the case, stressing on the precautions that should be taken to prevent reinfection.

Dr.Habiib:
 salaam to the all  our dear members.
 
plz try to th answer as soon as possible.
 if there is any answer i shall answer
 مستنيكم ياله يا شاطرين

Dr.Adnan:
I may try...First time in this section.. ;D

1-it is probably due to pinworms also known as entrobius vermicularis
2-stool analysis is negative because pinworms do not lay eggs in stool but in the anus during night.
3-here the doctor should have used "tape test" usually applied during morning for several times, Eggs or adult worm could be seen under microscope.
4-migration of worms causes irritation thus triggering itching and pruritis. but in females worms cause UTIs in  thus the Dysuria.
5-Mebendazole and Albendazole are effective, hygiene is to be advised,  other household members should recieve prophylactic treatment for 2 weeks..if UTI is suspected antibiotics are prescribed.

The last time I read about this was 2 years ago...

Dr.Habiib:
Answer:
1.  Enterobiasis Vermicularis (pin worm).
2. Female worm deposits its eggs by itself on the perianal skin.
3. Perianal swab:
   a. N.I.H Swab( national institute of health): The perianal area is swabbed in the     morning before defecations or bathing with cellophane paper folded and tied to tip of glass rod and inserted in test tube. The cellophane   is stretched on a slide and examined microscopically for eggs and adult worm.
  b. Scotch Adhesive Tabe Swab:  Scotch tabe with sticky side outwards is pressed against peri-anal area, then spread on a slide with sticky side downwards and examined microscopically.

4. Moving of female in perianal   skin where  it deposits its eggs causing:
  - Pruritus ani (itching) especially at night.
  - Nervous irritability, hyperactivity, insomnia (due to pruritus ani), secondary enuresis ( due to irritation of urethra and urinary infection).
  - Female migration to ectopic site stimulates granuloma formation:
  - Migration to the vagina will cause   vulvovaginitis (itching), they may migrate to the uterus or fallopian tubes.
  -migration to urinary tract causes infection and enuresis (involuntary micturition).
  -Migration to appendix may cause appendicitis.
 - Migration to the intestine may cause diarrhea and abdominal pain.
   - Migration to the peritoneal cavity (through uterine tubes) may cause pelvic peritonitis.

5. Treatment:
- Albendazole :
                        ?   In single oral dose of 400mg.
                        ?   It should be repeated after two weeks.
                         ? All members of family should be simultaneously treated.                           Or
- Mebebdazole:
         ? In single oral dose chewable tablet of 100mg
         ? To be repeated after two weeks.
- Local application of white mercury (white precipitate ointment) around the anus at night (receives itching, kills female worms coming out and prevents dispersal eggs.

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