1

http://www.millville.org/School_Pages_html/Elem_Schools_f/CFC_f/
earlychild/early_whacked/pinworm.html

Pinworm
Signs and Symptoms:
Pinworm is an intestinal infection caused by tiny parasitic worms measuring about 1/2 inch in length (less than 1 cm). Other names for a pinworm infection are "seatworm infection," "threadworm infection," "enterobiasis" or "oxyuriasis."

Sometimes these worms can actually be seen in the area around a child's rectum or in the stool. They may have the appearance of light-colored threads on the move. Often a person can have a pinworm infection without having any symptoms, but when symptoms are present, the most common one is itching around the rectum.

This itching is usually worse at night and is caused by worms migrating to the area around the rectum to lay their eggs. When a child scratches the itchy area, eczema or a bacterial infection around the rectum can result. In girls, pinworm infection can spread to the vagina and cause a vaginal discharge.

Description:
Pinworm is an intestinal infection by a parasite - a worm called ENTEROBIUS VERMICULARIS . Pinworm infections probably affect about 200 million people across the world, including about 40 million people in the United States and Canada. Of all age groups, school children are most at risk for pinworm infections.

People are infected by unknowingly eating microscopic pinworm eggs. The eggs pass into the digestive system and hatch in the small intestine. From the small intestine, pinworm larvae continue their journey to the large intestine, where they live as parasites - their heads attached to the inside wall of the bowel.

About 2-4 weeks after the pinworm eggs were originally acquired, adult female pinworms begin migrating from the large intestine to the area around the rectum. There they will lay new pinworm eggs, which trigger itching around the rectum. When someone scratches the itchy area, microscopic pinworm eggs are transferred to their fingers.

Contaminated fingers can carry pinworm eggs to many different surfaces, including: bed linens, towels, clothing (especially underwear and pajamas), toilets and bathroom fixtures, drinking glasses and eating utensils, toys, sandboxes and food. Pinworm eggs are able to live on a surface for 2-3 weeks.

Prevention:
You can prevent pinworm infections by reminding your child to wash her or his hands after using the toilet and playing with a pet, and before eating. Make sure that your child showers or bathes every day, and changes underwear frequently.

If your child has a pinworm infection, all members of your household will need to be treated with medication. This will help prevent the infection from coming back in most cases.

Incubation:
After pinworm eggs are ingested, it takes about 2-4 weeks for itching around the rectum to begin.

Duration:
Pinworm can usually be treated with one dose of medication. After two weeks, the doctor may repeat the dose.

Contagiousness:
Pinworm infections are contagious.
Persons become infected by inadvertently eating microscopic pinworm eggs that can be found on many different surfaces, including: bed linens, clothing, food, drinking glasses, eating utensils, toilet seats, bathroom fixtures, toys, and the sand in sandboxes.

Home Treatment:
If your child has a pinworm infection, follow your doctor's directions for giving pinworm medicine to everyone in your household. Routine household cleaning measures will help reduce spread of pinworm infection to the family.

Professional Treatment:
Your doctor may ask you to help make the diagnosis of pinworm by placing a sticky piece of cellophane tape against your child's rectum. Pinworm eggs will stick to the tape and can be seen under a microscope in a laboratory.

Your doctor will probably give everyone in your family one dose of an anti-worm medicine that will eliminate the pinworm infection. After two weeks, your doctor may give a second dose of anti-worm medicine.

2

http://www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/
factsht%5Flymphatic%5Ffilar.htm
CDC (Center for Disease Control), Division of Parasitic Diseases.

Lymphatic Filariasis
(lim-FAT-ick fil-ah-RYE-ah-sis)

Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms. The adult worms only live in the human lymph system. The lymph system maintains your body's fluid balance and fights infections.

Lymphatic filariasis affects over 120 million people in 80 countries throughout the tropics and sub-tropics of Asia, Africa, the Western Pacific, and parts of the Caribbean and South America. You cannot get the worms in the United States.

How does infection occur?
The disease spreads from person to person by mosquito bites. When a mosquito bites a person who has lymphatic filariasis, microscopic worms circulating in the person's blood enter and infect the mosquito. If the infected mosquito bites you, you can get lymphatic filariasis. The microscopic worms pass from the mosquito through your skin, and travel to your lymph vessels.

In your lymph vessels they grow into adults.
An adult worm lives for about 7 years.
The adult worms mate and release millions of microscopic worms into your blood. Once you have the worms in your blood when a mosquito bites you, you can give the infection to others through mosquitoes.

Who is at risk for infection?
You need many mosquito bites over several months to years to get lymphatic filariasis. People living or staying for a long time in tropical or sub-tropical areas where the disease is common are at the greatest risk for infection. Short-term tourists have a very low risk. An infection will show up on a blood test.

What are the symptoms of lymphatic filariasis?
At first, most people don't know they have lymphatic filariasis. They usually don't feel any symptoms until after the adult worms die. The disease usually is not life threatening, but it can permanently damage your lymph system and kidneys. Because your lymph system does not work right, fluid collects and causes swelling in the arms, breasts legs, and, for men, the genital area.

The name for this swelling is lymphedema (limf-ah-DE-ma). The entire leg, arm, or genital area may swell to several times its normal size. Also, the swelling and the decreased function of the lymph system make it difficult for your body to fight germs and infections. You will have more bacterial infections in your skin and lymph system. This causes hardening and thickening of the skin, which is called elephantiasis (el-ah-fan-TIE-ah-sis).

What is the impact of this disease?
Lymphatic filariasis is a leading cause of permanent and long-term disability worldwide. People with the disease can suffer pain, disfigurement, and sexual disability. Communities frequently shun women and men disfigured by the disease. Many women with visible signs of the disease will never marry, or their spouses and families will reject them.

Affected people frequently are unable to work because of their disability. This hurts their families and their communities. Poor sanitation and rapid population growth in tropical and subtropical areas of the world, where the disease is common, has created more places for mosquitoes to breed and has led to more people becoming infected.

How can I prevent infection?
Prevention includes giving entire communities medicine that kills the microscopic worms and controlling mosquitoes. Avoiding mosquito bites is another form of prevention. The mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn. If you live in an area with lymphatic filariasis:

• Sleep under a mosquito net.
• Use mosquito repellant on your exposed skin between dusk and dawn.

• Take a yearly dose of medicine that kills the worms circulating in the blood. The medicine will kill all of the microscopic worms in the blood and some of the adult worms. It does not kill all of them. [Taking a second dose 2 weeks following the first, and a third, possibly 2 weeks following the second -- will do a more complete eradication.]

What is the treatment for lymphatic filariasis?
If you have adult worms, you should take a yearly dose of medicine that kills the microscopic worms circulating in your blood. While this does not kill the adult worms, it does prevent you from giving the disease to someone else. Even after the adult worms die, you can have swelling of your arms, legs, breasts, or genitals. You can keep the swelling from getting worse.

• Carefully wash the swollen area with soap and water every day.

• Use anti-bacterial cream on any wounds.
  This stops bacterial infections and keeps the swelling from worsening.

• Elevate and exercise the swollen arm or leg to move the fluid and improve the lymph flow.

3

http://www.cdc.gov/healthyswimming/what.htm
Center for Disease Control, Healthy Swimming
Recreational Water Illnesses (RWI)

RWIs are illnesses that are spread by swallowing, breathing, or having contact with contaminated water from swimming pools, spas, lakes, rivers, or oceans. Recreational water illnesses can cause a wide variety of symptoms, including skin, ear, respiratory, eye, and wound infections. The most commonly reported RWI is diarrhea. Diarrheal illnesses can be caused by germs such as Crypto, short for Cryptosporidium, Giardia, Shigella, and E. coli O157:H7.

Diarrheal Illnesses
If swimmers are ill with diarrhea, the germs that they carry can contaminate the water if they have an "accident" in the pool. On average people have about 0.14 grams of feces on their bottoms which, when rinsed off, can contaminate recreational water. When people are ill with diarrhea, their stool can contain millions of germs. Therefore, swimming when ill with diarrhea can easily contaminate large pools or waterparks. In addition, lakes, rivers, and the ocean can be contaminated by sewage spills, animal waste and water runoff following rainfall. Some common germs can also live for long periods of time in salt water.

So, if someone swallows water that has been contaminated with feces, he/she may become sick. Many of these diarrhea-causing germs do not have to be swallowed in large amounts to cause illness.

Other RWIs
Many other RWIs (eye, skin, ear, and respiratory infections) are caused by germs that live naturally in the environment (water, soil). In the pool or hot tub, if disinfectant is not maintained at the appropriate levels, these germs can increase to the point where they can cause illness when swimmers breathe or have contact with water containing these germs.

Why doesn't chlorine kill these RWI germs?
Chlorine in swimming pools does kill the germs that may make people sick, but it takes time. Chlorine in properly disinfected pools kills most germs that can cause RWIs in less than an hour. Chlorine takes longer to kill some germs such as Crypto, which can survive for days in even a properly disinfected pool. This means that without your help, illness can spread even in well-maintained pools.

Hot tubs
Skin infections like "hot tub rash" are the most common RWIs spread through hot tubs and spas. Chlorine and other disinfectant levels evaporate more quickly because of the higher temperature of the water in the tubs. It is important to check disinfectant levels even more regularly than in swimming pools. "Hot tub rash" can also occur in pools and at the lake or beach.

Decorative Water Fountains
Not all decorative or interactive fountains are chlorinated or filtered. Therefore, when people, especially diaper-aged children, play in the water, they can contaminate the water with fecal matter. Swallowing this contaminated water can then cause diarrheal illness.

Lakes, Rivers, and Oceans
Lakes, rivers, and oceans can become contaminated with germs from sewage, animal waste, water runoff following rainfall, fecal accidents, and germs rinsed off the bottoms of swimmers. It is important to avoid swallowing the water because natural recreational water is not disinfected. Avoid swimming after rainfalls or in areas identified as unsafe by health departments.

Who is most likely to get ill from an RWI?
Children, pregnant women, and people with compromised immune systems (such as those living with AIDS, those who have received an organ transplant, or those receiving certain types of chemotherapy) can suffer from more severe illness if infected. People with compromised immune systems (i.e. mercury toxicity) should be aware that recreational water might be contaminated with human or animal waste that contains Cryptosporidium (or Crypto), which can be life threatening in persons with weakened immune systems.

4

http://www.dpd.cdc.gov/dpdx/HTML/Enterobiasis.htm
CDC-DPDx Laboratory Identification,
Pinworms - Enterobiasis vermicularis

Eggs are deposited on perianal folds.
Self-infection occurs by transferring infective eggs to the mouth with hands that have scratched the perianal area. Person-to-person transmission can also occur through handling of contaminated clothes or bed linens. Enterobiasis may also be acquired through surfaces in the environment that are contaminated with pinworm eggs (e.g., curtains, carpeting). Some small number of eggs may become airborne and inhaled. These would be swallowed and follow the same development as ingested eggs.

Following ingestion of infective eggs, the larvae hatch in the small intestine and the adults establish themselves in the colon. The time interval from ingestion of infective eggs to oviposition by the adult females is about one month. The life span of the adults is about two months.

Gravid females migrate nocturnally outside the anus and oviposit while crawling on the skin of the perianal area. The larvae contained inside the eggs develop (the eggs become infective) in 4 to 6 hours under optimal conditions. Retroinfection, or the migration of newly hatched larvae from the anal skin back into the rectum, may occur but the frequency with which this happens is unknown.

Geographic Distribution:
Worldwide, with infections more frequent in school- or preschool- children and in crowded conditions. Enterobiasis appears to be more common in temperate than tropical countries. The most common helminthic infection in the United States (an estimated 40 million persons infected).

Clinical Features:
Enterobiasis is frequently asymptomatic.
The most typical symptom is perianal pruritus, especially at night, which may lead to excoriations and bacterial superinfection. Occasionally, invasion of the female genital tract with vulvovaginitis and pelvic or peritoneal granulomas can occur. Other symptoms include anorexia, irritability, and abdominal pain.

Laboratory Diagnosis:
Microscopic identification of eggs collected in the perianal area is the method of choice for diagnosing enterobiasis. This must be done in the morning, before defecation and washing, by pressing transparent adhesive tape ("Scotch test", cellulose-tape slide test) on the perianal skin and then examining the tape placed on a slide.

Alternatively, anal swabs or "Swube tubes" (a paddle coated with adhesive material) can also be used. Eggs can also be found, but less frequently, in the stool, and occasionally are encountered in the urine or vaginal smears. Adult worms are also diagnostic, when found in the perianal area, or during ano-rectal or vaginal examinations.

Treatment:
The drug of choice is pyrantel pamoate.

5

http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis
/factsht%5Fblastocystis%5Fhominis.htm
CDC-DPD Division of Parasitic Diseases,
Pinworms - Blastocystis hominis

Blastocystis hominis is a common microscopic parasitic organism found throughout the world. Infection with Blastocystis hominis is called blastocystosis (BLASS-toe-SIS-toe-sis.)

What are the symptoms of infection with Blastocystis?
Watery or loose stools, diarrhea, abdominal pain, anal itching, weight loss, and excess gas have all been reported in persons with Blastocystis infection.
Many people have no symptoms at all.

How long will I be infected?
Blastocystis can remain in the intestines for weeks, months, or years.

Is Blastocystis hominis the cause of my symptoms?
It is hard to be sure, and experts disagree on this point.
Whether or not B. hominis is the primary cause of your symptoms is unknown. Finding Blastocystis in stool samples should be followed up with a careful search for other possible causes of your symptoms.

Symptoms may be caused by infection with other parasitic organisms, bacteria, or viruses. Often, B. hominis is found along with other such organisms that are more likely to be the cause of your symptoms.

Sometimes symptoms are not caused by an infection at all.
Antibiotics, some cancer drugs, and medications used to control high blood pressure may be causing your symptoms. Hormone or endocrine diseases, diseases like Crohn’s, colitis, or hereditary factors may be the cause of illness. Food additives or food allergies may also be a cause of abdominal discomfort.

Is having blastocystosis common?
Yes; in fact many people have Blastocystis, some without ever having symptoms.