A tentative diagnosis of Enterobiasis (Pinworm infection) was made. The mother was asked to apply the Scotch tape diagnostic procedure to the child early the next morning and bring the slide to the office.
A mother brought her 4-year-old son to the pediatrician. She said that the personnel at the daycare center had complained that the child was irritable, hyperactive and inattentative to learning activities. The mother had also observed restlessness, disturbed sleep, and some loss of appetite.
The medical record indicated the child's birth and development were normal; there was no history of unusual disease and the present physical examination presented no obvious abnormalities. In talking with the child, perianal itching and resultant scratching were admitted.
Question 1 - Single Best Answer
Based on his history the most likely diagnosis was?
A) Hemorrhoids
B) Pinworms
C) Cutaneous fungal infection
D) Contact allergy
E) Bacterial infection, e.g., impetigo
A tentative diagnosis of Enterobiasis (Pinworm infection) was made. The mother was asked to apply the Scotch tape diagnostic procedure to the child early the next morning and bring the slide to the office.
For this test, the adhesive side of translucent tape is applied to the perianal area with a tongue blade or microscope slide, pulled off and placed adhesive side down on a slide. Eggs deposited by the pinworm on the perianal area at night adhere to the tape and can be observed under the microscope.
Question 2 - Single Best Answer
The slide was examined and showed?
A) Pinworm eggs
B) Nothing of diagnostic significance
Two drugs are highly effective against Pinworms in a single dose: Pyrantel pamoate and Mebendazole. Mebendazole was used in this case and an additional treatment was given 3 weeks later since the drug does not kill eggs which may have been ingested just prior to treatment.
Question 3 - Single Best Answer
The advisability of treating the whole family - one younger sister, the parents and 2 dogs - to insure breaking the transmission cycle was discussed. What factors listed below are NOT valid as arguments for treating the whole family of the infected child?
A) Pinworm eggs are infective soon after deposition and are readily spread by fomites (clothing, utensils, etc) and may be airborne within the household.
B) Even with high standards of personal hygiene pinworm infections are often transmitted within family groups.
C) Most infections are asymptomatic and individuals may be unrecognized carriers within a family.
D) Pet dogs become infected and spread infection (eggs) to family members by contact (licking, petting, etc.)
It was decided not to treat the whole family. No other family member developed symptoms except for occasional perianal itching when thinking about the possibility of pinworm infection. After treatment the infected child no longer had pruritus. The mother thought he was eating more and sleeping better but behavior at the daycare center did not improve.
Question 4 - Single Best Answer
In considering the pathogenesis and clinical disease in pinworm infection which of the following are true?
A) There is no proof that many symptoms attributed to pinworm infection as enuresis, teeth grinding and nail biting are caused by the infection.
B) Pinworm eggs can hatch on the perianal area and enter the anus to establish colonic infection; in females larvae may occasionally enter the vagina producing a vulvo-vaginitis and rarely may reach the peritoneal cavity.
C) Pinworm infections are usually asymptomatic; the most common symptoms are pruritus induced by allergic responses to worm parts and products in the perianal area
D) All of the above