Mrs. Pedersen's 6-year old son Erik has been experiencing an itchy rectum and loss of sleep for 2 weeks. The doctor diagnosed Erik with pinworms and told Mrs. Pedersen to get medication from the pharmacy. Pinworms, also known as Enterobiasis, are a common parasitic infection caused by the nematode Enterobius vermicularis. The goals of treatment are to relieve itching so Erik can sleep, eliminate the infection, and prevent reinfection through promoting good hygiene for the entire household.

1. Pinworms
Hye Won
Dejan
Jepal

2. Overview
• Pathophysiology
• Drug Therapy Problem
• Goals of Therapy
• Patient assessment
• Diagnosis of pinworms
• Prevention
• Nonpharmacologic Therapy
• Pharmacologic Therapy
• Case discussion
• Monitoring

3. • Mrs. Pedersen, a single mother, comes into the pharmacy and asks
for your help.
• She seems a bit embarrassed. She says her only child, 6-year old
Erik, has worms.
• She tells you that he has had an itchy rectum for about the last 2
weeks, particularly at night, and he hasn’t been sleeping well at all.
• When she took Erik to the doctor, he told her that Erik has
pinworms and to get some medication from the pharmacy.
• What do you recommend for Mrs. Pedersen.

4. PathophysiologyPathophysiology
Enterobiasis = Pinworm (nematode Enterobius vermicularis ) Infection
Also called, seatworm
roundworm
threadworm (Strongyloides stercoralis)
threadworm

5. • Types of
Parasitic
Infections

6. • NematodesNematodes
Whipworm Pinworm Threadworm
Roundworm Filarialworm Guineaworm

7. Transmission of E.vermicularis
• At night
• On perianal
skin

8. Humans are the only natural host of Enterobius vermicularis.
• The most common helminthic infection in all over the world
• Usually affects all family members when one member is infected.
All household residents must be treated simultaneously.
• Do not cause any serious intestinal pathology.
Usual symptoms : loss of sleep, discomfort, embarrassment
• A heavy load of worms : anorexia, restlessness, insomnia
• Rare pathology : cystitis, appendicitis, chronic salpingitis, ulcer in the intestine
PathophysiologyPathophysiology

9. PathophysiologyPathophysiology
• Common in young children 5-10 years of age
(1/3 of Canadian Children)
• Temperate and cold climates
(less frequent bathing & changing underclothing)
• Overcrowding in school and family groupings
• Inadequate personal and community hygiene
• High-risk population
( institutionalized patients, residents of native reserves, travelers
to areas of high incidence such as India and Iran, homosexual men )

10. Drug Therapy Problem
Erik is experiencing symptoms of pinworm infection
(itchy rectum, loss of sleep) secondary to lack of
therapy and would benefit from reassessment.

11. Goals of Therapy
• Relieve itching so that Erik can sleep well
• Eliminate the infection
• Promote good hygiene
• Prevent reinfection
• Prevent pinworm infection of Mrs. Pedersen
• Prevent dermatitis and secondary bacterial infections

12. Reference
• Anandan J.V. Parasitic Infections. In: Alldredge B, Corelli R, Ernst M, Guglielmo B, Jacobson P,
Kradjan W. (ed.) Koda-Kimble & Young’s Applied Therapeutics. 10th
ed. Philadelphia, USA:
Lippincott Williams & Wilkins; 2013. P1839
• Carruthers-Czyzewski P. Pinworms. In: Repchinsky C (ed.) Therapeutic Choices for Minor
Ailments. 1st
ed. Ottawa: Canadian Pharmacist Association;2013 P360-364
• Healthline Networks. Parasitic Infections.
http://www.healthline.com/health/parasitic-infections#Overview1 (accessed 06 July 2014)
• O’Donoghue P. Faculty of Science. The University of Queensland. PARA-SITE.
http://parasite.org.au/para-site/introduction/introduction.html (accessed 06 July 2014)