Pinworm disease

　　Enterobiasis is a common parasitic disease in children, most common in children aged 2 to 9 years. It is characterized by anal and perineal itching, and restless sleep. It can cause outbreaks in collective children's institutions.

　　Enterobiasis is milky white and slender, about 1 cm long,寄生 in the lower segment of the small intestine, ileocecal region, colon, and rectum. The female worm migrates to the perianal skin crease area at night to lay eggs. The eggs develop into infective eggs containing larvae within 6 hours. After being swallowed, they develop into adults in the intestine, which takes about 2 to 4 weeks. The lifespan of the adult worm is short, not exceeding 2 months.

　　Patients with enterobiasis are the only source of infection, transmitted orally. The direct transmission from anus to hand to mouth becomes the main route of self-reinfection.

　　At different developmental stages in the intestine, the worm can stimulate the intestinal wall and nerve endings, causing gastrointestinal neurological dysfunction. The adult worm attaching to the intestinal mucosa can cause local inflammation, and the female worm after entering the deep intestinal mucosa can cause ulcers, bleeding, and submucosal abscesses. In rare cases, enterobiasis can also invade the intestinal wall and extraintestinal tissues, causing granulomas centered on the worm (or worm eggs).

　　The sites of displaced damage caused by enterobiasis are very extensive, the most common being the female reproductive system, pelvic cavity, abdominal organs, and so on. Damage to the lungs and prostate has also been reported. Due to the different organs of displaced damage, patients can show a variety of clinical symptoms and different signs, often leading to misdiagnosis.

　　The formation of enterobiasis granuloma is observed as small nodules with a white center and a faint yellow color. The tissue section shows an outer capsule composed of collagen fibers, and an inner granulation tissue encapsulating a necrotic center, which contains the worm or worm eggs.

　　Common complications include prostatitis, ischiorectal abscess, urethritis, and subcutaneous nodules due to enterobiasis. Displaced parasitism can cause displaced damage, such as vaginitis, salpingitis, endometritis, etc. It can also invade the appendix and cause appendicitis, and even peritonitis.

　　Vaginitis: Vaginitis is the inflammation of the vaginal mucosa and submucosal connective tissue, which is a common disease in gynecological clinics. Normal healthy women, due to anatomical and biochemical characteristics, have a natural defense function against pathogens. When the natural defense function of the vagina is destroyed, pathogens are more likely to invade, leading to vaginal inflammation. Young girls and postmenopausal women, due to the lack of estrogen, have thin vaginal epithelium, reduced intracellular glycogen content, and a vaginal pH of about 7, so the vaginal resistance is low, and they are more susceptible to infection than adolescents and women of childbearing age.

　　Vaginitis is characterized clinically by changes in the nature of leukorrhea and pruritus, burning pain of the vulva. When the infection involves the urethra, symptoms such as dysuria and urgency may occur.

　　Common vaginitis includes bacterial vaginitis, trichomoniasis vaginitis, candidiasis vaginitis, and senile vaginitis. Garder et al. conducted a study on 1181 cases of vaginitis and found that 41% were bacterial, 27% were fungal, and 24% were trichomonad. Senile vaginitis occurs after menopause, in women who have had their ovaries removed, or after pelvic radiation therapy, and its incidence is reported to be as high as 98.5%.

　　Vaginitis mainly belongs to the category of 'dribbling' and 'itching' in traditional Chinese medicine.

　　Salpingitis:

　　Salpingitis is the main site of pelvic inflammatory diseases, mostly occurring in women with sexual activity and menstruation, and it is rare in women before menarche, after menopause, or unmarried. If it occurs, it is often the spread of inflammation from adjacent organs. If it is not treated in a timely and correct manner, it can lead to sequelae such as infertility, salpingic pregnancy, chronic pelvic pain, and recurrent inflammation due to pelvic adhesions and salpingal obstruction. Salpingitis is often caused by pathogen infection, mainly including Staphylococcus, Streptococcus, Escherichia coli, Gonococcus, Proteus, Streptococcus pneumoniae, Chlamydia, etc., and is divided into acute salpingitis and chronic salpingitis, the latter being more common in infertile women.

　　Endometritis:

　　Endometritis is a very common disease in reproductive system infectious diseases. The inflammation of the uterine body we are talking about is mainly endometritis. If the inflammation cannot be effectively controlled, it can affect the uterine muscle layer and become uterine myometritis when it develops to a severe stage. The latter is an extension of endometritis, and simple uterine myometritis without endometritis basically does not exist.

　　Whether it is due to cervical stenosis caused by acute or chronic endometritis, if the inflammatory secretions in the uterine cavity cannot be discharged or drained smoothly, it can form uterine cavity abscess. However, as it is gradually formed due to chronic endometritis, uterine cavity abscess can also be asymptomatic. During gynecological examination, uterine enlargement, tenderness, and softness can be found, and the parauterine connective tissue can be significantly thickened, and inflammatory masses in the adnexa may also be present. When the uterine cavity probe is inserted into the uterine cavity, if pus is discharged, the diagnosis can be established, but at the same time, the uterine cavity tissue should be gently taken to understand whether there is any malignant tumor. Sometimes, due to the abundant scars in the cervical canal and the curved shape of the cervical canal, the probe is also not easy to be inserted, so patience is required in operation. Once the diagnosis is established, the cervix is dilated, and pus can be discharged smoothly. If the drainage is not satisfactory, a rubber tube can be placed in the cervical canal for drainage to prevent the cervical canal from being blocked again in the short term, affecting the discharge of pus.

　　After suffering from pinworm disease, the characteristic symptom is intense itching around the anal opening and perineum at night.

　　In addition, it can also cause symptoms such as loss of appetite, emaciation, nail-biting, irritability, night terrors, and insomnia. While the repeated stimulation of the gastrointestinal tract by pinworms can also cause symptoms such as nausea of unknown cause, vomiting, abdominal pain, diarrhea, and even rectal prolapse.

　　If the pinworms crawl into the urethra or vagina, it can also cause inflammation of the urethra, vagina, and other symptoms such as frequent urination, urgency, dysuria, or increased vaginal discharge and leukorrhea. At the same time, it can also cause symptoms such as loss of appetite, emaciation, nail-biting, irritability, night terrors, and insomnia. When pinworms repeatedly stimulate the gastrointestinal tract, symptoms such as nausea, vomiting, abdominal pain, diarrhea, and even rectal prolapse may occur.

　　At night, there is an intense itching around the anus, the anal opening becomes red, there is a lot of secretion, and the female worms that crawl out of the anus to lay eggs can be seen directly. The diagnosis of pinworm disease is not difficult. Since pinworms do not lay eggs in the intestines but on the skin around the anus, a cotton swab or adhesive tape can be used to swab the anal area in the morning to directly collect the specimen, which can be observed under a microscope to find the eggs.

　　Prevent reinfection due to the short lifespan of pinworms, which is only 20 to 30 days. If reinfection is prevented, and there is no infection within a month, pinworm disease can heal itself. The measures to prevent reinfection are as follows:

　　① Pay attention to personal hygiene, especially hand hygiene. Frequently trim nails, wash hands before and after meals, and correct the bad habits of sucking fingers and biting nails. Pay attention to dietary hygiene, and wash and blanch fruits and vegetables before eating. It is recommended that children not wear open pants, which can protect the perineum and prevent children from scratching the anus with their hands. In the morning, wash the anus with hot water, and first blanch the underwear and pants with boiling water before washing them. Bedding should be sunned frequently, for 3 to 4 hours each time, as sunlight can kill the eggs.

　　② Pay attention to environmental hygiene. Use wet mops and wet sweeping methods to clean the home and kindergartens to prevent eggs from flying with dust.

　　Collective treatment refers to the administration of medication to all patients in a family or in kindergartens at regular intervals, followed by regular follow-up examinations. If patients who have not been cured are found, they should take the medication again to completely eliminate the source of infection. Commonly used drugs include: mebendazole, 1 tablet or 5 milliliters of suspension taken once, as necessary, repeated once after two weeks, with a cure rate of 90% to 100%. Thiabendazole (Skelaxin), 100 milligrams taken once, with a cure rate of 100%. Citric acid piperazine, 50 to 60 mg per kilogram of body weight taken twice a day, with a total daily dose not exceeding 2g, taken continuously for 7 to 10 days, then taken twice a week with the same dose, for a total of 4 weeks, to prevent re-infection. After each bowel movement or before bedtime, use hot water to wash the buttocks, apply 2% mercury sublimate, 10% sulfanilamide ointment, or 10% zinc chloride ointment around the anal area, or apply a little pinworm cream (containing gentian violet and houttuynia) into the anus, which can relieve itching and prevent self-infection.

　　If a child frequently itches around the anus or perineum and is restless at night, it should be noted that there may be pinworm disease. If the worm or eggs can be found, it can be diagnosed. One method of checking for eggs: due to the special oviposition habit of pinworms, the positive rate of egg detection in feces is less than 5%. The method of checking for eggs outside the anus includes: using a cotton swab first soaked in disinfected saline, then wrung dry and wiped around the anus. Mix it evenly on a slide with 50% glycerol solution and examine it under a microscope. It can also be applied with a toothpick flat head inserted into 50% glycerol or 1% sodium hydroxide solution, then used to scrape the surrounding folds of the anus. The scraping material is scraped off with a cover slip and placed on a slide, add 1 drop of 50% glycerol or 1% potassium hydroxide and examine it by floating. The method of transparent adhesive tape swabbing: before morning defecation, stick transparent adhesive tape around the perianal skin and examine it under a low-power microscope. The positive rate can reach 79.4% by checking for three consecutive times. This method is simple and suitable for application in general surveys. Two methods of checking for the worm body: inspect the anus after the child falls asleep for 1 to 3 hours. If the worm crawls out, it can be picked up with a pair of forceps and put into a small bottle with alcohol for preservation. Because pinworms may not crawl out every night to lay eggs, continuous observation is needed for 3 to 5 days.

　　First, dietary treatment for pinworm disease

　　1. Sunflower seeds eaten raw, about 50 grams daily, eaten for a week, to expel pinworms.

　　2. Sunflower seeds eaten raw, one handful each in the morning and evening, with half a cup of celery juice, taken for a month, to treat hypertension.

　　3. One sunflower flower disc with stem, decocted in water, mixed with honey, to treat gastrointestinal hemorrhage, abdominal pain after childbirth, and hernia pain.

　　4. One flower disc, cooked with 250 grams of brown sugar, to reduce hypertension.

　　5. One flower disc, roasted into ash and ground into powder, 3 grams taken three times a day with yellow wine, to treat metrorrhagia and dizziness after childbirth.

　　6. The core of the sunflower flower, decocted and taken frequently, to treat abdominal pain after childbirth.

　　7. 30 grams of sunflower petals, cooked with rock sugar, to treat cough.

　　8. 30 grams of sunflower petals and 30 grams of wheat straw, decocted and taken frequently, to treat nephritis.

　　9. The sunflower petals dried in the shade and ground into powder, 6 grams taken daily on an empty stomach with warm wine, to treat leukorrhea.

　　10. The old sunflower stem of the previous year, decocted in water for internal use, to treat cough in the elderly.

　　11. 60 grams of sunflower stalk, decocted and used to wash the vagina, to treat vaginal sores.

　　12. The pith inside the sunflower stem (i.e., the white core inside the peeled stem), decocted in water for internal use; or roasted and ground into powder, 3 to 5 grams taken each time, twice or three times a day, with sugar water, to treat leukorrhea.

　　13. The pith of the sunflower stem, burned to ash and ground into powder, mixed with sesame oil and applied evenly to the affected area to treat mouth ulcers.

　　14. 30 grams of dried sunflower leaves (60 grams of fresh leaves), decocted in water for internal use, to treat hypertension.

　　15. One sunflower seed head, two black eggs, and appropriate amount of rock sugar are cooked together to make soup. Eat the eggs and drink the soup; or 6 grams of sunflower seeds, after peeling and grinding, are taken with sugar water before bedtime to treat dizziness.

　　16. The efficacy of Chinese foxglove and sweet chestnut: can expel the internal pinworms.

　　Ingredients:

　　250 grams of Chinese foxglove, 250 grams of sweet chestnut seeds, and 50 grams of white honey.

　　Preparation and administration:

　　Boil the stemonas in a pot with an appropriate amount of water, filter the decoction, add white honey to make it into a paste, grind the arillodes into powder and mix it into the paste, take 1 tablespoon each time, 3 times a day, take it on an empty stomach before meals, and take it for 1 week.

　　Second, the following foods are good for the body when eating pinworm disease:

　　1. Foods that are good for itching include amaranth, cabbage, rapeseed, taro, kelp, purple kelp, chicken blood, snake meat, and pangolin.

　　2. Foods that are good for cooling blood and detoxifying. Mung beans, glutinous rice, cucumbers, bitter melon, portulaca, green tea, etc.

　　Third, it is best not to eat the following foods for pinworm disease:

　　(1) Avoid cold and raw foods.

　　(2) Avoid spicy and刺激性 foods such as scallions, garlic, ginger, and cinnamon.

　　(3) Avoid greasy, fried, moldy, and preserved foods.

　　(4) Avoid seafood and刺激性, allergenic foods when itching is severe.

　　1. General treatment and care: Children should wear full-crotch pants to prevent fingers from contacting the anus, and the skin around the anus should be washed with soap and warm water every morning; underwear and innerwear should be steamed or soaked in hot water and then sunned to kill insects for 10 consecutive days. The lifespan of pinworms is short, and if re-infection can be prevented, there is a possibility of spontaneous recovery. If prevention is not paid attention to, reinfection can still occur after drug deworming treatment. Therefore, this disease must combine prevention with drug deworming to be根治.

　　2. Drug treatment

　　(1) Mebendazole: Taken orally, a single dose of 50-100mg can achieve a cure rate of up to 90%, if taken twice a day or once a day, and taken for 3 days, the cure rate can reach 100%.

　　(2) Pyrvinium pamoate: Taken orally, 250mg for adults, 5-7.5mg/kg for children, taken in one dose, and then taken once again after 7 days. The tablet should not be chewed. Treatment can be repeated every 2 weeks if necessary. The feces will turn red 1-2 days after taking the medicine.

　　(3) Thiabendazole (pyrantelum, antihelminthic): Taken orally, 10mg/kg, taken in one dose, the efficacy is about 80%; taken at 5mg/kg daily for 3 days, the efficacy can reach 99%.

　　3. Local treatment: For anal itching or eczema, wash the affected area with clean water every night before going to bed, apply 10% calamus oil ointment or 2% mercuric oxide nitrate ointment, which can kill insects and relieve itching until recovery.