Thu, May 1, 2025
Shalaleh Ganji1 
, Iraj Mobedi2 , Azim Rezamand1 , Farshid Ardabili3 , Pooya Yari4 , Majid Khanmohammadi5
, Iraj Mobedi2 , Azim Rezamand1 , Farshid Ardabili3 , Pooya Yari4 , Majid Khanmohammadi5
1- Department of Pediatric, Children’s Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
2- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical sciences, Tehran, Iran
3- Department of Biology, Faculty of Sciences, University of Maragheh, Maragheh, Iran
4- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
5- Department of Laboratory Sciences, Mara.C., Islamic Azad University, Marand, Iran ,majid593@gmail.com
2- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical sciences, Tehran, Iran
3- Department of Biology, Faculty of Sciences, University of Maragheh, Maragheh, Iran
4- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
5- Department of Laboratory Sciences, Mara.C., Islamic Azad University, Marand, Iran ,
Abstract: (47 Views)
Background and objectives: Enterobius vermicularis is the most important intestinal parasite in children worldwide. When this parasite migrates unexpectedly, the larvae move out of the intestine and enter organs such as the appendix and can cause health risks.
Case report: An 8-year-old boy was admitted to the oncology clinic of Tabriz Children’s Hospital complaining of fever of 39-40°C with abdominal pain, cramps, loss of appetite, weakness and fatigue associated with cervical lymphadenopathy, hepatomegaly, axillary mass, abdominal upper thigh, maculopapular rashes and tiny petechiae on the chest and abdomen.
Results: On CT examination of the chest, moderate mediastinal and mesenteric lymphadenopathy was noted. The patient was hospitalized with a definitive diagnosis of acute lymphoblastic leukemia (ALL). On the seventh day of hospitalization, the patient developed additive colic pain (contraction and cramping) around the umbilicus and concomitantly developed pain downward and rightward into the abdomen. Based on the clinical findings, the patient was thought to have acute appendicitis. Pathological examinations showed that E. vermicularis was the cause of the appendicitis.
Conclusion: The results of this study indicate that this parasite may be associated with inflammation of the appendix in patients with acute lymphoblastic leukemia. A screening program is still required in patients with immunodeficiency or those taking immunosuppressive drugs.
Case report: An 8-year-old boy was admitted to the oncology clinic of Tabriz Children’s Hospital complaining of fever of 39-40°C with abdominal pain, cramps, loss of appetite, weakness and fatigue associated with cervical lymphadenopathy, hepatomegaly, axillary mass, abdominal upper thigh, maculopapular rashes and tiny petechiae on the chest and abdomen.
Results: On CT examination of the chest, moderate mediastinal and mesenteric lymphadenopathy was noted. The patient was hospitalized with a definitive diagnosis of acute lymphoblastic leukemia (ALL). On the seventh day of hospitalization, the patient developed additive colic pain (contraction and cramping) around the umbilicus and concomitantly developed pain downward and rightward into the abdomen. Based on the clinical findings, the patient was thought to have acute appendicitis. Pathological examinations showed that E. vermicularis was the cause of the appendicitis.
Conclusion: The results of this study indicate that this parasite may be associated with inflammation of the appendix in patients with acute lymphoblastic leukemia. A screening program is still required in patients with immunodeficiency or those taking immunosuppressive drugs.
References
1. Shoup B. Diagnosis and management of pinworm infection. Primary Care Update for OB/GYNS. 2001; 8(6): 240-243. [View at Publisher] [DOI] [Google Scholar]
2. Lee SE, Lee JH, Ju JW, Lee WJ, Cho SH. Prevalence of Enterobius vermicularis among preschool children in Gimhae-si, Gyeongsangnam-do, Korea. Korean J Parasitol. 2011; 49(2): 183-185. [View at Publisher] [DOI] [PMID] []
3. Lala S, Upadhyay V. Enterobius vermicularis and its role in paediatric appendicitis: protection or predisposition. ANZ J Surg. 2016; 86(9): 717-719. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Boas H, Tapia G, Sodahl JA, Rasmussen T, Ronningen KS. Enterobius vermicularis and risk factors in healthy Norwegian children. Pediatr Infect Dis J. 2012; 31(9): 927-930. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Sodergren MH, Jethwa P, Wilkinson S, Kerwat R. Presenting features of Enterobius vermicularis in the vermiform appendix. Scand J Gastroenterol. 2009;44(4):457-461. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. da Silva DF, da Silva RJ, da Silva MG, Sartorelli AC, Rodrigues MA. Parasitic infection of the appendix as a cause of acute appendicitis. Parasitol Res. 2007;102(1):99-102. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Ariyarathenam AV, Nachimuthu S, Tang TY, Courtney ED, Harris SA, Harris AM. Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review. Int J Surg. 2010; 8(6): 466-469. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Wendt S, Trawinski H, Schubert S, Rodloff AC, Mössner J, Lübbert C. The Diagnosis and Treatment of Pinworm Infection. Dtsch Arztebl Int. 2019; 116(13): 213-219. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Caldwell JP. Pinworms (enterobius vermicularis). Canadian Family Physician. 1982; 28: 306-309. [View at Publisher] [Google Scholar]
10. Budd JS, Armstrong C. Role of Enterobius vermicularis in the aetiology of appendicitis. Br J Surg. 1987; 74(8): 748-749. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Khubchandani IT, Bub DS. Parasitic Infections. Clin Colon Rectal Surg. 2019; 32(5): 364-371. [View at Publisher] [DOI] [PMID] []
12. Purohit G, Mohanty S, Tirkey R, Sasmal PK. Inadvertent detection of massive Enterobius vermicularis infection in an asymptomatic adult with rectal blowout following barotrauma. Ann Parasitol. 2019; 65(1): 103-105. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Arca MJ, Gates RL, Groner JI, Hammond S, Caniano DA. Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature. Pediatr Surg Int. 2004;20(5):372-375. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health. 2007;38(1):20-23.
15. Gatti S, Lopes R, Cevini C, Ijaoba B, Bruno A, Bernuzzi AM, et al. Intestinal parasitic infections in an institution for the mentally retarded. Ann Trop Med Parasitol. 2000; 94(5): 453-460. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Yildirim S, Nursal TZ, Tarim A, Kayaselcuk F, Noyan T. A rare cause of acute appendicitis: parasitic infection. Scand J Infect Dis. 2005; 37(10): 757-759. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Mardani A, Feizi F, Fakhar M, Farrokhi M, Abbasi M, Asfaram S. Enterobius vermicularis infection among appendectomy specimens in Qom Province, Central Iran: a retrospective study. Comparative Clinical Pathology. 2017; 26(5): 1213-1219. [View at Publisher] [DOI] [Google Scholar]
18. Dahlstrom JE, Macarthur EB. Enterobius vermicularis: a possible cause of symptoms resembling appendicitis. Aust N Z J Surg. 1994;64(10):692-694. doi:10.1111/j.1445-2197.1994.tb02059.x [DOI] [PMID]
19. Dalimi A, Khoshzaban F. Comparative study of two methods for the diagnosis of Enterobius vermicularis in the appendix. J Helminthol. 1993; 67(1): 85-86. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Siavoshi M, Sattari M, Pile- Var M. Histopathology and Relative Frequency of Parasitic Appendicitis in the Main Treatment Centers of Hamadan City. Journal title. 1999; 8 (29 and 30): 63-68. [View at Publisher] [Google Scholar]
21. Isik B, Yilmaz M, Karadag N, Kahraman L, Sogutlu G, Yilmaz S, et al. Appendiceal Enterobius vermicularis infestation in adults. Int Surg. 2007; 92(4): 221-225. [View at Publisher] [PMID] [Google Scholar]
22. Aydin O. Incidental parasitic infestations in surgically removed appendices: a retrospective analysis. Diagn Pathol. 2007; 2: 16. [View at Publisher] [DOI] [PMID] []
23. Gutierrez Y, Diagnostic Pathology of Parasitic Infections with Clinical Correlations. Oxford University Press. 2000; 521-523. [View at Publisher] [DOI] [Google Scholar]
24. Burkhart CN, Burkhart CG. Assessment of frequency, transmission, and genitourinary complications of enterobiasis (pinworms). Int J Dermatol. 2005; 44(10): 837-840. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Cook G. Enterobius vermicularis infection. Gut. 1994; 35(9): 1159. [View at Publisher] [DOI] [PMID] []
26. Hammood ZD, Salih AM, Mohammed SH, Kakamad FH, Salih KM, Omar DA, et al. Enterobius vermicularis causing acute appendicitis, a case report with literature review. Int J Surg Case Rep. 2019;63:153-156. [View at Publisher] [DOI] [PMID] []
27. Madhukar KP, et al., Acute appendicitis secondary to enterobius vermicularis infestation in a young female: a case report. J. Evol. Med. Dent. Sci., 2014; 3(19): p. 5219-5223. [View at Publisher] [Google Scholar]
28. Gialamas E, Papavramidis T, Michalopoulos N, et al. Enterobius vermicularis: a rare cause of appendicitis. Turkiye Parazitol Derg. 2012;36(1):37-40. doi:10.5152/tpd.2012.09 [View at Publisher] [DOI] [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Enamad
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.