1
Q
What are Threadworms (pinworms) ?
A
- small white worms, 2-13mm long
- live in upper colon area
- only in humans, not transferrable to or from animals
- commonly affects children and residential homes
2
Q
How does Threadworms affect patients?
A
- intense itching and scratching due to large amount of eggs with irritant mucus
- Eggs are laid around anus or vaginal area
- Adult threadworms can live up to 6 weeks !
3
Q
How is diagnosis confirmed?
A
- sighting the worms , either around the perianal area, easily seen at night
- or more rarely on faeces
4
Q
secondary infection
A
- This can occur due to perianal scratching.
- In heavy infestation, this can lead to loss of appetite, weight loss, insomnia, irritability and enuresis
5
Q
perianal itching in adults
A
- may be due to haemorrhoids, eczema or irritants
- other worm infection could be possible e.g roundworm, if suspected then refer.
6
Q
Treatment options
A
- Suggest hygiene measures alone when drug treatment isnt wanted or not recommended (e,g in pregnancy)
- if all practical tips we discussed, are followed for 6 weeks, all the worms would have died.
- If anthelmintics are used, ALL members of the family should be treated simultaneously
7
Q
OTC treatment options
A
- Mebendazole 100mg (Ovex or vermox) is treatment of choice in adults and children over 2 years of age! ( children between 6months- 2 only given on RX)
- Given as a single oral dose but often needs to be repeated after 2-3 weeks if re-infection occurs
- The whole family should be treated as theres high risk of infection spreading ( including those without symptoms)
- ovex comes as either chewable tablets or liquid
- common side effect is abdominal pain
8
Q
Ovex mode of action
A
- Inhibits the uptake of glucose by worms causing them to immobilise and die
- transient abdominal pain or diarrhoea can sometimes occur , especially in people with heavy infestation
9
Q
Counselling points to the patient
A
- Wear close fitting pyjama bottoms or pants to avoid shedding eggs
- bathe/shower first thing in the morning, paying specific attention to anal area
- Emphasis good hygiene i.e washing hands after going the loo and before eating/preparing food. Ctutting fingernails short
- wash bedding and towels daily if possible as eggs can stay viable for up to 2 weeks
10
Q
When to refer to GP
A
- if they are preganant or breastfeeding
- if the child is under 2
- moderate interaction with cimetidine ( it increases conc of mebendazole)
11
Q
What are head lice?
A
- grey/brown 1-3mm long pediculus capitis
- They survive by sucking blood from the scalp of their host
- female louse lays eggs near hair shaft on scalp.
- egg shell firmly attaches to hair and cannot get washed off easily
- eggs hatch in about 7 days
12
Q
Confirmed diagnosis
A
- only made by finding live lice
- more common in school children, those with siblings, long hair, and lower socio-economic group
13
Q
How are they spread?
A
- via close head to head contact, so advise family and friends to check for infestation
- itching is a common symptom but can take up to 3 months to show as it could be asymptomatic till then.
14
Q
Treatment
A
- TWO applications of insecticide 7 days apatrt
- Each is to be left in the hair for 12 hours before rising off and hair is examined 14 days after to determine cure
- Treatment failure occurs when only ONE application is used or if insufficient product is applied
- average head of hair needs around 50ml.
15
Q
Treatment
A
- Alcoholic lotions are preferred but aqueous liquid formulations can be used where asthma, eczema or broken skin are present.
- The lotion should be left to dry naturally ( advise patients not to use hair dryer as the lotions are flammable )
- Advise to avoid swimming directly before and during the use of lotions as chlorine inactivates insecticides.
- Wet combing with a plastic detection comb plus conditioner should be performed every FOUR days over atleast TWO weeks until no lice are seen on 3 consecutive sessions. It is time consuming but suitable option for pregnant/breastfeeding women or children under 2.
16
Q
lotions
A
- Hedrin (4% dimeticone) works by physically covering the lice and disrupting their ability to manage water balance. Must be left on for 8 hours and treatment repeated after 7 days
17
Q
treatment failure
A
if treatments fails, a different insecticide should be used at least THREE weeks after the last application of insecticide.
