Nematode infestation of children in the North American hemisphere is a common problem, although it is not of the magnitude in this area that it is in some other areas of the world. Patients who harbor roundworms are frequently asymptomatic. However, appropriate treatment is required when clinical symptoms occur and significant infestation is found. Correct diagnosis is of paramount importance because choice of the proper drug is predicated on knowledge of the infecting organism.
The two roundworms most commonly seen in the United States are Enterobius vermicularis (pinworm) and Ascaris lumbricoides (large roundworm). In warmer climates infestation with Toxocara canis, T. cati (visceral larva migrans), Trichuris trichiura (whipworm), Necator americanus, Ancylostorna duodenale (hookworm), and Strongyloides stercoralis occurs. This commentary is limited to the treatment of A. lumbricoides and E. vermicularis infestations because of their widespread occurrence.
Enterobius vermicularis is probably the most ubiquitous parasite in the United States and Canada. In contrast to most other helminthic infections, enterobiasis is more of a nuisance than an actual health threat. It is most frequently identified in children and has been blamed, often erroneously, for a wide assortment of symptoms. The majority of pinworm infestations are asymptomatic. The most common symptom is anal pruritus, which in females may also extend to the vulva. Other symptoms less commonly associated with enterobiasis are abdominal pain, headache, diarrhea, and tenesmus.1-3
Symptoms such as poor appetite, behavior problems, nocturnal bruxism, and nightmares have been ascribed to, but are probably not caused by, pinworms. These and other complaints may coexist.