(1) In the history taking, focus on the living habits and hygiene of the child, pay attention to whether the child wears open pants, whether he or she changes and washes underwear and underwear regularly, and washes the vulva regularly; whether he or she has been enrolled in nursery school, and if so, whether there are similar children in the nursery school, and whether the children’s toys and usages are routinely disinfected; whether there are patients with urinary tract infections and vulvovaginitis in the family, especially close contacts; and whether there is a past history of eczema.
(2) Further physical examination and ancillary tests should focus on the identification of these diseases. Purely from the clinical symptoms of children, itching to the perianal area is the most obvious, especially at night when sleep aggravated, affecting the child’s sleep, sudden night cries, close contacts have a similar situation, the first consideration for pinworm disease, parents can sleep in the child 2 ~ 3 hours, pick open the buttocks, carefully examine the perianal folds, can be found in the white thread-like worms can assist in the diagnosis. If the child has obvious vulvar itching, vaginal discharge, or symptoms such as frequent urination, urinary urgency, painful urination, and close contacts with patients with urinary tract infection or vulvovaginitis, consider infection causing vulvovaginitis or (and) urinary tract infection. Itching of the vulva with eczema or diaper rash is to be considered vulvar eczema.
(3) The medical history of this case is characterized as follows.
①Girl, 3 years old.
(ii) Perineal itching, worse at night for 3 months.
(3) The child is irritable, has a decreased appetite, inattentive, nail biting, and sleep disturbance.
1. Description
T 37.0℃, P 96 times/min, R 28 times/min, weight 14kg.
General condition is acceptable, nutrition is moderate, mental clarity, mental atrophy, slightly pale, no yellowish staining of skin and mucous membrane, no skin rash. Superficial lymph nodes were not enlarged. Both pupils were equal in size and round, with sensitive reflex to light. The pharynx is not congested and the tonsils are not enlarged. There was no obvious resistance in the neck. The heart rate was 96 beats/minute, rhythmical, with moderate heart sounds and no murmurs were heard. The respiratory sounds of both lungs were clear, and no woven grass was heard. <怪闹闹巍M藁藁禹禹禹禹院ズ 郏薹置 谖铮 eczema. The abdominal wall reflexes exist, the bilateral knee reflexes are normal, the Gram's sign is negative, the Brønsted's sign is negative, and the bilateral Bartholomew's sign is negative.
2, physical examination analysis
The physical examination of this case lacked obvious positive signs, only the vulva was slightly red and scratch marks were seen, lacking specificity. There is no discharge and no eczema, so vulvar eczema can be excluded initially.
Auxiliary examination
1.Description
(1) Laboratory examination Blood routine: RBC 3.96×1012/L, Hb112g/L, WBC 7.98×109/L, neutrophils 48%, eosinophils 3%, platelets 307×109/L, stool routine normal, urine routine: protein(-), microscopy(-). Blood biochemistry was normal. The parents examined the child’s perianal area after he was asleep and saw milky white thread-like worms crawling around, and sent him to the hospital laboratory to confirm the diagnosis of pinworms.
(2) Electrocardiogram: sinus rhythm.
(3) chest X-ray: no abnormalities.
2, auxiliary examination analysis Because pinworms generally do not lay eggs in the intestine, it is not easy to find eggs in the feces, and the positive rate of fecal examination is only about 5%. The diagnosis can be confirmed by finding eggs in the perianal area. The method of examining eggs is mostly done with transparent tape, which is easy to use and has a high positive rate. Cut transparent tape into 4~5cm long strips, wrap them around a glass rod or a small piece of wood, sticky side out, and gently press them in the morning before defecation or at night in the folds around the anus to remove the eggs, then remove the tape strips and stick them downward on a slide with saline dripping on it, and a typical worm egg can be found under the microscope. Transparent tape can also be placed directly on the slide for examination. If no eggs are found, the examination should be repeated, usually three times.
Diagnosis and differential diagnosis
1.Diagnosis Pinworm disease (enterbisis)
2.Diagnosis basis
(1) The child has restless sleep and night terrors, and complains of itching around the anus.
(2) Physical examination shows slightly red vulva and scratch marks.
(3) The diagnosis of pinworms is confirmed when the parents check the perianal area after the child is asleep and see small, milky, thread-like worms crawling around.
3.Differential diagnosis
(1) Urinary tract infection Mainly manifested as frequent, urgent and painful urination, redness of the urethral orifice, abnormal urine routine, and interruption of urine culture with bacterial growth can be distinguished.
(2) Eczema of vulva It often manifests as itching of vulva, accompanied by eczema or diaper rash. There is no obvious daily lightness and nightly heavy phenomenon.
Treatment
1.Treatment principle On the basis of active prevention and elimination of repeated infection, deworming treatment is carried out.
2.Treatment plan
(1) Deworming treatment The commonly used deworming drugs are as follows.
①Mebendazole, the dose is 100mg in a single dose, the cure rate is 90%~100%.
②Albendazole, the trade name of intestinal wormer. The dose is 200mg per tablet. 200mg is taken in doses for pinworms and the cure rate is 100%.
③Compound albendazole: trade name Saitex, each tablet contains albendazole 67mg, thiazide 83.3mg (base). The treatment amount is 1 tablet taken in a single dose, and the cure rate is 100%. (2) Local therapy Wash the anus with warm water after defecation and before going to bed, then apply 2% white mercury ointment or 10% zinc oxide ointment on the skin around the anus, and also squeeze a little pinworm ointment into the anus through a thin tube to stop itching and reduce self-infection.
4.Treatment analysis
(1) In order to consolidate the treatment effect, it is best to repeat the treatment once at an interval of about 10 days, during which the environment is fully cleaned and clothes are washed. Members of families and childcare institutions should receive treatment at the same time.
(2) For patients with ectopic damage, in addition to deworming treatment, symptomatic treatment is also required.
Summary
Pinworm disease is widespread, with no obvious geographical distribution, and infection is common in children. It can be contracted orally by hand contact with clothes, food, toys, etc. contaminated with eggs, and can also be contracted by inhalation with dust in the room and then swallowed. Young children scratch the perineum and anus with their hands, so that their fingers are contaminated with eggs, and when they suck their fingers or take food, the eggs are ingested through the mouth, and this type of infection is called anal-hand-oral infection, which is the most important way of self-infection and an important reason why pinworm disease is difficult to prevent and treat.
Pinworm eggs are highly resistant and can survive for 2 to 3 weeks indoors and under children’s fingernails, and toys, tables, chairs and books in kindergartens can be contaminated with eggs, and children can infect each other by touching each other, so the infection rate is high. The main symptom of pinworm disease is that the female worms migrate around the anus and lay eggs, stimulating the local skin and causing itching in the perineum, especially at night. The itchiness affects the patient’s sleep, and children may cry suddenly and repeatedly at night. Lack of sleep makes the child irritable and anxious, and loss of appetite.
Dermatitis may also occur due to local skin scratching. Pinworms can enter the appendix, causing acute and chronic appendicitis and even perforation. Female worms can also enter the female urethra, causing irritation such as frequent urination, urgent urination, and painful urination. The mechanical stimulation of parasitic pinworms in the intestine causes nausea, vomiting, diarrhea, abdominal pain, loss of appetite and other symptoms. The diagnosis can also be confirmed by parents examining the perianal area after the child is asleep and seeing small, milky-white, thread-like worms crawling around, or finding eggs in the perianal area.
On the basis of active prevention and elimination of repeated infections, deworming treatment is crucial. Pinworm disease is easily transmitted to each other and repeatedly infected, so it is crucial to do a good job of prevention. First of all, health promotion and education, so that children understand the mode of transmission and harm of pinworm disease; secondly, to develop good habits of hygiene, hand washing before and after meals, diligent nail cutting, diligent washing of the perineum. Infected persons should be treated thoroughly, and family members and members in collective institutions should be treated at the same time, and the environment should be adequately cleaned and clothes washed during treatment.