Most infections are asymptomatic but patients often present with pruritis ani and perineal pruritis. Symptoms are typically worse at night and may produce insomnia and restlessness. Heavily infected children may develop blood loss, poor concentration and emotional disturbance and enuresis. Local eczematous reactions and dermatitis artefacta may be seen. Chronic abdominal pain is probably more common than is currently recognised (see above). In girls, vulval vaginitis, acute urinary infections, enuresis and incontinence are associated with infection. In addition to this, many parents become anxious about the appearance or stigmata of worm infection.
The diagnosis of E. vermicularis depends on acquiring samples from the perianal skin (Ashford et al., 1988). This can be achieved by the application of a strip of adhesive tape to the anus and then sticking it to a microscope slide. Optimal yields are obtained with at least three samples taken at night. Commercial systems to facilitate specimen collection are available. Faecal samples may occasionally be positive but their yield is significantly lower than perianal samples and are not recommended for diagnosis.
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