For the most part, Enterobius infections are asymptomatic or associated with mild peri-anal itching and excoriation. Serious complications with Enterobius are exceedingly rare and related to the appearance of eggs or worms in an ectopic location. There has been a suggestion of an association between Enterobius infection and acute appendicitis but this interaction is complex and difficult to dissect (Dahlstrom and Macarthur, 1994; Wiebe, 1991). Enterobius may cause symptoms in children that mimic appendicitis, with the effect that Enterobius is more frequently identified in appendiceal biopsies than would be anticipated. Additionally, the presence of Enterobius in the vermiform appendix may result in inflammation that causes true appendicitis (Bredesen et al, 1988). Intriguingly, more female Enterobius are found in the appendix than male (Williams and Dixon, 1988). It is clear that, at least on some occasions, E. vermicularis has a causal role in appendicular pain and may on occasions contribute to acute appendicitis.
Atopic worms may result in a granulomatous response and these have previously been reported in the perianal area, causing vaginitis and post-menopausal bleeding. Although usually asymptomatic, there are reports of eosinophilic colitis associated with the larvae of Enterobius that resolved on treatment of this infection (Liu et al., 1995). It has often been implicated in the causation of urinary tract infection in young girls (Ok et al., 1995). Other sites of Enterobius granulomata include the ovary (Donofrio et al., 1994), epididymis and, rarely, ileal perforation (Patterson et al., 1993) has been associated with infection. Enterobius has been reported to form granulomas in the peritoneum (Pearson et al., 1981; Sun et al., 1991).
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