LNSLNS

We very much welcome the detailed survey of pinworm infection, which is probably the most common intestinal parasitosis in Germany (1). However, some statements require critical commentary.

A decline in infection rates since Germany’s reunification cannot be proven. Due to the particular patient populations, the long period covered, as well as infrastructural changes between the point prevalence studies carried out in Schwerin in 1978 and 1997 (2), no solid conclusions can be drawn for Germany as a whole. The study from the Greater Berlin area (3) did not show any locally accumulated detection rates (for example, differences between districts), but 5578 examinations between 2007 and 2017 revealed a steady increase in pathogen detection. A seasonal distribution of pathogen detection was only seen for ≥ 6-year-old patients, but not for younger patients.

Migratory movements of pinworms may contribute to the unexplained pathophysiology of perianal itching. It is more likely, however, that itching is induced by egg antigens that are released. This is supported by the fact that female worms are outside the intestine only for a short time to attach the eggs, while itching is intermittent or permanent. In the Berlin study, worms were detected in only 9 out of 971 positive samples (3).

Disintegration of the worm cuticle by fingers and fingernails is unlikely. It is difficult to imagine that the thick cuticle of the small worms on skin (which gives way to pressure) would be slashed or otherwise disintegrated by fingers/fingernails of young children. Furthermore, viewed from the aspect of pathogen transmission, regular destruction of adult worms would be unfavorable.

The sensitivity of using cotton swabs for pathogen detection, indicated as an alternative to the adhesive tape test, should be supported by references from the literature.

Pyrvinium embonate has long been used for the treatment of pregnant women.

DOI: 10.3238/arztebl.2019.0561a

Prof. Dr. med. Hermann Feldmeier
Institut für Mikrobiologie und Infektionsimmunologie
Campus Benjamin Franklin, Berlin, Germany

Prof. Dott. Univ. Pisa Joachim Richter
Institut für Tropenmedizin und Internationale Gesundheit
Charité – Universitätsmedizin Berlin, Germany

Prof. Dr. med. Ralf Ignatius
MVZ Labor 28, Berlin and
Institut für Mikrobiologie und Infektionsimmunologie
Campus Benjamin Franklin, Berlin, Germany
r.ignatius@labor28.de

Conflict of interest statement
Prof. Ignatius has received honoraria from Springer-Verlag for a co-authorship of a book chapter that is related to the topic.

The remaining authors declare that no conflict of interest exists.

1.
Wendt S, Trawinski H, Schubert S, Rodloff AC, Mössner J, Lübbert C: The diagnosis and treatment of pinworm infection. Dtsch Arztebl Int 2019; 116: 213–9 VOLLTEXT
2.
Gauert B: Eine vergleichende Untersuchung über Vorkommen und Verbreitung von Intestinalparasiten in Kindertagesstätten der Landeshauptstadt Schwerin. Gesundheitswesen 1998; 60: 301–6.
3.
Friesen J, Bergmann C, Neuber R, et al.: Detection of Enterobius vermicularis in greater Berlin, 2007–2017: seasonality and increased frequency of detection. Eur J Clin Microbiol Infect Dis 2019; 38: 719–23 CrossRef MEDLINE
1.Wendt S, Trawinski H, Schubert S, Rodloff AC, Mössner J, Lübbert C: The diagnosis and treatment of pinworm infection. Dtsch Arztebl Int 2019; 116: 213–9 VOLLTEXT
2.Gauert B: Eine vergleichende Untersuchung über Vorkommen und Verbreitung von Intestinalparasiten in Kindertagesstätten der Landeshauptstadt Schwerin. Gesundheitswesen 1998; 60: 301–6.
3.Friesen J, Bergmann C, Neuber R, et al.: Detection of Enterobius vermicularis in greater Berlin, 2007–2017: seasonality and increased frequency of detection. Eur J Clin Microbiol Infect Dis 2019; 38: 719–23 CrossRef MEDLINE

Info

Specialities