American Journal of Infectious Diseases and Microbiology
ISSN (Print): 2328-4056 ISSN (Online): 2328-4064 Website: Editor-in-chief: Maysaa El Sayed Zaki
Open Access
Journal Browser
American Journal of Infectious Diseases and Microbiology. 2019, 7(1), 8-12
DOI: 10.12691/ajidm-7-1-2
Open AccessCase Study

Enterobius Vermicularis: Does it Invade Central Nervous System?

Venkataramana Kandi1, , Ritu Vaish1, Padmavali Palange1, Sri Sandhya Koka1, Padmajakshi Gurrapu1 and Mohan Rao Bhoomigari1

1Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar, India

Pub. Date: April 24, 2019

Cite this paper:
Venkataramana Kandi, Ritu Vaish, Padmavali Palange, Sri Sandhya Koka, Padmajakshi Gurrapu and Mohan Rao Bhoomigari. Enterobius Vermicularis: Does it Invade Central Nervous System?. American Journal of Infectious Diseases and Microbiology. 2019; 7(1):8-12. doi: 10.12691/ajidm-7-1-2


Enterobiasis is a common intestinal parasitic infection of humans caused by Enterobius vermicularis (E. vermicularis). Although it affects all age groups, in most instances, it causes a self-limiting illness. Infections in children may result in severe morbidity. Enterobiasis can remain as a chronic infection in cases of bad personal hygiene, and those who are not adequately treated. Dissemination of E. vermicularis larvae from the perineal and peri-anal regions into the vagina and other associated regions has been adequately documented. There are several reports of ectopic presentations of enterobiasis. This report presents a fatal case of a four-year-old child with E. vermicularis infection who presented with central nervous system (CNS) complications.

enterobius vermicularis enterobiasis childhood dissemination central nervous system (CNS)

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Tsai CY, Junod R, Jacot-Guillarmod M, Beniere C, Ziadi S, Bongiovanni M. Vaginal Enterobius vermicularis diagnosed on liquid-based cytology during papanicolaou test cervical cancer screening: A report of two cases and a review of the literature. Diagn Cytopathol. 2017 Sep 14.
[2]  Saleem F, Malik F, Fatima S. Enterobius vermicularis in tubo-ovarian abscess: A rare and interesting incidental finding - A case Report. J Pak Med Assoc. 2017 Apr; 67(4): 630-633.
[3]  Shetty JB, Kulkarni DV, Prabhu V. Eggs containing larvae of Enterobius vermicularis in vaginal smear. Journal of Cytology / Indian Academy of Cytologists. 2012; 29(1): 94-96.
[4]  Raju K, Verappa S, Venkataramappa SM. Enterobius vermicularis infestation masquerading as cervical carcinoma: A cytological diagnosis. Journal of Natural Science, Biology, and Medicine. 2015; 6(2): 476-479.
[5]  Caldwell JP. Pinworms (Enterobius Vermicularis). Canadian Family Physician. 1982; 28: 306-309.
[6]  Serpytis M, Seinin D. Fatal case of ectopic enterobiasis: Enterobius vermicularis in the kidneys. Scand J Urol Nephrol. 2012 Feb; 46(1): 70-2.
[7]  Dick L, Hannay J. Enterobius vermicularis presentation during laparoscopic cholecystectomy. Journal of Surgical Case Reports. 2017; 2017(1): rjw239.
[8]  Little MD, Cuello CJ, D'Alessandro A. Granuloma of the liver due to Enterobius vermicularis. Report of a case. Am J Trop Med Hyg. 1973 Jul; 22(4): 567-9.
[9]  Kaniyur V, Chandra Prasad KH, Devan PP, Doddamani SS, Balachandran B, Kulkarni V. Enterobius vermicularis in the nose: A rare entity. Indian Journal of Otolaryngology and Head & Neck Surgery. 2005; 57(2): 148-150.
[10]  Dutta LP, Kalita SN. Enterobius vermicularis in the human conjunctival sac. Indian J Ophthalmol. 1976 Apr; 24(1):34-5. Conjunctival sac.
[11]  Babady NE, Awender E, Geller R, et al. Enterobius vermicularis in a 14-Year-Old Girl’s Eye . Journal of Clinical Microbiology. 2011; 49(12): 4369-4370.
[12]  Anuradha S, Bharathi K, Khalique A. Oculosporidial polyp infected secondarily by Enterobius vermicularis. Advanced Biomedical Research. 2014; 3: 195.
[13]  Dass B. Oxyuris Vermicularis, an Unmentioned Cause of Fistula-In-Ano. The Indian Medical Gazette. 1876; 11(7): 193.
[14]  Fry GF, Moore JG. Enterobius vermicularis: 10,000-year-old human infection. Science. 1969 Dec 26; 166(3913): 1620.
[15]  Paknazhad N, Mowlavi G, Dupouy Camet J, et al. Paleoparasitological evidence of pinworm (Enterobius vermicularis) infection in a female adolescent residing in ancient Tehran (Iran) 7000 years ago. Parasites & Vectors. 2016; 9: 33.
[16]  de Araújo AJ, Ferreira LF, Confalonieri UE, Nuñez L, Ribeiro Filho BM. The finding of Enterobius vermicularis eggs in pre-Columbian human coprolites. Mem Inst Oswaldo Cruz. 1985 Apr-Jun; 80(2): 141-3.
[17]  Bharti B, Bharti S, Khurana S. Worm Infestation: Diagnosis, Treatment and Prevention. Indian J Pediatr. 2017 Nov 11.
[18]  Ragunathan L, Kalivaradhan SK, Ramadass S, Nagaraj M, Ramesh K. Helminthic infections in school children in Puducherry, South India. J Microbiol Immunol Infect. 2010 Jun; 43(3): 228-32.
[19]  Burkhart CN, Burkhart CG. Assessment of frequency, transmission, and genitourinary complications of enterobiasis (pinworms). Int J Dermatol. 2005 Oct; 44(10): 837-40.
[20]  Moosazadeh M, Abedi G, Afshari M, Mahdavi SA, Farshidi F, Kheradmand E. Prevalence of Enterobius vermicularis among Children in Iran: A Systematic Review and Meta-analysis. Osong Public Health Res Perspect. 2017 Apr; 8(2): 108-115.
[21]  Li H-M, Zhou C-H, Li Z-S, et al. Risk factors for Enterobius vermicularis infection in children in Gaozhou, Guangdong, China. Infectious Diseases of Poverty. 2015; 4: 28. More than 50% prevalence, teeth grinding, jaw clenching Bruxism
[22]  Pampiglione S, Rivasi F. Enterobiasis in Ectopic Locations Mimicking Tumor-Like Lesions. International Journal of Microbiology. 2009; 2009: 642481. Ectopic tumor like lesions, difficulties in the histopathological diagnosis of oxyurasis in nonhabitual sites, and their importance from a clinical point of view.
[23]  Kılıç S, Ekinci S, Orhan D, Senocak ME. Enterobius granuloma: an unusual cause of omental mass in an 11-year-old girl. Turk J Pediatr. 2014 Mar-Apr; 56(2):189-91.
[24]  Elsaid N, Mahmood H, Tekkis P, Tan E. Enterobiasis-related inflammatory caecal polyp masquerading as a malignancy. BMJ Case Rep. 2014 Jan 15; 2014.
[25]  Efared B, Atsame-Ebang G, Soumana BM, et al. Acute suppurative appendicitis associated with Enterobius vermicularis: an incidental finding or a causative agent? A case report. BMC Research Notes. 2017; 10: 494. Acute appendicitis/inflammation.
[26]  Maraghi S: Enterobius vermicularis in Cerebrospinal Fluid. Iran Biomed J. 1997, 1:49-51.
[28]  Dutta K., Ghosh S., Basu A. (2016) Infections and Inflammation in the Brain and Spinal Cord: A Dangerous Liaison. In: Jana N., Basu A., Tandon P. (eds) Inflammation: the Common Link in Brain Pathologies. Springer, Singapore.
[29]  Chow FC, Marra CM, Cho TA. Cerebrovascular disease in central nervous system infections. Semin Neurol. 2011 Jul; 31(3): 286-306.
[30]  Tickell KD, Pavlinac PB, John-Stewart GC, Denno DM, Richardson BA, Naulikha JM, Kirera RK, Swierczewski BE, Singa BO, Walson JL. Impact of Childhood Nutritional Status on Pathogen Prevalence and Severity of Acute Diarrhea. Am J Trop Med Hyg. 2017 Nov; 97(5): 1337-1344.
[31]  Walker MD, Zunt JR. Neuroparasitic Infections: Nematodes. Seminars in neurology. 2005; 25(3): 252-261.
[32]  Chau TT, Thwaites GE, Chuong LV, et al. Headache and confusion: the dangers of a raw snail supper. Lancet 2003; 361: 1866.
[33]  Patikulsila D, Ittipunkul N, Theerakittikul B. Intravitreal angiostrongyliasis: report of 2 cases. J Med Assoc Thai 2003; 86: 981-985.
[34]  Boschetti A, Kasznica J. Visceral larva migrans induced eosinophilic cardiac pseudotumor: a cause of sudden death in a child. J Forensic Sci 1995; 40: 1097-1099.
[35]  Huff DS, Neafie RC, Binder MJ, et al. Case 4: the first fatal Baylisascaris infection in humans—an infant with eosinophilic meningoencephalitis. Pediatr Pathol 1984; 2: 345-352.
[36]  Wachter RM, Burke AM, MacGregor RR. Strongyloides stercoralis hyperinfection masquerading as cerebral vasculitis. Arch Neurol 1984; 41: 1213-1216.
[37]  Tsai HC, Liu YC, Kunin CM, et al. Eosinophilic meningitis caused by Angiostrongylus cantonensis associated with eating raw snails: correlation of brain magnetic resonance imaging scans with clinical findings. Am J Trop Med Hyg 2003; 68: 281-285.
[38]  Rowley HA, Uht RM, Kazacos KR, et al. Radiologicpathologic findings in raccoon roundworm (Baylisascaris procyonis) encephalitis. AJNR Am J Neuroradiol 2000; 21: 415-420.
[39]  Cunningham CK, Kazacos KR, McMillan JA, et al. Diagnosis and management of Baylisascaris procyonis infection in an infant with nonfatal meningoencephalitis. Clin Infect Dis 1994; 18: 868-872.
[40]  Brant-Zawadzki M, Wofsy CB, Schechter G. CT-evidence of subarachnoid hemorrhage due to presumed gnathostomiasis. West J Med 1982; 137: 65-67.
[41]  Germann R, Schachtele M, Nessler G, et al. Cerebral gnathostomiasis as a cause of an extended intracranial bleeding. Klin Padiatr 2003; 215: 223-225.
[42]  Xinou E, Lefkopoulos A, Gelagoti M, et al. CT and MR imaging findings in cerebral toxocaral disease. AJNR Am J Neuroradiol 2003; 24: 714-718.
[43]  García A, Nambiar PR, Marini RP, Fox JG. Staphylococcal meningoencephalitis, nematodiasis, and typhlocolitis in a squirrel monkey (Saimiri sciureus). J Med Primatol. 2009 Oct; 38(5): 377-81.
[44]  Punyagupta S, Bunnag T, Juttijudata P, Rosen L. Eosinophilic meningitis in Thailand: epidemiologic studies of 484 typical cases and the etiologic role of Angiostrongylus cantonensis. Am J Trop Med Hyg 1970; 19: 950-958.
[45]  Hassan T, Kamal MU, Reddy P, et al. Anemia, intractable vomiting, chronic diarrhea, and syndrome of inappropriate antidiuretic secretion: a diagnostic dilemma Disseminated strongyloidosis in a patient with newly diagnosed HTLV infection—case report and review of literature. Medicine 2017; 96 (52): p e9229.
[46]  Huttunen P, Lappalainen M, Salo E, Lönnqvist T, Jokela P, Hyypiä T, Peltola H. Differential diagnosis of acute central nervous system infections in children using modern microbiological methods. Acta Paediatr. 2009 Aug; 98(8): 1300-6.
[47]  Akya A, Ahmadi K, Zehtabian S, Salimi A, Elahi A, Madani SH. Study of the Frequency of Herpesvirus Infections Among Patients Suspected Aseptic Meningitis in the West of Iran. Jundishapur J Microbiol. 2015; 8(10): e22639. Published 2015 Oct 18.
[48]  Thomson RB Jr, Bertram H. Laboratory diagnosis of central nervous system infections. Infect Dis Clin North Am. 2001 Dec; 15(4): 1047-71.
[49]  Nordholm AC, Søborg B, Andersson M, Hoffmann S, Skinhøj P, Koch A. CNS infections in Greenland: A nationwide register-based cohort study. PLoS One. 2017; 12(2): e0171094. Published 2017 Feb 3.
[50]  Finsterer J, Auer H. Parasitoses of the human central nervous system. J Helminthol. 2013 Sep; 87(3): 257-70.