Oxyurid Nematodes Detected by Colonoscopy in Patients with Unexplained Abdominal Pain
Abeer E Mahmoud1, Rasha AH Attia1, Hanan EM Eldeek1, Laila Abdel Baki2 and
Hussein A Oshaish3
Departments of Parasitology1 and Tropical Medicine and Gastroenterology2 Faculty of Medicine,
Assiut University, Egypt and GIT Consultant, Faculty of Medicine, Taez University, Yemen3
Received: April, 2009
Accepted: May, 2009
Abstract
Background: Pinworms are one of the common helminthic infections that generally live in the
gastrointestinal tract causing appendicitis and leading to unexplained abdominal pain. Species of
the genus Syphacia (rodent pinworm) are cosmopolitan and they also infect humans.
Objectives: To diagnose the cause of unexplained abdominal pain in patients with mild
eosinophilia by colonoscopy; to detect the relevance of Oxyurid nematodes as a cause of this
unexplained abdominal pain; and to identify and describe the extracted pinworms using light and
scanning electron microscopy (SEM).
Patients and Methods: The study was performed on 200 inpatients of different age groups
ranging from 3-60 years over a period of one year in the Tropical Medicine and Gastroenterology
Department, Assiut University Hospital. Laboratory investigations were done for each case,
including complete blood picture, liver function tests, stool examination for helminthes and
protozoa, and perianal swab for patients suffering from perianal itch. Colonoscopy was
performed for all cases not responding to antispasmodics. Detected worms were picked up by
biopsy forceps and sent to the Parasitology Department, Faculty of Medicine, Assuit University
and examined using light and SEM.
Results: Out of 200 patients, 25 (12.5%) were diagnosed as pinworm infection of the genus
Syphacia except in 5 children who had mixed infection with E. vermicularis. Laboratory findings
were mild eosinophilia (6-8%) and neutrophilia with moderate shift to the left in one patient with
recto-sigmoid nodule and negative stool examination. Perianal swab of patients presenting with
perianal itch was positive for Enterobius. vermicularis eggs. Light microscopic examination
illustrated the presence of three different species of Oxyurida: E. vermicularis, S. muris and
Syphacia species. SEM studies showed that Syphacia spp. were classified into two groups
according to morphological differences, and allowed for the reporting of additional
morphological and taxonomical features.
Conclusion and recommendations: Syphacia is considered as a cause of unexplained chronic
abdominal pain and E. vermicularis is not the only human pinworm in Egypt. Further studies
using SEM are needed to detect new characters that may help in differentiating Syphacia spp.
from different hosts.
Keywords: Syphacia muris, Syphacia spp., E. vermicularis, Colonoscopy, Unexplained
Abdominal Pain, Light Microscopy, SEM.
Introduction
Members of the Order Oxyurida are called pinworms because they, specially the females, have
sharp pointed tails(1). Pinworms are one of the common helminthic infections which generally
live in the gastrointestinal tract, leading to unexplained abdominal pain and may cause
appendicitis. Abdominal pain seen in some patients infected with E. vermicularis is due to
blockage of the appendiceal lumen with parasites, ischemia and associated acute appendicitis(2).
E. vermicularis worms or eggs were detected in histopathological sections of granulomas of
abdominal and pelvic peritoneum, granulomas on the surface of the ovary and necrotic
granuloma removed from the lung of many patients(3). Murata et al.(4) described a fatal infection
-1-
with human pinworm, E. vermicularis, in a chimpanzee in which many worms were observed in
the mucosa of the intestinal tract, especially in the ileum and caecum with caecal nodule
formation. Other tissues were also affected as the portal venule, parenchyma of the liver, spleen,
kidneys, adrenals and lung alveoli.
Species of the genus Syphacia (rodent pinworm) are cosmopolitan. Beside small mammals, they
may also infect humans(5). Route of infection may quite probably be contamination from fecal
droppings and hand to mouth infection. Kumar et al. (6) described several cases of rectal prolapses
associated with pinworms infection in a colony of mice. Moreover, they added that rectal
prolapse, constipation, intersucception and fecal impaction due to heavy infection with Syphacia
were recorded.
Scanning electron microscopy (SEM) has made it possible to study the ultrastructure of the head
end, genitalia and the surface structure of the body. This method revealed characters which had
not been reported earlier for Syphacia spp. as the presence of longitudinal septa on the surface of
the body and the ultrastructure of the transverse striations of the body(7). Scanning electron
microscopy studies(8) pointed out that there are apparently four groups within the genus Syphacia
based on the form of the head.
The present work aimed to diagnose the cause of unexplained abdominal pain in patients with
mild eosinophilia using colonoscopy, to detect the relevance of Oxyurid nematodes as a cause of
this unexplained abdominal pain, and to identify and describe the detected pinworms using light
and SEM.
Patients and Methods
The study was approved by the Ethical Committee of Faculty of Medicine, Assiut University.
Clinical data: After obtaining an informed consent, 200 inpatients of different age groups ranging from
3-60 years were enrolled for the study, over a period of one year, in the Tropical Medicine and
Gastroenterology Department, Assiut University Hospital. They all suffered from chronic abdominal
troubles (diffuse colicky abdominal pain and abdominal distension) of 3-5 months duration.
Ultrasonography was done to exclude gall bladder stones, cholecystitis, and abdominal masses and to
identify level of distension.
Laboratory investigations included complete blood picture, liver function tests, stool examination for
helminthes and protozoa by direct smear of the stool with saline and iodine and formal ether concentration
technique(1). Perianal swab was done for patients suffering from perianal itch by Scotch adhesive tape
swab early in the morning before bathing or defecation(1). Antispasmodic treatment was given for 3-5
months to this group of patients to relieve the pain. Failure of this treatment indicated colonoscopy.
Colonoscopy was performed for all cases. Preparation was done by purgative and enema. The instrument
used was videoscope long colonoscopy (Pentax EPM-3500), and the colonscope No. was F110118. The
procedure performed was complete colonic examination till the caecum in all patients. Detected worms
were removed by biopsy forceps and sent to the Parasitology Department, Faculty of Medicine, Assuit
University in saline containing containers within 15-30 minutes. Stool specimen was collected on the next
day and perianal swab was done before treatment of cases. Anti-helminthic treatment was given to the
positive cases (Albendazole) 200 mg twice/day for 3 successive days and repeated after one week. Follow
up of these patients was done for one month. Detected nodules were removed by biopsy forceps and sent
to the Pathology Department, Faculty of Medicine, Assuit University in formalin containing containers for
histopathological examination.
Parasitological studies: Adult worms recovered from the lumen of the colon of examined patients were
washed with saline and preserved in a solution of 5 parts glycerin plus 95 parts 70% alcohol(5). For
detailed examination, the specimens were placed in a drop of lactophenol and examined under a light
microscope, equipped with a calibrated eye piece micrometer. Light photomicrographs were taken with
the aid of digital microscopic camera. Identification of worms was done according to keys of Yamaguti (9)
and Younis(10). For SEM, some worms were relaxed in warm water then fixed in 5% glutaraldehyde for 24
hours and sent to SEM unit to be processed for examination. Finally, the specimens were segmented to
anterior, posterior and middle parts, put on holder, and examined with JEOL JSM-5400 LV scanning
electron microscope, operated at 15 kV(11).
-2-
Statistical methods: SPSS ver. 11 was used for data entry and analysis and unpaired t-test was used to
compare between the mean of Syphacia muris and Syphacia spp.
Ethical consideration: The study was approved by Ethical Committee of Faculty of Medicine, Assiut
University.
Results
Over a period of one year, 200 patients of different age groups ranging from 3-60 years, suffering
from abdominal pain and chronic abdominal troubles of unidentified etiology, were examined by
colonoscopy. Twenty-five patients (12.5%) were diagnosed as pinworm infection of the genus
Syphacia except for 5 children who had mixed infection with E. vermicularis. In these 25
patients, stool examination was negative for other helminthes and protozoa, and perianal swab
proved positive only for E. vermicularis eggs in the five children who were presenting with
perianal itch.
All laboratory investigations in these 25 patients were normal apart from mild eosinophilia (68%). Neutrophilia with moderate shift to the left was observed in one patient with a rectosigmoid nodule. Abdominal sonar revealed distention at the colonic level.
Colonoscopy examination revealed non specific diffuse colitis and hyperemia. Small worms were
seen wandering inside the lumen of the colon and picked up by biopsy forceps (Figure 1). A
small mucosal nodule was detected in one case at the recto-sigmoid junction. Histopathology of
this nodule revealed chronic non specific inflammation with marked eosinophilic infiltration.
Improvement of appetite, abdominal pain and distension was noticed in patients after antihelminthic treatment.
Light microscopic examination: All extracted worms from the 25 patients were gravid females
and only one male. All shared the general characters of the family Oxyuridae. Pinworms
differentiation into three species of the family Oxyuridae was done by light microscope
depending mainly on the marked difference in the shape of cephalic end, cervical alae and eggs.
They proved to be Syphacia spp., Syphacia muris females and E. vermicularis male and females
in five children.
1. Genus Syphacia: Two female species were identified; their differences are described in
table (1):
Syphacia muris (Figures 2-4): The worms are opalescent white in color. Body is relatively wide,
tapering at both ends. The anterior end has a small mouth with three distinct membranous lips
and small cervical alae ending sloppy while lateral alae are absent (Figure 2). The vulva opening
is at the end of anterior fourth of the body. The esophageal bulb is rounded in shape, separated
from the rest of the esophagus by a constriction (Figure 3). The adult female ends posteriorly
with a long pointed tail which is one fourth of the body length. The eggs are characteristically
planoconvex in shape, transparent, thin shelled and containing morula stage cells. A large pitted
area at one pole was seen which may represent an operculum or hatching area (Figure 4).
Syphacia spp. (Figures 5-10): Body of the adult is stout, narrowing at its posterior end. The
cephalic plate is spherical with three lips. Striated elongated cup-shaped cervical alae-like shields
are projecting from and cover the entire anterior end (Figures 5 and 6). Esophageal bulb is
spheroid (Figure 7). The vulva opening lies at the end of anterior fifth of the body. The whole
cuticle is transversely striated, except at the pointed tail (Figures 8 and 9). The lateral alae
illustrated characteristic zigzag shaped thickening of the cuticle running longitudinally and
directly backwards along the body of worm and ending at the tail beginning. It begins 125-155
µm from the anterior end, its width is 10-12 µm (Figures 8 and 9). The adult female ends
posteriorly with a long pointed tail which is one fourth of the body length. The eggs are
planoconvex, transparent, thin shelled and either contain morula stage or larvae. A large pitted
area seen at one pole may represent an operculum or hatching area (Figure 10).
-3-
Genus Enterobius (Figures 11-12): E. vermicularis was detected from children presenting with
perianal itch.
SEM examination of Syphacia spp. adult females (Figures 13-24): This separated Syphacia
spp. into two groups according to the difference in morphology, measurements and cuticular
structures which were evident from the region below the lips up to the anus (Table 2). In the first
group, which proved larger than the second, the cephalic plate is relatively large and rounded
with three large elevated and symmetrical lips surrounding the mouth. The mouth and the lips are
surrounded by a well defined cuticular collar which is not protruded apart from the body
circumstance and without conspicuous surface structure; it appears depressed in the first group
(Figure 13) but elevated in the second group (Figure 14). There are two cervical alae surrounding
the anterior end. Their width is more or less similar to the lateral alae in the first group (Figure
15) but is thinner than the lateral alae in the second group (Figure 16). Their shape is markedly
different from that of the lateral alae appearing as a shield, not penetrating deep into the cuticle.
Transverse cuticular striations are more marked in the second group. The two long lateral alae are
very characteristic, well developed, corrugated (zigzag shaped), penetrating deep into the
cuticular surface, are free from transverse striations while their margin appears beaded and
extending up to the beginning of the tail. Their width is 12 µm in the first group and 10 µm in the
second group. There is a free distance between cervical and lateral alae of 5 µm (Figures 17-19).
The cuticle appears transversely striated immediately below the cuticular collar but longitudinal
septa are lacking. In the first group the spaces between the transverse striations are narrow
anteriorly (6 µm) but they widen gradually (Figure 19) until they disappear in the posterior third
(Figure 20). In the second group, the cuticular transverse striations begin simple and then appear
as branching and interconnecting at a distance of 180-190 µm from the anterior end up to the tail
with the end of lateral alae (Figures 16 and 21). The long pointed tail is free from transverse
striations in the first group but crossly striated in the second group; the distance between these
striations being 13 µm (Figures 22 and 23). The vulva appears as a transverse slit with thick
margin, having two upper lips one behind and inner than the other. The surrounding cuticle is
transversely striated (Figures 15 and 24).
Table (1): The measurements and morphological differences between Syphacia muris and
Syphacia spp., using light microscope
Syphacia muris
Syphacia spp.
Mean ± SD
Range
5.6 ± 0.4
5–6
60.3 ± 4.2
55 – 66
37.5 ± 2.0
35 – 40
Absent
In the anterior fourth
Mean ± SD
Range
5.2 ± 0.6
4–6
137.3 ± 11.0 120 – 150
9.9 ± 1.6
8 – 12
Present
In the anterior fifth
Total body length (mm)
Cervical alae length (µm)
Cervical alae width (µm)
Lateral alae
Vulva opening from
anterior end
678.3 ± 2.2 674 – 680
688.9 ± 2.0
685 – 691
Length of cylindrical
esophagus (µm)
Planoconvex
Planoconvex
Egg shape
Egg length (µm)
59.8 ± 3.7
55 – 65
52.6 ± 2.0
50 – 55
Egg width (µm)
24.2 ± 4.4
20 – 30
27.3 ± 2.4
24 – 30
Unpaired t- test was used, *Significant at the level < 0.05.
-4-
Pvalue
0.053
0.000*
0.000*
--0.000*
-0.000*
0.024*
Table (2): The difference in measurements and morphological features between the two
groups of Syphacia spp. using SEM
First group of Syphacia spp.
Second group of Syphacia spp.
Depressed
Elevated
Cuticular collar
Less penetrating deep into the
Penetrating deep into the worm
Lateral alae
worm cuticle
cuticle
Simple until disappearing in the
Begin simple and then become
Transverse striation
posterior third
branching and interconnecting
of the cuticle
up to the tail
Narrow anteriorly and widens
No change from anterior to
Spaces between the
gradually towards the posterior
posterior end
transverse striation
end
of the cuticle
Figure Legends
Light microscopic photos:
Figure (1): Colonoscopic picture of a case with pinworms in the caecum (arrow).
Figure (2): Syphacia muris female
Figure (3): Syphacia muris female anterior end showing part of the cylindrical esophagus. Note
the round esophageal bulb which is typical of the Syphacia (arrow) (x200).
Figure (4): Syphacia muris eggs showing large pitted area on the convex egg side which
represents an operculum or hatching area (arrow) (x1000).
Figure (5): Syphacia spp. adult female, note the cervical alae (head arrow), the zigzag shaped
lateral alae running longitudinally and backward along the body (arrow) (x100).
Figure (6): Syphacia spp. female anterior region showing the cup shaped cervical alae (head
arrow) (x200).
Figure (7): Syphacia spp. female anterior region showing the cervical alae (head arrow). Note
the zigzag lateral alae (arrow) and double bulbed esophagus anterior end showing
small mouth, small sloppy cervical alae (arrow) with absent lateral alae (x200).
Figure (8): Syphacia spp. female middle region, showing the transversely striated cuticle. Note
the characteristic shape of the lateral alae (arrow) (x200).
Figure (9): Syphacia spp. female posterior half ending with a long, thin pointed tail. Note the end
of the lateral alae (arrow) (x100).
Figure (10): Syphacia spp. eggs showing the large pitted area at one pole of the eggs which
represent an operculum or hatching area (multiple head arrows) (x400).
Figure (11): Enterobius vermicularis adult male showing cervical alae (head arrow) and curved
posterior end (x100).
Figure (12): Enterobius vermicularis male posterior end showing the spicule of characteristic
spoon shape (arrow) (x400).
SEM examination of two groups of Syphacia species
Figure (13): Cephalic plate of the first group showing three lips and the depressed cuticular
collar (arrow).
Figure (14): Cephalic plate of the second group showing three lips and the elevated cuticular
collar (arrow).
Figure (15): The cervical alae width of the first group (more or less similar to the lateral alae)
(head arrow). Note the characteristic shape lateral alae (upper arrow) the vulva
(lower arrow) and the cuticular simple transverse striations.
Figure (16): The cervical alae width of the second group (thinner than the lateral alae) (head
arrow) and the characteristic shape lateral alae (arrow). Note the cuticular
-5-
transverse striations begin simple and then appear branching and interconnecting
(asterisk).
Figure (17): The lateral alae of the first group (not penetrating deep into the cuticle) are smooth
and free from transverse striations while the margins are beaded (arrow).
Figure (18): The lateral alae of the second group are penetrating deep into the cuticle (arrow).
Figure (19): The characteristic shape of the lateral alae of the first group (arrow); the space
between the transverse striations are narrow anteriorly and begin to widen
gradually (asterisk).
Figure (20): The end of middle third of the first group showing the area of maximum separation
between the transverse striations (arrow) and the free area of transverse striations
at the posterior third (asterisk).
Figure (21):The cuticular transverse striations of the second group are branching and
interconnecting (arrow).
Figure (22): The posterior end of the second group illustrating the end of lateral alae (arrow) and
the tail with simple transverse striations (asterisk).
Figure (23): The simple transverse striations of the tail end of the second group (arrow).
Figure (24): Syphacia spp. vulvar slit; note the thick margin, the two upper lips one behind and
inner than the other (arrow), and the surrounding cuticle transversely striated.
Discussion
In the present study, out of 200 patients, 25 (12.5%) were diagnosed as pinworm infection of the
genus Syphacia and 5 children had mixed infection with E. vermicularis. Pinworm infection was
directly related to the cause of abdominal pain in all cases. Pinworms have been noted in acute
appendicitis and in patients presenting with genitourinary complaints not responding to
therapies(2). Heavy infection by Syphacia causes rectal prolapse, constipation, intussusception
and fecal impaction in mice(6). Moreover, it was reported that severe cases of enterobiasis may
present with enteritis and intestinal ulceration in humans. A fatal condition was caused by
pinworm infection in chimpanzees(4). The investigators found that the pathogenicity of pinworms
tends to be more severe in an uncommon host than in its definitive host as Syphacia is mainly a
rodent pinworm. This however, may be related to the load of infection and the immunological
status of hosts.
Stool examination was negative for helminthes and protozoa, while perianal swab proved
positive only for E. vermicularis eggs. Because of their small size, Syphacia worms probably
descend unnoticed in patients' stool. Moreover, no perianal itching was encountered in older
patients(12), possibly because Syphacia females do not migrate downwards and do not lay their
eggs in the perianal area.
Investigations for the 25 patients with pinworm infection were normal apart from mild
eosinophilia (6-8%) in all cases. This was supported by the observation of Murata et al.(4).
Neutrophilia with moderate shift to the left was observed in one patient with a recto-sigmoid
nodule. This may be due to tissue-migrating worms from the intestinal lumen that may possess
enteric bacteria on their body surface or in their alimentary canals; in response to the bacterial
invasion, neutrophilia with shift to the left might occur(4).
Colonoscopic examination revealed a mucosal nodule at the recto-sigmoid junction in one case.
This agrees with Murata et al.(4) who found a large nodule in the caecum with chronic colitis in
response to E. vermicularis infection in chimpanzees. The histopathology of the recto-sigmoid
nodule revealed chronic non specific inflammation with marked eosinophilic infiltration which
suggested that the cause of this nodule was a parasitic infection(13).
Improvement of appetite and regression of the abdominal pain and distension were noticed in
patients after antihelminthic treatment. This agrees with other studies(6,14) reporting that antihelminthics are effective in eliminating a high percentage of adult pinworms.
-6-
In the present study, as detected by light microscopy, all extracted worms from patients were
gravid females and only one male. All extracted worms shared the general characters of the
family Oxyuridae; in terms of the size of the worms, mouth parts, shape of the esophagus, the
presence of cervical alae, and the prolonged caudal extremity with long pointed tail. This is in
agreement with other researchers(1,9,10) who stated that female Syphacia can be easily recognized
as a typical pinworm, with long pointed tail. Three species were identified depending on the
difference in shape of the cephalic end, cervical alae and eggs. These species are Syphacia spp.,
Syphacia muris, and E. vermicularis. Several genera and species of the family Oxyuridae were
reported to infest human beings as E. vermicularis(15), and other species of the genus Syphacia as
Syphacia muris and obvelata were reported as zoonotic parasites(16). Shaheen(17) identified three
species of the family Oxyuridae, E. vermicularis, E. gregorii and Acanthoxyurus spp. infecting
humans. Female parasites were predominantly identified in this study because they were more
available as the males usually die after female fertilization and are expelled from the host(18).
In the present study, SEM of Syphacia sp. separated it into two groups: Syphacia muris and
Syphacia species. A well-defined cuticular collar without conspicuous surface structure was
observed and the two long lateral allae were very characteristic and well developed but
longitudinal septa were lacking on the cuticle. Wiger et al (7) described the cuticular collar in the
Syphacia nigeriana as covered by cuticular bosses, and described the very characteristic lateral
allae in Syphacia pertrusewiczi from Europe with longitudinal septa on the cuticle. Marked
differences between cuticular transverse striations and the spaces between them were noted in the
first and second group while the vulval opening was surrounded by these striations in both
groups. Moreover, the Syphacia spp. had no longitudinal septa. This is in agreement with Wiger
et al (7) who stated that the structure and composition of the transverse striae may reveal
differences and characteristic features between species and those surrounding the vulval opening
are also a point of differentiation between species. Moreover, the presence or absence of
longitudinal septa on the cuticle is also important.
Detailed morphological features in the present study differ from those of other available known
species and from Acanthoxyurs as a parasite of rodents infecting human described by Shaheen(17).
The Syphacia muris female described(10) by SEM was markedly different from Syphacia spp. in
the present work. In that report, the anterior end was described as knob-like with a spongy area
located on either side of the lip region, and three fleshy bosses surrounding the mouth appeared
separated from each other by a deep depression in which the lips were extended. There were
longitudinal bands of fibrous material running allover the worm length with small papillae. In the
present work, the detailed structure of Syphacia spp using SEM illustrated some variations that
present the possibility of its being a new species not reported in the available literature; therefore,
the present specimens were designated as Syphacia spp. If this unknown specimen of Syphacia is
the result of a host transfer from rodent to human, loss of one or merging of new characters may
have occured. However, considering that Syphacia spp. is either an intermediate form (hybrid) or
not could not be completely excluded(19).
In conclusion, the detection of species of zoonotic pinworm Syphacia as human parasite can draw
the attention of parasitologists to the possibility that E. vermicularis is not the only human
pinworm in Egypt; especially that it was found in a considerable percent of patients (12.5%).
Further detailed studies by SEM to differentiate Syphacia spp. from different hosts is
recommended which will certainly result in new differentiating characters that may be used to fill
many gaps of the inconveniently described species or in the previous identified new species.
Author contribution: AE Mahmoud, RH Attia and HEM Eldeek shared in the study design,
parasitological studies and manuscript writing. L Abdel Baki and HA Oshaish selected the
patients, performed abdominal sonar and colonoscopy, shared in treatment and follow up of
patients and writing the clinical aspects of the manuscript.
-7-
References
1. Roberts LS, Janovy J. Foundations of Parasitology. Library of Congress7th ed; 2005, 445-449.
2. Burkhart A, Craig I. Assessment of frequency, transmission, and genitourinary complications of
enterobiasis (pinworms). Int J Derm; 2005, 44(10): 837- 40.
3. Sinniah B, Leopairut J, Neafie RC, Connor DH, Voge M. Enterobiasis: A histopathological study of
259 patients. Ann Trop Med Parasitol; 1991, 85(6): 625-35.
4. Murata K, Hasegawa H, Nakano T, Noda A, Yanai T. Fatal infection with human pinworm,
Enterobius vermicularis, in a captive Chimpanzee. J Med Primatol; 2002, 31: 104-8.
5. Ghazi RR, Khatoon N, Bilqees FM, Rathore SM. Syphacia caudibandata spp. (Nematoda: Oxyuridae)
from a Lagomorph host Lepus capensis Linn in Karachi, Sindh, Pakistan. Türkiye Parazitoloji
Dergisi; 2005, 29(2):131-34.
6. Kumar MJM, Nagarajan P, Venkatesan R, Juyal RC. Rectal prolapse associated with an unusual
combination of pinworms and Citrobacter species infection in FVB mice colony. Scand J Lab Anim
Sci; 2004, 31(4): 221-23.
7. Wiger R, Barus V, Tenora F. Scanning electron microscopic studies on four species of the genus
Syphacia (Nematoda, Oxyuridae). Zoologica Scripta; 1978, 7: 25-31.
8. Ogden CG. Observation on the systematics of nematodes belonging to the genus Syphacia Seurat,
1961. Bull Br Mus Nat Hist (Zool.); 1971, 20: 253-80.
9. Yamaguti S. Systema Helminthum (Vol. 3): The nematodes of vertebrates, Part 1 and 2. Interscience,
New York, USA; 1961.
10. Younis DA. Some studies on parasites of rats with special reference to these transmissible to man.
MD Thesis, Parasitology Department, Faculty of Medicine, Assiut University; 2006.
11. Hayat MA. Principles and techniques of electron microscopy. Vol 1, 2nd ed New Jersey, University
Park Presses; 1981.
12. De Ruiter H, Rijsptra AC, Swellengerebel NH. Ectopic Enterobius vermicularis variations in its
pattern. Am J Trop Med Hyg; 1962, 14: 475-80.
13. Chitwood MB, Lichtenfels JR. Identification of parasitic metazoan in tissue section. Exp Parasitol;
1972, 32(3):407-19.
14. Wescot RB. Helminthes. In: The mouse in biomedical research, New York: Academic Press; 1982,
373-84.
15. Beckman EN, Holland JB. Ovarian enterobiasis: A proposed pathogenesis. Am J Trop Med Hyg;
1981, 30: 74-76.
16. Miyazaki I. An illustrated book of helminthic zoonoses. International Medical Foundation of Japan.
Tokyo, Japan, 1991, 27: 327-31.
17. Shaheen MS. A comparative study between Enterobius vermicularis and two uncommon forms of
pinworms: first record of Acanthoxyurus as a human parasite. Assiut Med J; 2006, 30(3): 247-60.
18. Totkova A, Klobuiscky M, Molkova R, Valent M. Enterobius gregorii-reality or fiction. Bratisl Lek
Listy; 2003, 104: 130-33.
19. Jimenez-Ruiz FA, Gardner SL. The nematode fauna of long-nosed mice Oxymycterus spp. From the
Bolivian yungas. J Parasitol; 2003, 89(2):299-08.
Authors Contributions:
Abeer E Mahmoud, Rasha H Attia, Hanan EM Eldeek: Study design; Stool examination of
collected samples and perianal swab; Identification of worms; Detailed description of S. species
using SEM; Collection of references and writing of paper.
Laila Abdel Baki, Hussein Oshaish: Selection of patients and diagnosis; Abdominal sonar;
Colonoscopy and picking up of worms; Treatment and follow up of patients; Sharing in writing
the clinical aspects of the paper
-8-
‫‪Correspondence to:‬‬
‫)‪Abeer E. Mahmoud (MD‬‬
‫‪Department of Parasitology,‬‬
‫‪Faculty of Medicine, Assiut University,‬‬
‫‪Assiut, Egypt‬‬
‫‪E-mail: abeerwns@yahoo.com‬‬
‫‪Author title: Mahmoud et al.,‬‬
‫‪Short cut-title: Oxyurid Nematodes.‬‬
‫‪+‬‬
‫ديدان األكسيوريد المكتشفة بمنظار القولون للمرضى المصابين بألم فى البطن غيرمعروف السبب‬
‫عبير السيد محمود(‪ ،)1‬رشا عبد المنعم حسن عطية(‪ ،)1‬حنان الديك محمد الديك(‪ ،)1‬ليلى عبد الباقي(‪ ،)2‬حسين عبد هللا‬
‫عشيش(‪)3‬‬
‫أقسام الطفيليات(‪ )1‬وطب المناطق الحارة والجهاز الهضمي(‪ ،)2‬كلية طب أسيوط ‪،‬ج‪.‬م‪.‬ع‪ ،.‬واستشاري أمراض الجهاز الهضمي‪،‬‬
‫(‪)3‬‬
‫جامعة تعز‪ ،‬الجمهورية اليمنية‬
‫تم تشخيص بعض الديدان الدبوسية المعروفة في القوارض من جنس سيفيشيا بواسطة منظار القولون في ‪ 22‬مريض من بين‬
‫‪ ) %12.2( 222‬تم فحصهم في خالل عام من مجموعة أعمار مختلفة بقسم طب المناطق الحارة والجهاز الهضمي‪ ،‬مستشفى‬
‫أسيوط الجامعي بسبب معاناتهم من ألم وانتفاخ بالبطن غير معروف السبب لمدة تتراوح ما بين ‪ 2-3‬شهور‪.‬‬
‫تم اخذ التاريخ المرضى لكل حالة وعمل الفحوصات المعملية التى اشتملت على‪:‬‬
‫‪ .1‬صورة دم كاملة اظهرت وجود ارتفاع متوسط لخاليا االزينوفيل واظهرت ايضا خاليا النيوتروفيل مع انحياز متوسط تجاة‬
‫اليسار فى مريض واحد لدية عقدة ما بين تعريجة القولون األخيرة والمستقييم‪.‬‬
‫‪ .2‬فحص عينات البراز التى كانت سلبية الى نوع من الطفيليات‪ .‬تم عمل مسحة شرجية للمرضى الذين اشتكوا من هرش‬
‫حول فتحة الشرج والتى وجدت ايجابية لهؤالء المصابين باالنتروبيس فرميكيوالرس لخمسة أطفال‪.‬‬
‫‪ .3‬وظائف الكبد وعمل أشعة تليفزيونية وقد وجد انتفاخ في القولون‪.‬‬
‫تم إعطاء أدوية مسكنة لأللم لهؤالء المرضى لمدة ‪ 2-3‬شهور بدون استجابة للعالج مما استدعى عمل منظار قولوني لهم‪ .‬وقد‬
‫اظهر المنظار في هؤالء المرضى وجود احمرار والتهاب منتشر في جدار القولون ووجود بعض الديدان التي تسبح داخل‬
‫تجويف القولون واللتى تم التقاطها‪.‬‬
‫تم ف حص هذة الديدان بواسطة الميكروسكوب الضوئى بعد غسلها جيدا بالماء المقطر‪ ،‬ووجد انها تمثل ثالث انواع مختلفة من‬
‫عائلة االوكسييوريدى وتم الفصل بينهم من خالل بعض المواصفات الخاصة للدودة وهى االجزاء االمامية والخلفية والسطح‬
‫الخارجى للجسم ‪.‬‬
‫وبعد دراسة هذة الديدان واعطاء المواصفات القياسية والشكلية لهم‪ ،‬وجد انها تنتمى الى جنسين اساسيين من عائلة‬
‫االوكسييوريدى‪ :‬جنس االنتروبيس (االنتروبيس فرميكيوالرس)‪ ،‬جنس السيفيشيا (سيفيشيا سبيشس وسيفيشيا ميورس)‪.‬‬
‫تم استخدام الميكروسكوب الماسح االلكترونى لفحص دودة السيفيشيا سبيشس والذى اظهر نوعين مختلفين من هذة الدودة‬
‫لوجود بعض االختالفات القياسية والشكلية‪ .‬ومن خالل استخدام الميكروسكوب الماسح االلكترونى تم الحصول على بعض‬
‫المواصفات االضافية الشكلية والتقسيمية الدقيقة لالجزاء االمامية بما فيها الشفتين والغطاء الرأسى والجانبى الخطوط العرضية‬
‫للسطح الخارجى للسم‪ ،‬الفتحة التناسلية والجزء الخلفى لهذه الدودة‪.‬‬
‫‪-9-‬‬