Enterobius vermicularis homoeopathic management- repertorial rubrics

Dr Rohith PS

INTRODUCTION
Enterobius (syn. Oxyuris) vermicularis is a human- pathogenic intestinal parasite belonging to the nema todes (Nematoda). Synonyms include “threadworm” and “seatworm.” Symptomatic pinworm infection is referred to as enterobiasis (older term: oxyuriasis). The first description of the typically configured worm eggs by the Swedish natural scientist, Carl von Linné, dates back 1758 . One can assume that Enterobius vermicularis has been successfully established as a parasite in the host organism since the evolution of human hominids. Fossil findings confirm that their co-existence stretches back over many thousands of years (7–9). The distinguishing feature of these worms is their eponymous “thread-like” appearance .The females are 9–12mm long with a diameter of approximately 0.5 mm, while the males are shorter (3–5 mm) but visible to the naked eye. Striking whitish-beige in color, they are typically round in shape and move with a vigorous worm-like crawling motion. The head section is rounded and contains a muscular esophagus and bulb in females, the tail section is narrow and sharply tapered. The extensive uterine re- productive system of the fertilized female worm is often completely filled with eggs (>10 000/worm) . Like all nematodes, E. vermicularis has a thick outer protective covering (cuticle). The double-layered, elongate-oval eggs are 50–60 × 25 μm in size, translucent, and asymmetrical in shape (“slice of bread” shape). The first larval stage in the egg can often be well visualized. The parasite eggs are able to survive for a number of days outside the body (tenacity).

Life Cycle.
Enterobius vermicularis has a simple direct life cycle which takes place in the gastrointestinal lumen. Infection occurs via oral ingestion of infective eggs the larvae contained in the eggs become infective within as little as 4–6 h following oviposition. Once in the digestive system of the host organism, the external membrane of the eggs softens.

CLINICAL FEATURES
Approximately 40% of affected individuals are oligo or asymptomatic . If autoinfection does not occur, pinworm infection is self-limiting due to the short life span of adult worms . The main symptom of infection is pronounced perianal pruritus, which occurs primarily at night time while the affected individual sleeps. This can lead to disturbed sleep, childhood enuresis (in up to 53% of cases) and impaired concentration during the day . In some cases, childhood developmental disorders have been linked to enterobiasis .

Scratching in the perianal region can cause ulceration (excoriation) that shows a tendency toward bacterial superinfection. Anal dermatitis, perianal folliculitis, or ischiorectal abscess may develop. Very rarely, pinworms also migrate to the vaginal area, where they can cause vulvovaginitis or be indirectly responsible for urinary tract infections due to adherent enterobacteria such as Escherichia coli. The role of E. vermicularis in relation to the pathogenesis of some cases of acute appendicitis has been the subject of controversy for many years, despite the fact that no causality has been reliably demonstrated .

Extraintestinal infection patterns in the vagina, urinary bladder, peritoneum, kidneys, liver,  and eye have been described in isolated cases . Enterobiasis can sometimes also overlap with  the clinical picture of chronic inflammatory bowel disease . Invasive systemic infections do  not occur even in severely immunosuppressed patients. Alongside the intense itch, the disease  is also characterized by marked psychosocial strain.

DIAGNOSIS
Stool microscopy is not a helpful diagnostic tool, since the worm eggs are deposited outside the intestine. Serological methods are of no diagnostic relevance. Similarly, neither blood eosinophilia nor elevated immunoglobulin E levels are generally expected due to the low invasiveness of the worms.

NIH SWAB
Named after national institute of health ,USA

Has been used widely for collection of specimens. This consist of a glass road at one end of which a piece of transparent cellophane is attached with a rubber band . cellophane part is used for swabbing by rolling over the perianal area. It is returned to the test tube and sent to the laboratory, where the cellophane piece is detached , spread over a glass slide and examined microscopically.

CELLOPEAN TAPE TEST
The cellophane tape test or scotch tape test or cellulose tape test

The tape is folded sticky side out over the end of a slide or tongue blade, pressed firmly against the perianal area and then spread on a glass slide and examined under the low power of a microscope. The swab should be taken by the patient on 3 to 5 consecutive morning ,before bathing and brought to the laboratory for examination . About 50 percent of the infections are usually detected by single examination, 90 percent by three examinations and 99 percent by 5 consecutive examinations.

The ova can also be discovered from nail washing, bed linen and inanimate objects in the patient‘s  room .occasionally eggs are found in the urine deposit, duodenal aspirate and papain colour smear taken from vagina.

PREVENTION AND CONTROL
Complete eradication of pinworm infection from a population is virtually impossible. Careful personal hygiene is most effective means of control. Finger nails should be cut short and hands should be washed thoroughly after the toilet is used and before food is eaten or prepared since it is most prevalent in urban areas where relatively large population inter mingle, education of parents has proven most effective parent should be informed that it is a self limiting, nonfatal infection wide spread among children and that no social stigma should be attached to it. There is no evidence that dogs can transmit the infection. Infected children as well as other members of the house hold should be treated promptly. Bedclothes and towels from infected homes should be carefully laundered in hot water and aired in sunlight.

1. Children should keep their finger nails short.
2. Frequent hand washing before meals and after defecation.
3. Good personal hygiene.
4. Treatment of infected case and all other members in the family or institution.
5. Fingers should not be put in mouth, as a habit.
6. Ordinary washing of bedding will usually kill thread worm eggs.

Total prevention is neither realistic nor possible. It is also recommended that children sleep in closed garments. Sun and UV lamp radiation will destroy the eggs in the environment. However the level of chlorination done in swimming pools may not kill  the eggs.

REPERTORY ASPECT OF ENTEROBIUS VERMICULARIS

KENT REOERTORY

RECTUM WORM, sensation of. (See Crawling.)

Complain’s: Acon., all-c., ars., calc., carb- v., chim., cic., Cina, dol., ferr., fil., graph., ign., merc., nat-m., nat-p., nux-m., nux-v., petr., ruta, sabad., sec., sil., sin-n., Spig., spong., squil., stann., Sulph., ter., teucr., verat.

Ascarides: Abrot., acet-ac., acon., agn., ant-t, ars., asar., Bar-c., bar-m., calc., carb-s., chin., cina, crot-t., cupr., ferr., ferr-m., graph., grat., ign., gran., indg., mag-c., mag-s., merc., Nat-m., nat-p., nux-v., phos., plat., rat., Sabad., sep., sil., sin-n., spig., spong., squil., sulph., tell., Ter., teucr., thuj., urt-u., valer.

Lumbricoides: Acon., all-s., anac., ars., asar., bar-c., bell., calc., carb-s., cic., cham., chel., Cina, ferr-s, gran., graph., hyos., kali-c., lyc., mag-c., merc., nat-m., nux-v., rhus-t., ruta, sabad., sec., sil., Spig., stann., Sulph., ter.

Taniæ Ail., arg-n., Calc., carb-an., carb-s., carb-v ,chin., cupr., fil., form., frag-ves., graph., grat., kali-c., mag-m., merc., nat-c., nux-v., petr., phos., plat., puls., sabad., sep., sil., stann., sulph., ter., thuj.

HOMOEOPATHIC MEDICAL REPERTORY DR.MURPHY

FEVER
WORM, fever – acon., ambr., anac., ars., asar., bell., calc., calc-p., chin., cic., CINA, dig., ferr., fil.. graph., hyos., ign., indg., ip., kali-c., merc., nat-m., nux-v., passi., petr., phos., plat., puls., ruta, sabad., sabin., sant., sil., spig., spong., stann., stram., sulph., teucr., thuj., valer. Excitable, and restless, boy – CINA, stann.

Intestinal, inflammation and diarrhea – merc.

Slow, chronic form in scrofulous children, with Large bellies, and sweat about head-CINA,sil.

CHILDREN
WORMS, children, in, (see Intestines, chapter)-calad., CALC., calc-p., carc., chin., cic., CINA, dol., gaert., graph., ign., lyc., NAT-P., nux-m.,nux-v., ruta, sabad., sant., sil., SPIG., sulph.

Behavior, problems, from – calc., carc., CINA, Gaert., nux-v.

Dentition, with constipation – dol.

Difficult –SIL

Headaches, from calc., chin., CINA, graph., – nux-v., plat., sabad., sil., spig., sulph.

Masturbation, with – calad., cina.

Nightmares, with – calc, cina.

CONVULSIONS
Worms, from-art-v., asaf., bar-m., bell., cham.. cic., CINA, cupr., cupr-o., hyos., ign., indg., kali-br., sabad., sant., sil., spig., stann., stram., sulph., tanac., ter., teucr.

WORM, sensation, writhing along in-calad.

INTESTINES
WORMS, parasites, general-acon, aesc., all-c.. all-s, ambro, apoc, apoc-a.. arg-n, ars., art-v.. bapt, bell, calad.. CALC.,calc-p, carb-v carc, chelo, chin, cupr-acet,cupr-o,,cic., CINA, dol.. ferr, ferr-m., ferr-s.. fil., gaert, gran., graph.. helm., ign, indg., ip., kali-m., luna, lye, med.. mere, mere-e, morg..naphtin., NAT-M., NAT-P., nux-m., nux-v.. passi.. petr., podo., puls., quas., rat., ruta, sabad., sant., sec, sil, sin-n., SPIG., spong, squil.stann., SULPH., sumb,,ter, teucr., tub, valer, verat., viol-o., viol-t.

Ailments, from worms, parasites-art-v.. carc..chin..cina

Nerves and eyes, complaints-art-v., cina.

Ancylostomiasis-carb-tcl., chen-a., thymol.

Ascarides abrot., acet-ac., acon, aescagn ant-c., ant-t, ars., asar., ase-t., BAR-C., bar-m, calc., carb-v., carba-s., chelo, chin.. CINA, croto-t, cupr., dig, dol,. ferr., ferr-m gran., graph., grat., hyos, ign., indg., ip kali-chl.,lyc., mag-c.,mag-s., mere.. merc-d.. naphtin, NAT-M.,nat-p., nux-v.petr.. phos… pin-s, plat., ptel., rat., SABAD., sant., scirr., sep., sil., sin-n., spig., spong, squil, stann.. sulph, tell.. TER., teucr, thuj, urt-u., valer, viol-o.

Female genitalia cina, ferr., SABAD., sil, sulph.

Bilharziasis, (see schistosomiasis)

children, in art-v, calad, CALC. cic,CINA, gaert, ign, NAT-P,nux-v, ruta, SPIG.

Dentition, diffient-SIL

Constipation, with ;dol

Masturbation, with calad

Convulsions, with cic cina, indg

 headache, causes calc, chin, cina, nux-v, plat, sabad, sil, sabad, spig sulph.

 Hookworm carb-tct, card-m, chen-s, cina,cup,thymol

Itching, frum calc, calc-f. Chin, cina, ferr..,Ign, nat-p, sabad, sin-a, teucr, urt-u

Lumbricoides; acon, all-s, anac, ars, asar,ant-v, bar-c,.bell,calc,carbn-s ,.cic, cham, chel, CINA, ferr-s, gran, graph, hyos ,kali-c., lyc.. mag-c.. merc, nat-m, nux-v, ruta, sabad, sec sil, SPIG, stann SULPH, ter.

Oxyuris, vermicularis-ars, bapt, chelo., cina, ign, indg, lyc, merc-d, merc-s, nat-p ,rat ,sant, sil, sin-n, spig, teuer, valer.

Schistosomiasis, bilharziasis ant-t, ars, Chin., ip

 tenine ail, arg-n, CALC., carb-an, carb-v, carbo-s, chin., cina, cupr., cupr-acet. Cur. fil, form, frag, gran., graph., grat., kali-c kali-i, mag-m., merc, nat-c., nat-s, nux-v ,petr., phos… plat., puls, sabad, sant., sep., sil, stann., sulph, ter, thuj., valer.

Trichinae, trichinosis-ars, bapt, cina

weakness, from calc, care, chin., cic.,CINA, merc.

BOGER BOENNINGHAUSEN’S CHARACTERISTICS REPERTORY

HEARING

Worms in ears: Rut.

NAUSEA AND VOMITING

Worms, from: Aco., bell., carb-v., chin, CINA. Ip., lach.. Merc., Nux-v., Pul., SUL.

ABDOMENaggravation

Worms, from: Aco., asar., bell., Cic.. CINA, fer., hyo., ign., lach., Mar… Merc., nux-m., nux-v., rut., Saba., SPI., sul., val., ver-a

STOOL

Worms, emaciation, in with: Bar-c.. cake, CINA. Grap., lyc., nat-m., Spi., Sul.

Full moon at;calc-c.,chin,.cina,.fer.,sul.

Lumbricoids, with: ACO., Anac., ars., bar-c bell., bor. Calc-c., caus., Cham, chin., Cic.. CINA, colo., Grap., hyo, iod.. kali-c., lyc., mag-c.. mag-m.. MERC.. Nat-m., nux-m., nux-v., petr., pho.. Rhus-t.. rut., SABA., Sec-c., sil, Spi., Sul, Thu.

Pinworms: Aco., alu.. amb., arg-n., asar., CALC-C., CHIN., CINA, colch… croc., cup.. dig., FER., Grap., hyo.. IGN.. kali-c.. mag-c., MAR. MERC. Nat-c., nux-m., Nux-v.. petr.. Pho… plat, rhus-t.. saba., sabi., scil, sep, Sil.,spi,. spo., SUL., val., zin.

Tapeworm, with: Ag-c., alu., amb., anac.. ars, CALC-C., carb-a., Carb-v., caus ign., kali-e., lau.. lyc.. mag-m,.mar ,.chin., cina, cof., colch., croc., GRAP.. MERC.. nat-c., nat-m., nat-p., nat-s.. Nux-v., Petr., Pho., PLAT, PUL.. thus-t.. SABA.. sabi., sep., SIL. Sp. Spo., Stan., SUL., val., zin.

BOERICKE’S REPERTORY
WORMS: Remedies in general: Aesc., Ambro., Apoc-a., Ars., Bapt., Bell., Calad, Calc., Chelo, Cic., Cina, Cupr-act., Cupr-ox., Ferr-m, Ferr-s Fil., Gran., Ign., Indg., Ip., Kali-m., Kuo., Lyc., Merc-c., Naphtin., Nat- p., Passi., Puls., Quas., Rat., Sabad, Santin., Sil., Spig, Stann, Sulph., Sumb., Ter., Teucr., Verat., Viol-o.

Ascaris lubricoides: Abrot., Aesc., Ant-c., Calc., Chelo., Cina, Ferr., Gran., Helm., Ign., Indg., Kali-chl., Lyc., Merc-d., Naph., Pin-s., Sabad, Santin., Spig., Stann., Sulph., Ter., Teucr., Urt-u.

Oxyuris vermicularis: Ars., Bapt., Chelo., Cina, Ign., Indg., Lyc., Merc., Merc-d., Nat-p., Rat., Santin., Sil., Sin-n., Spig., Teucr., Valer.

Taenia: Arge, Carb-v., Cuc-p., Cupr-act, Cupr-ox., Fil., Gran, Graph.,Kali-i, Kam., Kuo, Mag-m., Merc., Pellin, Phos, Puls., Sabad., Sabin.,Santin., Stann., Sulph., Ter., Valer.

Trichnae: Ars, Bapt., Cupr-ox.

REFERENCE

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Dr Rohith PS
PG Scholar Department of Paediatrics
Government homoeopathic medical Bengaluru