Introduction
Vulvovaginitis is inflammation of the vulvovaginal mucous membranes (1)
that responsible of some of pediatric gynecology consultations (2).
Prepubertal girls commonly experience a gynecologic issue, which is
often characterized by symptoms such as vulvovaginal itching, discharge,
irritation, burning or skin changes. The development of these symptoms
is primarily influenced by anatomic, physiological, and behavioral
factors specific to this age group (3). Streptococcuspyogenes , Haemophilus influenzae andEnterobius vermicularis emerge as the predominant
pathogens, while fungal and viral infections exhibit lower occurrence
rates (4). The presence of genital discomfort or a burning sensation
during urination is often observed in cases of vulvovaginitis. This
condition, which is more prevalent in prepubescent girls, can caused by
a deficiency of estrogen and poor local hygiene leading to infection of
the vaginal mucosa. Despite the lack of precise data on its prevalence,
these predisposing factors are known to contribute to the development of
vulvovaginitis (3).
In addition, favor factors of development of this disease include local
alkaline pH, thin labia minora and reauctioned estrogen stimulus during
the prepubertal period results in thinning of the vulvovaginal
epithelium. Among prepubertal girls, the most common clinical
presentation is nonspecific vulvovaginitis caused by endogenous vaginal
flora (5). One of the most agents of vulvovaginitis is a parasite calledEnterobius vermicularis (E. vermicularis ) (4). This
worm exhibits the most extensive geographical distribution among
helminths (6). Its induced infection is a global phenomenon and is
recognized as the most prevalent form of helminth infection (7). This
condition is prevalent across all age groups and socioeconomic
backgrounds, although it is particularly widespread among children
between the ages of five and fourteen (8, 9). It is important to note
that parasitic infections even in children may lead to malnutrition and
decreased learning abilities (10). Embryonated eggs can be detected on
various surfaces such as fingernails, clothing, house dust and other
objects. Once these eggs are ingested, they undergo hatching within the
stomach, giving rise to larvae.
These larvae then make their way to the cecum, where they undergo
further development and eventually reach adulthood as pinworms,
measuring approximately 1 cm in length. The gravid adult female worms
exhibit a nocturnal migration to the perianal region, where they lay a
substantial number of eggs, up to 11,000 in total. These eggs become
infective within a relatively short period of time, approximately six
hours after being deposited. The lifespan of E.vermicularis typically ranges from 11 to 35 days (8).
Transmission of the infection takes place via direct transmission from
an infected individual through the oral-anal route, or through the
dispersal of airborne eggs from contaminated clothing or bed linen. Upon
ingestion, the eggs hatch and release larvae within the intestine (11).
Adult worms in girls may also infiltrate the vagina to release eggs and
consequently leading to the development of vulvovaginitis. In 1980,
Vaughan reported one of the first enterobiasis in direct observation of
vaginal region (9, 12). Moreover, these worms possess the ability to
invade the endometrial cavity, thereby inducing endometritis and
salpingitis in affected patients (9). For diagnosis collection of eggs
from infected area (anus or vagina) can be achieved through the use of
the cellophane swab or scotch tape swab method. stool examination not be
a reliable means of detecting eggs (13). Cases have been documented
wherein this worm have traversed the entire of the reproductive system
and penetrated the peritoneal cavity by means of the fallopian tubes
(9). In this paper we presented a 4 years Iranian girl that suffered of
vulvovaginitis caused by E. vermicularis . her family
infected by this parasitic helminth too.