{"id":10844,"date":"2023-02-03T14:00:45","date_gmt":"2023-02-03T22:00:45","guid":{"rendered":"https:\/\/www.everywomanover29.com\/blog\/?p=10844"},"modified":"2023-02-03T00:02:05","modified_gmt":"2023-02-03T08:02:05","slug":"a-case-of-enterobiasis-presenting-as-post-traumatic-stress-disorder-ptsd-i-e-a-common-and-parasitic-pinworm-infection","status":"publish","type":"post","link":"https:\/\/www.everywomanover29.com\/blog\/a-case-of-enterobiasis-presenting-as-post-traumatic-stress-disorder-ptsd-i-e-a-common-and-parasitic-pinworm-infection\/","title":{"rendered":"A case of enterobiasis presenting as post-traumatic-stress-disorder \/ PTSD (i.e. a common and parasitic pinworm infection)"},"content":{"rendered":"

\"case<\/p>\n

Enterobiasis (oxyuriasis) is a common infection in humans caused by Enterobius vermicularis (E. vermicularis), a human intestinal helminth. Because of the easy way of its transmission among people, it has an extremely high prevalence in overcrowded conditions, such as nurseries and primary schools. Oxyuriasis’s symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis.<\/p>\n

Here we report a curious case of oxyuriasis in the settings of a refugee camp in Greece. The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis.<\/p>\n

This infection is the first documented case of enterobiasis in the settings of a refugee camp and can highlight the unsanitary living conditions that refugees have to endure in those camps.<\/p><\/blockquote>\n

The above is the abstract from a 2017 paper: A case of enterobiasis presenting as post-traumatic-stress-disorder (PTSD): a curious case of the infection with predominant mental health symptoms, presenting for the first time in the settings of a refugee camp<\/a><\/p>\n

In addition to her symptoms of insomnia and irritability, she had a decreased appetite and mild abdominal (tummy) pain. She was also experiencing nausea and vomiting and had a slightly raised body temperature (subfebrile). She was severely malnourished and had lost 3kg\/6.6lbs in 5 days.<\/p>\n

Because of the violent nature of her situation she was initially seen by a psychologist but her symptoms worsened in a few days. When this young girl complained about itching in the perianal area (around her anus), the clinic reassessed her and scars around the anal area from the scratches.<\/p>\n

They then confirmed enterobiasis\/pinworm after using a piece of clear adhesive tape \u201cto collect a specimen from the perianal surface of the girl, for three consecutive mornings<\/em> \u2026 A microscopic examination showed the presence of oval shaped eggs, which is typical for the specific helminth [parasitic worm].\u201d <\/em><\/p>\n

She was treated with \u201ctwo doses of albendazole, with each dose two weeks apart, in order to avoid reinfection \u2026. And after a 3 month follow-up period, the patient remains asymptomatic without any signs of recurrence.<\/em>\u201d<\/p>\n

An overview of pinworm infections, symptoms, tape test and treatment approaches<\/h2>\n

This WebMD article<\/a> offers an overview of pinworm infections, the symptoms, the tape test and treatment approaches.<\/p>\n

As you\u2019ll read it\u2019s not only a problem in refugee camps – it\u2019s \u201cvery common in elementary school-aged children<\/em>\u201d and it\u2019s the most common kind of worm infection in the United States. \u201cMost of the time, pinworm infections don\u2019t cause serious problems.\u201d <\/em>However, when one child (or adult) gets a pinworm infection it can easily be spread to the entire family.\u00a0 The Syrian refugee paper mentions the whole family was tested.<\/p>\n

\nSystemic infection: female health issues and gut health<\/h2>\n

The WebMD authors also state, \u201cin rare cases, and especially if you have a lot of them, the pinworms can travel from the anal area up the vagina to the uterus, fallopian tubes, and around the pelvic organs. This can cause inflammation of the vagina (vulvovaginitis)<\/em>.\u201d<\/p>\n

I first learned about these serious systemic issues in women from naturopathic doctor Rachel Arthur at a conference in Australia. Contrary to the WedMD article, she believes this is not rare and more common than you\u2019d expect, contributing to hormonal imbalances and even infertility.<\/p>\n

The research confirms the impacts of pinworm on the gut, with reports of pinworm associated with appendicitis<\/a>, pinworm in the liver<\/a>, pinworms contributing to dysbiosis<\/a> and pinworm being a factor in inflammatory bowel disease<\/a>.<\/p>\n

The WebMD article doesn\u2019t mention the mental health symptoms and mechanisms but you can read more about that (and my interview with Dr. Jay Davidson) below.<\/p>\n

Annual deworming and concerns about drug resistance?<\/h2>\n

I\u2019m not going to get into anti-parasitic medications and herbal alternatives in this blog post – Dr. Jay talks about mimosa pudica seeds and Dr. Rachel recommends chondroitin sulfate – but do I want to mention that there are many public policy papers calling for annual deworming procedures for everyone. It\u2019s also mentioned in the above Syrian refugee paper, as is hand-washing for prevention.<\/p>\n

And many folks recall annual deworming concoctions as a child and did\/do the same with their children.<\/p>\n

There is, however, the concern about antiparasitic drug resistance<\/a> similar to what is being seen with antibiotics and antiviral drugs.<\/p>\n

If you are new to parasites and their impacts on mood issues, anxiety and insomnia and more<\/h2>\n

If you are new to parasites, here are some insights from an interview I did with Dr. Jay Davidson on The Anxiety Summit 5: Gut Brain Axis. The topic of our interview is – Parasites, Anxiety and TUDCA for Your Liver<\/a>. He shares this:<\/p>\n

The Greek meaning of parasite is one that sits at another\u2019s table. So essentially think of a parasite as it\u2019s taking things from you. It\u2019s taking nutrients, it\u2019s taking key things that your body needs and literally off of you, not to the point that it\u2019s killing you because then you\u2019re not a good host to give a good environment. So it\u2019s basically just kind of sucking you dry.<\/p><\/blockquote>\n

We discussed symptoms individuals may experience: mood issues, anxiety and insomnia (especially around full moon). He shared that with insomnia \u201cthe big issue that I see is restless sleep where you toss, you turn, you wake often. You can\u2019t just be relaxed when you sleep. Parasites get active when you go to bed. The more active they are within your body and the more you\u2019re trying to calm down, the more your body is getting stressed out. This is where teeth grinding happens when you sleep. <\/em><\/p>\n

This is very typical and likely the kinds of insomnia symptoms this young refugee girl experienced too. Pinworm is more active at night so the itching around her anus and the need to scratch would have affected her sleep too. This is a classic sign of pinworm.<\/p>\n

With regards to anxiety and mood issues and possible mechanisms, Dr. Jay shares how parasites contribute to neurotransmitter imbalances:<\/p>\n

Parasites will eat the protein you eat and not allow your body to break down that protein into amino acids. That\u2019s why amino acid therapy can be so beneficial symptomatically and change people\u2019s lives, because they\u2019re getting these amino acids that they\u2019re not getting when they have parasites.<\/p><\/blockquote>\n

When we digest protein, the amino acids are needed to help us make neurotransmitters. With his amino acid comments, he is making reference to my work with the amino acid tryptophan to support your low serotonin worry-type of anxiety symptoms and the amino acid GABA to support your low GABA physical-anxiety type symptoms. They are wonderful for quick relief of anxiety and mood symptoms, and even help sleep problems too. But as he says \u201cyou always want to make sure to go to the underlying cause to remove the parasitic infection.<\/em>\u201d<\/p>\n

Other symptoms of parasitic infection that we discuss at length: restless legs and calf cramping, diarrhea, bowel urgency, SIBO (small intestinal bacterial overgrowth), vertical wrinkles above your mouth, nail-biting, food sensitivities, bed-wetting and night sweats. These are all symptoms that we need to look for and then consider stool testing and\/or the sticky tape test\/clear adhesive tape test for pinworm (as mentioned in the Syrian refugee paper and WebMD article above).<\/p>\n

If you missed this interview and\/or summit, you can find the purchase link on the above blog and here<\/a>.<\/p>\n

Tryptophan is not working (possibly because of parasites) and toxoplasma gondii (and GABA\/anxiety)<\/h2>\n

Here is some additional reading on parasites on my site and in the literature:<\/p>\n