Q: My 7-year-old daughter was embarrassing all of us by constantly scratching between her buttocks. When I took her to the doctor we were told that it sounded like pinworms. But the tape test was negative.
The doctor provided her with a lotion and told us to return if it was not better in a few days. It's been a week and it's not better. What should we do?
-- B.E., Clakesville, Tenn.
A: Follow your doctor's advice. Go back and have your daughter reevaluated, including getting another tape test.
There are five major types of intestinal parasites in the United States that can cause significant medical problems. One of those is Enterobius vermicularis (commonly called pinworms).
Pinworms are found throughout the world and have been around for a long time. They were found recently in a 2,000-year-old archaeological site in Egypt and have been found in 10,000-year-old sites in the United States.
Pinworms are about a half-inch long, and hundreds of them can be found in a single person. They typically live in the large intestine, but they may colonize the appendix and cause inflammation there. Rarely, pinworms will also migrate up a female's genital tract.
They only live in humans. They can be easily passed from one person to another by an infected person touching their anal area and then touching the next person. Because of the way they are transmitted, they are much more common in children. Multiple infections can occur in households and institutions with many children.
Many people with an infestation of pinworms don't have any symptoms. When symptoms do occur, the most common one is itching around the anus, which is most often noticed at night. Unfortunately, scratching the itch only makes it worse. It can also make it look like there is a different cause, including a bacterial infection caused by the scratching.
Because of the nighttime irritation, many people will have trouble sleeping and become irritable and restless during the day. Intestinal symptoms such as diarrhea are rarely present.
The most reliable way to diagnose a pinworm infection is to find the eggs on the skin around the anus. This is most easily done by applying a clear tape to the anus and then looking at it under a microscope. Unfortunately this test is often negative and must be redone later.
Treatment includes better hygiene with hand-washing after defecation, especially before contact with someone else or preparing food. Fingernails should be kept short to prevent damage due to scratching and to prevent the collection of eggs under the nails. Washing clothes and bedding repeatedly may be required.
There are several drugs that are taken as pills. The most commonly used is mebendazole. Everyone in the household with an infection needs to be treated. Since the drugs don't kill the eggs, the drugs need to be repeated about three weeks later to kill the newly hatched pinworms.
Although treatment is very successful, many times re-infection will occur because of contact with the original source of the infection whether inside or outside of the home.
Update on statins: The use of statins has primarily been directed at lowering LDL cholesterol. This in turn has been associated with lowering the risk of heart and blood vessel disease caused by atherosclerosis.
But more recent evidence shows that C-reactive protein may be a better predictor of cardiovascular disease. Evidence also shows that statins' benefits are greater than those expected from simply lowering LDL. This may be explained by a recent study that showed that statins also directly lower C-reactive protein.
Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.