Newsletter from Penn Elm Medical Group

Penn Elm Medical Group
488 E. Valley Parkway
Suite 411
Escondido, CA 92025
(760) 745-2000

NEWSLETTER: March 2006

NEWS YOU CAN USE
Pinworms, an Easily Treated but Persistent Infection
BALTIMORE, October 27, 2005 - One of the prices of having children is pinworm (Enterobius vermiculari), a small white intestinal parasite that makes the human colon and appendix its home. The pinworm is generally innocuous, though insidious and persistent. During the night, while an infected person sleeps, a female pinworm creeps from the anus and deposits eggs on the surrounding skin, perhaps 10,000 of them. Then she dies.

Pinworms mature quickly, over approximately six hours, and by the time a person awakes, the worms are infective. Pinworm can race through a household, and every member should be treated. Pinworm infection, enterobiasis, is the most common nematode parasitic infestation of humans in the United States. According to the CDC, up to 50% of all children have been infected at some point in their lives. Schools and daycare centers can be hotbeds for infection.

There is no thought of even trying to eradicate it from society. So we live with it. Julia McMillan, M.D., a professor of pediatrics at Johns Hopkins here, likens pinworm's persistence to a common cold that drags on and on. Why some children may be more susceptible to pinworm infection than others is unclear. Dr. McMillian says it's more likely that behavioral factors are putting certain children at greater risk than others, not genetic susceptibility. "As long as there are people around who are infected," Dr. McMillan says, "they can spread the infection to other people."

Pinworms are about the length of a staple—5 mm to 10 mm—The eggs can infect within a few hours after landing on the skin. The eggs begin to lose infectivity after one to two days under warm and dry environmental conditions but may survive more than two weeks in cooler, more humid environments on clothes, particularly underwear and bedding.

Dr. McMillan is a member of the infectious disease committee at the American Academy of Pediatrics. She says young children with curious fingers are at the greatest risk of infection. They are the ones who are most likely to eat dirt or not wash their hands after using the bathroom. Or they touch a contaminated surface and then put their fingers in their mouths. And then it can spread throughout the household. "As long as people are infected they can transmit the infection through eating dirt and direct contact," she says. "It's like having bacteria on the surface of your skin. We can't prevent that from happening and occasionally it results in infection." Ingestion is the most common route of infection, however, a study in the October issue of International Journal of Dermatology suggests infection may also occur, primarily among children, from inadequate hand washing, inhalation, or ingestion of airborne pinworm eggs.

The most obvious symptom is anal itching, which can be worse at night and disturb sleep, caused by the pinworm's nocturnal peregrinations. Severe symptoms can include loss of appetite, restlessness and sleeplessness. Children can also become irritable. However, pinworm infection doesn't always cause symptoms, so many children and adults who become infected are asymptomatic and may be unknowingly spreading the infection, Dr. McMillan said.

There is a test parents can use to determine whether their child is infected, according to the CDC. It is a homespun technique called the Scotch tape test where parents apply the adhesive side of the tape to the anal area. The eggs become glued to the sticky tape and can be identified under a microscope.

There are three oral drugs that are primarily used to treat pinworm. Two prescription antiparasitic drugs, Mebendazole and Zentel (albendazole), both work by blocking glucose from the worm. They are both well tolerated with a cure rate of 95% to 100%. These drugs should be avoided during pregnancy. Another drug, Pyrantel Pamoate, works differently. It paralyzes the worm, which is then expelled from the body. It has a cure rate of only 90% and has a higher rate of side effects. For these reasons, it is used less frequently.
Patients take one capsule of Mebendazole once, and then a second capsule a week later to ensure the worms and eggs have been killed and to help prevent recurrences due to reinfection. The CDC said children can return to school or daycare while on the treatment. If a pinworm infection recurs, the same course of treatment is repeated.

Recommendations from the CDC that may help reduce the spread of infection:

Bathe in the morning to reduce egg contamination.

Change and wash the patient's underwear everyday. Also frequent changing of sleepwear is recommended. This is especially important after each treatment.

Pinworm eggs are sensitive to sunlight. Open blinds and curtains in the bedrooms.

Wash bedding because the eggs can survive on cloth for up to two weeks.

Enforce personal hygiene. Wash hands after using the toilet, changing a diaper, and before and after eating.

Discourage children from nail biting and keep children's fingernails trimmed because the eggs can survive on the skin. This also discourages the child from scratching the anal area and helps reduce the spread of infection.
While bathing, personal hygiene, and keeping clothes and bedding clean can help minimize infection, keeping the house spotless won't really make much of a difference. This has puzzled many parents who question how pinworm infection could thrive when they were keeping an immaculately clean house.

Moderate Exercise May Improve Arthritis of the Knee
MALMO, Sweden, October 28, 2005 - Moderate exercise for those with cartilage damage may ward off osteoarthritis of the knee, one of the banes of aging, researchers here reported. Such exercise aimed at better neuromuscular control, strength, and aerobic capacity appears to build up knee cartilage, and loss of cartilage is the hallmark of the structural changes in the knee in osteoarthritis, said Ewa Roos, Ph.D., of the Malmo University Hospital.

Although moderate exercise improves symptoms, many patients avoid it because they fear an increased loss of cartilage, Dr. Roos and her colleague, Leif Dahlberg, M.D., Ph.D., also of Malmo University Hospital, reported in the November edition of Arthritis & Rheumatism. That may mean that the symptomatic improvements reported by osteoarthritis patients who exercise are in fact a result of better cartilage, he said.

The study said nothing about the long-term effects of exercise on cartilage, but in the short term, the participants who worked out had improved content in their cartilage, combined with less pain and better function.

Most Over-the-Counter Cough Remedies Have No Value
NORTHBROOK, IL, January 10, 2006 - "Just say no" to over-the-counter cough remedies, according to new guidelines issued by the American College of Chest Physicians (ACCP) here. "There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough," said guidelines chair Richard S. Irwin, M.D., of the University of Massachusetts Medical School in Worcester, MA. The guidelines were published as a supplement to the January issue of Chest.

Products containing the expectorant guaifenesin or the cough suppressant dextromethorphan, or both, don't treat the underlying cause of cough, the guidelines noted. Instead, adults with acute cough or upper airway cough syndrome (also known as postnasal drip syndrome) should be treated with a decongestant and/or a first-generation antihistamine such as Benadryl (diphenhydramine). "There is considerable evidence that older-type antihistamines help to reduce cough, so, unless there are contraindications to using these medicines, why not take something that has been proven to work," Dr. Irwin said.

The new guidelines are a comprehensive set of recommendations for the diagnosis and management of cough in both children and adults, and include more than 200 specific recommendations for dealing with cough related to conditions ranging from the common cold to chronic airway disease. For example, the guidelines strongly recommend against the use of OTC cough and cold medications in children 14 years-old and younger. "Cough is very common in children. However, cough and cold medicines are not useful in children and can actually be harmful," Dr. Irwin said. "In most cases, a cough that is unrelated to chronic lung conditions, environmental influences, or other specific factors, will resolve on its own."

The ACCP says that nearly 30 million of the estimated 829 million annual visits to office-based physicians in the United States are for cough. Common causes of chronic cough include upper airway cough syndrome, asthma, gastroesophageal reflux disease (GERD), smoking, and side effects from medications (e.g., ACE inhibitors for high blood pressure).

IMPORTANT ANNOUNCEMENTS
Time for a Check Up?
Now that flu season is ending, this is a great time to get yourself scheduled for annual physicals and Pap Smears before Spring and Summer events occur! Call our office at 760-745-2000 to make an appointment with your doctor.

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