台灣地區罕見的成人糞便發現蟯蟲活體案例報告

A rare case: the living Enterobius vermicularis in adult feces in Taiwan

陳冠之(Kuan-Chih Chen) ； 張錦標(Jin-Biou Chang) ； 楊秉恆(Bing-Heng Yang)

《中華職業醫學雜誌》 25卷1期 (2018/01) Pp. 43-47

摘要

本案例為台灣地區罕見的成人糞便發現蟯蟲活體案例。病患為外籍男性33歲學生，兼任幼稚園英文老師。106/01/9因精神疾病至本院就醫(病歷號:2425XXX)後，因感覺不適陸續至本院診療。於106/01/20因失眠掛感染及熱帶醫學科再就醫，病患自訴糞便中有白色的物體，醫師申請糞便寄生蟲檢驗。106/01/21病患因持續的失眠3天再掛急診就醫治療，初步糞便鏡檢結果並無發現蟲卵於濕片中，但在目視糞便檢體前端有白色物體，進而觀察糞便檢體的白色條狀物移至玻片下鏡檢，判斷為蟯蟲(Enterobius vermicularis)活體，此雌蟲肉眼可見約0.5公分長，並在鏡檢下雌蟲正在排卵，機率低且十分罕見。文獻指出：蟯蟲感染好發於5-14歲之幼童，依蟯蟲的產卵特性，糞便檢查蟯蟲卵的陽性率較低，最常用檢查方法為玻璃膠帶肛圍擦試法，在早上剛起床及排便前採樣，三次檢出率達90%以上。但在成人並無標準採樣方法，本科檢驗室建立標準作業指引，提升成人蟯蟲感染陽性檢測率。

關鍵字

糞便 ； 蟯蟲活體 ； 玻璃膠帶肛圍擦試法

並列摘要

This is a rare case of living Enterobius vermicularis found in adult feces in Taiwan. The patient is a 33-year-old foreign male, who is a part-time English teacher at kindergarten. On 01/09/2017, he visited our hospital due to mental illness (medical history: 2425XXX). However, he still felt discomfort so that he continued follow-up at out-patient department. On 01/20/2017, he made an appointment at tropical and infectious clinic due to insomnia. The patient said that some white objects were found in stool sample, so that doctor applied for fecal parasite test. On 01/21/2017, the patient went back to emergency department because of persistent insomnia for three days. Initially, no parasite egg was found in the wet slide at microscopic examination, but some white objects were visible at visual examination of the feces. When the medical technologist took the white strip-shaped object on the slide and inspected with microscope, the diagnosis of Enterobius vermicularis was definitely confirmed. This female worm was 0.5 centimeters long and visible to naked eyes. This worm was laying of eggs under the microscopic examination, whose probability is extremely low. According to review of literature, pinworm is prone to infect 5-14 years old children. Based on the characteristics of pinworm ovulation, the fecal examination of pinworm's egg reveals low positive rate. Instead, the most used test is to wipe glass-tape around the peri-anal area when the patient just gets up in the morning and before defecation. As the tests are repeated for 3 times, detection rate can be as high as 90%. However, there is no standard sampling method in adults. We are dedicated to establishing the standard guidelines to elevate the positive detection rate of pinworm in adults.

並列關鍵字

feces ； living Enterobius vermicularis ； glass tape test