1. Saglam, Osman MD
  2. Ozask, Isl MD
  3. Karakurt, Nermin MD
  4. Dogan, Zeynal MD
  5. Kekilli, Murat MD

Article Content

Dear Editor,


Attention to hygiene rules to reduce the development of infections in intensive care units (ICUs) is important (Helder, Brug, Looman, van Goudoever, & Kornelisse, 2010). Enterobius vermicularis is an intestinal helminth that is transmitted by eating eggs containing larva. In this case, we report autoinoculation of Enterobius vermicularis from the patient's diaper to her nose.


An 85-year-old woman was admitted to the hospital with end-stage liver disease. She was intubated because of increased respiratory distress. After intubation, she was placed on mechanical ventilation due to pneumonia and sepsis and transferred to the ICU. She had a diagnosis of liver disease caused by hepatitis B virus 8 years ago. We distinguished worms in her nose a week after ICU which were localized in her nares on intranasal examination (Figure 1). There were no worms in the oropharynx.

Figure 1 - Click to enlarge in new windowFIGURE 1. Worms were found to be localized in the perinasal areas.

Enterobius vermicularis in nasal colonization is rare. We found only one case in the literature for nose colonization (Kaniyur et al., 2005). Enterobius vermicularis colonized in the nose was not an expected finding in our patient.


In ICU patients, the most effective way to provide protection against both bacterial infections and infestations is paying attention to the rules of hygiene. To prevent transmission of microorganisms, hand hygiene is the most important step. The use of gloves is critical to nurses and doctors in terms of self-protection (Pittet, 2001). Using the same glove after contact with infected areas in patients may cause autoinoculation. In this case, we report autoinoculation of Enterobius vermicularis from the patient's diaper to her nose.


We believe changing gloves while touching different body parts of the patient is essential for the patient's hygiene.


Osman Saglam, MD


Is[latin dotless i]l Ozas[latin dotless i]k, MD


Nermin Karakurt, MD


Department of Internal Medicine


Ankara Training and Research Hospital


Ankara, Turkey


Zeynal Dogan, MD


Murat Kekilli, MD


Department of Gastroenterology


Ankara Training and Research Hospital


Ankara, Turkey




Helder O. K., Brug J., Looman C. W., van Goudoever J. B., Kornelisse R. F. (2010). The impact of in education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: An intervention study with before and after comparison. International Journal of Nursing Studies, 47(10), 1245-1252. [Context Link]


Kaniyur V., Chandra Prasad K. H., Devan P. P., Doddamani S. S., Balachandran B., Kulkarni V. (2005). Enterobius vermicularis in the nose: A rare entity. Indian Journal of Otolaryngology and Head & Neck Surgery, 57(2), 148-150. [Context Link]


Pittet D. (2001). Improving adherence to hand hygiene practice: A multidisciplinary approach. Emerging Infectious Diseases, 7(2), 234-240. [Context Link]