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. 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

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