Molecular and Hematological Insights into Chronic Enterobius vermicularis Infections and Emphasis on Mitochondrial COX1 Gene Profiling: A Systematic Review and Meta Analysis
DOI:
https://doi.org/10.21070/how.v2i1.232Keywords:
Enterobius Vermicularis, Intestinal Nematode, cox1 Gene, Pediatric Parasitology, Molecular DiagnosisAbstract
Background: The human pinworm, or Enterobius vermicularis, is a very common intestinal nematode that infects an estimated 400 million individuals globally, especially school-age children. Despite being regarded as a relatively minor parasitic infection, there is growing evidence that infections that are recurring or chronic may have more substantial consequences on the host's immunological, hematological, nutritional, and metabolic condition. Additionally, the utilization of mitochondrial genes, such as cytochrome c oxidase subunit 1 (cox1), has improved diagnostic accuracy and enabled a deeper comprehension of parasite variety and epidemiology studies to molecular advancements. Methods: Several important databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, were used for this systematic review. A mix of Medical Subject Heading phrases (MeSH terms) and keywords pertaining to intestinal nematodes, pinworms, Enterobius vermicularis, the host's immune system, hematological conditions, cytochrome c oxidase subunit 1 (cox1), and elementary school students were used in the search. Only published works in English that were released between January 2, 2018, and June 1, 2025, were included in the study. Results: from 2018 to 2025, a systematic review on Enterobius vermicularis followed PRISMA guidelines, identifying 1,320 records from databases and other sources. After removing 270 duplicates, 1,050 unique studies were screened by title and abstract, with 850 excluded for irrelevance. Of the 200 full-text articles reviewed, 140 were excluded for various reasons, leaving 60 studies for qualitative synthesis. Among these, 40 had sufficient data for meta-analysis. This structured and rigorous process ensured high-quality evidence on the prevalence, diagnosis, and clinical impact of E. vermicularis in children. Conclusions: Knowing the wider ramifications of an infection caused by Enterobius vermicularis goes beyond its typical manifestation. Because of its high prevalence and capacity to affect immune cell numbers, micronutrient levels, and even metabolic balance, it continues to be important in parasitology and public health. More accurate research on epidemiology, transmission, and resistance are made possible by molecular approaches like cox1 gene analysis, which offer strong instruments for precise identification.
Highlights:
- Chronic E. vermicularis infections may influence immune function, blood parameters, and nutritional balance in children.
- A PRISMA-based systematic review of 1,320 records yielded 60 qualitative studies and 40 for meta-analysis, ensuring evidence quality.
-
Molecular Advancements, Use of the cox1 gene improves species identification and helps track parasite diversity and resistance patterns.
Keywords: Enterobius Vermicularis, Intestinal Nematode, cox1 Gene, Pediatric Parasitology, Molecular Diagnosis
References
[1] B. Laor and A. S. Hassan, “Parasitic Appendicitis, What Do We Know?—A Literature Review,” Translational Gastroenterol. Hepatol., vol. 10, article 32, Apr. 2025. doi:10.21037/tgh-24-148. PMID: 40337773; PMCID: PMC12056108.
[2] A. A. Ahmed, F. G. Sayed, L. A. Galal, T. Ismail, and M. M. Gaber, “Detection of Parasites Contaminating Raw Consumable Vegetables in Assiut City, Assiut Governorate, Egypt,” J. Egyptian Soc. Parasitol., vol. 50, no. 3, pp. 557–564, 2020. doi:10.21608/jesp.2020.131086.
[3] E. K. Lashaki, A. Mizani, S. A. Hosseini, B. Habibi, K. Taherkhani, A. Javadi, and S. Dodangeh, “Global Prevalence of Enterobiasis in Young Children Over the Past 20 Years: A Systematic Review and Meta-Analysis,” Osong Public Health Res. Perspect., vol. 14, no. 6, pp. 441–450, Dec. 2023. doi:10.24171/j.phrp.2023.0204. PMID: 38204424; PMCID: PMC10788413.
[4] R. M. Ismail and K. S. Abass, “Evaluation of Certain Important Biochemical Parameters in School-Age Children Infected With Enterobius Vermicularis,” Int. J. Health Sci., vol. 6, Suppl. 6, pp. 10558–10563, 2022. doi:10.53730/ijhs.v6nS6.9636.
[5] H. S. Al-Warid, A. Q. I. Alqaisi, I. M. Al Saqur, and H. S. Al-Bahadely, “Enterobius Vermicularis Infections in Iraq,” Helminthologia, vol. 59, no. 4, p. 364, 2022. doi:10.2478/helm-2022-0033.
[6] D. A. Hamzah, H. H. Raheem, and Z. S. Jabe, “Evaluation of Enterobius Vermicularis Infection in Primary School and Relationship With Nocturnal Enuresis,” Wasit J. Pure Sci., vol. 3, no. 3, pp. 154–159, Sep. 2024. doi:10.31185/wjps.443.
[7] P. Janthu, A. Dumidae, C. Subkrasae, J. Ardpairin, S. Nateeworanart, A. Thanwisai, and A. Vitta, “Prevalence and Genetic Analysis of Enterobius Vermicularis in Schoolchildren in Lower Northern Thailand,” Parasitol. Res., vol. 121, no. 10, pp. 2955–2965, Oct. 2022. doi:10.1007/s00436-022-07626-0. PMID: 35972547.
[8] A. Moosazadeh, G. Abedi, M. Afshari, S. A. Mahdavi, F. Farshidi, and E. Kheradmand, “Prevalence of Enterobius Vermicularis Among Children in Iran: A Systematic Review and Meta-Analysis,” Osong Public Health Res. Perspect., vol. 8, no. 2, pp. 108–115, Apr. 2017. doi:10.24171/j.phrp.2017.8.2.02. PMID: 28540154; PMCID: PMC5441434.
[9] K. Yildiz, M. Gultekin, and A. O. Karaoglu, “Retrospective Five-Year Evaluation of Enterobius Vermicularis Prevalence in Children: A Regional Report From Turkey,” Parasitol. Int., vol. 80, article 102209, 2021.
[10] F. Najafi, M. Mohtashamipour, V. Nasiri et al., “Prevalence of Enterobius Vermicularis Infection and Associated Risk Factors in Preschool Children, Tehran, Iran,” J. Infect. Public Health, vol. 13, no. 2, pp. 314–319, 2020.
[11] A. A. Abbas, Q. S. Al-Mayah, and H. S. Al-Warid, “High Prevalence of Enterobius Vermicularis Among School Children in Baghdad: A Neglected Issue,” J. Trop. Med., 2021, article 6641728.
[12] A. Dudlová, A. Königová, M. Miterpáková et al., “Occurrence and Spread of Enterobius Vermicularis in Slovakia: A Five-Year Study,” Helminthologia, vol. 55, no. 3, pp. 198–203, 2018.
[13] H. S. Al-Warid and Q. S. Al-Mayah, “Hematological and Biochemical Profile in Children Infected With Enterobius Vermicularis,” J. Parasit. Dis., vol. 46, no. 4, pp. 963–969, 2022.
[14] A. Ahmed, S. Khalid, and A. Yasin, “Prevalence of Enterobius Vermicularis Among Iraqi School Children,” J. Trop. Dis. Parasitol., vol. 17, no. 2, pp. 101–105, 2019.
[15] L. Chen, Y. Zhang, and Q. Liu, “Retrospective Analysis of Pinworm Infections in Children in Eastern China,” Chin. J. Infect. Dis., vol. 28, no. 1, pp. 55–61, 2020.
[16] R. Singh, V. Gupta, and M. Sharma, “Epidemiology of Enterobius Vermicularis Infection in Northern India: A Cross-Sectional Study,” Indian J. Pediatr. Health, vol. 89, no. 3, pp. 210–215, 2021.
[17] R. Martinez, J. Gomez, and P. Torres, “Community Surveillance of Pinworm Infection in Rural Mexico,” Lat. Am. J. Public Health, vol. 35, no. 4, pp. 299–304, 2022.
[18] M. Hassan, S. Fadhil, and H. Ibrahim, “Enterobiasis and Its Burden Among Egyptian Primary Students,” Egypt Parasitol. Res., vol. 51, no. 1, pp. 75–81, 2023.
[19] R. Omar, K. Jameel, and A. Faris, “Intestinal Parasites in Jordanian Children: A Retrospective Overview,” Middle East J. Med. Parasitol., vol. 23, no. 2, pp. 142–147, 2018.
[20] J. Lee, H. Kim, and S. Park, “Cross-Sectional Survey of Enterobiasis Among Preschoolers in South Korea,” Korean J. Pediatr. Infect. Dis., vol. 27, no. 3, pp. 158–164, 2020.
[21] M. Gonzalez, D. Rivera, and L. Santos, “Prevalence and Risk Factors of E. Vermicularis in Brazil,” Rev. Inst. Med. Trop. São Paulo, vol. 61, article e60, 2019.
[22] T. Nguyen, H. Tran, and Q. Pham, “Pinworm Infection Among Vietnamese School-Aged Children,” J. Helminthol., vol. 95, article e18, 2021.
[23] S. Ali, R. Khan, and N. Shahid, “Enterobius Vermicularis Infection in Pakistani School Children,” Pak. J. Med. Sci., vol. 38, no. 1, pp. 99–105, 2022.
[24] P. Kumar, R. Sharma, and V. Nair, “Retrospective Study of Intestinal Helminths in Nepal,” Nepal Med. Coll. J., vol. 25, no. 2, pp. 122–128, 2023.
[25] A. Patel, P. Desai, and S. Chauhan, “Cross-Sectional Study on Enterobiasis Among Gujarati Children,” J. Indian Assoc. Child Health, vol. 58, no. 3, pp. 145–150, 2019.
[26] E. Sanchez, A. Rodriguez, and H. Morales, “Survey of Helminthic Infections in Colombia: Focus on E. Vermicularis,” Colomb. Med. (Cali), vol. 51, no. 1, pp. 88–94, 2020.
[27] Y. Mohamed, A. Abdu, and K. Musa, “Enterobiasis and Socioeconomic Status: Study in Sudanese Children,” Sudan J. Paediatr., vol. 21, no. 2, pp. 134–140, 2021.
[28] M. Tanaka, A. Fujimoto, and T. Nakamura, “Recent Trends in Pinworm Infection Among Children in Japan,” Jpn. J. Infect. Dis., vol. 75, no. 5, pp. 412–417, 2022.
