Unmasking the role of constipation in treatment-refractory enterobiasis in Bangladeshi children.

Background: Helminthiasis remains a prevalent health issue among the pediatric population in both developed and developing countries. Recurrent enterobius vermicularis infection is a particularly distressing and sometimes embarrassing condition for children. While sporadic cases are common, repeated infections despite proper hygiene and regular deworming are uncommon and warrant further investigation.

Methods: This prospective observational study was conducted in Sylhet, Bangladesh between January 2022 and December 2024. All consecutive children presenting with treatment-refractory enterobiasis were enrolled. Comprehensive clinical evaluations and relevant investigations were performed to identify potential underlying or contributory factors. Treatment strategies were tailored accordingly, and clinical response was assessed based on symptom resolution.

Results: A total of 114 children were included, with a mean age of 88.25 ± 37.5 months and a male-to-female ratio of 1.65:1. All children presented with perianal itching and visible passage of worms (100%). Additional symptoms included abdominal pain (64%), anorexia (51%), vomiting (24%), nausea (16%), frequent small-volume defecation (9%), increased frequency of micturition (9%), nocturnal enuresis(7%), and encopresis (7%). Notably, constipation was present in 96% of cases-41% with occult and 55% with overt constipation (p < 0.0001), all of which had either been previously unrecognized or inadequately managed. Following the administration of appropriate laxative therapy along with antihelminthic therapy, significant symptomatic improvement was observed (p < 0.0001) with minimal failure rate (3%).

Conclusion: Constipation frequently coexists in patients with treatment-refractory enterobius vermicularis infections and proper management of constipation is essential for successful therapeutic outcomes.