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Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility

The most common causes of eosinophilia globally are helminth parasites. Refugees from high endemic areas are at increased risk of infection compared with the general U.S. population. It is widely accepted that eosinophilia is a good marker for helminth infection in this population, yet its absence h...

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Autores principales: Webster, Jessica L., Stauffer, William M., Mitchell, Tarissa, Lee, Deborah, O’Connell, Elise M., Weinberg, Michelle, Nutman, Thomas B., Sakulrak, Potsawin, Tongsukh, Dilok, Phares, Christina R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The American Society of Tropical Medicine and Hygiene 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128718/
https://www.ncbi.nlm.nih.gov/pubmed/35483390
http://dx.doi.org/10.4269/ajtmh.21-0853
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author Webster, Jessica L.
Stauffer, William M.
Mitchell, Tarissa
Lee, Deborah
O’Connell, Elise M.
Weinberg, Michelle
Nutman, Thomas B.
Sakulrak, Potsawin
Tongsukh, Dilok
Phares, Christina R.
author_facet Webster, Jessica L.
Stauffer, William M.
Mitchell, Tarissa
Lee, Deborah
O’Connell, Elise M.
Weinberg, Michelle
Nutman, Thomas B.
Sakulrak, Potsawin
Tongsukh, Dilok
Phares, Christina R.
author_sort Webster, Jessica L.
collection PubMed
description The most common causes of eosinophilia globally are helminth parasites. Refugees from high endemic areas are at increased risk of infection compared with the general U.S. population. It is widely accepted that eosinophilia is a good marker for helminth infection in this population, yet its absence has little predictive value for excluding infection. During an enhanced premigration health program, the CDC offered voluntary testing and management of intestinal parasites, among other conditions, to U.S.-bound refugees in Thailand. Stool specimens were tested for Ascaris lumbricoides, Strongyloides stercoralis, Trichuris trichiura, hookworms, Giardia lamblia, Cryptosporidium spp., and Entamoeba histolytica using quantitative polymerase chain reaction. Complete blood counts were performed to identify eosinophilia. Predictive values of eosinophilia for parasitic infections were calculated within nematode groups. Between July 9, 2012 and November 29, 2013, 2,004 participants were enrolled. About 73% were infected with at least one parasite. The overall median eosinophil count was 483 cells/μL (interquartile range [IQR] = 235–876 cells/μL). Compared with participants who did not test positive for any infection, higher eosinophil counts were observed in those infected with A. lumbricoides (RR = 1.3, 95% CI = 1.1–1.4), S. stercoralis (RR = 1.8, 95% CI = 1.4–2.4), Necator americanus (RR = 1.2, 95% CI = 1.1–1.4), and Ancylostoma ceylanicum (RR = 1.8, 95% CI = 1.5–2.2). Eosinophil counts were higher in younger participants (2–4 years versus 65+ years: RR = 4.2, 95% CI = 2.5–6.9), and lower in female participants (RR = 0.9, 95% CI = 0.8–0.9). Sensitivities ranged from 51% to 73%, specificities from 48% to 65%, and predictive values from 4% to 98%. The predictive value of eosinophilia is poor for the most common parasitic infections, and it should not be used alone for screening refugees.
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spelling pubmed-91287182022-06-09 Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility Webster, Jessica L. Stauffer, William M. Mitchell, Tarissa Lee, Deborah O’Connell, Elise M. Weinberg, Michelle Nutman, Thomas B. Sakulrak, Potsawin Tongsukh, Dilok Phares, Christina R. Am J Trop Med Hyg Research Article The most common causes of eosinophilia globally are helminth parasites. Refugees from high endemic areas are at increased risk of infection compared with the general U.S. population. It is widely accepted that eosinophilia is a good marker for helminth infection in this population, yet its absence has little predictive value for excluding infection. During an enhanced premigration health program, the CDC offered voluntary testing and management of intestinal parasites, among other conditions, to U.S.-bound refugees in Thailand. Stool specimens were tested for Ascaris lumbricoides, Strongyloides stercoralis, Trichuris trichiura, hookworms, Giardia lamblia, Cryptosporidium spp., and Entamoeba histolytica using quantitative polymerase chain reaction. Complete blood counts were performed to identify eosinophilia. Predictive values of eosinophilia for parasitic infections were calculated within nematode groups. Between July 9, 2012 and November 29, 2013, 2,004 participants were enrolled. About 73% were infected with at least one parasite. The overall median eosinophil count was 483 cells/μL (interquartile range [IQR] = 235–876 cells/μL). Compared with participants who did not test positive for any infection, higher eosinophil counts were observed in those infected with A. lumbricoides (RR = 1.3, 95% CI = 1.1–1.4), S. stercoralis (RR = 1.8, 95% CI = 1.4–2.4), Necator americanus (RR = 1.2, 95% CI = 1.1–1.4), and Ancylostoma ceylanicum (RR = 1.8, 95% CI = 1.5–2.2). Eosinophil counts were higher in younger participants (2–4 years versus 65+ years: RR = 4.2, 95% CI = 2.5–6.9), and lower in female participants (RR = 0.9, 95% CI = 0.8–0.9). Sensitivities ranged from 51% to 73%, specificities from 48% to 65%, and predictive values from 4% to 98%. The predictive value of eosinophilia is poor for the most common parasitic infections, and it should not be used alone for screening refugees. The American Society of Tropical Medicine and Hygiene 2022-05 2022-03-07 /pmc/articles/PMC9128718/ /pubmed/35483390 http://dx.doi.org/10.4269/ajtmh.21-0853 Text en © The American Society of Tropical Medicine and Hygiene https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Webster, Jessica L.
Stauffer, William M.
Mitchell, Tarissa
Lee, Deborah
O’Connell, Elise M.
Weinberg, Michelle
Nutman, Thomas B.
Sakulrak, Potsawin
Tongsukh, Dilok
Phares, Christina R.
Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility
title Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility
title_full Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility
title_fullStr Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility
title_full_unstemmed Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility
title_short Cross-Sectional Assessment of the Association of Eosinophilia with Intestinal Parasitic Infection in U.S.-Bound Refugees in Thailand: Prevalent, Age Dependent, but of Limited Clinical Utility
title_sort cross-sectional assessment of the association of eosinophilia with intestinal parasitic infection in u.s.-bound refugees in thailand: prevalent, age dependent, but of limited clinical utility
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128718/
https://www.ncbi.nlm.nih.gov/pubmed/35483390
http://dx.doi.org/10.4269/ajtmh.21-0853
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