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Thomsen GN, Christoffersen MN, Lindegaard HM, Davidsen JR, Hartmeyer GN, Assing K, Mortz CG, Martin-Iguacel R, Møller MB, Kjeldsen AD, Havelund T, El Fassi D, Broesby-Olsen S, Maiborg M, Johansson SL, Andersen CL, Vestergaard H, Bjerrum OW. The multidisciplinary approach to eosinophilia. Front Oncol 2023; 13:1193730. [PMID: 37274287 PMCID: PMC10232806 DOI: 10.3389/fonc.2023.1193730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty-e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.
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Affiliation(s)
| | | | - Hanne Merete Lindegaard
- Department of Rheumatology, Odense University Hospital, Denmark; Research Unit for Rheumatology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | | | | | - Anette Drøhse Kjeldsen
- Department of ORL- Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Troels Havelund
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Daniel El Fassi
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | - Michael Maiborg
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Odense University Hospital, Odense, Denmark
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Ananchaisarp T, Chamroonkiadtikun P, Julamanee J, Perdvong K, Chimpalee T, Rattanavirakul N, Leelarujijaroen N, Hathaipitak T, Tantinam T. Prevalence and management of eosinophilia based on periodic health examinations in primary care clinics. ASIAN BIOMED 2022; 16:273-282. [PMID: 37551315 PMCID: PMC10321192 DOI: 10.2478/abm-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background Eosinophilia is a common, hematologic abnormality detected in periodic health checkups with diverse etiologies. There are a few clinical practice guidelines for the management of eosinophilia. Objectives To determine the prevalence of eosinophilia among patients undergoing periodic health examinations, evaluate its management and outcomes, and identify its associated factors. Methods We conducted a retrospective study that included patients with eosinophilia diagnosed during the 2018 periodic health examinations at Songklanagarind Hospital. Results The prevalence rate of eosinophilia was 9.6% (988/10,299), and most patients (52.6%) were male with a median age of 53.0 (42.0-61.0) years. Only 174 patients (17.6%) were diagnosed and further examined to identify the cause of eosinophilia; including an examination of medical history (18.4%), physical examination (93.1%), laboratory analysis (9.2%), and consultation with internists (14.9%). Empirical anthelmintic therapy was administered in 130 patients (74.7%), and 49.2% achieved resolution. The possible causes of eosinophilia were identified in 20.7% (204/988), the most common cause being atopic disease (51.5%). Patients with moderate-to-severe eosinophilia were significantly more likely to be diagnosed, undergo further laboratory tests, and proceed with consultations with internists (adjusted OR [95% CI] = 3.52 [1.97-6.32], 17.13 [5.74-51.11], and 6.38 [1.95-20.93], respectively). Conclusions Eosinophilia is commonly identified in periodic health examinations, and most primary physicians lack knowledge regarding the diagnostic work-up required to determine the cause of eosinophilia. Empirical anthelmintic therapy showed satisfactory efficacy for the management of eosinophilia in areas where parasite infection is endemic.
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Affiliation(s)
- Thareerat Ananchaisarp
- Division of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla90110, Thailand
| | - Panya Chamroonkiadtikun
- Division of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla90110, Thailand
| | - Jakrawadee Julamanee
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla90110, Thailand
| | - Kewalee Perdvong
- Faculty of Medicine, Prince of Songkla University, Songkhla90110, Thailand
| | - Thitawan Chimpalee
- Faculty of Medicine, Prince of Songkla University, Songkhla90110, Thailand
| | | | | | | | - Thanarat Tantinam
- Faculty of Medicine, Prince of Songkla University, Songkhla90110, Thailand
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Bustamante J, Sainz T, Montojo FA, Almirón MD, Subirats M, Vega DM, Mellado MJ, López-Hortelano MG. Screening for parasites in migrant children. Travel Med Infect Dis 2022; 47:102287. [PMID: 35304329 DOI: 10.1016/j.tmaid.2022.102287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/26/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Globalization has pushed population movements in the last decades, turning imported diseases into the focus. Due to behavioral habits, children are at higher risk of acquiring iparasitosis. This study aims to investigate the prevalence of parasites in migrant children and factors associated with parasitic diseases. METHOD Retrospective cross-sectional study (2014-2018) including children diagnosed with parasitosis. The diagnosis was based on serology and/or microscopic stool-sample evaluation. Epidemiological and clinical data were recorded. RESULTS Out of 813 migrant children screened, 241 (29.6%) presented at least one parasite, and 89 (10.9%) more than one. The median age was 6.6 years (IQR: 3.1-11.9) and 58.9% were males. Most cases were referred for a health exam; only 52.3% of children were symptomatic, but 43.6% had eosinophilia. The most common diagnosis were giardiasis (35.3%), schistosomiasis (19.1%), toxocariasis (15.4%), and strongyloidiasis (9.1%). After the multivariate analysis, African origin and presenting with eosinophilia were the main risk factors for parasitism. CONCLUSIONS parasitosis are frequent among migrant children. Children are often asymptomatic, and thus active screening for parasitosis should be considered among high-risk populations. Eosinophilia can be useful to guide complimentary tests, as well as geographical origin, but normal eosinophil count does not exclude parasitosis.
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Affiliation(s)
- Jorge Bustamante
- Department of Pediatrics, Hospital General de Valdepeñas, Ciudad Real, Spain; La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain
| | - Talía Sainz
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain.
| | - Fátima Ara Montojo
- La Paz Research Institute (IdiPAZ) Madrid, Spain; General Pediatrics Department, Hospital de Quiron, Pozuelo, Spain
| | - Mariana Díaz Almirón
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Biostatistics Department, La Paz University Hospital, Spain
| | - Mercedes Subirats
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain
| | - Dolores Montero Vega
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain
| | - María José Mellado
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Milagros García López-Hortelano
- La Paz Research Institute (IdiPAZ) Madrid, Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
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Bustamante J, Sainz T, Pérez S, Rodríguez-Molino P, Montero Vega D, Mellado MJ, García López-Hortelano M. Toxocariasis in migrant children: A 6 years' experience in a reference pediatric unit in Spain. Travel Med Infect Dis 2022; 47:102288. [PMID: 35247580 DOI: 10.1016/j.tmaid.2022.102288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 12/21/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Toxocariasis is a worldwide distributed zoonosis that affects characteristically children. Clinical presentation is highly variable, often asymptomatic, and treatment duration is controversial. METHODS A retrospective descriptive study (January 2014-December 2019) was performed in a referral Unit for Pediatric Tropical Diseases. Patients younger than 18 years of age diagnosed with toxocariasis were included. RESULTS Out of 931 children screened for toxocariasis, 49 (5.3%) were seropositive. The median age was 11.0 years, 55.1% male and 30.6% referred contact with puppies. Overall, 34.7% were Latin-American, 24.5% Asiatic, 20.4% European, and 20.4% African. Only 34.7% presented symptoms, gastrointestinal the most common (52.9%). The 57.1% of children presented eosinophilia and 50% elevated total IgE. Most cases (95.9%) corresponded to covert toxocariasis. All children were treated with albendazole for 5-14-21 days, and 4 children required a second course. Follow-up data were available in 32 children (65.3%) for a median of 7 months, showing a progressive decline in eosinophils, IgE-titers and ELISA optical density. CONCLUSION Toxocariasis is mostly asymptomatic in children and eosinophilia is not always present. Serological tests should be included in migrant health screening and in the diagnostic assessment of eosinophilia. Eosinophil count, IgE-titers and ELISA optical-density could be useful during follow-up.
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Affiliation(s)
- J Bustamante
- Department of Pediatrics and Infectious Diseases, Hospital Universitario Doctor José Molina Orosa, Las Palmas, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain.
| | - T Sainz
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain; Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - S Pérez
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Hospital de Torrejón, Madrid, Spain.
| | - P Rodríguez-Molino
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain.
| | - D Montero Vega
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain.
| | - M J Mellado
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain; Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - M García López-Hortelano
- La Paz Research Institute (IdiPAZ), Madrid, Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain; Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
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Eosinophilia in Migrant Children: How Should We Proceed? Pediatr Infect Dis J 2022; 41:102-107. [PMID: 34890375 DOI: 10.1097/inf.0000000000003390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnostic approach to eosinophilia is complex, given the numerous reported etiologies. Intestinal parasites (especially helminths) are a concern in children from high-burden settings. We describe the diagnostic approach and clinical management of eosinophilia in a cohort of migrant children. METHODS We conducted a retrospective observational study that included children diagnosed with eosinophilia at a reference center for pediatric tropical diseases from 2014 to 2018. All patients were screened according to a unified protocol, including direct microbiologic and serologic tests. RESULTS A total of 163 children presented with eosinophilia during the study period [median age, 7.7 years (4.1-12.2); 57.1% boys], mostly from Asia (27.6%) and South America (22.1%). Most were internationally adopted children (43.6%) or migrants (26.4%). Only 34.4% of the children were symptomatic, and the main etiology for eosinophilia was helminths (56.4%). After a sequential diagnostic approach, no etiology was found for 40.5% of the patients. The independent risk factors for an unexplained etiology were younger age (≤2 years: odds ratio, 3.6; 95% CI, 1.3-10.2; P = 0.015), absence of symptoms (odds ratio, 4.8; 95% CI, 1.8-12.5; P = 0.001) and mild eosinophilia (<1000/µL: odds ratio, 4.2; 95% CI, 4.5-11.7; P = 0.005). Only 6 children were treated empirically. In those children with an identified cause and in those treated empirically, the eosinophilia resolved in 52% in a median of 7 months (5-9). CONCLUSIONS Helminths are the main cause of eosinophilia in migrant children and need to be hunted, especially in older children with eosinophil counts >1000 eosinophils/µL.
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Abdel-Haq N, Asmar BI. Fever in the Returned Pediatric Traveler. Glob Pediatr Health 2021; 8:2333794X211026188. [PMID: 34423077 PMCID: PMC8375340 DOI: 10.1177/2333794x211026188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/15/2022] Open
Abstract
Global mobility has been steadily increasing in recent years. The assessment of the febrile child returning from international travel is a diagnostic challenge. The COVID-19 pandemic has profoundly affected international travel and made evaluation and management of the sick returned traveler more challenging. Children visiting friends and relatives abroad remain at higher risk of infection compared to tourists. This review presents a guidance on the initial assessment of a traveling febrile child including interpretation of medical history, physical examination, and laboratory findings. Important clues to etiology include exposure to different infectious agents, incubation periods of pathogens, and prophylaxis regimens and vaccines received. Early identification of potentially life-threatening and highly contagious infections is essential. In this article, we discuss the epidemiology, evaluation, and management of specific travel related infections such as malaria, typhoid fever, dengue fever, viral hemorrhagic fever, rickettsiosis, leptospirosis, schistosomiasis, gastrointestinal, and respiratory infections.
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Affiliation(s)
- Nahed Abdel-Haq
- Children’s Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Basim I. Asmar
- Children’s Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
- Wayne State University, Detroit, MI, USA
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Hernández SA, Gabrie JA, Rodríguez CA, Matamoros G, Rueda MM, Canales M, Mergl R, Sanchez A. An Integrated Study of Toxocara Infection in Honduran Children: Human Seroepidemiology and Environmental Contamination in a Coastal Community. Trop Med Infect Dis 2020; 5:tropicalmed5030135. [PMID: 32842560 PMCID: PMC7559065 DOI: 10.3390/tropicalmed5030135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Infections caused by Toxocara canis and T. cati are considered zoonoses of global importance. Reports from North and South America indicate that human infections are widespread in both continents, but epidemiological information from Central America is still lacking. (2) Methodology: In the present cross-sectional multi-year study, we aimed to undertake the first seroepidemiological and environmental study on toxocariasis in Honduras. This included the determination of seroprevalence of anti-Toxocara spp. antibodies in children using a Toxocara spp. purified excretory-secretory antigens enzyme-linked immunosorbent assay (TES-ELISA) and a confirmatory Western blot. As well, through statistical analysis including logistic regression we aimed at identifying relevant biological and epidemiological factors associated with seropositivity. The study also entailed detection of parasites' eggs in the soil samples both through Sheather's concentration method and a nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. (3) Results: The study was undertaken in a coastal community of Honduras in 2 different years, 2015 and 2017. A total of 88 healthy schoolchildren completed the study, with participation of 79% (73/92) and 65% (46/71) of the student body in 2015 and 2017, respectively. Thirty-one children participated in both years (i.e., dual participants). Through both serological tests, seropositivity was confirmed in 88.6% (78/88) of children. Due to the high number of seropositives, logistic regression analysis was not possible for most socio-economic and epidemiological variables. Eosinophilia, on the other hand, was associated with seropositivity, independently of other intestinal helminthic infections. Continued seropositivity was observed in most of the dual participants, while seroconversion was determined in 8 of these children. Microscopic examination of soil samples did not yield any positive results. Through nested PCR-RFLP, 3 of the 50 samples (6%) were positive for Toxocara spp.; two were identified as T. canis and one as T. cati. (4) Conclusions: This work documents for the first time, high levels of human exposure to Toxocara spp. in Honduras. These findings, along with the country's favorable epidemiological conditions for this zoonosis, emphasize the need for more research to determine whether this infection is underreported in the country.
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Affiliation(s)
- Sergio A. Hernández
- Department of Health Sciences, Brock University, St. Catharines, ON L3S 2A1, Canada; (S.A.H.); (J.A.G.); (G.M.)
| | - José A. Gabrie
- Department of Health Sciences, Brock University, St. Catharines, ON L3S 2A1, Canada; (S.A.H.); (J.A.G.); (G.M.)
| | - Carol Anahelka Rodríguez
- Department of Parasitology, School of Microbiology and Institute of Microbiology Research, National Autonomous University of Honduras, Tegucigalpa, Honduras; (C.A.R.); (M.M.R.); (M.C.)
| | - Gabriela Matamoros
- Department of Health Sciences, Brock University, St. Catharines, ON L3S 2A1, Canada; (S.A.H.); (J.A.G.); (G.M.)
- Department of Parasitology, School of Microbiology and Institute of Microbiology Research, National Autonomous University of Honduras, Tegucigalpa, Honduras; (C.A.R.); (M.M.R.); (M.C.)
| | - María Mercedes Rueda
- Department of Parasitology, School of Microbiology and Institute of Microbiology Research, National Autonomous University of Honduras, Tegucigalpa, Honduras; (C.A.R.); (M.M.R.); (M.C.)
| | - Maritza Canales
- Department of Parasitology, School of Microbiology and Institute of Microbiology Research, National Autonomous University of Honduras, Tegucigalpa, Honduras; (C.A.R.); (M.M.R.); (M.C.)
| | - Ronald Mergl
- Niagara Falls Animal Medical Centre, Niagara Falls, ON L2E 6Z8, Canada;
| | - Ana Sanchez
- Department of Health Sciences, Brock University, St. Catharines, ON L3S 2A1, Canada; (S.A.H.); (J.A.G.); (G.M.)
- Department of Parasitology, School of Microbiology and Institute of Microbiology Research, National Autonomous University of Honduras, Tegucigalpa, Honduras; (C.A.R.); (M.M.R.); (M.C.)
- Correspondence:
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Menner N, Cronen T. [Infections of the lungs in returning travellers]. PNEUMOLOGE 2020; 17:338-347. [PMID: 32837496 PMCID: PMC7424555 DOI: 10.1007/s10405-020-00338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Auf Auslandsreisen kann es zu Infektionen mit Erregern kommen, die in Deutschland nicht endemisch sind. Vor dem Hintergrund einer stetig zunehmenden Reiseaktivität der Bevölkerung gewinnen diese Infektionen bei Reiserückkehrern an Bedeutung. Ältere und vorerkrankte Reisende stellen dabei eine besondere Risikogruppe dar. Die Kenntnis von im Ausland vorkommenden Erregern und typischen Krankheitsbildern ist essenziell, um eine entsprechende Verdachtsdiagnose stellen zu können, insbesondere bei Patienten, bei denen eine erste kalkulierte antibakterielle Therapie ohne Effekt bleibt. Die Erhebung einer detaillierten Reiseanamnese ist entscheidend, um Aufschluss über eine mögliche Exposition gegenüber spezifischen Erregern zu gewinnen und die korrekte Diagnostik in die Wege leiten zu können. Neben Erregern, die primär zu einer Infektion der Lunge führen, müssen differenzialdiagnostisch auch immer nichtpulmonale Infektionen mit einer pulmonalen Begleitsymptomatik, wie beispielsweise Schistosomiasis oder Malaria, in Betracht gezogen werden. Zwei Beispiele von pulmonalen Infektionen, die ausschließlich im Ausland erworben werden können, sind die Melioidose und die Kokzidioidomykose. Während eine pulmonale Manifestation der Melioidose akut und fulminant verlaufen und mit einer hohen Letalität assoziiert sein kann, ist die Kokzidioidomykose primär meist oligosymptomatisch, mit erheblicher Latenz können jedoch pulmonale Manifestationen auftreten, die in ihrer Vielfalt der Tuberkulose oder Malignomen ähneln können.
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Affiliation(s)
- N Menner
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Deutschland
| | - T Cronen
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Deutschland
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Approach to Eosinophilia in a Traveler from the Tropics. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Cañas García-Otero E, Praena-Segovia J, Ruiz-Pérez de Pipaón M, Bosh-Guerra X, Sánchez-Agüera M, Álvarez-Martínez D, Cisneros-Herreros JM. [Clinical approach to imported eosinophilia]. Enferm Infecc Microbiol Clin 2016; 34:661-684. [PMID: 27884406 DOI: 10.1016/j.eimc.2016.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 02/08/2023]
Abstract
Eosinophilia is a common finding in international travelers and immigrants, being an helmintic infection its main etiology. The positive predictive value of eosinophilia for an helmintosis is low in travellers. Eosinophilia may be an incidental finding, or symptomatic, and it represents a clinical challenge due to the low sensitivity and specificity of direct and indirect parasitological diagnostic tests, respectively. It requires a structured approach based on geographical areas, environmental exposures and behavioral risks, and associated symptoms. The initial assessment should include a comprehensive and tailored anamnesis and physical examination, basic laboratory tests, a complete parasitological examination of stool samples and a Strongyloides stercoralis serology, supplemented with other explorations guided by epidemiological and clinical suspicion. Empiric treatment with albendazole and/or ivermectin (plus praziquantel if risk of schistosomiasis) is an option for unidentified persistent eosinophilia after study, and in persons in whom a proper assessment or follow-up can not be assured. In patients at risk for estrongiloidosis who are candidates for immunosuppressive therapies, it is indicated a prior screening and treatment to prevent a future hyperinfestation syndrome.
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Affiliation(s)
- Elías Cañas García-Otero
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España.
| | - Julia Praena-Segovia
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Maite Ruiz-Pérez de Pipaón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Xerach Bosh-Guerra
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Magdalena Sánchez-Agüera
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Daniel Álvarez-Martínez
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - José Miguel Cisneros-Herreros
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
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11
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Answer to December 2016 Photo Quiz. J Clin Microbiol 2016; 54:3076. [PMID: 27881638 DOI: 10.1128/jcm.03116-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Dupouy-Camet J, Yera H, Dahane N, Bouthry E, Kapel CMO. A cluster of three cases of trichinellosis linked to bear meat consumption in the Arctic. J Travel Med 2016; 23:taw037. [PMID: 27296583 DOI: 10.1093/jtm/taw037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/10/2016] [Indexed: 11/12/2022]
Abstract
We report here three cases of trichinellosis due to polar bear meat consumption in East Greenland. In the past 20 years, 31 cases of trichinellosis have been reported in French travellers to the Arctic (North Quebec, Nunavut and Greenland) who consumed undercooked meat from black, brown, or polar bears. If local communities are increasingly becoming aware of the risk of trichinellosis, travellers visiting regions where bear meat is consumed should be informed of the risk of eating raw or non-heat-processed meats.
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Affiliation(s)
- Jean Dupouy-Camet
- Parasitology-Department, Hôpital Cochin, Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Yera
- Parasitology-Department, Hôpital Cochin, Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naïma Dahane
- Parasitology-Department, Hôpital Cochin, Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Christian M O Kapel
- Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
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13
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Jiero S, Ali M, Pasaribu S, Pasaribu AP. Correlation between eosinophil count and soil-transmitted helminth infection in children. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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14
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Salas-Coronas J, Cabezas-Fernández MT, Vázquez-Villegas J, Soriano-Pérez MJ, Lozano-Serrano AB, Pérez-Camacho I, Cabeza-Barrera MI, Cobo F. Evaluation of eosinophilia in immigrants in Southern Spain using tailored screening and treatment protocols: A prospective study. Travel Med Infect Dis 2015; 13:315-21. [PMID: 26001914 DOI: 10.1016/j.tmaid.2015.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the etiology of eosinophilia in immigrant patients in Southern Spain. METHODS Prospective study of immigrant patients with eosinophilia (> 500 Eo/μL) attended in a reference Tropical Medicine Unit and evaluated through the implementation of a specific protocol structured in different levels meant to be accomplished depending on the findings of each previous level. RESULTS Out of the 549 patients included in the study (89.6% from sub-Saharan countries), a diagnosis of helminthiasis was reached in 417 (75.9%), mainly by Strongyloides stercoralis (n = 190), Schistosoma (n = 33) and Hookworms (n = 126). 30 patients (5.5%) had a non-parasitic disorder (asthma, allergic rhinoconjunctivitis, skin conditions and drug-related eosinophilia). Multiple helminthic infections were very common: in 107 patients (19.5%) 2 helminth species were identified, three in 21 patients (3.8%), and four or more in 6 patients (1.1%). Eosinophilia was resolved in 31 of the 33 patients (93.9%) who received empirical treatment with ivermectin, albendazole and praziquantel as an etiological diagnosis was not reached after applying the whole protocol. CONCLUSIONS Diagnosis of helminthic infections in immigrant patients with eosinophilia can be improved by using tailored protocols based on geographical exposure. The implementation of these protocols may also save costs by systematizing diagnostic explorations. Empirical treatment with ivermectin, albendazol and praziquantel in sub-Saharan population when an etiologic diagnosis of eosinophilia has not been attained is an effective measure.
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Affiliation(s)
- Joaquín Salas-Coronas
- Tropical Medicine Unit, Hospital de Poniente, Ctra. De Almerimar sn, 04700, El Ejido, Almería, Spain.
| | | | | | | | - Ana Belén Lozano-Serrano
- Tropical Medicine Unit, Hospital de Poniente, Ctra. De Almerimar sn, 04700, El Ejido, Almería, Spain
| | - Inés Pérez-Camacho
- Tropical Medicine Unit, Hospital de Poniente, Ctra. De Almerimar sn, 04700, El Ejido, Almería, Spain
| | | | - Fernando Cobo
- Tropical Medicine Unit, Hospital de Poniente, Ctra. De Almerimar sn, 04700, El Ejido, Almería, Spain
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Abstract
Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy.
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Affiliation(s)
- Kristina N Feja
- Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital, 254 Easton Avenue, New Brunswick, NJ 08901, USA
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