Leukocytosis and blood eosinophilia in a polyparasitised population in north-eastern Brazil

Significant Leukocytosis with Hypereosinophilia Secondary to Trichuris trichiura in Adult: A Case Report

Eosinophilic leukocytosis can be attributed to a number of clinical conditions such as parasitic infection, allergies, and neoplasms. Parasitic infection is the main cause of eosinophilia; however, a marked leukocytosis with hypereosinophilia secondary to Trichuris trichiura in adults has not been previously reported. We describe a case of a 39-year-old man who presented with fever and diarrhea. The investigation revealed a white blood cell (WBC) count of 20.69 × 10⁹/L with an absolute eosinophil count of 12.44 × 10⁹/L. Fecal microscopic examination demonstrated T. trichuria eggs. The WBC count returned to normal following treatment with albendazole. The literature pertaining to hematological findings associated with Trichuris trichiura is explored in this report. This case highlights that a significant elevation of leukocyte count with hypereosinophilia can be one of the manifestations of trichuriasis infection in adults. Empirical treatment with anti-helminthic agents may play a role in suspected cases to avoid severe complications, such as Trichuris dysentery syndrome.

SOIL-TRANSMITTED HELMINTH INFECTION AND EOSINOPHIL LEVELS AMONG WASTE COLLECTORS IN BANDA ACEH

ABSTRACT.                 Soil-Transmitted Helminth (STH) has infected more than one billion people worldwide. Waste collectors are at risk for STH infection because their work mostly in contact with soil and waste. Eosinophilia is a sign of human immune response to STH infection in addition to increased IgE and cytokine production. This cross sectional study aims to examine the association between STH infection and eosinophil levels among waste collectors in Banda Aceh. The study sample were 60 waste collectors working for the Sanitation department of Banda Aceh. Examination of stool samples using Kato-Katz technique revealed the prevalence of STH infection among waste collectors was 23.3% (14/60), consisting of T.trichiura infection (21.7%) and mixed infection (1.6%). There were no single infections of A. lumbricoides nor the hookworm infection was found. Blood tests to count eosinophil showed the prevalence of eosinophilia at 21.7%. There was no significant correlation between the intensity of STH infection and eosinophil levels (p value = 1.00). This study does not recommend the use of eosinophilia to indicate STH infection.Keywords: Eosinophilia, Kato Katz, STH infection, Waste Collectors, Banda AcehABSTRAK.                Soil-Transmitted Helminth (STH) menginfeksi lebih dari satu milyar orang di seluruh dunia. Petugas sampah merupakan salah satu kelompok yang berisiko terifeksi STH karena pekerjaannya berhubungan dengan tanah dan sampah. Eosinofilia merupakan salah satu tanda timbulnya respon imun manusia terhadap infeksi STH selain peningkatan IgE dan produksi sitokin. Penelitian ini merupakan penelitian cross sectional untuk mengetahui hubungan infeksi STH dengan kadar eosinofil pada petugas pengangkut sampah. Penelitian di lakukan di Banda Aceh dengan subjek penelitian adalah  petugas pengangkut sampah Dinas Kebersihan dan Keindahan Kota Banda Aceh sebanyak 60 sampel. Pemeriksaan sampel feses dengan tehnik Kato-Katz menunjukkan pevalensi infeksi STH pada petugas pengangkut sampah sebesar 23,3 % (14/60) terdiri dari infeksi T.trichiura 21,7 % dan infeksi campuran 1,6 %. Tidak ditemukan infeksi tunggal A.lumbricoides dan infeksi hookworm. Pemeriksaan darah untuk menghitung eosinofil menunjukkan prevalensi eosinofilia adalah 21,7%. Tidak terdapat hubungan yang signifikan antara intensitas infeksi STH dengan kadar eosinofil darah  (p value= 1.00 ). Penelitian ini tidak menganjurkan eosinofilia sebagai marker adanya infeksi STH.Kata kunci : eosinofilia, Kato-Katz,  infeksi STH, Kato-Katz, petugas sampah, Banda Aceh

Hematological and hepatic alterations in Brazilian population heavily exposed to organochlorine pesticides

The aim of this study was to investigate the frequency of hematological and hepatic alterations and possible association with serum levels of beta-hexachlorocyclohexane (beta-HCH), p,p'-DDE, and hexachlorobenzene (HCB) among residents in an area heavily contaminated with organochlorine (OC) pesticides. A cross-sectional study was conducted in 415 male and 432 female residents aged >14 years. Serum samples were collected and analyzed for OC pesticides concentrations and biochemical parameters. Frequencies of hematological and hepatic alterations were calculated for each gender. Association between beta-HCH, p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene), and HCB levels and presence of alterations was determined by logistic regression stratified by gender and controlling for confounders. Highest frequencies were observed for eosinophilia (23% men and 18% women), low hemoglobin (12% men and 15% women), and low erythrocyte count (12% men). High levels of bilirubin, glutamic-oxaloacetic transaminase (GOT), and glutamic-pyruvic transaminase (GPT) were observed, respectively, in 10, 11, and 12% of men and <10% of women. Gamma-glutamyl transferase (GGT) was elevated in 26 and 25% of males and females, respectively. Multivariate analysis revealed associations between eosinophilia and beta-HCH in men (OR = 1.06, 95%CI = 1.01-1.12) and women (OR = 1.05, 96%CI = 0.99-1.11), p,p'-DDE in men (OR = 1.03, 95%CI = 0.99-1.06) and women (OR = 1.02, 95%CI = 0.99-1.06), and HCB in women (OR = 1.54, 95%IC = 0.85-4.45). Beta-HCH was found to be associated with increased risk of elevated bilirubin in females (OR = 1.18, 95%CI = 1.07-1.29) and males (OR = 4.21, 95%CI = 1.87-9.47 for fourth vs. first quintile). Thus, OC pesticides may exert adverse effects on hematopoietic tissue and liver in populations chronically exposed to high levels of these compounds.

Fascioliasis and eosinophilia in the highlands of Cuzco, Peru and their association with water and socioeconomic factors

There are limited data about the epidemiology of fascioliasis in Cuzco, Peru. We studied children 3-12 years old from six communities in the highlands of Cuzco to evaluate the epidemiology of fascioliasis; 227 children were included, one-half were female, the mean age was 7.5 (±2.6) years, and 46.2±% had one or more parasites, including Fasciola (9.7%), Ascaris (12.8%), Hymenolepis (9.3%), Trichuris (1.3%), hookworm (1.8%), Strongyloides (0.9%), and Giardia (27.8%). Fasciola was associated with the number of siblings in the household, drinking untreated water, and giardiasis. Eosinophilia was encountered in 21% of children and more common in those drinking untreated water at home and those infected with a parasite, but the differences were not significant. Eating water plants was not associated with Fasciola or eosinophilia. Fascioliasis and eosinophilia were common in the highlands of Cuzco. Fascioliasis was associated with socioeconomic factors and drinking water.

A survey of ectoparasite infestation in dogs in Tehran, Iran

This survey was conducted to identify and estimate the frequencies of ectoparasites of dogs in Tehran, Iran. A total of 143 dogs attended at the Small Animal Hospital of the Veterinary School, the University of Tehran, were examined for the presence of ectoparasites and dermatological lesions. Ectoparasite specimens and blood samples were sent to parasitology and hematology laboratories, respectively. Ticks were the most frequent ectoparasite (36.4%, 52/143), followed by fleas (29.4%, 42/143), mites (25.9%, 37/143), and lice (8.4%, 12/143). Mixed infestations with two or more ectoparasites were detected in eight dogs. Rhipicephalus bursa was the most frequent ectoparasite in spring and summer. Ectoparasitic infestations were recorded mainly in large breeds and juvenile animals. Eosinophilia was more observed in dogs infested with Sarcoptes scabiei. The most common clinical sign, skin pruritus, was associated with mite and lice infestations. These results indicate that the tick R. bursa was the most prominent species of ectoparasite found in the evaluated group, followed by Ctenocephalides canis and S. scabiei var canis.

Cytological and parasitological analysis of bronchoalveolar lavage fluid for the diagnosis of Angiostrongylus vasorum infection in dogs

Bronchoalveolar lavage (BAL) is a procedure that retrieves cells and other elements from the lungs for evaluation, which helps in the diagnosis of many pulmonary diseases. The aims of this work were to perform this procedure in dogs in the acute and chronic phases of an Angiostrongylus vasorum infection for cytological analysis and to evaluate the potential of this technique as a diagnostic method for this lung-heart worm. The BAL procedure was performed through the use of an endotracheal tube on seven A. vasorum infected dogs and on five non-infected dogs lined as a control group. Sixty days post-infection (dpi) active and live larvae were retrieved from the bronchoalveolar fluid (BALF) of all infected dogs. Furthermore, in one animal it was possible to retrieve larvae in its BALF before the pre-patent period. This work reports that the A. vasorum infection resulted in an increase of relative neutrophils and eosinophils counts. In contrast, there was a significant decrease in the alveolar macrophage relative count in infected animals from 60 to 330 dpi. This study shows that the BAL is an accurate technique for the diagnosis of canine angiostrongylosis. Moreover, the technique allows us to retrieve cells and other elements that line the lung surface for cytological evaluation, which provides information about inflammatory diseases, and the diagnosis and prognosis of pulmonary parasites such as A. vasorum.

Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans

Hookworm-related cutaneous larva migrans is caused by the migration of animal hookworm larvae in the human skin. The disease mainly occurs in resource-poor communities in the developing world, but it is also reported sporadically in high-income countries and in tourists who have visited the tropics. Diagnosis is made clinically in the presence of a linear serpiginous track moving forward in the skin, associated with itching and a history of exposure. Itching is typically very intense and can prevent patients from sleeping. Bacterial superinfection occurs as a result of scratching. Treatment is based on oral drugs (albendazole or ivermectin) or the topical application of tiabendazole. To control hookworm-related cutaneous larva migrans at the community level, regular treatment of dogs and cats with anthelmintic drugs is necessary, but this is seldom feasible in resource-poor settings. Animals should be banned from beaches and playgrounds. For protection at the individual level, unprotected skin should not come into contact with possibly contaminated soil.

Eosinophilia during intestinal infection

Eosinophilia is a common finding in tropical developing countries, and is mainly caused by chronic helminth infections, predominantly of the gut. Although only a minority of infections is symptomatic, development during childhood can be impaired, and in some patients serious complications and sequelae may occur. Eosinophilia in helminth infection is typically associated with a strong Th2 immune response, and eosinophils can effectively kill or damage larvae and adult worms in vitro. However, in vivo, eosinophils are only partly effective in the control of helminth infection, and recent research has shown that eosinophils are involved in a range of immunomodulatory effects, such as increased production of the down-modulatory cytokines interleukin 10 and tumour growth factor beta, as well as stimulation of regulatory T cells and alternatively activated macrophages. Increasing evidence suggests that immunomodulation favours parasite survival and reduces immune pathology. On the other hand, immunomodulation induced by helminth infections may contribute to protection from allergic and autoimmune responses, as proposed by the 'hygiene hypothesis' to explain the increase in allergic diseases in the industrialised world. The predictive value of eosinophilia for the presence of helminth infections is limited and depends on the epidemiological background and the extent of the eosinophilia. It increases considerably in populations with a high prevalence of parasitic infections, as in developing tropical countries or in travellers to those areas.

High expression of co-stimulatory and adhesion molecules are observed on eosinophils during human Schistosoma mansoni infection

Herein we have focused attention on major phenotypic features of peripheral blood eosinophils from chronic Schistosoma mansoni-infected patients. For this purpose, detailed immunophenotypic profiles of a range of cell surface markers were performed, including activation markers (CD23/CD69/CD25/HLA-DR), co-stimulatory molecules (CD28/CD80/CD86), chemokine receptors (CXCR1/CXCR2/CCR3/CCR5) besides L-selectin-CD62L and adhesion molecules (CD18/CD54). Our major findings pointed out increased frequency of CD23+-cells, besides decreased percentages of CD69+-eosinophils, suggesting a chronic activation status with low frequency of early activated eosinophils in chronic S. mansoni-infected patients (INT) in comparison to non-infected individuals (NI). Moreover, a dichotomic expression of beta-chemokine receptors was observed during human schistosomiasis mansoni with higher CCR5 and lower levels of CCR3 observed between groups. Enhanced expression of co-stimulatory receptors (CD28/CD86) and adhesion molecules (CD54/CD18), besides striking lower frequency of L-selectin+ were reported for eosinophils from INT group as compared to NI. Interestingly, the frequency of CD62L+-eosinophils and a range of cell activation related molecules pointed out an opposite pattern of association in NI and INT, where only INT patients that display lower frequency of CD62L+-eosinophils (first CD62L tertile) kept the unusual relationship between the expression of L-selectin and the CD23 activation marker. These findings suggest that distinct dynamic of activation markers expressed by eosinophils may occur during chronic S. mansoni infection.