Anemia, leukocytosis and eosinophilia in a resource-poor population with helmintho-ectoparasitic coinfection

Daniel Pilger; Jörg Heukelbach; Alexander Diederichs; Beate Schlosser; Cinthya Pereira Leite Costa Araújo; Anne Keysers; Oliver Liesenfeld; Hermann Feldmeier

doi:10.3855/jidc.1688

Authors

Daniel Pilger Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany
Jörg Heukelbach School of Medicine, Federal University of Ceará, Fortaleza, CE 60430-140, Brazil
Alexander Diederichs Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany
Beate Schlosser Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany
Cinthya Pereira Leite Costa Araújo Estate University of Health Science of Alagoas, Alagoas, CEP 57010-300, Brazil
Anne Keysers Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany
Oliver Liesenfeld Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany
Hermann Feldmeier Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany

DOI:

https://doi.org/10.3855/jidc.1688

Keywords:

anemia, leukocytosis, eosinophilia, intestinal helminths, ectoparasites, epidemiology, resource-poor community

Abstract

Introduction: Eosinophilia and anemia are very common hematological alterations in the tropics but population-based studies scrutinizing their value for diagnosing parasitic infections are rare.

Methodology: A cross-sectional study was conducted in a rural district in northeast Brazil where parasitic infections are common. Stool and blood samples were collected and individuals were clinically examined for the presence of ectoparasites.

Results: In total, 874 individuals were examined. Infection with intestinal helminths occurred in 70% (95% CI 67 - 75), infestation with ectoparasites in 45% (95% CI 42 - 49) and co-infection with both helminths and ectoparasites was found in 33% (95% CI 29% - 36%) of all inhabitants. Eosinophil counts ranged from 40/µl to 13.800/µl (median: 900/µl). Haemoglobin levels ranged from 4.8 g/dl to 16.8 g/dl (median: 12.5 g/dl), and anemia was present in 24% of the participants. Leukocytosis was found in 13%, eosinophilia in 74%, and hypereosinophilia in 44% of the participants. Eosinophilia was more pronounced in individuals co-infected with intestinal helminths and ectoparasites (p < 0.001) and correctly predicted parasitic infection in 87% (95% CI 84%-90.7%) of all cases.

Conclusions: Eosinophilia is strongly associated with the presence of intestinal helminthiases and accentuated by co-infestation with ectoparasites. Our study confirms in a population with high prevalence of intestinal helminthiases and ectoparasites that eosinophilia can be used to accurately diagnose current parasitic infection and initiate treatment.