Eosinofilia duodenal en pacientes Colombianos con dispepsia funcional: un estudio de casos y controles / Duodenal eosinophilia in functional dyspepsia in a Colombian sample: a case-control study

Introducción: La dispepsia funcional (DPF) es una entidad compleja cuya fisiopatología no está claramente definida. Existen alteraciones motoras gastroduodenales y recientemente se ha dado importancia a la eosinofilia duodenal. Objetivo: El objetivo de este estudio fuedeterminar si existe asociación entre eosinofilia duodenal y DPF. Materiales y métodos: Estudio de casos y controles. Pacientes mayores de 18 años con dispepsia según ROMA IV, a quienes se descartó DP orgánica con endoscopia alta (EVDA). Los controles fueron pacientes con anemia ferropénica y diarrea crónica a quienes de rutina se toman biopsias tanto del estómago como del duodeno. Se calcularon 70 pacientes en cada grupo. La información se recolectó en un formulario específico. Resultados: Hubo 243 pacientes elegibles. Se incluyeron 84 pacientes en grupo. El 80% eran mujeres. Edad promedio 53,6 años. Se encontró eosinofilia duodenal con diferencia significativa en los pacientes con saciedad precoz (p=0,01). No hubo diferencia significativa en los pacientes con llenura posprandial (p=0,63), dolor o ardor epigástrico (p=0,26), síntomas de reflujo gastroesofágico (p=0,13), alergia e intolerancia a alimentos (p=0,42) y tabaquismo (p=0,28). Asimismo, no se encontró relación entre mastocitosis duodenal y saciedad precoz (p=0,98), llenura posprandial (p=0,78) y dolor o ardor epigástrico (p=0,82). Conclusiones: La eosinofilia duodenal fue más frecuente en pacientes con DPF que tenían saciedad precoz.

Introduction: Functional dyspepsia (FD) is a complex symptom. Currently there are multiple therapeutic options that are used for the management of these patients; however, FD therapies are based on symptomatic control and do not address the pathophysiological pathways involved in its development. The duodenum has been proposed as a key site to understand the complex pathophysiology involved in FD. Objective: The aim of the study is to determine duodenal eosinophilia in patients with FD and establish the clinical-pathological correlation with the cardinal symptoms of dyspepsia. Material and methods: Case-control study. Patients older than 18 years with dyspepsia according to the Rome IV criteria, and upper gastrointestinal endoscopy normal (FD group).Patients with iron deficiency anemia and chronic diarrhea (control group). Biopsies were taken in the stomach, duodenal bulb and second portion of duodenum. A sample size of 140 patients (70 patients in the FD group and 70 patients in the control group) was calculated. The collected information was described and analyzed by conventional statistical techniques. Results: 243 patients were recruited. 84 patients were included in the FD group and 84 patients in the control group. 135 patients were women (80.3%). The mean age was 53.6 years (SD 14.9). Duodenal eosinophilia was found with significant difference in patients with early satiety (p=0.01). There was no difference in patients with postprandial fullness (p=0.63), epigastric pain or burning (p=0.26), gastroesophageal reflux symptoms (p=0.13), allergy and food intolerance (p=0.42) and smoking (p=0.28). There was no relationship between duodenal mastocytosis and early satiety (p=0.98), postprandial fullness (p=0.78), and epigastric pain or burning (p=0.82). Conclusions: Duodenal eosinophilia was similar in FD and controls. In subgroup analysis, duodenal eosinophilia occurs in patients with early satiety.

Eosinophilic meningitis caused by Angiostrongylus cantonensis: an emergent disease in Brazil

Eosinophilic meningitis (EoM) is an acute disease that affects the central nervous system. It is primarily caused by infection with the nematode Angiostrongylus cantonensis. This infection was previously restricted to certain Asian countries and the Pacific Islands, but it was first reported in Brazil in 2007. Since then, intermediate and definitive hosts infected with A. cantonensis have been identified within the urban areas of many states in Brazil, including those in the northern, northeastern, southeastern and southern regions. The goals of this review are to draw the attention of the medical community and health centres to the emergence of EoM in Brazil, to compile information about several aspects of the human infection and mode of transmission and to provide a short protocol of procedures for the diagnosis of this disease.

Epidemiological analysis of eosinophilia and elevation of immunoglobulin E as a predictable and relative risk of enteroparasitosis / Análisis epidemiológico de eosinofilia y la elevación de inmunoglobulina E como riesgo relativo y predecible de enteroparasitosis

Introduction: among the intestinal parasites, the helminthiasis occupies a prominent position in Brazil, since it worsens malnutrition and the gives rise to neurovegetative disorders. Helminths like Ascaris lumbricoides, Enterobius vermicularis, hookworm, Trichuris trichiura and Strongyloides stercoralis stand out due to several factors that modulate the immune response of individuals. Among the protozoa are Giardia lamblia, Entamoeba histolytica/E. dispar. Parasitic helminth antigens are important to stimulate the production of cytokines such as interleukin-4 and interleukin-5, which act through the induction of IgE synthesis and activation of eosinophils. Eosinophilia is usually detectable in pre-patent period of parasitism, initially linked to B lymphocytes, under the command of Th-2 lymphokines (IL-4 and IL-5), producing IgE in response to initial exposure to an antigen or allergen. Serum IgE high levels occur in tissue migration of larvae or harboring of parasites in tissues. Objective: to determine the presence of eosinophils and IgE elevation in children with intestinal parasites. Methods: high levels of IgE and eosinophils were observed in groups infected and not infected (allergic) to calculate the relative risk of intestinal parasites presumptive differentiated between protozoa and helminths and check what values of these indicators are observed in the epidemiological profile of the surveyed population. Results: the values obtained by calculating the relative risk for eosinophilia, compared with helminths and allergies was 11.71, but when examined by giardiasis compared with other diseases, the relative risk was 0.75. Since the comparison of helminths and giradiase, the relative risk was 27.33. Since IgE and its parameters were appropriate commit Helminth relative risk 0.39; Giardiasis had relative risk 8.18 and Helminths compared with giardiasis had 0.03. Conclusion: in this study it was possible to observe that helminthiasis is connected with cases of eosinophilia with alteration of IgE, which in turn contributes to the presence of IgE eosionofilia and has an effector response against helminths that provides the expulsion of its larvae.

Introducción: entre los parásitos intestinales, la helmintiasis ocupa un lugar destacado en Brasil, porque causa malnutrición y la instalación de cuadros de trastornos neurovegetativos. Helmintos como Ascaris lumbricoides, Enterobius vermicularis, anquilostoma, Trichuris trichiura y Strongyloides stercoralis se destacan debido a varios factores que modulan la respuesta inmune de los individuos. Entre los protozoos, los más destacados son Giardia lamblia y Entamoeba histolytica/E. dispar. Los antígenos de helmintos parásitos son importantes para estimular la producción de citocinas como la interleucina-4 e interleucina-5, que actúan a través de la inducción de la síntesis de IgE y la activación de los eosinófilos. La eosinofilia es detectable por lo general en el período pre-patente de parasitismo, inicialmente vinculada a los linfocitos B, bajo el mando de Th-2 linfocinas (IL-4 e IL-5), la producción de IgE en respuesta a la exposición inicial a un antígeno o alergeno. Los niveles séricos de IgE se producen en la migración de las larvas de los tejidos o la acogida de los parásitos en estos. Objetivo: determinar la presencia de eosinófilos y la elevación de IgE en niños con parásitos intestinales y cuantificar el riesgo relativo de estos parámetros biológicos. Methods: se observaron altos niveles de IgE y de eosinófilos en grupos infectados y no infectados (alergias) a fin de calcular el riesgo relativo (RR) de parásitos intestinales presuntamente diferenciados entre protozoos y helmintos, así como chequear qué valores de estos indicadores se observan en el perfil epidemiológico de la población estudiada. Resultados: los valores obtenidos mediante el cálculo del riesgo relativo para la eosinofilia, en comparación con helmintos y otras enfermedades fue 11,71, pero cuando se examina por la giardiasis en comparación con alergias resultó de 0,75. En la comparación de los helmintos y la giardiasis, el riesgo relativo fue de 27,33. Dado que la IgE y sus parámetros eran adecuados, entonces helmintos RR 0,39; giardiasis RR 8,18; y helmintos en comparación con giardiasis 0,03. Conclusión: con este estudio se pudo observar que las helmintiasis están relacionadas con casos de eosinofilia con alteración de la IgE; este último, que a su vez contribuye a la presencia de IgE eosionofilia y a tener una respuesta efectora frente a helmintos que causan la expulsión de sus larvas.

Neuroimmunological findings of Angiostrongylus cantonensis meningitis in ecuadorian patients / Hallazgos neuroinmunologicos en meningitis por Angiostrongylus cantonesis en pacientes ecuatorianos

Meningitis caused by Angiostrongylus cantonensis has recently been reported in patients resulting from the first outbreaks in subtropical regions of Ecuador. METHOD: Eight young adult patients from the two outbreaks were studied. IgA, IgM, IgG and albumin in cerebrospinal fluid and serum were quantified and plotted in cerebrospinal fluid/serum quotient diagrams (Reibergrams). The anamnesis on the patients included asking about any consumption of raw snails, symptoms and harm caused. RESULTS: Mean eosinophilia of 7.5 percent and 26 percent in serum and cerebrospinal fluid respectively was observed, as well as a moderate increase in total proteins. The most frequent pattern of intrathecal synthesis was observed in three classes of immunoglobulins. Intrathecal synthesis of IgM was observed in all cases two weeks after the first symptoms appeared. CONCLUSION: The intrathecal synthesis patterns of eosinophilic meningitis due to Angiostrongylus cantonensis, facilitated by cerebrospinal fluid analysis, were similar to those of previous cases from abroad.

La meningitis provocada por Angiostrongylus cantonensis ha sido reportada recientemente en pacientes procedentes de los primeros brotes reportados en regiones subtropicales de Ecuador. MÉTODO: Ocho adultos jóvenes procedentes de dos brotes fueron estudiados. Se cuantificó IgA, IgM, IgG y albúmina en suero y líquido cefalorraquídeo y fueron colocados en los gráficos de las razones líquido cefalorraquídeo/suero (reibergramas). La anamnesia incluía ingestión de caracoles crudos, los síntomas y los daños provocados. RESULTADOS: Una eosinofílica promedio de 7,5 y 26 por ciento en suero y líquido cefalorraquídeo fue observada al igual que un moderado incremento en las proteínas totales. El patrón de síntesis intratecal predominante fue de tres clases de inmunoglobulinas. La síntesis intratecal de IgM se observó en todos los casos a las dos semanas después del inicio de los síntomas. CONCLUSIÓN: El patrón de síntesis intratecal de la meningitis eosinofílica por Angiostrongylus cantonensis facilitado por el análisis del líquido cefalorraquídeo fue similar a los casos previos reportados fuera del país.

Clinical Significance of Incidentally Detected Eosinophilic Esophagitis with Pathologic Review / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EE) is a chronic inflammatory disorder characterized by abnormal dense eosinophilic infiltration of esophageal mucosa and results in dysphasia and food impaction. EE is being increasingly recognized in adults. The prevalence is largely unknown. This study was performed to evaluate the detection rate of EE diagnosed based on pathologic criteria and to define the clinical characteristics of EE in Korea. METHODS: We reviewed biopsy specimen of the 1,609 patients who underwent esophageal biopsy from January 2006 till August 2008. The presence of more than 20 eosinophils per high power field in biopsy specimens was considered cases of EE. Clinical information and endoscopic findings were obtained. RESULTS: 7 (0.4%) patients were diagnosed as EE based on pathologic criteria retrospectively. Clinical symptoms were epigastric pain (43%), regurgitation (29%), dyspepsia (14%), and no symptom (14%). Endoscopic findings were whitish exudates or granules (57%), esophageal polyp (29%), and hyperemic change (14%). Two patients received treatment. One patient with bronchial asthma improved after treatment with inhaled corticosteroid, and one patient improved after 8 week proton pump inhibitor therapy. CONCLUSIONS: Eosinophilic esophagitis was found in 0.4% of the total esophageal biopsied cases. Our results suggest that Korean patients with eosinophilic esophagitis showed symptoms mimicking gastroesophageal reflux disease and atypical endoscopic findings. Therefore, regardless of the gross appearance of the mucosa, meticulous diagnostic approaches are needed for patients with swallowing difficulty and lack of response to proton pump inhibitor.

Esofagitis eosinofílica: una entidad emergente / Eosinophilic Esophagitis: an emerging entity

La esofagitis eosinofílica (EE) es una enfermedad primaria del esófago, previamente confundida con el reflujo gastroesofágico (RGE), cuyo conocimiento se ha desarrollado principalmente en la última década. Se define como la presencia de síntomas de disfunción esofágica (principalmente disfagia e impactación alimentaria), asociados a por lo menos una biopsia esofágica con más de 15 eosinófilos por campo de mayor aumento (CMA), y la exclusión de RGE. Su prevalencia va en aumento y afecta principalmente a niños y hombres jóvenes de raza blanca con historia previa de atopía. La EE sería causada por una reacción alérgica a ciertos alimentos y/o aeroalérgenos mediada por citoquinas y con cambios genéticos involucrados. La presentación clínica varía con la edad siendo la disfagia el síntoma más frecuente en todos los grupos etarios. El diagnóstico es clínico, endoscópico y anatomopatológico. Se requiere de una endoscopía digestiva alta (EDA) para evaluar hallazgos característicos y tomar biopsias para el estudio histológico. Los tratamientos actuales incluyen medidas dietéticas basadas en la eliminación de la exposición de alérgenos alimentarios y uso de corticoesteroides tópicos. El objetivo de esta revisión es analizar el estado actual de la definición de EE, historia, epidemiología, fisiopatología, diagnóstico y principalmente ayudara mejorar su sospecha diagnóstica y manejo.

Eosinophilic esophagitis (EE) is a primary disease of the esophagus, previously mistaken with gastroesophageal reflux disease (GERD). Its knowledge has developed over the last decade. EE is defined as the presence ofesophageal dysfunction symptoms (mostly dysphagia and food impaction) associated to at least 1 esophageal biopsy with 15 or more eosinophils in 1 high-power field and absence of GERD. Its prevalence is rising, affecting principally white boys and young males with previous history of atopy. EE would be caused by an allergic reaction to certain food and aeroallergens mediated by citoquines with genetic changes involved. Clinical presentation varies with age being dysphagia the most common symptom in all age goups. The diagnosis is clinical, endoscopic and histopathologic. It requires an endoscopy to evaluate mucosal findings and to take the biopsies. Treatment includes elimination diets and topical steroids. The purpose of this review is to analyze the current state of the definition, history, epidemiology, fisiopathology and the diagnosis of EE, with an emphasis on improving its suspicion index and initial management.

Incidence and Causes of Hypereosinophilia in the Patients of a University Hospital / 대한진단검사의학회지

BACKGROUND: Eosinophilia may be associated with various primary and reactive conditions. The incidence and the causes of eosinophilia might have been changed according to the changes in the incidence of diseases such as cancer, chronic degenerative diseases, etc. We have conducted a retrospective study to investigate the incidence and causes of eosinophilia. METHODS: Eosinophilia and hypereosinophilia were defined when absolute eosinophil count was greater than 500/microL and 1,500/microL, respectively. Patient's clinical records were reviewed to find out the underlying clinical conditions responsible for causes of hypereosinophilia. Conventional chromosomal analysis, reverse transcriptase PCR and FISH for gene rearrangement were performed to check the presence of clonal eosinophilia. RESULTS: Out of 41,137 patients who had a hematology profile performed, 5,019 (12.2%) and 373 patients (0.9%) were found to have eosinophilia and hypereosinophilia, respectively. Among patients with hypereosinophilia, 227 patients (60.9%) had identifiable and/or possible causes. The major causes of hypereosinophilia were malignancy (35.2%), allergy and skin diseases (18.1%), infectious diseases (15.4%), hepatobiliary diseases (7.5%), bone marrow clonal diseases (6.6%) and parasite infections (6.6%). We also found a rare case of FIP1L1-PDGFRalpha positive chronic eosinophilic leukemia combined with light chain multiple myeloma. CONCLUSIONS: We found a difference in the distribution of causes of hypereosinophilia in comparison with previous Korean studies, and the most common cause of hypereosinophilia in the current study was malignancy. A rare case of clonal eosinophilia (chronic eosinophilic leukemia) associated with multiple myeloma was confirmed using molecular studies.

Estudio en niños con diagnóstico presuntivo de toxocariasis en Santa Fe, Argentina / Analysis of children with a presumptive diagnosis of toxocariasis in Santa Fe, Argentina

La toxocariasis humana es una parasitosis de amplia distribución en el mundo, cuyo agente etiológico más importante es el Toxocara canis, parásito del perro. El hombre adquiere esta zoonosis mediante la ingesta de huevos infectivos; en el intestino delgado desarticulan sus envolturas y las larvas se liberan atravesando la mucosa, ubicándose en diversos tejidos. Los niños son la población de mayor riesgo. El diagnostico clínico es dificultoso. El test de ELISA usando antígenos de excreción-secreción de la larva, es la técnica de elección. Se estudiaron por esta técnica inmunoserológica 100 niños con diagnóstico presuntivo de toxocariasis y se revisaron posteriormente sus historias clínicas de Hospital. La técnica de diagnóstico fue estandarizada y validada en el laboratorio. Su aplicación permitió identificar dos poblaciones de niños: infectados (59) y no infectados (41). La eosinofilia fue más frecuente en la población infectada (100% vs. 85.2%, p = 0.017); no así la leucocitosis (p = 0.950). La fuerza de asociación de ambos parámetros fue mayor en la población positiva (R = 0.918). La dificultad respiratoria se presentó más frecuentemente en pacientes con ELISA positiva, considerados como infectados (p = 0.05). La edad promedio de los positivos fue significativamente mayor que la de los negativos (p = 0.009). Se halló eosinofilia en el 100% de los infectados y en el 85.2% de los no infectados. La tenencia de canes en los domicilios no fue significativamente mayor entre los casos positivos que entre los negativos (p = 0.53). Sería necesario investigar esta enfermedad en niños consultantes con sospecha clínica, y promover las medidas de prevención, diagnóstico temprano y su correcto tratamiento.

Human toxocariasis is a parasitic disease found worldwide. The most important etiological agent is Toxocara canis, a dog parasite. Humans are infected by the ingestion of their eggs; the eggs hatch in the small intestine and the larvae migrate through the capillaries, taking up residence in different tissues. Clinical manifestations are associated with mechanical and/or reaction damage caused by these parasites larvae. Clinical diagnosis is difficult. The method applied in this work is the demonstration of antibodies against the helminth in the blood of children, target host population of this parasitic disease. An ELISA test was performed using T. canis larval excretory-secretory products as antigen. A total of 100 children presumptively diagnosed of toxocariasis that had been derived from different services of the Regional Children’s Hospital for complementary studies, were included in the analysis. The test detected two different populations: infected (59) and non-infected (41). The statistical analysis showed a non significant association between infection and sex (p = 0.279). Infected subjects tended to be older than the non infected (p = 0.009). Eosinophilia was detected in 100% of seropositive children and in 85.2% of the seronegative. There was no significant association between infection and leucocytosis ( = 0.950). The association of these two parameters was significantly higher among infected patients (R = 0.918). Respiratory symptoms and signs were more frequently detected in the positive population (p = 0.05). Dogs tenancy was as frequent among infected as in the non infected homes (p = 0.53). According to these results, prevention, early diagnosis and opportune treatment for toxocariasis should be considered as prioritary health activities in this region.

Frequency of eosinophilia and risk factors and their association with Toxocara infection in schoolchildren during a health survey in the north of Lima, Peru / Freqüência de eosinofilia e fatores de risco e sua associação com infecção pela Toxocara em escolares, durante estudo epidemiológico no norte de Lima, Peru

During a health survey in a primary school from the district of Carabayllo (North of Lima, Peru), 200 schoolchildren (96 male and 104 female between five to 12 years old) were randomly selected and divided in two groups (as positive or negative group), according to the serologic result of the Toxocara ELISA test from a total population of 646 schoolchildren. All children were analyzed by hematologic tests to determinate the frequency of eosinophilia and leukocytosis. Additionally, all clinical and epidemiological data were also analyzed to determine their association with toxocariasis. From group of children with positive serology, 40 percent had some type of eosinophilia in contrast to 19 percent of children with negative serology, and their association was statistically significant (OR = 2.84, p < 0.001). From all signs and symptoms evaluated, only 'dry cough' was more frequent and statistically significant in the positive serology group (OR = 2.79, p < 0.001). Almost all risk factors evaluated were highly frequent and statistically associated to the positive serology. In conclusion, the presence of eosinophilia and the risk factors evaluated in this population were frequently associated to human toxocariasis.

Durante estudo epidemiológico em escola primária do Distrito de Carabayllo (norte de Lima, Peru), 200 crianças (96 do sexo masculino e 104 do feminino, entre cinco e 12 anos de idade) foram selecionadas ao acaso e divididas em dois grupos (grupo positivo e grupo negativo) de acordo com os resultados de teste de ELISA para Toxocara em população total de 646 escolares. Todas as crianças foram analisadas por testes hematológicos para determinar a freqüência de eosinofilia e leucocitose. Adicionalmente, os dados clínicos e epidemiológicos foram analisados para determinar associação com toxocaríase. No grupo de crianças com sorologia positiva 40 por cento tinham eosinofilia em contraste com 19 por cento de crianças com sorologia negativa e esta associação foi estatisticamente.significante (OR = 2,84, p < 0,001). De todos os sinais e sintomas avaliados, somente tosse seca foi mais freqüente e estatisticamente significante no grupo de sorologia positiva (OR = 2,79, p < 0,001). Quase todos os fatores de risco avaliados foram de alta freqüência e estatisticamente associados à sorologia positiva. Em conclusão, a presença de eosinofilia e dos fatores de risco avaliados nesta população foram frequentemente associados à toxocaríase humana.

Related factors to human toxocariasis in a rural community of Argentina

The objective of this study was to evaluate the relationship between toxocariasis frequency and demographic, environmental, sanitary variables, eosinophylia, and other intestinal parasites in a rural population of Argentina. Serological examination of 100 individuals was carried out by using ELISA technique for the detection of anti-toxocara antibodies. Eosinophiles in peripheral blood, presence of intestinal parasites, and demographic, environmental, and socio-cultural data were evaluated. Eighty-one feces samples of dogs belonging to the studied people were analyzed to detect eggs of Toxocara canis. Thirty of them were from 30 dogs and 51 were pools from dog feces. Samples of dirt from around the homes (n: 47) and from public park (n: 4) were taken. To determine the associations, the c² and Fisher tests were used. The seroprevalence was 23 percent. Eosinophilia in peripheral blood was detected in 86.95 percent seropositive individuals and in 37.66 percent seronegative individuals (p < 0.001, OR = 11.03). Of the 23 people with positive serology, 69.56 percent had at least one intestinal parasite. All individuals with positive serology had dogs in their homes. Among the dog owners there was a significant association between the presence of anti-toxocara antibodies and home flooding. Eggs of T. canis were detected in the feces of 5/81 dogs and three of these dogs belonged to individuals with positive serology. Eggs of Toxocara spp. were found in 41.17 percent of the dirt samples, eight of which came from the area surrounding the homes of individuals with positive serology (p = 0.032; OR = 4.36). Taking into account all the variables influencing the frequency of toxocariasis in this population, the implementation of Public Health programs specifically focused on anti-parasitic treatment of dogs is recommended.

Eosinophilic pleural effusion in adults at Srinagarind Hospital.

The presence of pleural eosinophilia remains a controversy in etiology and prognosis. We conducted this study to evaluate the etiology of eosinophilic pleural effusion and to define the factors that determine malignancy in eosinophilic pleural effusion. Between 1 August 1994 and 1 July 2000, 50 patients were diagnosed with eosinophilic pleural effusion; 35 men and 15 women averaging 56.4 years of age. Most (96%) had exudative pleural effusion. Malignancy was the most common (46%) established cause followed by tuberculosis (10%), parapneumonic effusion (8%), and empyema thoracis (2%). We encountered only one case of pneumothorax and parasitic pleural effusion (from Strongyloides stercoralis). Unknown causes constituted 22% of cases. The etiology of those who had previously undergone thoracocentesis did not differ from those having their first thoracocentesis. Patients with malignant pleural effusion had significant longer duration of clinical symptoms (> or = 1 month) and weight loss than benign pleural effusion. The median duration of symptoms in benign pleural effusion was 14 days. Fever was more characteristic in patients with benign than in those with malignant pleural effusion. The percentage of eosinophils in pleural fluid and blood did not differ between the two groups. Pleural fluid eosinophils in malignant vs benign pleural effusion were 26.6% (range 10% to 63%), and 30.6% (range 10% to 93%), respectively. We concluded that, pleural eosinophilia did not indicate benign conditions which would spontaneously resolve. Malignant pleural effusion should be considered especially in areas malignancy is prevalent.

Toxocarosis en Chile: serie clínica en un centro de pediatría ambulatoria / Toxocarosis in Chile: clinical serie in a pediatric ambulatory center

Este trabajo tuvo como objetivo averiguar la frecuencia y presentación clínica de la toxocarosis en una población infantil. Para ello se realizó entre febrero y agosto de 1997, un estudio descriptivo en una población menor de 15 años, consultante a la Unidad de pediatría Ambulatoria del Centro Médico San Joaquín de la Universidad Católica de Chile. Los niños con eosinofilia (400 o más cel/mm) fueron elegidos para el estudio. La infección por toxocara se diagnosticó mediante la medición del antígeno somático por técnica de ELISA, con dilución de al menos 1/64. Durante el período se realizaron 7.898 consultas, tomándose 364 hemogramas. Se encontró eosinofilia en 24 niños (6,6 por ciento) (rango: 400-9.135 cel/mm). Ocho de éstos fueron positivos para toxocara (30 por ciento). El promedio de edad del grupo de estudio fue 4 años 6 meses (rango: 2 años 4 meses). Todos vivían en centros urbanos y habían tenido contacto con perros, gatos y 5 de los ocho practicaban geofagia. El hemograma fue tomado por adenitis (n=2), mal incrementado ponderal (n=2), bronquitis obstructiva (n=2), exatema (n=1). Sólo en un caso fue positivo el examen oftalmológico, 6/8 pacientes tenían otra parasitosis

Eosinophilia, anemia and parasitism in a rural region of northwest Thailand.

Parasitic infections are prevalent in Thailand. The parasites' relationship with anemia and eosinophilia has been rarely reported due to limited health care access, especially in rural areas. We studied the prevalence and relationship between eosinophilia, anemia and parasitism in 169 Thai-Karens from Mae Lamung and Mae Chan subdistricts, Umphang district, Tak Province, using an automated complete blood counter, and microscopic examination for intestinal parasites and microfilaria. In Mae Chan, 5 individuals were microfilaremic, 72% of individuals examined were infected with at least one kind of intestinal parasites, and 50% were anemic, with normal mean red cell volume (MCV). In Mae Lamung, 46% were parasitized (Triteeraprapab et al, 1997) but none were microfilaremic or anemic. In both populations, eosinophilia was prevalent (77%). Hookworm infection was found to be significantly associated with eosinophilia, but not anemia nor microcytosis of red cells.

Estudio clínico epidemiológico y determinación de la eosinofilia en escolares con hymenolepiasis: Chuquibamba 1995

Se estudió 158 escolares de ambos sexos con edades entre los 5 y 16 años de edad del C.E. primario 41-045 del distrito de Chuquibamba, de ellos 24 fueron portadores de Hymenolepis nana(15.2 por ciento). La prevalencia por edades fue de 7 a 8 años: 18 por ciento; de 9 a 10 años: 25.5 por ciento; de 11 a 12 años: 7.4 por ciento; de 13 a 14 años: 12.5 por ciento. Prevalencia por sexo fue en varones: 12.6 por ciento; y en mujeres de 18.3 por ciento. De los 24 casos con H. nana, 23 de ellos fueron asociados con E. coli(25 por ciento) y con G. lamblia(17 por ciento). Los escolares infectados con H. nana, presentaron una sintomatología con predominio de la esfera digestiva: dolor abdominal(37.3 por ciento), diarrea(25.5 por ciento), náuseas(50 por ciento) y sensación de llenura(14.3 por ciento). Los factores epidemiológicos condicionantes a la infección por H. nana tiene valor estadístico: Saneamiento básico defectuosos con mala disposición de excretas y basuras 23.7 por ciento y 26.1 por ciento respectivamente; así mismo, el consumo de verduras crudas(25.5 por ciento), el no lavado de manos antes de comer(34.1 por ciento) son factores que influyen a la presencia de hymenolepiasis. La eosinofilia relativa(6 a 10 por ciento) así como la absoluta(501-1000 eos/mm3), fue de intensidad leve, 41.7 por ciento y 50 por ciento respectivamente; siendo el porcentaje promedio de eosinófilos 10.83 por ciento y de 907 eos/mm3

Toxocariasis: estudio epidemiológico clínico en humanos / Toxocariasis: epidemiological clinical study on human beings

Se realizó un estudio epidemiológico-clínico de toxocariasis en humanos, en la ciudad de Bahía Blanca, Provincia de Buenos Aires, República Argentina. A tal fin se procesaron 690 muestras para investigar la seroprevalencia de Anticuerpos Anti-Toxacara canise. Se halló una positividad global del 33 por ciento(en adultos 26,4 por ciento y en población pediátrica 44,2 por ciento de positividad). No se encontraron diferencias significativas al evaluar la población céntrica y periférica, ni tampoco entre aquellas personas con caninos en su habitat y sin ellos. Se confirmó que la eoosinofilia tiene un importante valor predictivo. Para el procesamiento de las muestras, se desarrolló en nuestro laboratorio un enzimoinmunoensayo, cuyos resultados se compararon con los obtenidos con un kit comercial

Gnathostoma larva migrans among guests of a New Year party.

An outbreak of Gnathostoma larva migrans occurred among guests of a New Year's party in Chachoengsao, Thailand. Nine people who consumed a raw fish dish called 'Hu-sae' contracted the disease. Five of them developed gastro-intestinal symptoms consisting of nausea, vomiting, abdominal cramps and diarrhea as early as within the first 24 hours, while in the other four, symptoms started on the following day. After the initial symptoms pertaining to the gut, malaise, chest discomfort, cough, myalgia, weakness, itching and migratory swellings were experienced. Eosinophilia was demonstrated in every patient with a mean (+/- SE) count of 5,516 +/- 1,010 cells/cu mm. Detection of antibody against aqueous extracts of G. spinigerum adult antigen using an enzyme-linked immunosorbent assay showed a titer of 1:1,600 or greater in every patients except one who had a titer of 1:400 (positive greater than or equal to 1:400). This outbreak illustrates the high attack rate when heavily infected fish are consumed.

Prevalence of intestinal parasites in a rural community in north-central Puerto Rico

Se realizó un estudio hematológico y parasitológico en Bayaney, Hatillo, una comunidad rural localizada en la parte norte-central de Puerto Rico. Un hallazgo sorprendente fue la alta proporción comparativa de casos de eosinofilia encontrados (43 de 83; 52%). De estos 83 casos, 16 resultaron positivos para parásitos intestinales utilizando el método de concentración (Formol-Ether) Ritchie. Con eosinofilia de 5 a 10%, sen encontró infección con un parásito intestinal en 35% de los casos, con eosinofilia mayor de 10%, el 75% de los casos estaban infectados con un parásito intestinal. Los parásitos o larvas encontrados fueron: Uncinaria (N=8), Stronglyoides Stercoralis (N=2), Trichuris Trichiura (N=5) y un caso con una infección combinada de uncinaria y trichuris. Quince de estos 16 (94%) casos con parásitos intestinales tenían eosinofilia de 5 a 40%. De un subgrupo de niños de quinto grado de escuela, 11 de 35 (31%) tenían eosinofilia de 5 a 17%, pero solo dos de estos tenían huevos de parásitos (Trichuris). No se encontraron protozoos intestinales, a pesar de que todos los casos infectados estaban aparentemente asintomáticos, se les informó del resultado del estudio y en aquellos casos necesarios se les suplió examen médico y tratamiento. Se estudió la presencia de anticuerpos contra el huevo de S. mansoni por ELISA, usando una fracción de antígeno cationico llamado CEF-6. De 44 sueros analizados, 20 eran de un grupo de alto riesgo debido al contacto frecuente con agua infectada. Por serología solo un caso (2%) fue positivo y en este, el examen de excreta para huevos de S. mansoni fue negativo. Se necesitan estudios adicionales para determinar la etiología de eosinofilia en ausencia de infección por parásitos intestinales

Health status of Indochinese refugees in Japan: statistical analyses on anemia, eosinophilia and serum alkaline phosphatase.

Detailed statistical analyses were attempted on anemia, eosinophilia and elevation in serum alkaline phosphatase in the Indochinese refugees in Japan. A high statistical correlation was found between hemoglobin concentration and hematocrit for most of the refugees except the Cambodian females. Refugees with parasitic infections, particularly hookworm infection had significantly lower values for hemoglobin concentration and hematocrit. Significant eosinophilia was observed in the refugees infected with hookworms, Strongyloides stercoralis, Rhabditis sp., Endolimax nana and/or Hymenolepis nana. However, these parasites were found in the same subpopulations more frequently than expected by chance. Elevation in serum alkaline phosphatase was observed in young Cambodian immigrants. Analyses showed that the variations of this enzyme could be well predictable by those of enzymes such as serum glutamic oxaloacetic transaminase, which are good markers for liver functions, in Cambodian immigrants, 13-24 of age, whereas no such correlation was observed in non-Cambodians of the same age group.