International Journal of Microbiology & Parasitology

JMP 15 01| Volume 1|Issue 1|2015

Research Article

Significance of high Eosinophilic count in Non-Helminthic parasitic

infections

Vinay Khanna, Kriti Tilak, Archi Ghosh, Chiranjay Mukhopadhayay

Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India

Correspondence should be addressed to Vinay Khanna

Received April 16, 2015; Accepted April 25, 2015; Published July 24, 2015;

Copyright: © 2015 Vinay Khanna et al. This is an open access article distributed under the Creative

Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any

medium, provided the original work is properly cited.

Cite This Article: Khanna, V.,Tilak, K., Ghosh, A., Mukhopadhayay, C. (2015). Significance of high

Eosinophilic count in Non-Helminthic parasitic infections Context. International Journal of Microbiology

& Parasitology, 1(1).1-

ABSTRACT

Eosinophilia in asymptomaticpatients remained a diagnostic challenge which requires understanding of differentparasites. The high eosinophilic counts are usually seen helminths and protozoans but it remained challenging to diagnose other asymptomatic nonhelminthic parasitic diseases. So, it is important to do a controlled study of finding significance of high eosinophilic count in these parasites. In the present study we attempt to find an association between high eosinophilia and non-helminthic parasitic infections.

KEY WORDS: Eosinophilia, parasitic infestation

INTRODUCTION

It is alreadyproven that the High eosinophilia is

attributable, to the presence of helminthic infection in large number of cases [1-5]. But theimplication and literature regarding of high absolute eosinophilia with nonhelminthic parasitic diseases are varied. In an asymptomatic individual problem becomes more confusing, and whether to treat or not to treat these individuals will become a major management challenge. To understand about anextensiverange of probable pathogens causinghigh eosinophil count and their significance therefore become absolute essential for betterment of these patients. Moreover, It is always challenging to prevent these nonhelminthic infections in asymptomatic dwelling in community.

Eosinophilia is an immunologically mediated response occurs in response to varied challenges such asAllergens,hypersensitivity, collagen vascular diseases,

and malignancies and parasitic diseases. According to literature reviewabsolute eosinophilia is particularly associated with helminth infections, and especially during the development of parasites in tissues[6]. These Infections are usually chronic and have high reinfection rates with varied patterns and dispersion. [7,8].

The degree of eosinophilia in parasitic infections depends on host response to parasitic development, migration, maturation, burden and distribution. Parasites provokes marked eosinophilia when they or their products interact with immune effector cells in tissues, chiefly during migratory phase. In cases of non-invasion and absence of tissue invasion due to barriers in place eosinophilia is not as marked. Therefore, eosinophilia is highest among geohelminths parasites with their phase of development that involves migration through tissue, but a persistent eosinophilic response is not seen among parasites that are solely intraluminal (e.g., adult tapeworms) or enclosed in a cystic structure (e.g., hydatid cysts) unless there is disruption of the integrity of the cyst wall with escape of

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International Journal of Microbiology & Parasitology

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these cyst contents and exposed to the host immune system [9, 10]

Nonhelminthic parasites such as protozoans,flagellates,Apicomplexans,coccidian parasites and ciliates pose increased risk to patients in terms of morbidity such as diarrhea, malabsorption and abdominal discomfort and high mortality in untreated cases.

The objective of this study wasto find an association between high absolute eosinophilia and parasitic

infestation and to know which parasites commonlyare responsible for eosinophilia in number of cases. We did retrospective study on a total of 530 cases found to be positive for parasitic infections, attending tertiary care center in South India, over a study period of five years from year 2005 to 2010, to find out eosinophilic count with that of non-helminthic parasitic infections. The data was analyzed using SPSS software ver. 16.The following results were obtained in our study.

RESULTS

Table 1: Total Number of parasitic infections with eosinophilia

Parasites Isolated Infected patients with Eosinophilia

<500 eosinophils/µl ≥500 eosinophils/ µl

Plasmodium falciparum 163 03(0.8%)

Plasmodium vivax 182 01(0.05%)

Mixed infection (Plasmodium falciparum and Plasmodium

vivax)

41 03(0.7%)

Plasmodium ovale 2 0 (0%)

Toxoplasma gondii 18 0 (0%)

Scabies 19 07(36.8%)

Leishmaniadonovani 2 0 (0%)

Pneumocystis carinii 3 0 (0%)

Trichomonas spp. 8 0 (0%)

Giardia lamblia 6 02(33.3%)

Cyclospora 6 01(16.6%)

Cryptosporidium parvum 21 02(10.5%)

Entamoebahistolytica/ dispar 14 06(42.8%)

Entamoeba coli 23 02(8.7%)

Isospora belli 8 0 (0%)

Total 506 24 (4.5%)

International Journal of Microbiology & Parasitology

JMP 15 01| Volume 1|Issue 1|2015

Figure 1: Total number of cases with male and female proportion

As shown in figure 1, Out of total 530 cases of nonhelminthic infections, 396 (74.7%) were male patients while 134 (25.2%) were female patients. Out of total 530 cases, 72 (13.6%) belonged to Pediatrics age group (0-18), 355(66.9%) were between 19-50 years of agewhile 103 (19.4%) were more than 50 years of age. Patient’s positive for various nonhelminthes such as Plasmodium ovale, Toxoplasma gondii, Leishmaniadonovani, Pneumocystis carinii, Trichomonasspp. andIsospora bellihad normal had no eosinophilia, while other infections such as P.vivax,P.flaciparum,coccidian parasites such as Cyclosporaspp.,Cryptosporidium parvum, Giardia lamblia, Entamoebahistolytica/disper. Entamoeba coli and scabies patients have ≥500 eosinophils/ µl of blood.

DISCUSSION AND CONCLUSION

High eosinophil count was present in only 4.5% of patients with non-helminthic infections, which was not statistically significant. This suggests that nonhelminths does not cause definite rise in eosinophilcounts, this may be due to localized infection without any tissue invasion.While studies done on patients with helminthic infections showed that,high blood eosinophilic count can be present at the time of diagnosis only in 44% of 1107 travelers and immigrants with blood flukes. Innonimmigrant population this value was even lower [12].

In conclusion, we found that there is limited significance of high eosinophilic count in patients with non-helminthic infections. Clinician should manage the patients on other criteria’s such as symptoms, endemicity, contacts transmission and other parameters rather than solely depended on eosinophil counts.Parasitic diagnosis should not be ignored even if then patients have low or normal eosinophils in blood.

REFERENCES

[1] PardoJ, CarranzaC, MuroA, et al. Helminth-related eosinophilia in African immigrants, Gran Canaria. Emerg Infect Dis 2006;12:1587-9.

[2] LibmanMD, MacLeanJD, GyorkosTW. Screening for schistosomiasis, filariasis, and strongyloidiasis among

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[3] NutmanTB, OttesenEA, IengS, et al. Eosinophilia in Southeast Asian refugees: evaluation at a referral center. J Infect Dis 1987;155:309-13.

[4] SchulteC, KrebsB, JelinekT, NothdurftHD, von SonnenburgF, LoscherT. Diagnostic significance of blood eosinophilia in returning travelers. Clin Infect Dis 2002;34:407-11.

[5] ]SeyboltLM, ChristiansenD, BarnettED.Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia. Clin Infect Dis 2006;42:363-7.

[6] ]GuerrantRL, WalkerDH, WellerPF, WilsonME. Eosinophilia. In: GuerrantRL, WalkerDH, WellerPF, editors. Tropical infectious diseases: principles, pathogens, and practice. 1st edition.Philadelphia: Churchill Livingstone; 1999. p. 1400-19.

[7] BehnkeJM, BarnardCJ, WakelinD. Understanding chronic nematode infections: evolutionary considerations, current hypotheses, and the way forward. Int J Parasitol1992;22:861-907.

[8] PawlowskiZS, CooperES, BundyDAP. Trichuriasis. In: PawlowskiZS, editor. Bailliere's clinical tropical medicine and communicable diseases. 2nd edition.London: Bailliere Tindall Limited; 1987. p. 629-43.

[9] Moore TA, Nutman TB. Eosinophilia in the returning traveler. Infect Dis Clin North Am. 1998;12:503

[10] Weller PF. Eosinophilia in travelers. Med Clin North Am.1992;76:1413.

74%

26%

0% 0%

Total no. of cases(530)

Males

Females

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[11] NokesC, Grantham-McGregorSM, SawyerAW, et al. Moderate to heavy infections to Trichuristrichuria affect cognitive function in Jamaican children. Parasitology 1992;104:539-47.

[12] WhittyCJ, MabeyDC, ArmstrongM, et al. Presentation and outcome of 1107 cases of schistosomiasis from Africa diagnosed in a non-endemic country. Trans R Soc Trop Med Hyg2000;94:531-4.