Goswami Neela D, Shah J Jina, Corey G Ralph, Stout Jason E
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Trop Med Hyg. 2009 Aug;81(2):302-4.
Chronic helminth infections are common in refugee populations and may persist years after immigration. Asymptomatic Strongyloides stercoralis infection raises particular concern because of its potential for complications in immunosuppressed patients. We examined 172 Montagnard refugees resettled to Wake County, North Carolina from 2002 through 2003. Refugees were pretreated with albendazole for five days and screened for health conditions after arrival. Eosinophilia was present in 41 of 171 refugees at the first blood draw. Only 1 of 172 had a stool helminth (Fasciola) identified by microscopy. On repeat testing, 13 people had persistent eosinophilia. Results of serologic analysis for Strongyloides were available in 24 persons. Eosinophil counts decreased significantly after treatment with ivermectin in nine refugees (P = 0.039). Persistent eosinophilia, likely caused by Strongyloides infection, was common in this cohort of Montagnard refugees. Clinicians should understand the limitations of stool microscopy in diagnosis of strongyloidiasis, the limited effectiveness of albendazole in treating strongyloidiasis, and the importance of following-up refugees with persistent eosinophilia.
慢性蠕虫感染在难民群体中很常见，并且在移民多年后仍可能持续存在。无症状的粪类圆线虫感染尤其令人担忧，因为它在免疫抑制患者中可能引发并发症。我们对2002年至2003年期间重新安置到北卡罗来纳州韦克县的172名蒙塔格纳德难民进行了检查。难民在抵达前先用阿苯达唑进行了五天的预处理，并在抵达后对健康状况进行了筛查。在首次抽血时，171名难民中有41人出现嗜酸性粒细胞增多。172人中只有1人通过显微镜检查发现粪便中有蠕虫（肝片吸虫）。在重复检测时，有13人持续存在嗜酸性粒细胞增多。对24人的粪类圆线虫血清学分析结果可用。9名难民在接受伊维菌素治疗后嗜酸性粒细胞计数显著下降（P = 0.039）。在这群蒙塔格纳德难民中，由粪类圆线虫感染引起的持续性嗜酸性粒细胞增多很常见。临床医生应了解粪便显微镜检查在粪类圆线虫病诊断中的局限性以及阿苯达唑治疗粪类圆线虫病的效果有限，并且要重视对持续嗜酸性粒细胞增多的难民进行随访。
