Department of Gastroenterology, University College London Hospital, UK.
Postgrad Med J. 2012 Jan;88(1035):28-33. doi: 10.1136/pgmj.2010.003392rep.
To estimate the prevalence of, and implement a diagnostic strategy for, imported helminth infection in the gastroenterology clinic.
A retrospective study of eosinophil count and probable tropical exposure (phase I) followed by a prospective study of parasitological investigation (phase II).
Gastroenterology service of an inner London hospital.
Adult patients newly attending general gastroenterology and inflammatory bowel disease clinics.
In phase I, evidence of undiagnosed helminth infection was sought by analysing patient records for associations between eosinophil count and ethnicity. In phase II, a UK guideline for investigation of eosinophilia in migrants was implemented and diagnostic yield determined.
In phase I, prevalence of eosinophilia was determined; in phase II, helminth prevalence and degree of eosinophilia before and after treatment were reported. Information on symptomatic response to treatment was recorded. Ethnicity was used as a proxy measure for tropical exposure.
426 new patients attended in a 12 month period. Eosinophilia was present in 27 (6.3%). 10/27 (37.0%) patients with eosinophilia were of African or Asian ethnicity whereas only 20% (85/426) of patients overall were from these ethnic groups (χ(2)=5.27, p=0.02). Following implementation of the protocol, 25/36 migrants with eosinophilia attended for parasitological investigations. Helminth infection was diagnosed in 10/25 (40%). Strongyloidiasis (six patients) and schistosomiasis (three patients) were the most common diagnoses. Median eosinophil count was 1.06×10(9)/l in those with helminths and 0.58×10(9)/l in those without (p=0.004). Eosinophil counts normalised in, and symptomatic improvement was reported by, most patients after treatment.
Eosinophilia is associated with African or Asian ethnicity in an inner city gastroenterology service. This association is probably explained by imported helminths, which are prevalent in this setting, may be a cause of gastrointestinal symptoms and is easily diagnosed and treated by standard protocols.
评估寄生虫感染在胃肠病学门诊中的流行情况，并制定相应的诊断策略。
一项回顾性研究，分析嗜酸性粒细胞计数和可能的热带暴露情况（第 I 阶段），随后进行寄生虫学调查的前瞻性研究（第 II 阶段）。
伦敦一家医院的胃肠病科。
新到普通胃肠病和炎症性肠病门诊就诊的成年患者。
在第 I 阶段，通过分析患者记录中嗜酸性粒细胞计数与种族之间的关联，寻找未确诊的寄生虫感染证据。在第 II 阶段，实施了英国移民嗜酸性粒细胞增多症的诊断指南，并确定了诊断的收益。
在第 I 阶段，确定嗜酸性粒细胞增多症的患病率；在第 II 阶段，报告寄生虫感染的患病率以及治疗前后的嗜酸性粒细胞计数，并记录治疗后的症状反应。种族被用作热带暴露的替代指标。
在 12 个月的时间里，有 426 名新患者就诊。27 名（6.3%）患者存在嗜酸性粒细胞增多症。嗜酸性粒细胞增多症患者中，10/27（37.0%）为非洲裔或亚洲裔，而总体上只有 20%（85/426）的患者来自这些族裔（χ(2)=5.27，p=0.02）。在实施方案后，36 名嗜酸性粒细胞增多症的移民中有 25 名接受了寄生虫学检查。在 25 名患者中诊断出寄生虫感染 10 例（40%）。最常见的诊断是钩虫病（6 例）和血吸虫病（3 例）。有寄生虫的患者嗜酸性粒细胞计数中位数为 1.06×10(9)/l，无寄生虫的患者为 0.58×10(9)/l（p=0.004）。大多数患者接受治疗后，嗜酸性粒细胞计数恢复正常，症状改善。
在城市中心的胃肠病学服务中，嗜酸性粒细胞增多症与非洲裔或亚洲裔有关。这种关联可能是由内城常见的寄生虫感染引起的，这些寄生虫可能是胃肠道症状的原因，并且可以通过标准方案轻松诊断和治疗。
