From the Department of Pediatrics, Hospital General de Valdepeñas, Ciudad Real, Spain.
La Paz Research Institute (Instituto de Investigación Hospital Universitario La Paz), Madrid, Spain.
Pediatr Infect Dis J. 2022 Feb 1;41(2):102-107. doi: 10.1097/INF.0000000000003390.
The diagnostic approach to eosinophilia is complex, given the numerous reported etiologies. Intestinal parasites (especially helminths) are a concern in children from high-burden settings. We describe the diagnostic approach and clinical management of eosinophilia in a cohort of migrant children.
We conducted a retrospective observational study that included children diagnosed with eosinophilia at a reference center for pediatric tropical diseases from 2014 to 2018. All patients were screened according to a unified protocol, including direct microbiologic and serologic tests.
A total of 163 children presented with eosinophilia during the study period [median age, 7.7 years (4.1-12.2); 57.1% boys], mostly from Asia (27.6%) and South America (22.1%). Most were internationally adopted children (43.6%) or migrants (26.4%). Only 34.4% of the children were symptomatic, and the main etiology for eosinophilia was helminths (56.4%). After a sequential diagnostic approach, no etiology was found for 40.5% of the patients. The independent risk factors for an unexplained etiology were younger age (≤2 years: odds ratio, 3.6; 95% CI, 1.3-10.2; P = 0.015), absence of symptoms (odds ratio, 4.8; 95% CI, 1.8-12.5; P = 0.001) and mild eosinophilia (<1000/µL: odds ratio, 4.2; 95% CI, 4.5-11.7; P = 0.005). Only 6 children were treated empirically. In those children with an identified cause and in those treated empirically, the eosinophilia resolved in 52% in a median of 7 months (5-9).
Helminths are the main cause of eosinophilia in migrant children and need to be hunted, especially in older children with eosinophil counts >1000 eosinophils/µL.
由于众多报道的病因，嗜酸粒细胞增多的诊断方法较为复杂。肠道寄生虫（尤其是蠕虫）是高负担地区儿童的关注点。我们描述了一组移民儿童嗜酸粒细胞增多的诊断方法和临床处理。
我们进行了一项回顾性观察性研究，纳入了 2014 年至 2018 年期间在一家儿科热带病参考中心被诊断为嗜酸粒细胞增多症的儿童。所有患者均根据统一方案进行筛查，包括直接微生物学和血清学检测。
研究期间共有 163 例儿童出现嗜酸粒细胞增多症[中位数年龄 7.7 岁（4.1-12.2）；57.1%为男孩]，主要来自亚洲（27.6%）和南美洲（22.1%）。大多数是国际收养儿童（43.6%）或移民（26.4%）。只有 34.4%的患儿有症状，嗜酸粒细胞增多的主要病因是寄生虫（56.4%）。在进行序贯诊断方法后，仍有 40.5%的患儿未发现病因。病因不明的独立危险因素为年龄较小（≤2 岁：比值比 3.6；95%置信区间 1.3-10.2；P = 0.015）、无症状（比值比 4.8；95%置信区间 1.8-12.5；P = 0.001）和轻度嗜酸粒细胞增多症（<1000/µL：比值比 4.2；95%置信区间 4.5-11.7；P = 0.005）。仅 6 例患儿进行了经验性治疗。在那些明确病因的患儿和那些经验性治疗的患儿中，中位时间为 7 个月（5-9 个月）时，52%的患儿嗜酸粒细胞增多症得到缓解。
寄生虫是移民儿童嗜酸粒细胞增多的主要病因，需要进行检测，尤其是对于嗜酸粒细胞计数>1000/µL 的年龄较大的患儿。
