Webster Jessica, Stauffer William, Mitchell Tarissa, Lee Deborah, O'Connell Elise, Weinberg Michelle, Nutman Thomas, Sakulrak Potsawin, Tongsukh Dilok, Phares Christina
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
Am J Trop Med Hyg. 2022 Mar 7;106(5):1552-9. doi: 10.4269/ajtmh.21-0853.
The most common causes of eosinophilia globally are helminth parasites. Refugees from high endemic areas are at increased risk of infection compared with the general U.S. population. It is widely accepted that eosinophilia is a good marker for helminth infection in this population, yet its absence has little predictive value for excluding infection. During an enhanced premigration health program, the CDC offered voluntary testing and management of intestinal parasites, among other conditions, to U.S.-bound refugees in Thailand. Stool specimens were tested for Ascaris lumbricoides, Strongyloides stercoralis, Trichuris trichiura, hookworms, Giardia lamblia, Cryptosporidium spp., and Entamoeba histolytica using quantitative polymerase chain reaction. Complete blood counts were performed to identify eosinophilia. Predictive values of eosinophilia for parasitic infections were calculated within nematode groups. Between July 9, 2012 and November 29, 2013, 2,004 participants were enrolled. About 73% were infected with at least one parasite. The overall median eosinophil count was 483 cells/μL (interquartile range [IQR] = 235-876 cells/μL). Compared with participants who did not test positive for any infection, higher eosinophil counts were observed in those infected with A. lumbricoides (RR = 1.3, 95% CI = 1.1-1.4), S. stercoralis (RR = 1.8, 95% CI = 1.4-2.4), Necator americanus (RR = 1.2, 95% CI = 1.1-1.4), and Ancylostoma ceylanicum (RR = 1.8, 95% CI = 1.5-2.2). Eosinophil counts were higher in younger participants (2-4 years versus 65+ years: RR = 4.2, 95% CI = 2.5-6.9), and lower in female participants (RR = 0.9, 95% CI = 0.8-0.9). Sensitivities ranged from 51% to 73%, specificities from 48% to 65%, and predictive values from 4% to 98%. The predictive value of eosinophilia is poor for the most common parasitic infections, and it should not be used alone for screening refugees.
全球嗜酸性粒细胞增多症最常见的病因是蠕虫寄生虫。与美国普通人群相比，来自高流行地区的难民感染风险更高。人们普遍认为嗜酸性粒细胞增多症是该人群蠕虫感染的良好标志物，但其不存在对排除感染几乎没有预测价值。在一项强化的迁移前健康计划中，美国疾病控制与预防中心（CDC）在泰国为前往美国的难民提供了肠道寄生虫以及其他疾病的自愿检测和管理服务。使用定量聚合酶链反应对粪便标本进行检测，以查找蛔虫、粪类圆线虫、鞭虫、钩虫、蓝氏贾第鞭毛虫、隐孢子虫属和溶组织内阿米巴。进行全血细胞计数以确定是否存在嗜酸性粒细胞增多症。在线虫组内计算嗜酸性粒细胞增多症对寄生虫感染的预测值。在2012年7月9日至2013年11月29日期间，招募了2004名参与者。约73%的人感染了至少一种寄生虫。嗜酸性粒细胞计数的总体中位数为483个细胞/μL（四分位间距[IQR]=235 - 876个细胞/μL）。与未检测出任何感染呈阳性的参与者相比，感染蛔虫、粪类圆线虫、美洲板口线虫和锡兰钩口线虫的参与者嗜酸性粒细胞计数更高（相对危险度[RR]=1.3，95%置信区间[CI]=1.1 - 1.4；RR = 1.8，95%CI = 1.4 - 2.4；RR = 1.2，95%CI = 1.1 - 1.4；RR = 1.8，95%CI = 1.5 - 2.2）。年轻参与者（2 - 4岁与65岁以上相比：RR = 4.2，95%CI = 2.5 - 6.9）的嗜酸性粒细胞计数更高，女性参与者的计数更低（RR = 0.9，95%CI = 0.8 - 0.9）。敏感度范围为51%至73%，特异度为48%至65%，预测值为4%至98%。嗜酸性粒细胞增多症对最常见寄生虫感染的预测价值较差，不应单独用于筛查难民。
