van Waasdijk Maëli, van der Werff Suzanne D, Sjöholm Daniel, Wyss Katja, Asgeirsson Hilmir, Naucler Pontus, Färnert Anna, Requena-Méndez Ana
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Clin Microbiol Infect. 2025 Jan;31(1):113-120. doi: 10.1016/j.cmi.2024.10.009. Epub 2024 Oct 18.
The aim of this study was to determine predictors for helminthiasis among travellers and migrants with eosinophilia for which a visit to tropical regions or endemic regions for common helminthiasis had been registered.
A retrospective cohort study was performed using electronic health records of 23 905 patients with eosinophilia (January 2011-August 2021) at Karolinska University Hospital, Stockholm, including patients tested for helminthiasis with a registered stay in a helminth endemic region. Outcomes were diagnosis of any helminthiasis and diagnosis of schistosomiasis and strongyloidiasis. Multivariable logistic regression was used to assess associations between potential predictors and helminthiases with a backwards stepwise elimination approach until a predictive model was reached in which each variable had a p value < 0.15.
Of 1112 eligible patients with eosinophilia and documented stay in endemic regions, 219 (19.7%) had been diagnosed with helminthiasis, most frequently schistosomiasis (n = 95, 43.4%) and strongyloidiasis (n = 64, 29.2%). A stay in Sub-Saharan Africa (SSA) (OR, 8.2; 95% CI, 2.44-27.56), malaise and fatigue (OR 2.65; 95% CI, 0.77-9.09), and high-grade eosinophilia >1500 cells/μL (OR 2.26; 95% CI, 1.54-3.32) were the most important predictors for any helminthiasis (area under the curve [AUC], 0.77; 0.74-0.80). An SSA origin (AUC, 2.97; 1.11-7.95), malaise and fatigue (AUC, 5.48; 1.13-26.63), and high-grade eosinophilia (AUC, 1.53; 0.86-2.71) were predictors for schistosomiasis (AUC, 0.74; 0.70-0.77); whereas SSA origin (AUC, 5.68 (3.04-10.59)), itching symptoms (AUC, 5.05; 1.32-19.36), and high-grade eosinophilia (AUC, 2.42; 1.33-4.41) were predictors for strongyloidiasis (AUC, 0.73; 0.69-0.76).
A stay in an endemic region, specifically SSA, having high-grade eosinophilia, and malaise and fatigue were the most important predictors for helminthiasis. Itching was an additional predictor for strongyloidiasis.
本研究旨在确定有嗜酸性粒细胞增多症的旅行者和移民中蠕虫病的预测因素，这些人曾前往热带地区或常见蠕虫病的流行地区就诊。
采用回顾性队列研究，利用斯德哥尔摩卡罗林斯卡大学医院23905例嗜酸性粒细胞增多症患者（2011年1月至2021年8月）的电子健康记录，包括在蠕虫病流行地区有登记停留史且接受过蠕虫病检测的患者。结局指标为任何蠕虫病的诊断、血吸虫病和类圆线虫病的诊断。采用多变量逻辑回归，通过向后逐步排除法评估潜在预测因素与蠕虫病之间的关联，直至建立一个预测模型，其中每个变量的p值<0.15。
在1112例有嗜酸性粒细胞增多症且有在流行地区停留记录的合格患者中，219例（19.7%）被诊断为蠕虫病，最常见的是血吸虫病（n = 95，43.4%）和类圆线虫病（n = 64，29.2%）。曾在撒哈拉以南非洲（SSA）停留（比值比[OR]，8.2；95%置信区间[CI]，2.44 - 27.56）、不适和疲劳（OR 2.65；95% CI，0.77 - 9.09）以及重度嗜酸性粒细胞增多>1500个细胞/μL（OR 2.26；95% CI，1.54 - 3.32）是任何蠕虫病最重要的预测因素（曲线下面积[AUC]，0.77；0.74 - 0.80）。SSA地区出身（AUC，2.97；1.11 - 7.95）、不适和疲劳（AUC，5.48；1.13 - 26.63）以及重度嗜酸性粒细胞增多（AUC，1.53；0.86 - 2.71）是血吸虫病的预测因素（AUC，0.74；0.70 - 0.77）；而SSA地区出身（AUC，5.68（3.04 - 10.59））、瘙痒症状（AUC，5.05；1.32 - 19.36）以及重度嗜酸性粒细胞增多（AUC，2.42；1.33 - 4.41）是类圆线虫病的预测因素（AUC，0.73；0.69 - 0.76）。
曾在流行地区停留，特别是在SSA地区，有重度嗜酸性粒细胞增多以及不适和疲劳是蠕虫病最重要的预测因素。瘙痒是类圆线虫病的另一个预测因素。
