Prevalence of Eosinophilia and Parasites in a Newly Arrived Refugee Population
Eosinophilia is a major health issue concerning immigrant populations from parasite endemic regions such as Sub-Saharan Africa, the Middle East and Asia. The presence of eosinophilia is most commonly due to parasite infections in this group. This study was undertaken to assess the prevalence of eosinophilia and the prevalence of parasitic infections in refugees being resettled in Dayton, Ohio.
This was a retrospective chart review of all refugees who were evaluated at Public Health – Dayton & Montgomery County (Ohio) from 2009-2013. Inclusion criteria was country of origin in Africa, Asia or Middle East. Evaluation included a single stool examination for O&P as well as a CBC with automated differential. Refugees were excluded from the study if there was no country of origin listed, or for missing lab values. Eosinophilia was defined as absolute eosinophil count > 500 cells/μL or eosinophil percentage ≥ 7.0.
A total of 637 charts of individuals were reviewed; 39 were excluded from analysis. Of the remaining 598 refugees, 364 were male and 234 female. A total of 300 were from countries in Africa, 211 from the Middle East and 87 from Asia. The mean age was 29.1; 450 (75.3%) of refugees were adults (age ≥ 18 yrs). Overall, 197 (32.9%) of the refugees had a positive screen for O&P. The most common parasite found was Giardia (29), followed by E. histolytica/dispar (17), Schistosoma (4), Hookworm (4), Strongyloides (3), Trichuris (3), and Ascaris (1). Non-pathogens were found in a total of 165 refugees. Eosinophilia was noted in 95 (15.9%) of the refugees and was associated with the finding of a tissue parasite in the stool O&P screen.
The percentage of refugees arriving with intestinal helminth infection was fairly low in this study, as compared to studies prior to the recommendation for refugees from sub-Saharan Africa and Asia to receive empiric therapy with albendazole prior to departure. Despite the recommendations for pre-departure treatment, many refugees arrive in the United States with parasitic infection, and many more have significant eosinophilia, emphasizing the need for prompt and thorough screening after arrival in the US.
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