title: Anemia, leukocytosis and eosinophilia in a resource-poor population with helmintho-ectoparasitic coinfection.
abstract: BACKGROUND
  Eosinophilia and anemia are very common hematological alterations in the tropics but population-based studies scrutinizing their value for diagnosing parasitic infections are rare.
  
  
  METHODS
  A cross-sectional study was conducted in a rural district in northeast Brazil where parasitic infections are common. Stool and blood samples were collected and individuals were clinically examined for the presence of ectoparasites.
  
  
  RESULTS
  In total, 874 individuals were examined. Infection with intestinal helminths occurred in 70% (95% CI 67 - 75), infestation with ectoparasites in 45% (95% CI 42 - 49) and co-infection with both helminths and ectoparasites was found in 33% (95% CI 29% - 36%) of all inhabitants. Eosinophil counts ranged from 40/µl to 13.800/µl (median: 900/µl). Haemoglobin levels ranged from 4.8 g/dl to 16.8 g/dl (median: 12.5 g/dl), and anemia was present in 24% of the participants. Leukocytosis was found in 13%, eosinophilia in 74%, and hypereosinophilia in 44% of the participants. Eosinophilia was more pronounced in individuals co-infected with intestinal helminths and ectoparasites (p < 0.001) and correctly predicted parasitic infection in 87% (95% CI 84%-90.7%) of all cases.
  
  
  CONCLUSIONS
  Eosinophilia is strongly associated with the presence of intestinal helminthiases and accentuated by co-infestation with ectoparasites. Our study confirms in a population with high prevalence of intestinal helminthiases and ectoparasites that eosinophilia can be used to accurately diagnose current parasitic infection and initiate treatment.
authors.affiliation: Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Microbiology and Hygiene, D-12203 Berlin, Germany. daniel.pilger@charite.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Pilger
authors.forename: Jörg
authors.initials: J
authors.lastname: Heukelbach
authors.forename: Alexander
authors.initials: A
authors.lastname: Diederichs
authors.forename: Beate
authors.initials: B
authors.lastname: Schlosser
authors.forename: Cinthya
authors.initials: C
authors.lastname: Pereira Leite Costa Araújo
authors.forename: Anne
authors.initials: A
authors.lastname: Keysers
authors.forename: Oliver
authors.initials: O
authors.lastname: Liesenfeld
authors.forename: Hermann
authors.initials: H
authors.lastname: Feldmeier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004478:Ectoparasitic Infestations / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D004802:Eosinophilia / Q000453:epidemiology* / Q000209:etiology; D005243:Feces / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D006403:Hematologic Tests; D006801:Humans; D007223:Infant; D007964:Leukocytosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D055815:Young Adult