title: Should parasitic disease be investigated in immigrant children with relative eosinophilia from tropical and sub-tropical regions?
abstract: BACKGROUND
  Immigrants to Spain are mainly from low- and middle-income countries, and around 20% are children. Absolute eosinophilia is defined as >0.45×109eosinophilic leucocytes/L of peripheral blood. Absolute eosinophilia in travelers and immigrants from tropical and sub-tropical areas is frequently associated with parasitic diseases. However, the significance of relative eosinophilia in immigrant children, defined as >5% eosinophilic leucocytes in those with <0.45×109eosinophils/L, is unresolved.
  
  
  OBJECTIVE
  To describe the importance of relative eosinophilia in a cohort of immigrant children (<18 years) from sub-Saharan Africa, North Africa and Latin America.
  
  
  METHODS
  176 immigrant children without absolute eosinophilia were prospectively evaluated.
  
  
  RESULTS
  25 of them (14.2%) had relative eosinophilia. 10 patients with relative eosinophilia had no diagnosis. 15 with relative eosinophilia (60%) were diagnosed with a parasitic disease, 7 (46.7%) of whom had only one parasite, while co-infection accounted for 8 of the 15 cases (53.3%). Of the parasitic infections, the most frequent causes of relative eosinophilia were filariasis spp. (7/15, 46.7%), strongyloides spp. (5/15, 33.3%), schistosoma spp. (4/15, 26.6%) and Ascaris lumbricoides (2/15, 13.3%).
  
  
  CONCLUSIONS
  The findings suggest that relative eosinophilia is frequently associated with helminthic infection in immigrant children from tropical and sub-tropical areas, so a thorough parasitological study is highly advisable in this group of patients.
authors.affiliation: a Servicio de Medicina Interna, Seccion de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigacion Biomedica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS).
authors.forename: Moncef
authors.initials: M
authors.lastname: Belhassen-García
authors.affiliation: b Servicio de Medicina Interna, Hospital General de Palencia Río Carrión , Palencia.
authors.forename: Javier
authors.initials: J
authors.lastname: Pardo-Lledias
authors.affiliation: c CIETUS, IBSAL, Universidad de Salamanca.
authors.forename: Luis
authors.initials: L
authors.lastname: Pérez Del Villar
authors.affiliation: d Laboratorio de Inmunología Parasitaria y Molecular,CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca.
authors.forename: Antonio
authors.initials: A
authors.lastname: Muro
authors.affiliation: a Servicio de Medicina Interna, Seccion de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigacion Biomedica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS).
authors.forename: Virginia
authors.initials: V
authors.lastname: Velasco-Tirado
authors.affiliation: e Servicio de Microbiologia, CAUSA, CIETUS, IBSAL, Grupo de Investigación Reconocido MICRAPE, Universidad de Salamanca , Departamento de Ciencias Biomédicas y del Diagnóstico.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Muñoz Bellido
authors.affiliation: f Laboratorio de Inmunología Parasitaria y Molecular , CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca.
authors.forename: Belén
authors.initials: B
authors.lastname: Vicente
authors.affiliation: g Servicio de Microbiologia, CAUSA, CIETUS, IBSAL, Grupo de Investigación Reconocido MICRAPE, Departamento de Medicina Preventiva, Salud Pública y Microbiología Médica, Universidad de Salamanca , Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Blázquez de Castro
authors.affiliation: a Servicio de Medicina Interna, Seccion de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigacion Biomedica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS).
authors.forename: Miguel
authors.initials: M
authors.lastname: Cordero-Sánchez
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants; D004802:Eosinophilia / Q000209:etiology*; D005260:Female; D006373:Helminthiasis / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology
keywords: Child; Helminthiasis; Immigrants; Relative eosinophilia