title: Strongyloides stercoralis, Eosinophilia, and Type 2 Diabetes Mellitus: The Predictive Value of Eosinophilia in the Diagnosis of S stercoralis Infection in an Endemic Community.
abstract: Background.  This study examines the predictive value of eosinophilia for Strongyloides stercoralis infection, as measured by enzyme-linked immunosorbent assay (ELISA) testing, in an endemic community. In remote communities, eosinophilia is frequently used as a proxy test for the presence of helminth infections. Past studies of eosinophilia and Strongyloides infection have been conducted in specific groups such as immigrants and refugees, or in subpopulations of nonendemic communities, rather than in endemic communities. Methods.  We conducted a cross-sectional study of the relationship between eosinophilia and Strongyloides ELISA serology, as part of a study into the relationship between S stercoralis infection and type 2 diabetes mellitus (T2DM) in an Indigenous community in northern Australia. Results.  Two hundred thirty-nine adults had their eosinophil count and S stercoralis ELISA serology measured in 2012 and 2013, along with other biometric and metabolic data. Eosinophilia was found to have a relatively poor sensitivity (60.9%), specificity (71.1%), positive predictive value (54.6%), and negative predictive value (76.1%) for S stercoralis ELISA positivity in this group. However, there was a more constant relationship between eosinophilia and S Stercoralis ELISA positivity in patients with T2DM (negative predictive value 87.5%). Conclusion.  This study suggests that the presence or absence of eosinophilia is not an adequate proxy test for S stercoralis infection in a community where the infection is prevalent, and that the association between eosinophilia and S stercoralis ELISA positivity is more constant in patients with T2DM.
authors.affiliation: Kimberley Aboriginal Medical Council, Western Australia; James Cook University, Cairns Campus, Smithfield.
authors.forename: Russell
authors.initials: R
authors.lastname: Hays
authors.affiliation: Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences , James Cook University , Cairns.
authors.forename: Fintan
authors.initials: F
authors.lastname: Thompson
authors.affiliation: Centre for Research Excellence in Chronic Disease Prevention, The Cairns Institute, James Cook University, Cairns Campus, Smithfield, Queensland, Australia; Sansom Institute of Health Service Research and School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide.
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.affiliation: Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns; School of Population Health, University of South Australia, Adelaide.
authors.forename: Robyn
authors.initials: R
authors.lastname: McDermott
keywords: Strongyloides stercoralis; eosinophilia; type 2 diabetes mellitus