Eosinophilia characteristic of patient with parasitic infection in fecal specimen diagnosis Background:Eosinophiliaresponsenotonlytoparasiticinfectionbutalsoseveralotherstimulatingfactorsthatincreasesbloodcirculation.Ourteamsuspectedwhethereosinophilinbloodstreamassociatedwiththekindsofintestinalparasitesthatwerefoundinfecalspecimenornot. Objective:Todescribepercentageofeosinophilinpatientwhohaveapositiveresultofeachintestinalparasiteinstool. Materials/Methods:Thedatawereselectedduring2015inbothoffecesandblood.ParasiteclassificationsweredonebydirectmicroscopicstoolexaminationandpercentagesofeosinophilweremeasuredinEDTAbloodusingDXH®800BeckmanCoulter,Miami,FL,hematologyautomatedanalyzer.Total119caseswereobtainedandcategorizedinto2groups,49caseswerepositiveofintestinalparasitesand70caseswerenon‐parasiticinfection(negativecontrol).T‐testanddescriptivestatisticswasusedtoanalyzedataandexplainassociationparameters. Results:Thestudypresentedthatpatientsinfectedwithpathogenicparasitesshowedpercentofeosinophil(meanas10.38%(95%CI;6.86‐13.89))higherthanhealthypersons(meanas1.72%(95%CI;1.35‐2.09))withstatisticalsignificance(p<0.001).Ingroupofhelminths;round,flukeandtapewormweredemonstratedtheaverageofeosinophilcountat11.08±11.92,10.62±15.95,5.12±3.70%respectively.Interestingly,Strongyloidesstercoralisshowedthehighestaverageofpercentageat10.18±10.56amongclusterofhelminths. Conclusions:Highpercentageofeosinophilwillremindphysicianstoinvestigateparasitesbyrequestingstoolexamination.Thispreliminaryresultrevealedaneosinophiliapatterninpatientswhomwereinfectedwithhelminthsespeciallyincaseofroundandflatworm.Thedatainthisstudywaslimitedduetothelownumberofpositivecases(1year) therefore,anincreaseinthenumberofsamplesisneededformoreconfidentresultsandabsoluteeosinophilshouldbeappliedforconsideration. Keywords:Eosinophilia,Parasite,Helminthes,Infection,Fecal

1. Eosinophilia characteristic of patient with parasitic infection in fecal specimen
diagnosis
Kridsada Sirisabhabhorn, Supaporn Pumpa, Surapong Pornprasitseang and Palakorn Puttaruk
Medical Technology Laboratory, Thammasat University Hospital, Pathumtani Province, Thailand 12120
Background: Eosinophilia response not only to parasitic infection but also several other stimulating factors that increases blood circulation. Our team suspected
whether eosinophil in blood stream associated with the kinds of intestinal parasites that were found in fecal specimen or not.
Objective: To describe percentage of eosinophil in patient who have a positive result of each intestinal parasite in stool.
Materials/Methods: The data were selected during 2015 in both of feces and blood. Parasite classifications were done by direct microscopic stool examination and
percentages of eosinophil were measured in EDTA blood using DXH®800 Beckman Coulter, Miami, FL, hematology automated analyzer. Total 119 cases were obtained
and categorized into 2 groups, 49 cases were positive of intestinal parasites and 70 cases were non‐parasitic infection (negative control).T‐test and descriptive statistics
was used to analyze data and explain association parameters.
Results: The study presented that patients infected with pathogenic parasites showed percent of eosinophil (mean as 10.38 % (95% CI; 6.86‐13.89)) higher than healthy
persons (mean as 1.72% (95% CI; 1.35‐2.09)) with statistical significance (p<0.001). In group of helminths; round, fluke and tape worm were demonstrated the average
of eosinophil count at 11.08 ± 11.92, 10.62 ± 15.95, 5.12 ± 3.70% respectively. Interestingly, Strongyloides stercoralis showed the highest average of percentage at
10.18 ± 10.56 among cluster of helminths.
Conclusions: High percentage of eosinophil will remind physicians to investigate parasites by requesting stool examination. This preliminary result revealed an
eosinophilia pattern in patients whom were infected with helminths especially in case of round and flatworm. The data in this study was limited due to the low number
of positive cases (1 year) therefore, an increase in the number of samples is needed for more confident results and absolute eosinophil should be applied for
consideration.
Key words: Eosinophilia, Parasite, Helminthes, Infection, Fecal
Introduction
Eosiniphil is the product from body immune response processing,
especially present increase of count in case of parasitic infection. Nevertheless,
not all cases of parasitic infection react to eosinophilia‐high count of eosinophil
in blood stream. [1] Particularly, association in high percent of eosinophilia is
relevant to parasite finding in fecal specimen and consist with many previous
study. [2] This knowledge provides useful in parasitic suggestive investigation in
feces for physician’s diagnosis. The purpose to study characteristic of
eosinphilia relate to kinds of parasite positive finding in fecal specimen benefit
for diagnosis and treatment.
Materials & Methods
Parasites 119 cases
(positive cases by
formalin‐ethyl acetate
technique)
Healthy human
70 cases
(negative control)
UniCel®DxH 800
Medical record in 2015 year
Analysis by Stata software
Result
Discussion & Conclusion
References
No. Type Parasite Stage N
% average of
eosinophil
1. Flatworm or
flukeworm
Opisthorchis viverrini &
Minute intestinal
egg 10 10.62 ± 15.95
2. Roundworm Strogyloides
stercoralis*, Ascaris
lumbricoides,Trichuris
trichiura & Hookworm
Larva, egg 34 11.08 ± 11.92
3. Tapeworm Taenia spp.
& Hymenolepis nana
egg 5 5.12 ± 3.70
Note Round worm Strogyloides stercoralis Rhabditiform
larva
31 10.18 ± 10.56
No. Group N % average of eosinophil
(95%CI)
P‐value
1. Positive parasite
result in fecal
specimen
49 10.38
(6.86‐13.89)
< 0.001*
2. Healthy human
(negative control)
70 1.72
(1.35‐2.09)
This study shown high percent of eosinophil count in bloodstream with each types of parasite follow on table 1. The increasing of eosinophilia was presented in
cases of positive parasite finding when compare with healthy human group especially in helminths infection with significant statistic follow on table 2. The sequence
of the highest eosinophilia to the lowest mean values are round, flat and tape worm respectively. The couple of round and flatworm reveal mean as over 10%
particularly, in Strogyloides stercoralis infection stage in rhabditiform larva present the highest percent of eosinophilia when compare among parasite types so
its characteristics may be invasion auto infection and migration induce blood cell immune respond releasing. [3]
Even though, no certain criteria percent is cut for percent of eosinophilia that uses define parasite finding but it can be useful as guide line in helminths
infection then in addition, Ehrhartd et al. study reveal associate highly eosinophilia with traveler and migrants. [4] Better medical decision cut off should be
get larger sample size and analysis combine with absolute eosinophil count per volume unit in the next trial for reliable predictive value.
Table 2. Results of average percent of eosinophilia were classified follow as kinds of
parasite finding in fecal specimen.
Table 1. Comparison of eosinophilia’s mean value between groups of parasite
finding in fecal specimen with healthy human, non parasite infection as negative
control.
* The p‐value lower than 0.05 was assigned in different significant statistic
1. Rothenberg ME. Eosinophilia. N Engl J Med. 1998; 338: 1592–1600.
2. Machnicka‐Rowińska B, Dziemian E. Eosynophils in parasitic infections‐‐clinical and functional significance. Wiad Parazytol. 2003; 49: 245‐54.
3. Guerrant RL, Walker DH, Weller PF, Wilson ME. Tropical infectious diseases: principles, pathogens, and practice. 1st edition. Philadelphia: Churchill Livingstone; 1999.
Eosinophilia. In: Guerrant RL, Walker DH, Weller PF, editors; pp. 1400–19.
4. Ehrhartd, S., Burchard, G.D. Eosinophilia in Returning Travelers and Migrants. Dtsch Arztebl Int. 2008; 105: 801–807.
Abstract
This study declared no conflicts and interest.