Eosinophilia due to multiple parasitic infection

Area of Science:

• Tropical medicine
• Infectious diseases
• Clinical parasitology

Background:

• Eosinophilia is a common hematological finding associated with allergic reactions and parasitic infections.
• In tropical regions, polyparasitism is frequently implicated as the cause of significant eosinophilia.
• This case highlights a diagnostic challenge of parasitic infections presenting in a non-endemic setting (UK).

Observation:

• A patient in the UK presented with eosinophilia and symptoms suggestive of parasitic disease.
• Initial diagnostic workup revealed positive serological or stool tests for multiple helminthic infections, including amoebiasis, filariasis, schistosomiasis, and fascioliasis.
• Despite empirical treatment for these identified parasites, the patient's clinical condition did not improve.

Findings:

• Subsequent, extensive stool examinations (19 in total) eventually led to the identification of Strongyloides stercoralis infection.
• Treatment specifically targeting strongyloidiasis resulted in the resolution of the patient's eosinophilia and associated symptoms.
• This underscores the potential for Strongyloides to be overlooked in differential diagnoses, even when other parasitic infections are present.

Implications:

• The case emphasizes the importance of considering strongyloidiasis in patients with unexplained eosinophilia, particularly those with a history of travel to or residence in endemic areas.
• Diagnostic delays can occur, necessitating persistent and thorough investigation, including repeated stool examinations.
• Accurate diagnosis and targeted treatment of Strongyloides infection are crucial for resolving persistent eosinophilia and clinical manifestations, even in the presence of co-infections.