18 responses to “Never ignore an elevated eosinophil count – especially in travellers, immigrants and refugees”

  1. It was very refreshing view of looking at elevated eosinophil count. It is certainly very useful in my practice that has high percentage of immigrants from South Asia.

  2. Eosinophil counts are not reported on Interior Health automated differentials. I used to find these counts useful. now, they have to be ordered specifically.

  3. Nice to see this summary of the CCIRH guidelines as well as and a relevant case study.

  4. good info. Any figures re the actual incidence?

  5. Excellent review

  6. Interesting article on a group of illnesses that I feel I do not know much about. I think we often do think of these types of things in people with an obvious travel history, but the problem is that travel is only a risk factor and we all know that risk factors alone don’t pick everyone up with the disease. Just to name 2, I know of cases of Cryptococcous gatii and Typhoid without any risk factors or travel to emdemic areas. I am sure the same holds for many of these parasitic infections. It seems like we need a guideline for workup of eosinophilia for all patients, keeping in mind what would be cost effective. I am not sure how many of our patients have undiagnosed eosinophilia right now…perhaps this could be a lot?

  7. Good to consider in treating travellers and refugees especially when the eos count is high

  8. I, too, appreciated having the guidelines summarized. I don’t believe we should have to ask for an eosinophil count at Interior Health; it should be part of a CBC.

  9. Thank you for this excellent case presentation. I confess I knew nothing about strongyloides infection (I even have a hard time pronouncing it).
    I too will change my practise.

  10. I do a fair amount of work at YVR so a fair number of the patients we see are from the endemic areas and this information will I’m sure be useful in the future.

  11. This information is useful. I have a number of immigrant patients and travellers from areas at risk for parasitic infections.

  12. Interesting.One’s education continues. you don’t mention his Ca Lung. How did he get into Canada and would that likely not be a potential life limiting issue?

  13. This is very relevant to my Hospitalist practice in Burnaby as we have patients from all over the world. I will watch for eosinophilia more carefully in future!

  14. Thanks to my background medical degree from Hong Kong, where tropical and parasititc diseases course was manadatory, we have been taught even 45 years ago to use eosinophil counts as “allerts” to parasitic diseases.

  15. Thanks for the informative review. Lots of immigrant patients and I never knew there’s even a Tropical Medicine clinic at VGH which I could refer to… Two years ago I had a returning traveller from South Asia who presented with delirium and a 40+ degree fever 4 months after her return, sent to VGH Emerg specifically for malaria work up, and had a resident call me to argue that this patient would NOT need any malaria blood smears. I think more time and resources was spent to convince me that the workup was redundant, than to actually work up the patient.
    Anyways, I digress. Any similar tropical medicine / parasitology referral center that will see children?? I often have cases of perianal itch / failure to thrive etc in toddlers who turn out to have an eosinophil count… but we never find anything on repeated Stool O&P attempts….

  16. Useful reminder, especially in this age of diverse travel by all age groups.
    Will definitely pay more attention to this.

  17. Travel to South Asia is increasingly popular among my young adult patients. They will be more carefully screened in future, and their eosinophil counts will be more closely looked at. By the way, how does raccoon roundworm present in children?

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