Eosinophilia in Migrant Children: How Should We Proceed?. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Bustamante, Jorge; García López-Hortelano, Milagros; Barcia, Cristina; Díaz Almirón, Mariana; Subirats, Mercedes; Montero Vega, Dolores; Mellado, María José; Sainz, Talía
• Is Part Of: Pediatric infectious disease journal. Volume 41:Issue 2(2022)
• Publication Date: 2022-02
• Subjects: eosinophilia -- migrant children -- helminthiasis -- parasites; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000003390
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: The diagnostic approach to eosinophilia is complex, given the numerous reported etiologies. Intestinal parasites (especially helminths) are a concern in children from high-burden settings. We describe the diagnostic approach and clinical management of eosinophilia in a cohort of migrant children. Methods: We conducted a retrospective observational study that included children diagnosed with eosinophilia at a reference center for pediatric tropical diseases from 2014 to 2018. All patients were screened according to a unified protocol, including direct microbiologic and serologic tests. Results: A total of 163 children presented with eosinophilia during the study period [median age, 7.7 years (4.1–12.2); 57.1% boys], mostly from Asia (27.6%) and South America (22.1%). Most were internationally adopted children (43.6%) or migrants (26.4%). Only 34.4% of the children were symptomatic, and the main etiology for eosinophilia was helminths (56.4%). After a sequential diagnostic approach, no etiology was found for 40.5% of the patients. The independent risk factors for an unexplained etiology were younger age (⩽2 years: odds ratio, 3.6; 95% CI, 1.3–10.2; P = 0.015), absence of symptoms (odds ratio, 4.8; 95% CI, 1.8–12.5; P = 0.001) and mild eosinophilia (<1000/µL: odds ratio, 4.2; 95% CI, 4.5–11.7; P = 0.005). Only 6 children were treated empirically. In those children with an identified cause and in those treated empirically, the eosinophilia resolved in 52% in a median of 7 months (5–9). Conclusions: Helminths are the main cause of eosinophilia in migrant children and need to be hunted, especially in older children with eosinophil counts >1000 eosinophils/µL.