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Open Access Research article

Travel-related schistosomiasis, strongyloidiasis, filariasis, and toxocariasis: the risk of infection and the diagnostic relevance of blood eosinophilia

Gijs G Baaten123*, Gerard J Sonder123, Tom van Gool24, Joan A Kint1 and Anneke van den Hoek12

Author Affiliations

1 Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE Amsterdam, The Netherlands

2 Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

3 National Coordination Centre for Traveler's Health Advice (LCR), Nieuwe Achtergracht 100, PO Box 1008, 1000 BA Amsterdam, The Netherlands

4 Department of Microbiology, Parasitology Section, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

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BMC Infectious Diseases 2011, 11:84  doi:10.1186/1471-2334-11-84

Published: 5 April 2011

Abstract

Background

This study prospectively assessed the occurrence of clinical and subclinical schistosomiasis, strongyloidiasis, filariasis, and toxocariasis, and the screening value of eosinophilia in adult short-term travelers to helminth-endemic countries.

Methods

Visitors of a pre-travel health advice centre donated blood samples for serology and blood cell count before and after travel. Samples were tested for eosinophilia, and for antibodies against schistosomiasis, strongyloidiasis, filariasis, and toxocariasis. Previous infection was defined as seropositivity in pre- and post-travel samples. Recent infection was defined as a seroconversion. Symptoms of parasitic disease were recorded in a structured diary.

Results

Previous infection was found in 112 of 1207 subjects: schistosomiasis in 2.7%, strongyloidiasis in 2.4%, filariasis in 3.4%, and toxocariasis in 1.8%. Recent schistosomiasis was found in 0.51% of susceptible subjects at risk, strongyloidiasis in 0.25%, filariasis in 0.09%, and toxocariasis in 0.08%. The incidence rate per 1000 person-months was 6.4, 3.2, 1.1, and 1.1, respectively. Recent infections were largely contracted in Asia. The positive predictive value of eosinophilia for diagnosis was 15% for previous infection and 0% for recent infection. None of the symptoms studied had any positive predictive value.

Conclusion

The chance of infection with schistosomiasis, strongyloidiasis, filariasis, and toxocariasis during one short-term journey to an endemic area is low. However, previous stay leads to a cumulative risk of infection. Testing for eosinophilia appeared to be of no value in routine screening of asymptomatic travelers for the four helminthic infections. Findings need to be replicated in larger prospective studies.

Keywords:
helminth infection; eosinophilia; travel; prospective study