As we improve our preventative health screening practices in Remote Indigenous Health we inevitably encounter incidental abnormalities in routine pathology. Given our limited resources and developing recall systems, what do we do about them? Over the next few weeks we will address a handful of common queries and a sensible approach to management.
Eosinophilia is a common finding in this region. Infections that are endemic to northern Australia and that are known to produce eosinophilia include Trichuris trichuria, hookworm species, Hymenolepis nana, Toxocara canis, and S stercoralis, as well as ectoparasites such as Sarcoptes scabiei.
Heavy infections with helminths cause clinical disease including anaemia, diarrhoea and malabsorption of nutrients. Moderate or light infections in children can cause morbidity by adversely affecting nutritional status and affect educational outcomes by impairing cognitive processes.
Control is based on:
- periodical deworming to eliminate infecting worms
- health education to prevent re-infection
- improved sanitation to reduce soil contamination with infective eggs.
WHO recommends periodic medicinal treatment (deworming) without previous individual diagnosis to all at-risk people living in endemic areas. Treatment should be given once a year when the baseline prevalence of soil-transmitted helminth infections in the community is over 20%, and twice a year when the prevalence of soil-transmitted helminth infections in the community is over 50%.
Therefore in our population all children >2 and women of child bearing age should be treated with Albendazole 400mg opportunistically at their annual health review. Any other adult with incidental finding of eosinophilia should be assessed for signs and symptoms of parasitic infection and treated accordingly. Anaemia or iron deficiency can be a common finding and deserves investigation in its own right however should trigger treatment for helminth infection when accompanied with eosinophilia.