Asymptomatic eosinophilia is a common finding in returning travelers
and immigrants from parasite-endemic areas. We present a 49-year-old
man from Guyana who immigrated to the United States 4 years prior
to examination. He had persistent asymptomatic eosinophilia, and multiple
stool examinations were negative for ova and parasites. Although the
list of parasitic diseases associated with eosinophilia is extensive,
the differential diagnosis of asymptomatic eosinophilia with negative
stool evaluations is rather limited. We discuss herein elements of
the clinical history and examination essential for evaluating eosinophilia
in patients at risk of parasitic diseases and present a simple algorithm
to guide diagnostic testing. Despite the importance of repeated stool
examinations for the presence of ova and parasites, in practice this
test is not sensitive. Serologic testing for chronic parasitic infections
is often necessary. Most cases without a definitive diagnosis can
be conservatively managed with serial monitoring or empirically treated
with antihelminthic therapy, but patients with an absolute eosinophil
count of more than 3000/μL or more than 1500/μL for more than
6 months are at risk of end organ damage and should be referred for
specialized parasitic and/or hematology consultation.
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