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PLATELET DYSFUNCTION–EOSINOPHILIA SYNDROME IN PARASITIZED VENEZUELAN CHILDREN

Platelet dysfunction was detected in six children with purpura and eosinophilia. We conducted clinical evaluations, hematologic and platelet function tests, clotting studies (bleeding time, prothrombin time, partial thromboplastin time, thrombin time, factor XIII, factor VIII, and von Willebrand factor), assays for IgG and IgM antibodies to platelets, and a search for stool parasites. Mild bleeding phenomena (ecchymoses, petechiae, epistaxis, and gingival) were transient. All children showed intestinal parasites and marked eosinophilia (mean count = 2,615.2 cells/µL, 95% confidence interval = 1,259.6–5,429.8). Main abnormalities included prolonged bleeding times (50%) and defective aggregation with collagen (100%) adrenaline (66%), or ADP (66%). Antibodies to platelets were not detected. Anti-parasite therapy reversed the hemorrhagic manifestations and normalized eosinophil counts and platelet alterations. No relationship could be established between excess eosinophils, intensity of bleeding, or type and degree of platelet abnormalities. Thrombocytopathic features mimicked the intrinsic defect of storage pool disease. The possible pathogenic roles of eosinophilia and parasitism are reviewed. This is the first report of this pathologic combination in Latin American children.

Received May 28, 2004. Accepted for publication February 25, 2005.

Acknowledgments: We thank Isbelia Rada for technical assistance. The American Committee on Clinical Tropical Medicine and Travelers’ Health (ACCTMTH) assisted with publication expenses.

Financial support: This work was supported by a grant from the Consejo de Desarrollo Científico y Humanístico of the Universidad Central de Venezuela.

^* Address correspondence to Dr. Luz Núñez Sifontes, Cátedra de Parasitologia, Escuela de Medicina José María Vargas, Facultad de Medicina, Universidad Central de Venezuela, Esquina Pirineos, San José, Caracas, Venezuela. E-mail: nenagold{at}cantv.net

Authors’ addresses: Arlette Ruiz-Sáez, Rosa Feijoo, and Norma Bosch, Banco Municipal de Sangre del Distrito Capital, Esquina Pirineos, San José, Caracas, Venezuela, Telephone: 58-212-562-2325, Fax: 58-212-552-9905, E-mails: arletteruizsaez{at}hotmail.com, bms3{at}hotmail.com, and bms3{at}cantv.net. Luz Núñez Sifontes, Gabriela Certad, Alejandro Arenas Pinto, Leonor Pocaterra, Guiseppe Ferrara, Rita Gimenez, and Obdulita Torres, Cátedra de Parasitología, Escuela de Medicina José María Vargas, Facultad de Medicina, Universidad Central de Venezuela, Esquina Pirineos, San José, Caracas, Venezuela, Telephone: 58-212-564-5686, Fax: 58-212-562-9928, E-mails: nenagold{at}cantv.net, gfombo{at}cantv.net, Aarenas-pinto{at}gum.ucl.ac.uk, Leopoca25{at}hotmail.com, Picho99{at}cantv.net. Carlos Goldstein, Centro Médico de Caracas, Plaza El Estanque, San Bernardino, Caracas, Venezuela, Telephone: 58-212-552-1504, Fax: 58-212-551-6066, E-mail: cargolds{at}cantv.net.

Reprint requests: Luz Núñez Sifontes, Cátedra de Parasitología, Escuela de Medicina José María Vargas, Facultad de Medicina, Universidad Central de Venezuela, Esquina Pirineos, San José, Caracas, Venezuela, E-mail: nenagold{at}cantv.net