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Eosinophilia Among Returning Travelers: A Practical Approach

Eosinophilia is not uncommon among returning travelers; however, the optimal diagnostic and therapeutic approach in travelers, as opposed to immigrants and refugees, is not clearly established. This was a retrospective case series. All returning travelers from developing countries presenting at the post-travel clinic with eosinophilia ( 500 cells/mcl) during 1994–2006 were evaluated. Data were compared with other referrals to the post-travel clinic and with a random sample of a pre-travel clinic. Of the 955 returning travelers evaluated during the study period, 82 (8.6%) had eosinophilia, and 44 (4.4%) were diagnosed with schistosomiasis. Another 38 (4.2%) cases presented with non-schistosomal eosinophilia (NSE), among whom a definite parasitologic diagnosis was achieved in only 23.7%. However, an empiric course of albendazole led to a clinical improvement in 90% of NSE cases. Helminthic disease probably accounts for the majority of cases of post-travel eosinophilia. Empiric albendazole therapy should be offered to undiagnosed NSE patients.

Received September 17, 2007. Accepted for publication January 3, 2008.

^* Address correspondence to Eli Schwartz, The Center for Geographic Medicine and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. E-mail: elischwa{at}post.tau.ac.il

Authors’ addresses: Eli Schwartz, The Center for Geographic Medicine and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, Fax: 972-3-5302011, E-mail: elischwa{at}post.tau.ac.il. Eyal Meltzer, The Infectious Disease Unit and Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, Telephone: 972-54-4728552, Fax: 972-3-5303501, E-mail: emeltzer{at}post.tau.ac.il. Ruth Percik, Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, Fax: 972-3-5302011, E-mail: ruth_percik{at}yahoo.com. Joshuah Shatzkes, The Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, E-mail: Joshua.shatzkes{at}yale.edu. Yehezkel Sidi, Department of Medicine C, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, Fax: 972-3-5302011, E-mail: ysidi{at}sheba.health.gov.il.