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IJCRR - 7(20), October, 2015

Pages: 01-05

Date of Publication: 20-Oct-2015

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A DETAILED STUDY OF ABSENCE OF EOSINOPHILIA IN PATIENTS WITH HOOKWORM INFECTION DIAGNOSED BY DOING UPPER GASTRO-INTESTINAL ENDOSCOPY

Author: Govindarajalu Ganesan

Category: Healthcare

Abstract:Objective: Many studies have shown the presence of eosinophilia in hookworm infection. But so far detailed study was not done to know about the absence of eosinophilia in hookworm infection. Hence a detailed study was done to know about the absence of eosinophilia in hookworm infection diagnosed by doing upper gastro-intestinal endoscopy in our institute. Methods: A study of 1137 patients who had undergone upper gastro-intestinal endoscopy for a period of four years and eight months from May 2009 to December 2013 was carried out in our institute to know about the absence of eosinophilia in hookworm infection diagnosed by doing upper gastro-intestinal endoscopy in our institute. Results: Out of these 1137 patients, 14 patients found to have hookworms in duodenum while doing upper gastro-intestinal endoscopy were taken into consideration for our study. Out of these14 patients with hookworms in duodenum, as many as 10 patients with hookworms in duodenum were found to have eosinophilia [71%]. But 4 patients with hookworms in duodenum di nt have any eosinophilia[29%]. Out of these 4 patients without eosinophilia with hookworm infection, 3 patients without eosinophilia with hookworm infection had anaemia[75%].
Conclusion: Hence, eosinophilia can sometimes be absent in hookworm infection. But 3 out of 4 patients without eosinophilia with hookworm infection had anaemia in our study. Hence anaemia is an important indicator of hookworm infection which is not associated with eosinophilia.

Keywords: Absence of eosinophilia, Presence of anaemia, Hookworm infection, Upper gastro-intestinal endoscopy

Full Text:

INTRODUCTION

Many studies have also shown the presence of eosinophilia in hookworm infection (1 to 14) . But so far detailed study was not done to know about the absence of eosinophilia in hookworm infection. Hence a detailed study was done to know about the absence of eosinophilia in hookworm infection diagnosed by doing upper gastro-intestinal endoscopy in our institute.

MATERIALS AND METHODS

This study was conducted in the department of general surgery, Aarupadai Veedu Medical College and Hospital, Puducherry. A study of 1137 patients who had undergone upper gastro-intestinal endoscopy for a period of four years and eight months from May 2009 to December 2013 was carried out in our institute. In each of these 1137 patients, the first and second part of duodenum were carefully examined to find out the presence of hookworms. In all the patients found to have hookworms in duodenum, investigations were done to know about the presence or absence of eosinophilia and anaemia. Anaemia is defined as haemoglobin < 12g/dl or 12g% in women (15 to 22) and haemoglobin < 13g/dl or13g% in men (21, 22). Mild anaemia is taken as haemoglobin 10to12g/dl or10to12 g%, moderate anaemia is taken as haemoglobin 7to10g/dl or 7to10 g% and severe anaemia is taken as haemoglobin or = 500 cells/cu.mm (24). Se vere eosinophilia or hypereosinophilia is defined as eosinophils>1000 cells/cu.mm (4). The results were found as given below.

RESULTS

1. Out of these 1137 patients, 14 patients found to have hookworms in duodenum while doing upper gastrointestinal endoscopy were taken into consideration for our study.

2. Out of these14 patients with hookworms in duodenum, as many as 10 patients with hookworms in duodenum were found to have eosinophilia[71%].

3. But 4 patients with hookworms in duodenum did not have any eosinophilia[29%].

4. Out of these 4 patients without eosinophilia with hookworm infection, 3 patients without eosinophilia with hookworm infection had anaemia[2 patients had mild anaemia and 1 patient had severe anaemia].

5. One patient without eosinophilia with hookworm infection also had absence of anaemia.

Hence the 4 patients without eosinophilia with hookworm infection can be divided into 3 groups as follows

a. Absence of both eosinophilia and anaemia in hookworm infection [1 patient].

b. Mild anaemia without eosinophilia with hookworm infection [2 patients]

c. Severe anaemia without eosinophilia with hookworm infection [1 patient]

DISCUSSION

a. Absence of both eosinophilia and anaemia in hookworm infection [1 patient].
1. One patient with hookworm infection neither had eosinophilia[absolute eosinophil count - 160cells/ cu.mm] nor had anaemia[haemoglobin -14g%] which is of extremely great significance.

2. This patient had adequate amount of haemoglobin indicating clearly that the patient was in the extremely early stage of hookworm infection.

3. Eosinophilia was probably not present since the patient was in such extremely early stage of hookworm infection.

4. Eosinophilia only peaks at 5to 9weeks after the onset of infection, a period that coincides with the appearance of adult hookworms in the intestine (10).

b. Mild anaemia without eosinophilia with hookworm infection [2 patients]

1. 2 patients without eosinophilia with hookworm infection had mild anaemia [1. haemoglobin 11.2g% , absolute eosinophil count - 396cells/cu.mm 2. haemoglobin 10g% , absolute eosinophil count - 364cells/ cu.mm].

2. The single hookworm in duodenum found in the patient with mild anaemia [haemoglobin 10 g%] without eosinophilia [absolute eosinophil count - 364cells/ cu.mm] is shown in Fig 1, 2. 3.

The hookworm in duodenum is identified by its bent head which looks like a hook (Fig1) and by its Sshaped appearance (25) (Fig1) .

c. Severe anaemia without eosinophilia with hookworm infection [1 patient]

1. Severe anaemia is due to significant loss of blood due to large number of hookworms and very heavy burden of hookworm infection and indicates severe hookworm infection.

2. Severe anaemia without eosinophilia with hookworm infection was present in one patient in our study [haemoglobin 2.1g%, absolute eosinophil count - 366 cells/cu.mm].

3. Hence even in patients with severe anaemia due to severe hookworm infection, eosinophilia need not be present.

4. Hence significant anaemia always occurs in severe hookworm infection, but eosinophilia can sometimes be absent even in severe hookworm infection.

5. Various other studies have also shown the presence of severe anaemia without eosinophilia in hookworm infection (25to29).

6. Multiple hookworms in duodenum without eosinophilia [absolute eosinophil count - 366cells/cu.mm] and with severe anaemia [haemoglobin 2.1 g%]indicating severe hookworm infection is shown in Fig 3.

CONCLUSION

1. 3 out of 4 patients without eosinophilia with hookworm infection in our study had anaemia. Of these 3 patients, 1 patient without eosinophilia had severe anaemia due to severe hookworm infection.

2. Hence significant anaemia always occurs in severe hookworm infection, but eosinophilia can sometimes be absent even in severe hookworm infection.

3. Hence upper gastro intestinal endoscopy should be done to confirm the presence of hookworms in all patients with anaemia even when there is no eosinophilia.

ACKNOWLEDGEMENT

The author sincerely thanks the staff nurse Nithya who was assisting the author while doing endoscopy and the staff nurses A.K. Selvi and Nithya for their immense help rendered to the author while conducting this work. The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. The author is extremely grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.

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A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

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A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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A DETAILED STUDY OF ABSENCE OF EOSINOPHILIA IN PATIENTS WITH HOOKWORM INFECTION DIAGNOSED BY DOING UPPER GASTRO-INTESTINAL ENDOSCOPY

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