Empirical Anthelmintic Therapy for Patients with Eosinophilia in Nepal: A Prospective Cohort Study

Eosinophilia is common in low-resource countries and usually implies helminthiasis. Since helminthiasis is a common cause of eosinophilia and its diagnosis is cumbersome, we hypothesized that broad-spectrum anthelmintic therapy may decrease the eosinophil count and eventually cure helminthiasis, whether microbiologic diagnosis is established or not. We recruited patients with eosinophilia aged 5 years and older who presented to Dhulikhel hospital, Nepal. Patients were treated with albendazole and ivermectin. A stool sample for microscopy was obtained. Of a total of 113 patients, 106 had a follow-up visit and 56 were classified as responders to treatment (defined as a decrease in eosinophil count to below 500 cells/µL, or an absolute decrease of more than 1000 cells/µL). For all patients, we found an absolute decrease in the eosinophil count and for the responding group (more than 50% of the whole cohort), the eosinophil count decreased substantially. All stool samples were negative. The reason for a lack of response in the remaining patients is unclear. In order to ascertain whether eosinophilia should be an indication for anthelmintic treatment, a randomized controlled study of empirical treatment after a thorough microbiologic workup is needed.