EOSINOPHIL!A IN SOME CASES

OF HELMINTHIASIS.

V By J. A. SINTON, m.b., d.p.h., d.t.ji.,

CAPTAIN, I M.S.

and

J. D. BAILY.

SUB-ASSISTANT SOROEON.

While doing the routine examination of blood slides for malarial parasites in the Kohat Brigade Laboratory, it was comparatively common to

note an apparent increase of the eosinophile leucocytes in the smears. In such a case it was customary to ask the medical officer, under whose care the patient was, to send a sample of the feces to be examined for the ova of the

parasites, and we found in a large number of these cases the eggs of various worms.

Of the samples examined, ova were found in

150 cases. These were eggs of four different

species, namely, Agchylostomcc duodenale, Ascaris lumbricoides, Trichuris trichiura, and Oxyuris vermicidaris.

In a large number of cases the ova of two

or three species of worm were found in the same

stool. The frequency of the various species is shown below :?

Table I.

S 3 s

22 54 30

e ? fS ?

?2 *2 a S

O o

IS Eh

10

s o c

s-S | ?s-S ? si

51 "?3 d ! T Eh d Eh d

150

From this table it will be seen that the fre-

quency of the various worms, alone and together with other species, was as follows :?

Table II.

Species.

A. duodenale ...

A. lumbricoides T. trichiura 0. vermicularis

Alone.

22 54 30

In associa- tion with

other species.

18 21 29 9

Total cases

infected.

40 75 59 17

The majority of these cases were probably infected in their own villages, as they occurred amongst Indian troops whose stay in this station is usually only three years.

These figures therefore cannot be taken as any index of the relative frequency of these worms

amongst the civil population, as the homes of the cases varied from Nepal in the north, to Poona in the south, and from Amritsar in the east to Peshawar in the west.

Amongst the civil inhabitants of the Kohat

district, ankylostomiasis does occur, but is ap- parently not very common, but round worms, thread worms, and whip worms, are frequently met with.

In certain portions of the Kurram valley in-

fection with the round worm is very common

indeed, but, although a large number of samples of feces from this district was examined, no case of ankylostomiasis was found.

The beef tape worm {Taenia saginata) is

sometimes found in Kohat, but T. solium is ap-

parently unknown.

Eosinophils.

If, in a differential blood count, any rise of the eosinophile leucocytes occurs above 4 per cent., this is usually taken as constituting an eosino-

philia (Gulland and Goodall (l) ). This condition has been found in a variety of

conditions, varying from asthma and skin diseases to the ingestion of certain varieties of cheese, but the commonest cause is infection with various

kinds of intestinal parasites. In schistosomiasis, Coles (2) records a case with

an eosinophilia of 20%. Balfour (3) reported a case of dracontiasis with 3G~/0 eosinophils. While in ankylostomiasis, Boycott and Haldane

(4) had a case with 66"2% and Ehrlich and Leichtenstern (5) reported 72%.

Recently the subject of eosinophilia has been

investigated by a number of observers. Weinberg and Seguin (6 and 7) found that the

injection of hydatid fluid produced a marked

eosinophilia in guinea pigs, and that ascaris toxin instilled into the eye of the horse caused a local

eosinophilia. By further experiments they showed that the eosinophiles absorbed hydatid antigen and produced antibodies to it. Their conclusion was that the eosinophiles were chiefly adapted to the neutralisation of certain toxic substances.

Paulian (8) by the injection of the toxins of worms into guinea pigs produced first a polymor- phonuclear increase and an intense eosinophilia. The eosinophilia was greater with injections of nematode toxins than with cestode toxins, and reached as high as 44%.

Apparently therefore the eosinophile increase is an attempt made by nature to counteract

Feb,, 1916.] EOSINOPHILTA. 59

poisonous substances given off by parasite worms, and may perhaps be compared to the polymor- phonuclear increase found in pneumonia and

septic conditions. Kecently certain observers have recorded severe cases of ankylostomiasis without eosinophilia. These are possibly similar to cases of pneumonia and septicemia without

leucocytoris and may indicate a grave prognosis. In the research recorded in this paper, differ-

ential blood counts were done on 101 cases in whose stools the ova of worms had been found. To minimise the error of the counts, 500 white cells were counted in each case.

The majority of these cases although harbour- ing parasites showed no symptoms, and were only discovered in most cases because an increase of the eosinophiles in blood smears suggested that the stools should be examined for eggs.

On this account, probably the percentage of

eosinophilia found is higher than would be found if the stools of a large series of people were examined and blood counts done on all

cases showing ova in the faeces, but the result is possibly lower than would be recorded if the counts had been done only on the cases which showed symptoms of worm infection.

Unfortunately, as the majority of the cases were not under our care we were not able to

verify the results of the examination of the stools by the recovery of the parasites whose ova had been identified. It is also possible that a

number of the cases, in which the eggs of only one species were found, may have been infected with other species also.

It would have been of interest to note what relation existed between the number of worms recovered and the degree of eosinophilia, as well as the effects of treatment on the blood counts.

In the following table are shown the canes on which differential blood counts were done :?

Table III.

a a

a "8 1 | 1 1 ! I C a a 5 ? ? -s I J

o ^ ^ d ^ ^

7 I 17 37 13 1 5 2 3 8 2 2 4 101

A large number of the cases showed a relative mononuclear leucocytoris (in one case as high as

! 48'G%), but we think with Johnston (9) that this was probably due to malarial infection, as this

disease is very prevalent at Kohat.

Eosinophils in infections with F. medinensis.

Differential counts were done on 7 cases of

guinea worm and these showed eosinophile counts of 7-2% 3 12-8%; 14*0%; 14*4% s 15*0%; 10'2/o; and 20%, respectively. The average count was 14*6% of eosinophils.

These counts are much higher than those

recorded by Powell (10) who found in G cases

counts of 4-7%; 5*5% ; 7*5% ; 7*5%; 8*0%; and 12*2%, an average of 7*6%. Balfour (3) however in G cases of dracontiasis found counts

varying from G% to 36%.

Eosinophils in Ankylostomiasis.

In the 17 counts of cases in which the eggs of A. cluodenale alone were found in the faeces, the lowest eosinophile count was G% and the

highest 30*2%. (In this case 40 eggs were found on a single cover-glass preparation of the

faeces.) The average count of these cases was

n-%7. These cases were divided as follows :?

Eosinophile counts. Number of cases.

5%?10% ... ... 3

10%?15%

15%?20% 20%?25% 25%?30% over 30%

Total ... 17

In addition to the 17 cases where ankylostome eggs alone were found, there were 10 cases where

they were associated with other ova ( vide Table III ). In these cases the lowest count was 11% and the highest 34*4%. In both these cases the

ova of T. trichiura were also present in the feces.

The counts of these cases showed an average eosinophile percentage of 21*9 and could be divided as follows :?

Percentage eosinophiles. Cases.

5%?10% ... ... nil.

10%?15% ... ... l

15%?20% ... ... 4

20%?25% ... 9

25%?30% over 30%

Total ... 10

VX

60 THE INDIAN MEDICAL GAZETTE [Feb., lbi6.

If these cases are included with the other 17

cases of ankylostomiasis the average eosinophile count of the 27 cases would be 19*3%.

These results may be compared with those of other observers. Boycott and Haldane (4) found an average of 23% eosinophiles in 16 cases, and

found in 46 cases that it varied from 3*7% to 66%. Asliford (11) in Porto Rico found that in 19 cases the eosinophile count varied from 3% to 40%, and that the highest counts occurred in recent cases, while the lowest counts were in chronic cases.

Gromez (12) in the Philippines got counts varying from 3% to 21 "9%, with 80% to 95% of

haemoglobin. Johnston (9) in Nigeria found

eosinopliilia in almost every case of 26 examined, and in one case the eosinopliilia was 56%. Cocken (13) in Grenada in 25 examinations of

advanced cases found an eosinophilia that averaged 22'4%.

The percentage of haemoglobin was taken in

21 cases of ankylostomiasis at Kohat and varied from 80%?98%.

Eosinophilia in Ascaridiasis.

Differential blood counts were done on 37 cases

in which the eggs of A. lumbricoides only were found in the feces, and in 20 cases where

they were found in association with other ova

( vide Table III ). In the first series of cases the average eosino-

phile count was 7*3%. The lowest count was

1-2% and the highest 21*6%.

Percentage of eosinophiles. Cases.

1%? 4% ... ... H

4%?5% ... ... 5

5% ?10% ... ... 6

10%?15% ... ... 9

15%?20% ... ... 2

over 20% ??? ... 1

Total ... 37

, J?rom this it will be seen that out of 37 cases

infected with A. lumbricoides only 23 cases showed an eosinophilia.

In the second series where 20 cases were

examined of multiple infection, the average percentage of eosinophiles was 20'6. The

highest being 28"8% when A. lumbricoides was found in association with both A. duodenale and T. trichiura.

Buckler (14) reported a case of ascaridiasis with 19% eosinophiles, and Macgregor (15) a case where the eosinophilia varied from 20% to 25%.

Eosinophils in Infections with T. Trichiura.

The eggs of this parasite were found in 59

stools and in 29 of these cases other ova were

associated with it. (Vide Tables I and II). Differential blood counts were done on 13 of

the cases in which this parasite alone was found, and these gave an average ot' 14*27% eosinophiles. The lowest count being G% and the highest 23-2%.

Percentage of Eosinophils Cases.

5%-10% ... ... 3

10%-15% ... ... 6

15%-20% ... ... 2

Over 20% ??? ... 2

Total ... 13

In the 23 cases where it was associated with other worms the average count was 21'2/Q. The highest count being 34*4% when it was

found together with A. duodencde and the next

highest 28*8% where both A. duodenal e and A. lumbricoides were also present.

Eosinophils in Infection with 0. Vermicularis.

A count done on one case of infection with this worm showed an eosinopliilia of 7'4%.

Buckler (14) reports a case with 16?/o of

eosinophiles.

References.

(1) Gulland, G. L. and Goodall, A. " The Blood." Edin

burgh, 1912.

(2) Coles. " Diseases of the Blood," 1905.

(3) Balfour, A., Lancet, 1903, Vol. II, p. 1649.

(4) Boycott and Haldane, quoted in "A Guide to the Clinical Examination of the Blood

"

by Cabot, R. C., London, 1904. ,

v ' "

(5) Ehrlich and Leichtenstern, quoted by Brumpt, E., "Precis de Parasitologic," Paris, 1911.

(6) Weinberg, M. and Seguin, P. " Reclierches biologiques sur l'eosinophile" Ann. deVInst. Past. T. XXVIII, May 1914.

(7) Ibid. Ann. de L'Inst. Past. I. XXIX, No. 7, July 1915.

(8) Paulian, D. E. " Parasitisme et Eosinophile." Comp. rend. Soc. de Biol. Vol. 78, p- 155, 1915. Quoted in Rev. of Bact. and Gen. Parasit, Vol. V., pt. I, 1915.

(9) Johnston, J. E. L. "A Note on Helminthiasis in Bassa Province, Northern Nigeria-" Lancet Sept. 27, 1913, pp. 926-927.

!

j (10) Powell, B. M. J., 1904, Vol. I, p. 73.

(11) Asliford. Quoted by Cabot. 11. C. " A Guide to the Clinical Examination of the Blood," London. 1904.

(12) Comez, L. " Clinical Study of Hookworm Infection in

the Philippines." Phillip. Jour. Sc. Vol. VI., B., No. 3, June 1911, p. 239.

(13) Cockin, It. P. "Ankylostomiasis in Grenada."

Parasitology, April 1913, Vol. VI. No. 1. pp. 57-67. Quoted in Trop. Dis. Bull. 1913 Vol. II, No. 4, p. 184. '

(14) Buckler quoted in "The Blood" in Nothnagels' Encyclopedia of Practical Medicine, 1905.

(15) Macgregor. R. F. " Ascaris infection." Indian Jfled. tfaz., May 1914, Vol. XLIX, No. 5, pp. 181?1 .