gms | German Medical Science

Background: Eosinophilia is frequently observed in children in Nepal and clinical presentation is highly variable. However, severe disease requiring intensive care treatment was reported. Even though, a parasitic genesis is suspected, the causing etiology currently remains unknown. To identify the cause of eosinophilia in Nepalese children, a clinical study to evaluate the clinical and laboratory profile of these patients was initiated as a cooperation between Dhulikhel Hospital, Nepal and University Hospital Mainz, Germany. Here we present initial data from a pilot phase of this collaboration.

Methods: Pediatric patients presenting with eosinophilia at a tertiary referral hospital in Nepal were offered participation in our study. Eosinophilia was defined as an absolute eosinophil count more than 500/µL. As a control group, patients without eosinophilia presenting within in +/- 1 month of an included case at the study site were offered inclusion to achieve seasonal matching. Controls must not have received anti-parasitic treatment or steroids in the past 6 weeks. Clinical data of both groups were collected from medical records. In addition, participants were interviewed using a questionnaire to collect further data regarding socio-demographics, present symptoms and the medical history.

Results: During a period from June 2020 to April 2021, 19 participants were included into our study. Median age of the participants was 11.3 years, 8 were female, 11 male. 8 of the 19 patients did show an absolute eosinophil count of more than 500/µL, ranging from 550/µl to 8800/µl. We did not observe any difference between cases and controls regarding age (11.7 vs, 10.8 years) or sex (3 female/5 male vs. 3 female/4 male). The majority of participants from both groups lived within the rural Kabhrepalanchok district southeast of Kathmandu (75.0% vs. 85.7%).

Cases did belong to the Tamang community more frequently in comparison to controls (75% vs. 28.6%). In contrast, the majority of cases did belong to the Brahmin group (42.9%). In addition, cases did report to have only access to an outdoor toilet more frequently (87.5 vs. 57.1%). All participants indicated to eat an omnivore diet. However, consumption of raw or undercooked freshwater crab was reported more frequently within the case group (25.0% vs. 14.3%).

Conclusion: Eosinophilia is still observed in children in Nepal. The initial socio-demographic data from our study indicates that eosinophilia seems to be more prevalent in disadvantaged communities such as the Tamang. In contrast, more affluent parts of the Nepalese society seem to be less at risk. These results are in line with previous reports. Accordingly, it seems promising to investigate food and living habits of the Tamang ethnic group to further understand the genesis of eosinophilia in children in Nepal.