UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants

Clare Thakker¹, Clare Warrell², Jessica Barrett³, Helen L Booth⁴, Peter L Chiodini⁵, Sylviane Defres⁶, Jane Falconer⁷, Nathan Jacobs⁸, Jayne Jones⁹, Jonathan Lambert¹⁰, Clare Leong¹¹, Angela McBride¹², Elinor Moore¹¹, Tara Moshiri¹³, Laura E Nabarro¹⁴, Geraldine O'Hara¹⁵, Neil Stone⁴, Clare van Halsema⁸, Anna M Checkley¹⁶; British Infection Association

Affiliations

¹ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; University College London, Gower Street, London, WC1E 6BT, UK. Electronic address: clare.thakker@nhs.net.
² Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; Rare and Imported Pathogens Laboratory, UKHSA, Porton Down, SP4 0JG, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
³ North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK.
⁴ University College London Hospitals NHS Trust, 235 Euston Road, London, NW1 2BU, UK.
⁵ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
⁶ Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK; Liverpool University Hospitals NHS Foundation Trust, Mount Vernon Street, Liverpool, L7 8XP, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK.
⁷ London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
⁸ Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester University NHS Foundation Trust, M8 5RB, UK.
⁹ Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
¹⁰ University College London Hospitals NHS Trust, 235 Euston Road, London, NW1 2BU, UK; UCL Cancer Institute, 72 Huntley St, London, WC1E 6DD, UK.
¹¹ Cambridge University Hospitals, Addenbrookes Hospital, Hills Rd, Cambridge, CB2 0QQ, UK.
¹² Kings College Hospital, Denmark Hill, London, SE5 9RS, UK; University of Oxford, Oxford, OX1 2JD, UK.
¹³ Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
¹⁴ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK.
¹⁵ Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
¹⁶ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: anna.checkley@nhs.net.

PMID: 39537036
DOI: 10.1016/j.jinf.2024.106328

Review

UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants

Clare Thakker et al. J Infect. 2025 Feb.

. 2025 Feb;90(2):106328.

doi: 10.1016/j.jinf.2024.106328. Epub 2024 Nov 12.

Authors

Affiliations

¹ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; University College London, Gower Street, London, WC1E 6BT, UK. Electronic address: clare.thakker@nhs.net.
² Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; Rare and Imported Pathogens Laboratory, UKHSA, Porton Down, SP4 0JG, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
³ North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK.
⁴ University College London Hospitals NHS Trust, 235 Euston Road, London, NW1 2BU, UK.
⁵ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
⁶ Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK; Liverpool University Hospitals NHS Foundation Trust, Mount Vernon Street, Liverpool, L7 8XP, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK.
⁷ London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
⁸ Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester University NHS Foundation Trust, M8 5RB, UK.
⁹ Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
¹⁰ University College London Hospitals NHS Trust, 235 Euston Road, London, NW1 2BU, UK; UCL Cancer Institute, 72 Huntley St, London, WC1E 6DD, UK.
¹¹ Cambridge University Hospitals, Addenbrookes Hospital, Hills Rd, Cambridge, CB2 0QQ, UK.
¹² Kings College Hospital, Denmark Hill, London, SE5 9RS, UK; University of Oxford, Oxford, OX1 2JD, UK.
¹³ Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
¹⁴ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK.
¹⁵ Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
¹⁶ Hospital for Tropical Diseases, Capper Street, London, WC1E 6JB, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Electronic address: anna.checkley@nhs.net.

PMID: 39537036
DOI: 10.1016/j.jinf.2024.106328

Abstract

Eosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting, it often indicates an underlying helminth infection. Infections associated with eosinophilia are frequently either asymptomatic or associated with non-specific symptoms but some can cause severe disease. Here the British Infection Association guidelines group has comprehensively reviewed and updated the UK recommendations for the investigation and management of eosinophilia in returning travellers, migrants and other relevant groups, first published in 2010.¹ Literature reviews have been undertaken to update the evidence on the prevalence and causes of eosinophilia in these groups and on the treatment of relevant pathogens and clinical conditions. Diagnostic tests available to UK-based clinicians are summarised. Changes made to the guidelines include updates in the sections on the investigation and empirical treatment of asymptomatic eosinophilia and on the treatment of trichuriasis, lymphatic filariasis, onchocerciasis, hookworm, fascioliasis and taeniasis. Pathogens which are rarely encountered in UK practice have been removed from the guidelines and others added, including an expanded section on fungal infection. A section on off-license and rarely used drugs has been included.

Keywords: Eosinophilia; Travel medicine; filariasis; helminth; schistosomiasis; strongyloides; strongyloidiasis.

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Conflict of interest statement

Declaration of interests The authors declare the following financial interests/personal relationships which may be consideredas potential competing interests:Jonathan Lambert has received advisory board fees and reimbursement of conference expenses fromTakeda, Novartis, Blueprint Medicines and Gilead. None of these are relevant to his contribution to this paper.

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UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants

Affiliations

UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms