Patients’ characteristics.

Background
Prognosis and factors correlated to diagnostic delays in patients with strongyloidiasis, a parasitic disease, remain poorly understood. This study investigated the relationship among diagnostic delay, prognosis, and eosinophilia in patients with strongyloidiasis.
Methodology/Principal findings
Hospitalized patients with a confirmed diagnosis of strongyloidiasis at a single hospital over 10 years (2013–2023) were retrospectively screened. Fifty-five inpatients were included (median age, 81 years); 34 patients (61.8%) were male, and all but one patient was born in Okinawa before 1960. Duration from onset of symptoms to diagnosis was 10 days (median), hospitalization length was 37 days (median), and eight patients (14.5%) died. We classified diagnoses made after ≥30 days as delayed diagnosis and compared the patients with and without delayed diagnosis. Patients with delayed diagnosis had more in-hospital deaths than their counterparts (55.6% versus [vs.] 7.1%, P < 0.005). Compared with patients diagnosed earlier, those with delayed diagnosis were also characterized by older age (90 vs. 78.5 years, P < 0.005), more frequent fever (55.6% vs. 19.6%, P = 0.037), lower hemoglobin levels (10.1 vs. 11.8 g/dL, P = 0.0363), absence of eosinophilia (0% vs. 22%, P = 0.015), higher rates of sepsis (50% vs. 10.7%, P = 0.03), and prolonged hospitalization (77 vs. 23.5 days, P < 0.005). Diagnostic delay even after adjusting for age and sex using multivariate logistic regression analyses was a significant risk factor for mortality (odds ratio = 11.3, P = 0.022). Patients without eosinophilia were older than those with eosinophilia (84.5 vs. 76 years, P = 0.005) and not associated with in-hospital death (23.3% vs. 4.8%, P = 0.118).
Conclusions/Significance
Diagnostic delays are associated with a poor prognosis of strongyloidiasis. The absence of eosinophilia led to overlooked diagnoses. Screening should be considered before starting immunosuppressive therapy; relying on eosinophil counts could delay diagnosis.

背景
类圆线虫病（strongyloidiasis）作为一种寄生虫病，其患者的预后与诊断延迟相关影响因素目前仍未得到充分阐明。本研究旨在探讨类圆线虫病患者的诊断延迟、预后与嗜酸性粒细胞增多症（eosinophilia）之间的关联。
方法学与主要结果
本研究对2013—2023年十年间某单中心医院内确诊为类圆线虫病的住院患者进行回顾性筛查。最终纳入55例住院患者，年龄中位数为81岁；其中34例（61.8%）为男性，除1例外其余所有患者均于1960年前出生于冲绳县。从症状发作至确诊的时间中位数为10天，住院时长中位数为37天，共8例患者（14.5%）在院死亡。本研究将确诊时间≥30天的病例定义为诊断延迟组，并对比诊断延迟组与非延迟组患者的临床特征。结果显示，诊断延迟组的院内死亡率显著高于非延迟组（55.6% vs. 7.1%，P<0.005）。与早期确诊患者相比，诊断延迟组患者表现出以下特征：年龄更大（90岁 vs. 78.5岁，P<0.005）、发热发生率更高（55.6% vs. 19.6%，P=0.037）、血红蛋白水平更低（10.1 g/dL vs. 11.8 g/dL，P=0.0363）、未出现嗜酸性粒细胞增多症（0% vs. 22%，P=0.015）、脓毒症发生率更高（50% vs. 10.7%，P=0.03）以及住院时长更长（77天 vs. 23.5天，P<0.005）。经多因素logistic回归分析校正年龄与性别因素后，诊断延迟仍是患者死亡的显著危险因素（比值比（odds ratio）=11.3，P=0.022）。无嗜酸性粒细胞增多症的患者年龄大于存在该表现的患者（84.5岁 vs. 76岁，P=0.005），但二者院内死亡率无显著差异（23.3% vs. 4.8%，P=0.118）。
结论与意义
诊断延迟与类圆线虫病患者的不良预后密切相关。嗜酸性粒细胞增多症的缺失易导致诊断漏诊。在启动免疫抑制治疗前，应考虑对患者进行类圆线虫病筛查；仅依赖嗜酸性粒细胞计数可能会延误诊断。