Mean Absolute Eosinophil Count Research Articles

Baseline Peripheral Eosinophil Count Independently Predicts Proton Pump Inhibitor Response in Eosinophilic Esophagitis.

To assess the predictive value of baseline peripheral absolute eosinophil counts (AECs) for proton pump inhibitor (PPI) response in eosinophilic esophagitis (EoE). PPI leads to histologic remission in ~50% of EoE patients, although there are few distinguishing clinical features between PPI-responsive (PPI-r-EoE) and nonresponsive (PPI-nr-EoE) diseases. Peripheral eosinophilia is present in ~50% of EoE cases and is associated with eosinophil density on esophageal biopsy and worse clinical outcomes. The association between peripheral eosinophilia and PPI-responsiveness in EoE remains unclear. This is a retrospective cohort study of adult EoE patients at a tertiary center between 2012 and 2016. All patients underwent twice daily PPI trials for ≥8 weeks followed by repeat esophageal biopsies and were classified as PPI-r-EoE or PPI-nr-EoE based on histologic response (<15 eosinophils/high power field). Baseline peripheral AEC was obtained within 1 month before index endoscopy. Analyses were performed using Fisher exact/Student t test (univariate) and logistic regression (multivariable). One hundred eighty-three patients (91 PPI-nr-EoE and 92 PPI-r-EoE) were included. Mean peripheral AEC was higher among PPI-nr-EoE patients (0.41 vs 0.24 K/µL, P = 0.013). Baseline peripheral eosinophilia (>0.5 K/µL) was more prevalent among patients with PPI-nr-EoE (70.4% vs 45.5%, P = 0.023) and a history of food impaction (51.9% vs 23.7%, P = 0.0082). On multivariable analyses, peripheral eosinophilia remained an independent predictor for PPI response (adjacent odds ratio = 2.86, CI: 1.07-7.62, P = 0.036) and food impaction (adjacent odds ratio = 2.80, CI: 1.07-7.35, P = 0.037). Baseline peripheral eosinophilia independently predicts PPI nonresponse and food impaction in EoE patients. Peripheral AEC may help therapy selection in EoE and prevent delays in achieving histologic remission.

The Role of Absolute Eosinophil Count as a Diagnostic and Prognostic Marker for Sepsis and Its Relation with Sequential Organ Failure Assessment/Quick Sequential Organ Failure Assessment Score.

Sepsis is a dysregulated host response to an infection that causes organ failure that poses a serious risk to life. Although culture results are not always available right away and the majority of patients continue to test culture negative, microbial culture is still the gold standard for diagnosing sepsis. Therefore, the objective of the current study was to assess absolute eosinophil count as a new marker for diagnosing sepsis and also to assess the prognosis of the patient in relation to Sequential Organ Failure Assessment (SOFA)/quick Sequential Organ Failure Assessment (qSOFA) score. Resources and procedures: In this cross-sectional study, 100 patients with sepsis were enrolled. The other 100 patients without any evidence of sepsis were taken as controls. Absolute eosinophil count (AEC), SOFA/qSOFA scores of all the patients were measured on the 1st, 3rd, and 7th day and data was analyzed statistically. The mean AEC on admission day in sepsis patients was 49.5. The mean AEC among survivors was >50 and nonsurvivors was <50. AEC and SOFA/qSOFA scores exhibit a statistically significant and inverse correlation on the 1st, 3rd, and 7th day of illness. Absolute eosinophil count (AEC) is a simple and cost-effective marker that may be helpful in diagnosis as well as in predicting the prognosis of sepsis as evidenced by its linear inverse correlation with SOFA/qSOFA score.

Evaluation of the Clinicoradiological Profile in Cases of Allergic Bronchopulmonary Aspergillosis: An Original Research.

A complicated hypersensitive reaction to inhaled fungal antigens results in allergic bronchopulmonary aspergillosis (ABPA), an immunologic pulmonary disease. ABPA complicates nearly 2% of instances of persistent asthma as well as nearly 10% of chronic cases of steroid-dependent asthma, and it occurs most frequently in immunocompetent patients. The purpose of the current research was to analyze the radiological and clinical features of the participants as well as the serological association of ABPA. From April 2020 to April 2021, a retrospective investigation was conducted. The study included patients based on the International Society for Human and Animal Mycology's criteria for ABPA confirmation. Analysis was done on the demographic information and pathological and radiological test results of the patients. The patients' pre-bronchodilator and post-bronchodilator spirometry was compared, and asthmatic control was estimated. A total of 50 patients were investigated at in this study. Demographic findings indicated young subjects and aa female predominance. Cough was the most prevalent symptom in 84% of patients. Asthma of the bronchi was a risk factor for all of the patients. The mean serum immunoglobulin E level and the mean absolute eosinophil count were 533 cells/L and 2269 UI/mL, respectively. Spirometry results from the study's participants indicated an obstructive pattern in about 80% of cases. The most typical radiological abnormality observed was bronchiectasis, followed by parenchymal opacities. In conclusion, when treating asthma that is challenging to control, the diagnosis of ABPA must be taken into account. Delay in diagnosis might result in declining lung function, worsening asthma control, possibly irreversible alterations, greater treatment costs, and declined quality of life.

Excess of blood eosinophils prior to therapy correlates with worse prognosis in mesothelioma.

Only a fraction of patients with malignant pleural mesothelioma (MPM) will respond to chemo- or immunotherapy. For the majority, the condition will irremediably relapse after 13 to 18 months. In this study, we hypothesized that patients' outcome could be correlated to their immune cell profile. Focus was given to peripheral blood eosinophils that, paradoxically, can both promote or inhibit tumor growth depending on the cancer type. The characteristics of 242 patients with histologically proven MPM were retrospectively collected in three centers. Characteristics included overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR). The mean absolute eosinophil counts (AEC) were determined by averaging AEC data sets of the last month preceding the administration of chemo- or immunotherapy. An optimal cutoff of 220 eosinophils/µL of blood segregated the cohort into two groups with significantly different median OS after chemotherapy (14 and 29 months above and below the threshold, p = 0.0001). The corresponding two-year OS rates were 28% and 55% in the AEC ≥ 220/µL and AEC < 220/µL groups, respectively. Based on shorter median PFS (8 vs 17 months, p < 0.0001) and reduced DCR (55.9% vs 35.2% at 6 months), the response to standard chemotherapy was significantly affected in the AEC ≥ 220/µL subset. Similar conclusions were also drawn from data sets of patients receiving immune checkpoint-based immunotherapy. In conclusion, baseline AEC ≥ 220/µL preceding therapy is associated with worse outcome and quicker relapse in MPM.

Endotyping of nasal polyps in a multiracial Asian population

Background: Chronic rhinosinusitis is a heterogenous disease with variation in the endotypes of nasal polyps, with type 2 inflammation being more prevalent in Caucasian populations whereas Chinese populations are more heterogenous. We aim to describe the variation in endotypes for patients with chronic rhinosinusitis with nasal polyposis in our unique multiracial population. Methodology: Demographic, clinical and structured histopathological data of 66 patients who underwent sinus surgery for nasal polyposis were evaluated retrospectively. Results: 54.6% had eosinophilic disease, and 45.4% had non-eosinophilic disease with no significant demographic differences between the 2 populations. There were significantly higher peripheral eosinophil levels in patients with eosinophil-predominant inflammation on tissue histology (mean absolute eosinophil count 0.59 ± 0.18 x 109) compared with non-eosinophilic disease (mean absolute eosinophil count 0.24 ± 0.11 x 109). Structured histopathological reporting revealed that patients with eosinophilic disease had higher degree of inflammation and eosinophil aggregates. Conclusions: Our population is shown to have a slight preponderance toward eosinophilic disease, however the Chinese majority tended to have non-eosinophilic disease. Serum eosinophilia and the presence of asthma seems to correlate well with tissue eosinophilia, which can potentially be utilised as markers of type 2 inflammatory disease.

The role of eosinopenia in the diagnosis of bacterial infection in children

Purpose: Number of eosinophils circulating in the blood decreased significantly after acute infections. Our aim in this study is to determine the role of eosinopenia in the diagnosis of bacterial infection in children and to compare it with other acute phase reactants. Material and methods: Patients aged 0-14 years, who applied to İzmir Tepecik Training and Research Hospital Pediatrics Polyclinics and Pediatric Emergency Service between 01.01.2008 and 31.12.2008, whose hemogram and C-reactive protein were studied within the first 24 hours of admission were included in this study. The cases were screened according to the International Classification of diseases (ICD-10) diagnostic codes. Results: Totally 1857 patients were included in the study. The patients were evaluated in 3 groups; 519 cases (28%) with bacterial infection,356 cases (19.2%) with viral infection, and 972 cases (52.6%) in the control groups. The mean absolute eosinophil count in the bacterial infection group was 103.7±76.9/mm³, while it was 192.8±129.3/mm³, in the viral infection group, and this difference was statistically significant (p<0.001). It was determined that the bacterial infection group had the highest C-reactive protein value, the lowest absolute eosinophil count, and the lowest absolute eosinophil count /white blood cell ratio, and this was statistically significant (p<0.001). The parameter with the highest sensitivity was absolute eosinophil count/white blood cell with 73.7%, and highest specificity was absolute eosinophil count with 82.4%. Conclusion: Absolute eosinophil count and absolute eosinophil count / white blood cell ratio as specific and sensitive markers in the diagnosis of bacterial infection in children, can be promising diagnostic parameters by providing ease of use in daily practice.

Prevalence of Allergic Sensitization in Childhood Asthma.

IntroductionThe allergic sensitization in childhood asthma is common and the prevalence varies in different geographical locations. The data on allergen sensitization to guide clinicians on allergy avoidance is limited.MethodThis prospective observational study was conducted between October 2019 and April 2020 on children aged two to 14 years attending an outpatient clinic. Those with recurrent wheezing or physician-diagnosed asthma were interviewed; eosinophil count, total serum immunoglobulin E (IgE) was measured; and skin prick test (SPT) was done using standardized reagents. Wheal size of ≥3mm was considered positive.ResultsA total of 80 children were enrolled. The mean age was 71.15 ± 33.52 months (M:F ratio =1.96:1). Allergic rhinitis, conjunctivitis, and dermatosis were seen in 76 (95.0%), 33 (41.3%), and 22 (27.5%) cases, respectively. The mean absolute eosinophil count was 576 ± 427per cmm. The mean total IgE was 800.9 ± 883.2IU/ml. Seasonal and diurnal variations were found in 34 (42.5%) and 79 (98.8%) cases. Out of 1753 skin pricks using 27 reagents, 355 (20.25%) were positive. Increasing age was significantly associated with increasing SPT positivity (P = 0.0001). The most common sensitive aeroallergens were Kentucky bluegrass (25%), Dermatophagoides pteronyssinus (22.5%), Dermatophagoides farinae (21.3%), Timothy grass, and Alternaria alternans (20% each). The most common sensitive food allergens were spinach (25%), banana (22.5%), carp (20%), shrimp and hen’s egg (18.8% each), and cow’s milk (17.5%).ConclusionIncreasing age was associated with increasing SPT positivity in childhood asthma. The most common sensitive aeroallergens were Kentucky bluegrass and Dermatophagoides pteronyssinus; spinach and banana were the most common food allergen.

Eosinophilia in Asthma Patients Is Protective Against Severe COVID-19 Illness

BackgroundThere is a paucity of information on coronavirus disease 2019 (COVID-19) outcomes in asthmatics.ObjectiveTo identify risk factors associated with admission and subsequent mortality among COVID-19–infected asthmatics.MethodsAdults at our institution with a positive polymerase chain reaction for COVID-19 between March 14 and April 27, 2020, were retrospectively identified. Comorbidities, laboratory results, and mortality rates during hospitalization were recorded.ResultsIn total, 737 of 951 (77.5%) asthma patients with COVID-19 were seen in the emergency department (ED), and 78.8% of these ED patients (581 of 737) were admitted. Individuals with previously measured mean absolute eosinophil counts (AEC) ≥150 cells/μL were less likely to be admitted (odds ratio [OR] = 0.46, 95% confidence interval [CI]: 0.21-0.98, P = .04), whereas concomitant heart failure (CHF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) were risk factors for admission. Hospitalized patients with asthma with peak hospital-measured AEC ≥150 cells/μL (n = 104) were less likely to die compared with those whose AEC remained <150 cells/μL (n = 213) (mortality rate 9.6% vs 25.8%; OR = 0.006, 95% CI: 0.0001-0.64, P = .03). This group had also higher preadmission mean AEC (237 ± 181 vs 163 ± 147 cells/μL, P = .001, OR = 2012, 95% CI: 27.3-14,816). The mortality rate in patients with asthma alone (no associated CHF, CKD, COPD, diabetes, or hypertension) was similar to that of patients without asthma or any of these comorbidities.ConclusionsIn asthmatics, pre-existing eosinophilia (AEC ≥150 cells/μL) was protective from COVID-19–associated admission, and development of eosinophilia (AEC ≥150 cells/μL) during hospitalization was associated with decreased mortality. Preadmission AEC influenced the AEC trend during hospitalization. Having a Th2-asthma phenotype might be an important predictor for reduced COVID-19 morbidity and mortality that should be further explored in prospective and mechanistic studies.

Allergy status in children with adenoid hypertrophy with and without serous otitis media

Introduction: Serous otitis media (SOM) is one of the most common diseases of children which can lead to hearing loss and imbalance in many cases. Objective: To evaluate the relationship between allergy status and SOM in children with adenoid hypertrophy and whether affected by age group. Materials and Methods: This cross-sectional study was conducted on 103 children aged 1-15 years with grade III or IV adenoid hypertrophy (± SOM) who referred to ear, nose, and throat (ENT) clinic. Additionally, children were divided into two subgroups based on age category of below and above seven years. The allergy status in children with and without SOM was compared by measuring the total immunoglobulin E (IgE) level, serum eosinophil level and skin prick test (SPT). Results: There was no difference in prevalence of mean absolute eosinophil count (127.3 versus 141.3 eosinophils/ µL, respectively) (P=0.63), mean total IgE level (68.2 versus 140 IU/L, respectively; P=0.119) and positive SPT results (23.5% versus 28.4%, respectively; P=0.551) between children with adenoid hypertrophy (± SOM). Conclusion: It seems absolute eosinophil count, total IgE level and positive SPT results have no significant role in SOM of children with adenoid hypertrophy and maybe other factors are implicated in its occurrence.

Development of peripheral eosinophilia in inflammatory bowel disease patients on infliximab treated at a tertiary pediatric inflammatory bowel disease center is associated with clinically active disease but does not result in loss of efficacy or adverse outcomes

IntroductionInflammatory bowel disease (IBD) consisting of Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory conditions affecting the gastrointestinal tract. Infliximab (IFX) is a chimeric anti‐tumor necrosis factor antibody used to treat moderate to severe IBD. Eosinophils are commonly found in chronically inflamed tissues in IBD. Peripheral eosinophilia (PE) was previously implicated as a marker of disease severity at diagnosis. The main aim of this study was to investigate whether in IBD patients on IFX, development of PE is associated with adverse outcomes and poor IFX efficacy.MethodsA comprehensive retrospective chart review of IBD patients on IFX (January 2006 to July 2015) treated at a tertiary pediatric IBD center was performed. Data was collected at time specified points over a 24 month period and included demographics, atopy, disease severity, development of PE, human antichimeric antibodies (HACA), infusion reactions, cancer, psoriasis, and loss of clinical response.ResultsOne hundred twenty‐one IBD patients starting IFX (67 male), mean age of 12.4 years (range 4–22 years old), met inclusion criteria. Of them, 36.3% had ≥1 PE episode (CD: 25 male, 11 female; UC: 6 male, 2 female). Mean absolute eosinophil count (AEC) did not change over time. PE was associated with clinically active disease. Among patients who developed PE, adverse outcomes were not significantly different versus those who did not have PE.ConclusionsIn a cohort of primarily pediatric IBD patients on IFX, PE was associated with clinically active disease; however, PE was not related to increased incidence of adverse outcomes or loss of drug efficacy.

A Study on Role of NOSE Scale in the Management of Allergic Rhinitis.

Allergic rhinitis is a global health problem and patients present with varied symptoms. The severity of symptoms is evaluated by a 5 point Nasal Obstruction Symptom Evaluation Scale (NOSE) and levels of absolute eosinophil count (AEC). A prospective observational study was conducted in 140 patients in a tertiary care hospital over a period of 1year. A detailed clinical examination was performed, NOSE scale scoring based on symptomatology was done, and AEC values were assessed. Subjects were treated with intra nasal steroid spray and symptom evaluation done by NOSE scale at 3months of use for follow up. NOSE scale and AEC values were correlated in our study. The mean NOSE 1 scale was 64.07 ± 16.71 in the study population, the mean AEC value was 633.07 ± 152.77. In our study correlation between intra nasal steroid spray and NOSE scale has been done. NOSE scale evaluation is simple, economical, and non-invasive. Therefore, it may be used in the management of allergic rhinitis.

Clinicopathological, epidemiological, and immunological relationship between allergic rhinitis and bronchial asthma

INTRODUCTION: Allergic rhinitis and bronchial asthma are thought to be sequela of the same allergic airway disease. The relationship between both diseases has been confirmed by various clinicopathological epidemiological and immunological studies. In this study, we tried to establish a different relationship between both diseases and strengthen the concept of “One-airway one disease.” MATERIALS AND METHODS: A total of 100 patients visiting ear, nose, and throat and respiratory medicine outpatient department were taken. They were divided into two groups of fifty each and were studied for various mediators of inflammation. Group 1 consisted of patients of allergic rhinitis and Group 2 consisted of patients of bronchial asthma. RESULTS: Most of the patients in Group 1 were in the age group of 21–30 years (40%) and in Group 2, in the age group of 11–20 years (38%) with a mean age 28.4 ± 1.3 years. The most common symptoms in Group 1 patients were sneezing (90%) and rhinorrhea (68%) and in Group 2 wheezing (86%), followed by shortness of breath (66%). The most common sign in Group 1 was B/L inferior turbinate hypertrophy (70%), while in Group 2, it was rhonchi (76%). Mean absolute eosinophil count was 575.35 in Group 1 and was 446.61 in Group 2. Nasal smear for eosinophil was positive for 86% of patients in Group 1 and bronchial lavage showed eosinophilia in 64% of Group 2 patients. Mean total serum immunoglobulin E was 777.23 IU/ml in Group 1 and 662.08 IU/ml in Group 2. The incidence of bronchial asthma in patients of allergic rhinitis was 36%, while the incidence of allergic rhinitis in patients in bronchial asthma was 74%. CONCLUSION: Thus, in our study, we found that both the diseases were closely linked clinicopathologically epidemiologically as well as immunologically pointing toward the concept one-airway one disease.

Establishment of reference intervals for complete blood count parameters in venous blood for children in the Xiamen area, China

To observe changes in the complete blood count (CBC) venous blood parameters of healthy children and establish appropriate reference intervals (RIs). Overall, 4066 healthy children were selected and divided into four groups: infants, toddlers, preschool-age children and school-age children. Venous blood was analysed for 17 parameters. Outlier data for each parameter were eliminated and RIs were established based on the Clinical and Laboratory Standards Institute C28-A3c guideline. The RIs for certain parameters differed among the different age groups. The white blood cell (WBC) count differed among the four age groups. The variation trends for absolute neutrophil count in all age groups were opposite to those for WBC and absolute lymphocyte count. The mean absolute eosinophil count values were significantly higher in the infant group than in the other groups. The RIs for red blood cell were identical across all age groups except in infants. The mean Hb level for infants was significantly lower than that for the other age groups. The mean and RI for platelet count were significantly higher in the infant group than in the other groups. There are dynamic variations in the values reported for measurements of most CBC parameters in children. Hence, such results should always be interpreted according to the child's age. Thus establishing appropriate RIs for different age groups in paediatrics is essential.

A study on serum ig E and AEC in chronic urticaria and correlation between serum ig E and disease activity in chronic urticaria

Abstract Introduction: Urticaria is one of the most common allergic skin disorders having significant psychological impact. It occurs either acutely or evolves in chronic course, this study estimates significance of serum IgE levels, AEC in chronic urticaria and also the association between activity of chronic urticaria and serum Ig E levels. Objective: To measure the serum Ig E levels and Absolute eosinophil count (AEC) in cases and control group and to correlate Serum Ig E with disease activity in chronic urticaria Materials and Methods: It is a prospective case control study conducted in 103 chronic urticaria cases, Serum Ig E levels and AEC were measured in cases and controls, serum Ig E level was correlated with UAS7 in cases. Results: Out of 103 age and sex matched cases and controls the mean age was 29.23±1.27 years in patient group, mean AEC in patients was 541±36.01, significantly higher compared to the controls 126.74±12.82, and mean Ig E levels in patients was 759.19±73.79 IU/ml, significantly higher compared to the controls 153.24±11.51IU/ml. Mean UAS7 score was 19.95±1.02 in cases, five had well controlled urticaria (4.85%), 31 mild (30.09%), 48 moderate (46.60%) and 19 had severe urticaria (18.44%). We observed a statistically significant correlation between serum Ig E and UAS7. Conclusion: The present study suggests that serum Ig E levels needs to be considered as a valuable serological marker of disease severity in cases of chronic urticaria or management. Further similar studies are also required to assess based on the regional and ecological changes as the immunology differs from region to region and lifestyle changes. Keywords: Chronic urticaria, Serum Ig E levels, AEC, UAS7. Introduction Urticaria is a common allergic skin disease affecting 15% to 25% of the population atleast once in lifetime, which occurs either acutely or evolve in chronic course. Acute urticaria can present as acute onset of transient w

A controlled crossover study to assess the role of dietary eliminations in reducing the severity of atopic dermatitis in children

Background: In the pathogenesis of atopic dermatitis (AD), immune sensitization to food-derived allergens has a role. However, the evidence of allergen sensitization is not a proof of clinically relevant allergy and it has to be confirmed by food challenges so that unnecessary food restrictions in growing children can be avoided. Aims and Objectives: This study was conducted to assess the clinical severity of AD in children after certain dietary modifications and to correlate absolute eosinophil count (AEC) with dietary modification. Materials and Methods: A total of thirty AD children were enrolled randomly into a trial period of egg and cow's milk exclusion diet or control period of egg and cow's milk inclusion diet of 3 weeks. At the end of 3 weeks, patients resumed their normal diet to minimize any carryover effect for next 3 weeks. In the last 3 weeks, the trial and the control groups were crossed over. Patients were assessed at baseline and at the end of each 3-week period using SCORing AD (SCORAD) index and AEC. The data were analyzed using paired t-test. Results: The mean SCORAD at the end of control and trial period was 18.3 and 14.3, respectively, with a mean difference of 3.4, which is statistically not significant (P = 0.165). The mean AEC at the end of control and trial period was 836.5 and 799.6, respectively, the reduction being statistically not significant. Conclusion: Our study could not confirm the beneficial effects of an allergen avoidance diet in AD. We propose that dietary elimination advices should be given only to patients with a definite history of food-induced exacerbations of the disease.

A Retrospective Analysis of Patients Presenting with Eosinophilia and Strongyloidiasis

Rationale: Peripheral eosinophilia is a common finding among patients referred to hematology and immunology ambulatory care centers and may be linked to primary (i.e. clonal or idiopathic) or reactive conditions such as infections (especially helminths), neoplasms, connective tissue disorders, endocrinopathies, and allergies. We recently identified a cohort of patients diagnosed with strongyloidiasis, a disease caused by parasitic roundworms, in our urban population. Through this study, seek to identify the clinical variables that may be linked to baseline peripheral eosinophilia among these individuals.Methods: We analyzed a retrospective cohort of 49 patients who had a positive Strongyloides stercoralis serology, and were seen between 2011 and 2014 at the Allergy/Immunology outpatient clinics of Montefiore Medical Center, Jacobi Medical Center, and North Central Bronx Hospital. We included adult patients who had data available regarding age, birthplace, and baseline serum total immunoglobulin E (IgE), absolute eosinophil counts (AEC), and serum 25-hydroxyvitamin D levels. We considered peripheral eosinophilia as greater than or equal to 500 cells per microliter, and patients were categorized as having eosinophilia or non-eosinophilia (i.e. less than 500 cells/microliter). We sought to further characterize the eosinophilic vs non-eosinophilic groups, and therefore calculated the mean age, baseline serum total IgE levels, and serum 25-hydroxyvitamin D levels in each group. We noted each patient's birthplace (Asia, Africa, Central/South America, Europe, United States, Caribbean), and determined the mean AEC for each birth location. In the eosinophilia versus non-eosinophilia groups, we determined the mean AEC change (baseline to post-treatment follow-up) in patients that received ivermectin treatment for strongyloidiasis. We utilized the two-sample t-test to compare numeric variables between the eosinophilia and non-eosinophilia groups, and recognized a p-value of less than 0.05 as statistically significant. Institutional Review Board approval was obtained from the Montefiore Medical Center, Bronx, New York.Results: The cohort included 37 female and 12 male patients with an overall mean (SD) age of 55.8 (16.2) years. There were 37 ‘non-eosinophilia’ patients with a mean AEC of 214.6 cells/microliter and 12 ‘eosinophilia’ patients with a mean AEC of 993.3 cells/microliter. Patients born in the Caribbean Islands and Asia had the highest AEC, with means of 607.5 and 497.2 cells/microliter, respectively, of the eosinophilia sample. Patients in the ‘non-eosinophilia’ group had a mean age of 51.9 (15.4) years, while patients in the ‘eosinophilia’ group had a mean age of 67.5 (13.2) years (p=0.003). Baseline serum total IgE titers were significantly elevated in ‘eosinophilia’ patients with a mean of 1576.83 kU/L when compared to ‘non-eosinophilia’ patients with a mean of 285.1 kU/L, p=0.007. Serum 25-hydroxyvitamin D levels did not vary significantly between both groups (p=0.443). Of the patients that received a 2-day course of oral ivermectin (200 mcg/kg/day), the ‘non-eosinophilia’ patients had an increase in peripheral eosinophil counts following treatment with a mean AEC change of 180.8 cells/microliter when compared to ‘eosinophilia’ patients who had a decrease in eosinophil counts following treatment with a mean AEC change of 654.4 cells/microliter (p=0.003).Conclusion: We identified several clinical characteristics that are associated with peripheral eosinophilia as a presenting feature in this cohort of patients diagnosed with strongyloidiasis. Importantly, most of the patients did not present with eosinophilia. Patients born in the Caribbean Islands and Asia presented with higher AEC; additional studies should be conducted in these individuals to determine genetic and environmental features that determine eosinophilia in the setting of strongyloidiasis. Older patients presented with higher eosinophil counts, and additional studies are needed to identify the contributing reasons. Patients in the ‘eosinophilia’ group saw a decrease in AEC following ivermectin treatment. Further studies should be conducted to determine if peripheral eosinophilia in patients can predict response to medication, and help optimize treatment plans. DisclosuresNo relevant conflicts of interest to declare.

A study on correlation of serum IgE levels with diagnosis and severity of asthma in children

Background: Asthma is a chronic inflammatory airway disorder which increases bronchial hyperreactivity to various allergens and irritants characterized by narrowing of airways. Immunoglobulin E (Ig E) plays major role in the pathogenesis of asthma which is produced due to dysregulation of type 2 T helper lymphocytes (Th2) induced cytokines in genetically susceptible individual after exposing to allergens or irritants. The aim of this study was to estimate serum Ig E level in children between 3-12 years of age and to correlate it with the clinical diagnosis and severity of asthma.Methods: A prospective interventional study was done over a period of one year, enrolling 81 children aged between 3-12 years, who were newly diagnosed cases of asthma attending asthma clinic in a tertiary care pediatric government hospital. Serum IgE level was estimated and its correlation with the severity of asthma was assessed.Results: The mean Absolute Eosinophil Count (AEC) of the study was 305.85±188.40 cells /mm3. Mean Ig E level was increased in asthmatic children (874.59±287 IU/ml). Mean serum Ig E level in mild intermittent asthma was 247.92 ± 89.50 IU/ml, in mild persistent asthma was 742.95±306.78 IU/ml, in moderate persistent asthma was 1142±196.88 IU/ml and in severe persistent asthma was 1790±121.50 IU/ml. The increasing level of serum Ig E was found to be statistically significant (p &lt;0.05) with increasing grading of asthma.Conclusions: Elevated serum IgE levels support clinical diagnosis of asthma in children and can predict severity of asthma and can be used to counsel parents for better compliance in the management of bronchial asthma.

A Road Less Travelled: Clinical Comparison of HIV Seropositive and Seronegative Patients with Cystoisosporiasis – An 11-Year Experience from a Tertiary Care Centre in Northern India

Background:Cystoisospora is a well-known opportunistic enteric parasite among human immunodeficiency virus (HIV) seropositive patients but there is a paucity of data among HIV negative patients. This study investigated Cystosporiasis on both HIV positive and negative patients, with or without diarrhea, presenting to a tertiary care and super specialty center of northern India. Methodology:Oocysts of Cystoisospora were detected on light microscopy, by modified Kinyoun staining of stool specimens, over an 11-year study period. Results: Of the 10,233 stool specimens evaluated, Cystoisospora was detected in 64 patients, 37 (57.81%) of whom were HIV positive. Year-wise analysis showed an overall declining trend of cystoisosporiasis. Maximum cases were detected in May and June in HIV positive patients and February and September among HIV negative patients. Among HIV positive patients, the mean CD4 count was 152.04 ± 81.12cells/μL, mean absolute eosinophil count (AEC) was 229.16 ± 175.62 cells/μL and 12.5% patients had mild eosinophilia. Tuberculosis was the most common co-morbidity. Dual infections of Cystoisospora with Cryptosporidium and Giardia were also seen. Among HIV negative patients, eight had primary autoimmune disorders, seven were solid organ transplant recipients and the rest had chronic bowel diseases. The mean AEC was 485.47 ± 414.88 cells/μL, with 14.81% patients showing mild and 11.11% showing marked eosinophilia. Dual infection with Giardia was seen. Recurrent cystoisosporiasis was noted, despite cotrimoxazole treatment in a single case. Conclusion: The epidemiology of cystoisosporiasis differs between HIV seropositive and seronegative patients in terms of year-wise and month-wise trends, co-infections and most importantly, AECs.

Prevalence of allergic bronchopulmonary aspergillosis in asthmatic patients: A prospective institutional study

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) is characterized by an allergic inflammatory response to colonization by Aspergillus species, most commonly Aspergillus fumigatus. AimTo study the prevalence of ABPA in asthmatic patients presenting to our institute. Materials and methodsAll consecutive asthma patients attending our allergy clinic Out Patient Department (OPD) over a period of 20 months were tested with skin prick test (SPT) for Aspergillus antigens and those who were found positive were further evaluated for ABPA using Greenberger's criteria. ResultsSeventy consecutive asthmatic patients were screened by SPT using Aspergillus antigens. Thirteen patients (18.57%) were found to be SPT positive, out of which nine patients (12.9%) were diagnosed as having ABPA using Greenberger's criteria. ABPA was common among 25–35 age group with no gender predilection. ABPA patients had longer duration of illness, predominantly mixed pattern in PFT, higher mean absolute eosinophil count (AEC) and serum total IgE compared to non-ABPA asthmatic patients. Specific IgE for A. fumigatus was positive in all ABPA patients and serum precipitins were positive in seven patients (77.58%). Chest X-ray abnormalities were seen in five patients (55.6%) and HRCT showed central bronchiectasis in eight patients (88.9%) with varying other radiological features. None were sputum fungal culture positive and five patients (55.6%) have been misdiagnosed as pulmonary tuberculosis in the past. ConclusionThe prevalence of ABPA is significantly higher in bronchial asthma patients presenting to tertiary care centers and hence awareness is required among physicians for early diagnosis and management of ABPA to achieve better asthma control and to avoid permanent lung damage.

Comparison of total serum immunoglobulin E and absolute eosinophil count levels among asthmatic and non-asthmatic children

Background: Immunoglobulin E (IgE) and associated cellular responses such as absolute eosinophil count (AEC) are responsible for allergic airway diseases. A hypersensitivity reaction initiated by immunological mechanisms, mediated by IgE antibodies, and eosinophils occur in allergic asthma. Objective: To compare the total serum IgE level and AEC levels among asthmatic and non-asthmatic children. Methods: The present study was conducted in the department of pediatrics and TB and Chest of a Medical College of North India from October 2015 to November 2016. Children from 3 years to 18 years, 30 with bronchial asthma and 30 healthy children were included in this study randomly. Results: The mean total serum IgE level in children with bronchial asthma was significantly higher (700.97±571.01 IU/ml) than that in healthy children (189.33±14.29 IU/ml). The mean AEC was also significantly higher in cases (746.63±492.02 cells/mm3) as compared to healthy children (220.23±121.69 cells/mm3). In bronchial asthma group, mean AEC increased with the increasing severity of asthma. Conclusion: The elevated level of total serum IgE and AEC may demonstrate the allergic etiology of asthma and hence, estimation of serum IgE and AEC levels can be considered as laboratory investigations in diagnosing cases of bronchial asthma.