Peripheral Eosinophil Levels Research Articles

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.

Peripheral blood immune cell dynamics reflect antitumor immune responses and predict clinical response to immunotherapy

BackgroundDespite treatment advancements with immunotherapy, our understanding of response relies on tissue-based, static tumor features such as tumor mutation burden (TMB) and programmed death-ligand 1 (PD-L1) expression. These approaches are...

Eosinophil Levels in Blood of COVID-19 Patient’s VS Seasonal Allergy

Eosinophilia, a peripheral blood with eosinophil count of more than 450 cells per microliter has been linked to allergies, medication responses, among others. However, the reduction in eosinophil levels has been particularly found to be having linkage with SARS-CoV-2 infection. This study aims at comparing COVID-19 patients' peripheral blood eosinophil levels to seasonal allergy patients' eosinophil counts to determine whether there is a link between eosinophil numbers and COVID-19 disease severity. Data was obtained from the review of the electronic medical records of 300 confirmed COVID-19 patients, alongside their clinical features were obtained. Data collected was then subjected to retrospective cohort analysis. Eosinopenia was found in 73.7 percent, 86.7 percent, and 94.3 percent of patients in the mild, moderate, and severe categories, respectively (p value 0.002). When compared to patients with moderate and severe illnesses, patients with critical disease had significantly lower eosinophil levels. Results from this study shows that increase in COVID-19 severity is associated with a significant drop in peripheral eosinophil levels, and that eosinopenia was present in the majority of COVID-19 patients. Seasonal allergic rhinitis is indicated as a particularly good model for studying the potential pathogenic effects of eosinophils and eosinophilic inflammation.

Differences of the Nasal Microbiome and Mycobiome by Clinical Characteristics of COPD Patients.

While studies suggest that the lung microbiome may influence risk of chronic obstructive pulmonary disease (COPD) exacerbations, little is known about the relationship between the nasal biome and clinical characteristics of COPD patients. We sampled the nasal lining fluid by nasosorption of both nares of 20 people with moderate-to-severe COPD. All 40 samples, plus 4 negative controls, underwent DNA extraction, and 16SV4 ribosomal RNA (rRNA) (bacterial) and ribosomal internal transcribed spacer 2 (ITS2) (fungal) sequencing. We measured the proportion of variance (R2) in beta diversity explained by clinical factors, including age, sex, body mass index (BMI), COPD treatment, disease severity (forced expiratory volume in 1 second [FEV1], symptom/exacerbation frequency), peripheral eosinophil level (≥150 versus <150 cells/µL) and season of sampling, with the PERMANOVA test on the Bray-Curtis dissimilarities, accounting for within-person correlation of samples. We assessed the relative abundance of microbial features in the nasal community and their associations with clinical characteristics using the Microbiome Multivariable Association with Linear Models (MaAsLin2) package. The most abundant nasal fluid bacterial taxa were Corynebacterium, Staphylococcus, Streptococcus, Moraxella, and Dolosigranulum, and fungal taxa were Malassezia, Candida, Malasseziales, Cladosporium and Aspergillus. Bacterial microbiome composition was associated with short-acting muscarinic antagonist use (R2 11.8%, p=0.002), sex (R2 8.3%, p=0.044), nasal steroid use (R2 7.7%, p=0.064), and higher eosinophil level (R2 7.6%, p=0.084). Mycobiome composition was associated with higher eosinophil level (R2 14.4%, p=0.004) and low FEV1 (R2 7.5%, p=0.071). No specific bacterium or fungus differed significantly in relative abundance by clinical characteristics in the multivariate per-feature analysis. The taxonomical composition of the nasal biome is heterogeneous in COPD patients and may be explained in part by clinical characteristics.

Low-dose mepolizumab is effective as an add-on therapy for treating long-lasting peripheral neuropathy in patients with eosinophilic granulomatosis with polyangiitis.

To assess the effectiveness of low-dose mepolizumab as an add-on therapy for treating peripheral neurological symptoms in eosinophilic granulomatosis with polyangiitis (EGPA). We prospectively studied 13 EGPA patients with conventional treatment-resistant peripheral neuropathy. Their symptoms (pain, numbness, and muscle weakness) were assessed on a visual analogue scale (VAS) before and after 12 months of mepolizumab therapy (100 mg every 4 weeks). Peripheral eosinophil levels and several biomarkers including urinary levels of eosinophil-derived neurotoxin (EDN) were measured before and after therapy. VAS scores for pain and numbness significantly improved after 12 months of mepolizumab therapy (from 67.0 to 48.0, P = 0.012, and from 67.0 to 51.0, P = 0.017, respectively). However, the VAS score for muscle weakness did not improve (P = 0.36). There were significant correlations between treatment-related changes in urinary EDN levels from baseline to 6 months later and percent changes in the VAS scores of pain and numbness (r = 0.75, P = 0.020; r = 0.88, P = 0.002). Treatment-resistant peripheral neuropathy in EGPA was significantly improved by low-dose mepolizumab, and effectiveness was correlated with decreased urinary EDN. Because the possibility of a placebo effect cannot be formally excluded, placebo-controlled studies will be required in the future.

Association Between Peripheral Eosinophilia and Clinical Characteristics of Adult-onset Still's Disease with Persistent Eruption: A Retrospective Study.

Persistent eruption occurs in a subset of patients with adult-onset Still’s disease. In our experience, a considerable proportion of these patients present with peripheral eosinophilia. The aims of this study were to summarize the clinical and histological features of patients with adult-onset Still’s disease with persistent eruption in the current study cohort, and to assess the association between peripheral eosinophil levels and disease characteristics. A total of 21 patients with adult-onset Still’s disease with persistent eruption were included in this retrospective study. Koebner signs, an important diagnostic clue, were found in 85.7% of patients. The proportion of patients presenting with eosinophilia within the disease course was 57.1%. Skin histology revealed infiltration of eosinophils in 90.5% of patients. Peripheral eosinophil levels were positively associated with involved body surface area. Patients with normal peripheral eosinophil counts were more likely to achieve complete remission than those with abnormal peripheral eosinophil counts. Eosinophils may be involved in the pathogenesis of skin eruption. Abnormal peripheral eosinophil counts in these patients may indicate a more refractory disease course.

Health-Related Effects of Home Nebulization With Glycopyrronium on Difficult-to-Treat Asthma: Post-Hoc Analyses of an Observational Study.

BackgroundBronchial asthma remains a clinical enigma with poorly controlled symptoms or exacerbations despite regular use of inhaled corticosteroids. Home nebulization offers a simplified solution for the delivery of rescue and maintenance bronchodilators, which is especially true for patients with frequent exacerbations during management of uncontrolled or difficult-to-treat asthma.ObjectiveWe aimed to assess the clinical impact and outcomes associated with home nebulization—delivered long-acting bronchodilators for uncontrolled or difficult-to-treat asthma.MethodsThis observational, concurrent study was conducted with 60 patients at 2 centers during November 2018. Statistical analyses for prebronchodilator forced expiratory volume in one second (FEV1) and Global Initiative for Asthma (GINA) asthma control score in patients on long-acting bronchodilators and corticosteroids were conducted, with two-tailed P values <.05 considered statistically significant.ResultsPer protocol analyses (53/60) for consecutive cases receiving home nebulization with long-acting bronchodilators and corticosteroids were conducted. The baseline demographics included a male-to-female ratio of 30:23 and mean values of the following: age, 60.3 years (SD 11.8 years); weight, 64 kg (SD 16.8 kg); FEV1, 43% (SD 16%); GINA asthma control score, 3.0 points (SD 0.8 points); serum eosinophil level, 4% (SD 3%); fractional exhaled nitric oxide (FeNO), 12.1 ppb (SD 6 ppb). Of the patients, 100% (53/53) had uncontrolled symptoms, 69.8% (37/53) had prior exacerbations, 100% (53/53) used formoterol/budesonide, and 75.5% (40/53) used glycopyrronium. The per protocol group (n=53) had significantly improved mean prebronchodilator FEV1 (23.7%, SD 29.8%; 0.46 L, SD 0.58 L; P<.001) and GINA asthma control score (2.1 points, SD 0.8 points, P<.001). At baseline, patients (n=40) receiving glycopyrronium/formoterol/budesonide (25/20/500 mcg) nebulization admixture had the following mean values: prebronchodilator FEV1, 38% (SD 15%); GINA asthma control score, 3.0 points (SD 0.8 points); reversibility, 12% (SD 6%); peripheral eosinophil level, 4% (SD 3%); FeNO, 12 ppb (SD 5.7 ppb). In the post hoc analyses, these patients had significantly improved mean prebronchodilator FEV1 of 27.7% (SD 26.2%; 0.54 L, SD 0.51 L; P<.001) at 8 weeks compared with baseline. At baseline, patients (n=13) receiving formoterol/budesonide (20/500 mcg) nebulization had the following mean values: FEV1, 55% (SD 12%); GINA asthma control score, 3.0 points (SD 1.2 points); reversibility, 14% (SD 7%); serum eosinophil level, 4% (SD 3%); FeNO, 13.3 ppb (SD 6.8 ppb). In the post hoc analyses, these patients showed a significant improvement in prebronchodilator FEV1 of 11.2% (SD 13.1%; 0.22 L, SD 0.25 L; P<.001) from baseline. Breathlessness of mild to moderate intensity was reported by 10 cases (10/53, 18.9%), with no other treatment-emergent adverse events or serious adverse events.ConclusionsHome nebulization remains a viable option for symptomatic difficult-to-treat asthma cases with frequent use of rescue medications. Glycopyrronium as add-on therapy offers a synergistic response in patients on corticosteroids with difficult-to-treat asthma.Trial RegistrationClinical Trial Registry of India CTRI/2018/11/016319; https://tinyurl.com/y78cctm3

Inhaled corticosteroid use and its implication in peripheral eosinophil level

Inhaled corticosteroid use and its implication in peripheral eosinophil level

Eosinophils and other peripheral blood biomarkers in glioma grading: a preliminary study

BackgroundMany peripheral blood biomarkers are associated with glioma grade, but eosinophils (Eo) are scarcely reported. This study assessed preoperative peripheral eosinophil levels and other peripheral biomarkers presented in prior literature, probing their associations and diagnostic value in the grading of glioma, including its most aggressive type, glioblastoma (GBM).MethodsPatients newly diagnosed with neuroepithelial tumors were included and divided into low-grade glioma (LGG)/high-grade glioma (HGG) groups and non-GBM/GBM groups separately. Preoperative peripheral biomarkers were collected, such as the counts of Eo, neutrophils (Neu), and lymphocytes (Ly), and values such as the eosinophil to lymphocyte ratio (ELR) and neutrophil to lymphocyte ratio (NLR) were calculated. Correlation analyses were also performed between these biomarkers and the groups. Receiver operating characteristic curves were utilized to assess the individual and joint diagnostic values of the biomarkers.ResultsThe HGG patients presented lower Eo and ELR values, which had negative correlations with glioma grade. The diagnostic efficiency of Eo and ELR could be enhanced when combined other biomarkers. In the non-GBM vs GBM analysis, GBM patients displayed reduced Eo and a negative correlation between Eo and a GBM diagnosis The combination of Eo and other biomarkers enhanced the diagnostic efficiency.ConclusionsA negative correlation between peripheral eosinophils and glioma grade was found in our study. Numerous cytokines derived from eosinophils could regulate the immune response and affect the tumor microenvironment; moreover, eosinophils may inhibit the tumorigenesis of glioma, which should be explored in the future and may enlighten some new paths for glioma therapy.

Clinical and pathological profile of eosinophilic gastroenteritis.

Eosinophilic gastroenteritis (EoGE) can be diagnosed on the basis of histologic criteria; however, the pathology is considered to be heterogeneous. There is no consensus on the management of this enigmatic disorder with an unknown etiology. Data for patients diagnosed with EoGE and followed up over a 1-year period were analyzed. Their symptoms, patterns of flares, and type of treatment were documented. The shift in peripheral blood eosinophil levels was also examined. A total of 10 (mean age, 44 years; range: 31-70 years; women, 5) patients were diagnosed with EoGE. The most frequent presenting symptom was abdominal pain, and eight patients were classified with mucosal type of EoGE. Chronic disease or multiple flares were observed in seven out of 10 (70.0%) patients, and all of them had a history of allergy. Four were corticosteroid dependent (three relapsed during corticosteroid tapering and one following corticosteroid withdrawal). One of them received anti-IL5 monoclonal antibody that enabled corticosteroid dose tapering. In four patients with highly elevated initial eosinophil levels at diagnosis, the peripheral eosinophil level correlated with the amelioration and deterioration of their symptoms. The remaining three patients had a single flare without relapse. Two had no history of allergy. EoGE is a unique disorder with a variable clinical course. Although further studies are required to confirm our observations, the presence of other allergic disorders is associated with chronicity or multiple flares. Peripheral eosinophil level may be an effective biomarker for recurrence in patients with severe systemic disorders at diagnosis.

Tetrahydrocurcumin, a major metabolite of curcumin, ameliorates allergic airway inflammation by attenuating Th2 response and suppressing the IL-4Rα-Jak1-STAT6 and Jagged1/Jagged2 -Notch1/Notch2 pathways in asthmatic mice.

Curcumin (Cur), derived from Curcuma species, exhibits anti-inflammatory, antioxidant, and anticancer effects. Although Cur has some beneficial effects on asthma, its clinical application is limited by its low bioavailability. Tetrahydrocurcumin (THC), the major active metabolite of Cur, has multiple biological functions, similarly to Cur, and importantly, it showed enhanced bioavailability in tissues and plasma. However, the effect of THC on asthma has not been reported. The current study sought to investigate the efficacy of dietary THC on allergic asthma compared to that of Cur in an animal model. The anti-inflammatory effects of Cur and THC were evaluated in an ovalbumin-induced asthmatic mouse model. The nasal symptoms, pathological alterations of the lung tissues, oxidants and antioxidants, cytokine production, T cell subsets, and Th2-related signalling pathway activity were assessed. Both THC and Cur had beneficial effects on asthmatic mice with regard to nasal symptoms, pathological changes (eosinophils and mucus hyper-production), oxidative stress (malondialdehyde), cytokine production (IL-13), Th17 and cytotoxic T cell subsets, and Th2 signalling pathway (IL-4Rα-Jak1-STAT6 and Jagged1/Jagged2-Notch1/Notch2 axis) activity. THC was more effective than Cur in suppressing tissue eosinophilia, mucus production, and IL-4Rα/Jak1/STAT6 pathway activity. Furthermore, only THC inhibited peripheral eosinophil levels, Th2 cytokines (IL-4 and IL-5), and Th2 cell subsets and enhanced an antioxidant enzyme (glutathione). The above results demonstrated for the first time that THC was superior to Cur in modulating allergic asthmatic phenotypes, especially attenuating the Th2 response. THC might be a potentially effective agent for asthma treatment.

There is no correlation between the serum level of interleukin-21 and bullous pemphigoid

Objective To investigate the correlations of the serum level of interleukin-21 (IL-21) with anti-BP180 antibodies, peripheral eosinophil level, bullous pemphigoid disease area index (BPDAI) in patients with bullous pemphigoid (BP) . Methods A total of 31 patients with bullous pemphigoid and 31 healthy controls were enrolled into this study. Blood samples were collected from all the subjects, and enzyme-linked immunosorbent assay (ELISA) was performed to detect the serum level of IL-21 and serum titer of anti-BP180 antibodies. BPDAI was assessed among 13 patients, and the correlation of the IL-21 level with anti-BP180 antibody titers, eosinophil count and BPDAI were analyzed. Results No significant difference in the serum level of IL-21 was observed between the patients (M[P25 - P75]: 255.28 [156.19 - 361.59] ng/L) and healthy controls (150.47 [72.4 - 268.73] ng/L, P = 0.14) . There was no correlation between the serum level of IL-21 and serum titer of anti-BP180 antibodies (82.98 [26.82 - 132.92]U/ml, rs = 0.18, P = 0.332) . Among the 27 BP patients who underwent blood cell count, no correlation was found between the serum levels of IL-21 and whole-blood eosinophil counts (rs = 0.104, P = 0.606) . Among the 13 BP patients who underwent assessment of BPDAI, there was no correlation between the serum levels of IL-21 and BPDAI scores (rs = 0.233, P = 0.464) . Conclusion The IL-21 level is uncorrelated with anti-BP180 antibody level, peripheral eosinophil level or BPDAI in patients with BP. Key words: Pemphigoid, bullous; Eosinophils; Interleukin-21; Anti-BP180 antibody

Kimura's Disease without Peripheral Eosinophilia: An Unusual and Challenging Case Simulating Venous Malformation on Imaging Studies-Case Report and Review of literature.

Kimura's Disease (KD) is a rare chronic inflammatory disorder presenting as multiple painless solitary subcutaneous nodules, predominantly in the head and neck region and frequently associated with regional lymphadenopathy and/or salivary gland involvement. Because of painless nature and indolent course, there is usually a delay in the patient's presentation. KD may radiologically mimic other chronic inflammatory conditions like tuberculosis, vascular malformations and neoplasms. Clinical correlation and histological evaluation along with elevated peripheral eosinophil and serum IgE level are considered important for confirmatory diagnosis. We report a case of painless swelling over right submandibular region extending to the right superficial parotid. The haematological reports were within normal limits. Ultrasound (USG), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA) favoured a diagnosis of venous malformation. However, histopathological examination of excised lesion confirmed a diagnosis of KD. This case proves the possibility of the KD even in the absence of peripheral eosinophilia and/ or elevated serum IgE level, and may mimic venous malformation on imaging studies. Therefore, KD must find a place in the differentials of solitary painless neck swelling even in the absence of peripheral eosinophilia and/or elevated IgE level.

Circulating microRNAs as biomarkers in patients with allergic rhinitis and asthma

MicroRNAs (miRNAs) are emerging as important regulatory molecules that might be involved in the pathogenesis of various diseases. Circulating miRNAs might be noninvasive biomarkers to diagnose and characterize asthma and allergic rhinitis (AR). We sought to determine whether miRNAs are differentially expressed in the blood of asthmatic patients compared with those in the blood of nonasthmatic patients with AR and nonallergic nonasthmatic subjects. Furthermore, we sought to establish whether miRNAs could be used to characterize or subtype asthmatic patients. Expression of plasma miRNAs was measured by using real-time quantitative PCR in 35 asthmatic patients, 25 nonasthmatic patients with AR, and 19 nonallergic nonasthmatic subjects. Differentially expressed miRNAs were identified by using Kruskal-Wallis 1-way ANOVA with Bonferroni P value adjustment to correct for multiple comparisons. Arandom forest classification algorithm combined with a leave-one-out cross-validation approach was implemented to assess the predictive capacities of the profiled miRNAs. We identified 30 miRNAs that were differentially expressed among healthy, allergic, and asthmatic subjects. These miRNAs fit into 5 different expression pattern groups. Among asthmatic patients, miRNA expression profiles identified 2 subtypes that differed by high or low peripheral eosinophil levels. Circulating miR-125b, miR-16, miR-299-5p, miR-126, miR-206, and miR-133b levels were most predictive of allergic and asthmatic status. Subsets of circulating miRNAs are uniquely expressed in patients with AR and asthmatic patients and have potential for useas noninvasive biomarkers to diagnose and characterize these diseases.

Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis.

(1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predicts disease severity in CRSwNP. Case series with chart review. Academic hospital specializing in respiratory and allergic disease. Patients with CRSwNP treated from 2008 to 2010. Clinical data were collected; sinus computed tomography (CT) scans were scored according to the Lund-Mackay system; and surgical specimens were evaluated for degree of tissue eosinophilia. Statistical analysis was performed to compare eosinophilia with indicators of disease severity. Seventy CRSwNP patients were included, with a mean Lund-Mackay score of 16.7; 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms, or Lund-Mackay scores, nor did it correlate with presence of asthma or aspirin-sensitivity (P = .09). Patients with mild asthma had significantly more tissue eosinophils versus patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics. There was no correlation between tissue and serum eosinophil counts (P = .97), but there was a significant positive correlation between CT score and peripheral eosinophil level (P < .05). Higher serum eosinophil levels may indicate more extensive mucosal disease as measured on CT scan. Neither serum nor tissue eosinophilia predicted disease severity in our retrospective analysis of CRSwNP patients, and serum eosinophil level did not serve as a marker of tissue eosinophilia.

Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis

Objectives: (1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predict disease severity in CRSwNP. Methods: Patients with CRSwNP treated at an academic hospital specializing in respiratory and allergic disease from 2008 to 2010 were included in this study. Clinical information was collected retrospectively. Sinus computed tomography (CT) scans were scored by a single author according to the Lund-Mackay (LM-CT) system, and surgical specimens were evaluated by a single author for degree of tissue eosinophilia. Statistical analysis was performed with t test, chi-squared test, Fisher’s exact test, and multiple regression models. Results: Seventy CRSwNP patients were included. They had a mean LM-CT score of 16.7, 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. There was no significant correlation between tissue and serum eosinophil counts ( P = .97). There was a significant positive correlation between CT score and peripheral eosinophil level ( P &lt; .05). Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms ( P = .91), or Lund-Mackay scores ( P = .25), nor did it correlate with presence of asthma, but it may be elevated in aspirin-sensitive patients ( P = .09). Patients with mild asthma had significantly more tissue eosinophils when compared to patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics. Conclusions: Higher serum eosinophil levels may indicate worse mucosal disease as measured on CT scan, but neither serum nor tissue eosinophilia predicted disease severity in our population CRSwNP patients.

Correlation of immunoglobulin E levels and peripheral eosinophilia with paranasal sinus mucosal disease

EnAbstract Objective The aim of this study was to assess whether total immunoglobulin E (IgE) levels and peripheral eosinophilia correlate with the extent of sinus mucosal disease on computed tomography (CT) of paranasal sinuses. Patients and methods CT scans were performed; total IgE and peripheral eosinophil levels were measured for all patients. The relationships between peripheral eosinophilia, total IgE levels, and the presence of mucosal disease on sinus CT imaging were also determined. Results The total IgE did not correlate with CT stage of the disease, whereas there was a significant moderate positive correlation between CT stage and peripheral eosinophil levels. Conclusion The data suggest that eosinophil levels contribute toward mucosal inflammation in paranasal sinuses and the presence of peripheral eosinophilia in patients with sinusitis indicates a high likelihood of extensive disease. However, IgE levels did not correlate with CT scan findings. Calculation of the percentage of peripheral eosinophils by measurement of the differential leukocyte count is a simple, easy, and rapid technique for assessment of the severity of chronic rhinosinusitis.

Four cases of nafcillin-associated acute interstitial nephritis in one institution

Over the course of 1 year, four patients in a single institution developed acute kidney injury most likely secondary to nafcillin-associated acute interstitial nephritis, indicating that this complication might not be as rare as is commonly believed. The main case presented here is that of a 73-year-old man with a history of chronic low back pain who presented with worsening back pain, as well as nausea, vomiting and volume depletion. Imaging studies revealed a soft tissue abscess in the left psoas major muscle. Physical examination, complete urine analysis, blood and urine cultures, measurement of peripheral eosinophil and plasma creatinine levels, and renal ultrasound. Nafcillin-associated acute interstitial nephritis. Discontinuation of nafcillin and provision of supportive care.

Total IgE Levels and Peripheral Eosinophilia

To evaluate the relationship among peripheral eosinophilia, total IgE, and paranasal sinus mucosal disease based on computed tomography (CT) of the sinus. Retrospective review of a large medical information database from a tertiary referral medical center. Tertiary referral medical center specializing in respiratory disorders. Consecutive patients having total IgE and peripheral eosinophil levels and sinus CT imaging available for review. Patients 18 years or older were included; subjective or objective evidence of chronic rhinosinusitis was not used as selection criteria. A total of 303 patients were found to have peripheral eosinophil levels and CT imaging for review; 288 patients had total IgE levels and CT imaging. Linear regression analysis was used to evaluate (1) the correlation between peripheral eosinophil level and CT stage of sinus disease and (2) the correlation between total IgE level and CT stage of sinus disease. The CT scans were graded using the Lund-MacKay scoring system. There was a significant positive correlation between sinus CT stage and peripheral eosinophil levels (r=0.60, P<.05). Eighty-nine percent of the abnormal eosinophil counts (>550 cells/microL) were associated with CT scores higher than 12. Total IgE did not correlate with CT stage of disease (r=0.05, P>.05). The presence of peripheral eosinophilia indicates a high likelihood of mucosal sinus disease based on CT imaging. No correlation was noted between total IgE levels and CT stage of mucosal disease. These data support a link between eosinophilia and the presence of paranasal sinus mucosal inflammation.

Effect of Sho-Seiryu-To (XIAO-QING-LONG-TANG) on skin itching and peripheral eosinophil level in three elderly patients

Sho-Seiryu-To is known to be effective against allergic diseases, but its effect on skin itching has not been reported. We observed the effect of Sho-Seiryu-To on three elderly patients who, desoite using an anti-allergic drug, has severe chronic skin itching with peripheral eosinophilia. All three patients decreased their peripheral eosinophilia and improved their skin condition within eight weeks. We conclude that Sho-Seiryu-To could be capable of treating elderly patients with chronic skin itching and peripheral eosinophilia.