Presence Of Peripheral Blood Eosinophilia Research Articles

PRESENCE OF PERIPHERAL EOSINOPHILIA IN CUTANEOUS DERMATOPHYTOSES IN WESTERN MAHARASHTRA- AN OBSERVATIONAL STUDY

Introduction: Dermatophytosis is a supercial fungal infection of the skin, hair and nails. The clinical and pathological features of dermatophytosis have been extensively reported in literature but its association with peripheral eosinophilia has not received any attention. Aim: The aim of the study is to report peripheral eosinophilia in patients with supercial cutaneous fungal infections. Materials and methods : Total 305 patients attending a Dermatology OPD suffering from cutaneous fungal infection were included in this study. Peripheral blood sample was collected in all patients to estimate absolute eosinophil count. Patients with eosinophil count more than 500 cells/μL were considered as having eosinophilia. Results : In a study of 305 cases of cutaneous fungal infections, dermatophytosis was found to be the most common fungal infection accounting for 282 (92.45%) cases. Absolute eosinophil count (AEC) more than 500 cells/μLwas observed in 76 (26.95%) cases, out of which Six (2.12%) patients had marked eosinophilia (AEC >1500 cells/μL). No peripheral eosinophilia was observed in remaining 23 (08.15%) cases of other cutaneous fungal infections. Conclusion : The presence of peripheral blood eosinophilia is a signicant nding in dermatophytosis particularly in chronic, long standing cases. One should be aware of this nding so as to avoid over investigating eosinophilia

Immunoglobulin G4-associated autoimmune hepatitis with peripheral blood eosinophilia: a case report

BackgroundImmunoglobulin G4 (IgG4) associated autoimmune hepatitis (AIH) has been recognized as a type of autoimmune disease that responds to corticosteroid. The diagnosis is based on elevation of the serum IgG4 level, abundance of IgG4 enhanced plasma cell infiltration in the portal region of the liver, and satisfaction of the criteria for “definite AIH” under the revised International Autoimmune Hepatitis Group (IAIHG) scoring system. However, the clinical course of the disease is unclear.Case presentationA 65-year-old man with jaundice and peripheral blood eosinophilia.His IAIHG and simplified score was compatible with definite AIH and his IgG4 level was elevated. Magnetic resonance imaging did not reveal abnormalities in the hepatobiliary system or pancreas. A liver biopsy revealed interface hepatitis with IgG4 positive plasma cell infiltration in the portal region, without evidence of bile duct injury. He responded to 4-week period of induction prednisolone therapy and had no recurring symptoms under maintenance therapy of 5 mg prednisolone during the 3-year follow up.ConclusionsThis was a rare case that demonstrated an association between IgG4 associated AIH and the presence of peripheral blood eosinophilia.

Electrochemical detection of Toxocara canis excretory-secretory antigens in children from rural communities in Esmeraldas Province, Ecuador: association between active infection and high eosinophilia

BackgroundThe diagnosis of active Toxocara canis infections in humans is challenging. Larval stages of T. canis do not replicate in human tissues and disease may result from infection with a single T. canis larva. Recently, we developed a nanobody-based electrochemical magnetosensor assay with superior sensitivity to detect T. canis excretory-secretory (TES) antigens. Here, we evaluate the performance of the assay in children from an Ecuadorian birth cohort that followed children to five years of age.MethodsSamples were selected based on the presence of peripheral blood eosinophilia and relative eosinophil counts. The samples were analyzed by the nanobody-based electrochemical magnetosensor assay, which utilizes a bivalent biotinylated nanobody as capturing agent on the surface of streptavidin pre-coated paramagnetic beads. Detection was performed by a different nanobody chemically labelled with horseradish peroxidase.ResultsOf 87 samples tested, 33 (38%) scored positive for TES antigen recognition by the electrochemical magnetosensor assay. The average concentration of TES antigen in serum was 2.1 ng/ml (SD = 1.1). The positive result in the electrochemical assay was associated with eosinophilia > 19% (P = 0.001). Parasitological data were available for 57 samples. There was no significant association between positivity by the electrochemical assay and the presence of other soil-transmitted helminth infections.ConclusionsOur nanobody-based electrochemical assay provides highly sensitive quantification of TES antigens in serum and has potential as a valuable tool for the diagnosis of active human toxocariasis.

745 Developing Precision Medicine in IBD: Peripheral Blood Eosinophilia Identifies Individuals With Worse Outcomes Following Initiation of Anti-TNF Biologic Agents

INTRODUCTION: Peripheral blood eosinophilia (PBE) has been recognized as a biomarker, identifying a subgroup of inflammatory bowel disease (IBD) patients with worse clinical outcomes. With more severe disease, anti-TNF therapy is often employed, with varied rates of success. The aim of this study was to determine whether the presence of pre-treatment PBE identifies IBD patients at risk for diminished anti-TNF treatment response. METHODS: We performed a registry analysis of IBD patients starting anti-TNF therapy who were enrolled in a consented, prospective, natural history IBD cohort at a tertiary center. Metadata was collected in the 2 years preceding and 2 years following anti-TNF initiation. The presence of PBE before and after anti-TNF initiation was recorded and treatment response was assessed for those with/without PBE using disease activity scores [Harvey Bradshaw Index (HBI) and Ulcerative Colitis Activity Index (UCAI)], quality of life measures [Short Inflammatory Bowel Disease Questionnaire (SIBDQ)], inflammatory markers (ESR, CRP), steroid use (prednisone or methylprednisolone), IBD-related hospitalizations, and IBD-related surgeries. Outcomes were assessed via linear mixed-effects and Cox proportional-hazards models for Crohn's disease (CD) and ulcerative colitis (UC). RESULTS: A total of 580 IBD patients (CD 430, UC 150) were included with 111 (19%) demonstrating pre-treatment PBE (CD 66, UC 45). Table 1 summarizes demographic and clinical data. Following anti-TNF therapy, CD patients with pre-treatment PBE were more likely to have an IBD-related hospitalization [adjusted hazard ratio (AHR) 1.88, 95% CI 1.22-2.90, P = 0.004] and require anal fistula repair (AHR 3.88, 95% CI 1.09-13.8, P = 0.04) than CD patients without PBE. UC patients with pre-treatment PBE were more likely to have an elevated CRP following anti-TNF therapy (OR 2.77, 95% CI 1.50-5.10, P = 0.001) with a non-significant trend towards increased IBD-related admissions and surgeries. CD patients with pre-treatment PBE were less likely to require steroids following anti-TNF therapy than CD patients without PBE (AHR 0.40, 95% CI 0.18-0.86, P = 0.019). There was no significant difference in HBI, UCAI, or SIBDQ scores in patients with/without PBE undergoing anti-TNF therapy. CONCLUSION: Pre-treatment PBE identifies IBD patients at risk for worse outcomes following anti-TNF therapy, particularly in CD. Further studies are warranted to determine if alternate mechanism of action biologics will function optimally in the PBE IBD population.

The effect of peripheral blood eosinophilia on inflammatory markers in asthmatic patients with lower respiratory tract infections.

BackgroundTo investigate the behaviour of the inflammatory marker neutrophil-to-lymphocyte ratio (NLR) in the presence of peripheral blood eosinophilia (PBE) in paediatric asthma patients with lower respiratory tract (LRT) infections.MethodsThis retrospective study enrolled consecutive patients aged ≥5 years who were diagnosed with asthma and whose haemogram values were available. The patients were further subdivided based on the presence or absence of LRT infections and allergies. NLR and C-reactive protein (CRP) were evaluated in relation to the presence or absence of PBE (≥4% eosinophils).ResultsA total of 991 patients were enrolled in the study. Patients with LRT infections had significantly higher leucocyte and neutrophil counts, a greater NLR and a higher level of CRP compared with patients without LRT infections. Overall, patients with PBE had significantly lower NLRs and CRP regardless of the presence or absence of an LRT infection. The PBE percentage showed moderate inverse correlations with NLR (r = −0.34) and CRP (r = −0.20).ConclusionThe presence of PBE was significantly associated with lower NLR and CRP regardless of the presence or absence of an infectious condition.

Computerized tomography features and clinicopathological analysis of Kimura disease in head and neck.

The aim of the current study was to discuss and analyze computerized tomography (CT) features and clinicopathological characteristics of patients with Kimura disease in head and neck. CT and clinicopathological data of 12 patients with Kimura disease diagnosed between May 2011 and May 2015 were analyzed. The mean age was 43.9 years and the disease course varied from 1 week-20 years. The mean absolute value of eosinophil granulocytes was 1.95×109/l. Multiple nodules were detected in 4 patients with Kimura disease. Main symptoms included multiple enlarged lymph nodes in neck and submaxillary regions. CT imaging of nodular lesions revealed a clear boundary, with moderate to marked homogeneous enhancement. Diffuse mass lesions were observed in 6 patients with Kimura disease. Main symptoms included subcutaneous diffuse soft tissue mass in parotid gland and maxillofacial regions. CT imaging of diffuse mass revealed unclear boundaries, adjacent skin thickness and moderate heterogeneous enhancement. In some cases, the diffuse mass involved soft mass with unclear boundaries. Pathological symptoms of Kimura disease included infiltration of eosinophilia, lymphocytic proliferation, formation of lymphatic follicles and variable degrees of fibrosis and vascular proliferation. Diagnosis of Kimura disease in head and neck regions may be improved based on lesions with clear or unclear boundaries, homogeneous or heterogeneous enhancement, with or without lymphadenectasis and by the presence of peripheral blood eosinophilia. However, a final diagnosis relies on a pathological examination.

Current Approach to Diagnosis and Management of Pulmonary Eosinophilic Syndromes: Eosinophilic Pneumonias, Eosinophilic Granulomatosis with Polyangiitis, and Hypereosinophilic Syndrome.

Eosinophils play a key role in orchestrating the complex clinicopathological pulmonary and extrapulmonary disease features in patients with eosinophilic syndromes. Eosinophilic pulmonary syndromes consist of a heterogeneous group of disorders characterized by the presence of peripheral blood eosinophilia and/or eosinophilic-related pulmonary impairment. These disorders can present with varying degrees of organ involvement, and while their presentation may be similar, it is important to define the disease state, as management and prognosis differ. In this article, we discuss acute and chronic eosinophilic pneumonias, eosinophilic granulomatosis with polyangiitis, and the hypereosinophilic syndromes. The mainstay of therapy for these disorders has been corticosteroids; however, recent and ongoing studies have provided strong grounds for optimism for specific targeted treatment approaches.

Development of Allergic Bronchopulmonary Aspergillosis with Central Bronchiectasis Over a 10-year Period: The Need to Recheck Allergen Sensitization

A 55-year-old woman visited our hospital for an investigation of central bronchiectasis, mucoid impaction and infiltrative shadows on chest CT. She had a 10-year history of bronchial asthma; however, her adherence to treatment was poor. Based on the presence of peripheral blood eosinophilia and immediate cutaneous reactivity to Aspergillus fumigatus, the patient was clinically diagnosed with allergic bronchopulmonary aspergillosis. Her condition and CT findings improved with systemic corticosteroid therapy. It was found that the patient had not been sensitized to Aspergillus 10 years earlier, indicating that single testing is inadequate for the early diagnosis of this disease.

Roundtable Discussion

Dr. Eugene Bleecker (symposium chairman): I would like to thank all the speakers for participating in an interesting and informative symposium today. The first question I'd like to ask is directed to Professor Postma. A number of markers have been used to differentiate COPD from asthma, including any evidence of atopy—skin test atopy, symptomatic atopy, the presence of peripheral blood eosinophilia, or even sputum eosinophilia. Do you think this is a good way to approach differentiating these diseases in clinical practice?

Infection of mice with the helminth Strongyloides stercoralis suppresses pulmonary allergic responses to ovalbumin.

Asthma and helminth infections induce similar immune responses characterized by the presence of peripheral blood eosinophilia and elevated serum IgE levels. Epidemiological surveys have reported either increases or decreases in the development of atopic diseases and asthma based on the prevalence of helminth infections in the population. The aim of this study was to determine if a pre-existing helminth infection would increase or decrease subsequent allergic responses to an unrelated allergen in the lungs. BALB/cByJ mice were infected with the nematode parasite Strongyloides stercoralis prior to ovalbumin (OVA) immunization and intratracheal challenge. Bronchoalveolar lavage (BAL) and fluid (BALF) were collected 3 days post-challenge and cellular and humoral immune responses were measured. Intracellular cytokine staining revealed increased IL-4 and IL-5 producing cells in BAL from mice infected with S. stercoralis before OVA sensitization. Increased IL-5 protein levels and decreased IFN-gamma protein levels were also observed in the BALF. There was, however, no increase in airway eosinophil accumulation in mice infectd with parasites before sensitization with OVA as compared to mice exposed to OVA alone. Furthermore, eotaxin levels in the lungs induced by OVA was suppressed in mice infected with the parasite before OVA sensitization. The development of OVA specific IgE responses in BALF was also impaired in mice infected with the parasite before sensitization with OVA. These results suggest that a pre-existing helminth infection may potentiate a systemic Type 2-type response yet simultaneously suppress in the lungs allergen-specific IgE responses and eotaxin levels in response to subsequent exposure to allergens.

Skin eosinophilia in patients with allergic and nonallergic asthma and atopic dermatitis

Skin eosinophilia induced by grass pollen or platelet-activating factor (PAF) was investigated in patients with allergic and nonallergic asthma and atopic dermatitis (AD) and in normal control subjects. Intracutaneous injection of PAF resulted in positive immediate skin reactions in all tested individuals. Since most of the patients with allergic and nonallergic asthma and eczema under investigation were characterized by a peripheral blood eosinophilia, we investigated whether PAF should be capable of mobilizing blood eosinophils to the skin of patients with nonallergic asthma and AD using the Rebuck skin window technique. Our results demonstrated that, in allergic individuals, allergen induced a much stronger skin eosinophilia than PAF and in a larger percentage of the patients (77% versus 45%). There was no correlation between skin eosinophilia induced by PAF and the occurrence of late skin reactions to allergen. Furthermore, the PAF-induced and the allergen-induced skin eosinophilia differed histologically. In nonallergic individuals, neither allergen nor PAF was capable of mobilizing eosinophils in the skin window, in spite of the presence of peripheral blood eosinophilia. Our results indicate that the allergen- and PAF-induced skin eosinophilia are different and that in patients with nonallergic asthma and AD, another chemoattractant than PAF must be responsible for eosinophil mobilization in the target organ.