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PubMed1996

Predictive value of eosinophilia for neutropenia during clozapine treatment.

BACKGROUND: Myelotoxicity continues to hinder the widespread use of clozapine in the United States. It has been theorized that eosinophilia predicts later agranulocytosis and that agranulocytosis occurs due to an immunologic mechanism. Our study compares the rates of these dyscrasias in clozapine-treated patients and a control group. METHOD: Forty-one patients taking clozapine and 29 patients taking haloperidol were monitored for a period of 6 months. Rates of eosinophilia and neutropenia were compared between the two treatment groups. RESULTS: Treatment-emergent eosinophilia occurred frequently in both haloperidol- and clozapine-treated patients. No significant difference was seen between groups in the incidence of eosinophilia and neutropenia. CONCLUSION: We find no statistical difference between the rates of eosinophilia or neutropenia in haloperidol- and clozapine-treated patients. This study does not support the use of eosinophilia as a reliable predictor of neutropenia.

Adult↗

PubMed1976

[Eosinophilia in the preleukaemic phase of acute granulocytic leukaemia (author's transl)].

The pathogenesis of a marked eosinophilia in the preleukaemic phase of an acute granulocytic leukaemia is described and discussed. An otherwise symptom-free girl 4 years of age, presented with a transient increased WBC count with eosinophilia during one year before onset of acute granulocytic leukaemia. All relevant tests for explanation of this eosinophilia proved negative. The phenomenon of transient eosinophilia with successive onset of acute granulocytic leukaemia may fit into the concept of immunological control of tumorgenesis. In the present case it is suggested that the initial eosinophilia was the manifestation of the body's fight against the first malignant leukaemic cells. Finally the immunological defence was overwhelmed and the eosinophilia disappeared with concomitant appearance of leukaemic cells.

Antibodies, Neoplasm↗

PubMed2000

Tissue eosinophilia correlates strongly with poor prognosis in nodular sclerosing Hodgkin's disease, allowing for known prognostic factors.

Although eosinophilic granulocytes are frequently observed in lymphatic tissue of Hodgkin's patients, no substantial data reveal the prognostic role, if any, of tissue eosinophilia. Thus, eosinophilia was analyzed histologically in 1511 diagnostic biopsy specimens of patients treated under protocol therapy of the German Hodgkin's Lymphoma Study Group between 1988 and 1994. Prominent eosinophilia was seen in 38% of cases, which differed among the histologic types of Hodgkin's disease (HD): none in lymphocyte predominant, 14% in lymphocyte rich classical, 40% in nodular sclerosis grade 1 (NS-1), 55% in nodular sclerosis grade 2, 43% in mixed cellularity (MC), and 54% in lymphocyte depleted. In a multivariate analysis, tissue eosinophilia proved to be the strongest prognostic factor for freedom from treatment failure (P <. 001) and overall survival (P <.001) in a stage-stratified model. Among NS-1 patients, the effect was highly significant. In MC, no significant effect of eosinophilia on survival could be demonstrated. Eosinophils secrete CD30 ligand that is capable of binding to CD30 positive HD cells. The activation of TRAF2, followed by NF-kappaB, which occurs on CD30L/CD30 binding, may explain the neoplastic proliferation and apoptosis protection of HD cells. TRAF2 is also activated by EBV-LMP expression, which is detectable in the majority of MC but not NS cases. In addition to the possibility that eosinophils are only passive indicators for other unknown prognostic determinants, it may be concluded that the positive clinical outcome of eosinophilia-negative NS cases could be due to lower NF-kappaB activity. (Blood. 2000;95:1207-1213)

Adolescent↗

PubMed2000

[Major eosinophilia in a premature infant induced by topical ketoconazole].

INTRODUCTION: Ketoconazole is a member of a newer group of imidazole antifungals. Except for treatment of oral candidiasis, there is no reported experience of use in neonates. Thus, its use in neonatalogy must be considered experimental. Herein we report a major eosinophilia in a very low birth weight neonate induced by transcutaneous resorption of topical ketoconazole. CASE REPORT: A 26 week premature was intubated and ventilated for a hyaline membrane disease. At more than 2 weeks, he developed diaper dermatitis with Candida albicans. Treatment consisted of local application of ketoconazole. After 6 days of application, WBC showed a major eosinophilia [20,000/microL]. Discontinuation of the drug was followed by a prompt normalization of the eosinophil count. The challenge test by topical ketoconazole reproduced eosinophilia, implicating this drug, which, to our knowledge, has not been described previously to cause eosinophilia in very low weight neonates. DISCUSSION: Peripheral eosinophilia is an uncommon finding present in a relatively limited number of conditions in children. A minor eosinophilia often seen in premature neonates may in part be due to intubation. This case illustrates the potential danger of percutaneous application of drugs in newborn and infants as it has previously been pointed out way various chemicals. Any deterioration of the corneal layer such as observed in many dermatosis prompts an increase in the cutaneous permeability. Immaturity of the premature skin may have aiso played a role. Dermatologists should be aware of potential toxic topical ointments before prescribing them to very low weight babies.

Administration, Cutaneous↗

PubMed2000

Severe eosinophilia in disseminated gastric carcinoma.

Peripheral blood eosinophilia is a well-recognised but unusual manifestation of malignancy, and may represent a paraneoplastic phenomenon. We present a case of poorly differentiated adenocarcinoma of the stomach associated with severe peripheral blood eosinophilia A 55-year old man was admitted for abdominal pain of one week duration. An incidental finding of leucocytosis with eosinophilia was noted. After excluding haematological and infectious causes, an oesophagogastroduodenoscopy (OGD) followed by biopsy confirmed the diagnosis. Eosinophilia appears to be a response to cytokine production,and treatment is aimed at the underlying malignancy, and reducing the eosinophil count when necessary, to prevent end-organ damage. Studies have shown that peripheral eosinophilia is associated with disseminated, metastatic disease and hence signifies a poor prognosis,whereas tissue eosinophilia in advanced cancer has a better survival rate.

Abdominal Pain↗

PubMedDate not supplied

A 34-year-old man with chronic itching and peripheral and submucosal eosinophilia.

A 34-year-old man with peripheral eosinophilia, chronic pruritus, and colonic eosinophilic infiltration is presented as a patient-oriented problem-solving case report to show the important aspects of differential and specific diagnosis, treatment, prognosis, and caveats in the approach to the workup of the patient with eosinophilia. Allergic rhinitis, asthma, atopy, and drug-induced eosinophilia should come to mind in the initial differential diagnosis of any patient with peripheral eosinophilia. Also included in the differential after allergic disease processes would be the general categories of infectious, neoplastic, and the various forms of organ-specific eosinophilic infiltration and idiopathic syndromes. The importance of ruling out infectious causes for eosinophilia is paramount, especially given the dangers of immunosuppressive treatments often used to treat other conditions associated with eosinophilia.

Adult↗

PubMed1990

Detection of interleukin-5 messenger RNA in Reed-Sternberg cells of Hodgkin's disease with eosinophilia.

Hodgkin's disease of nodular sclerosis and mixed cellularity subtypes is frequently associated with eosinophilia. To determine if interleukin-5 (IL-5) is implicated in producing the eosinophilia, we performed in situ hybridization studies on cytopreparations of 16 cases of Hodgkin's disease with eosinophilia as well as cells from various controls. A single-stranded, anti-sense complementary DNA (cDNA) probe coding for a portion of the human IL-5 molecule was tail-labeled with digoxigenin -11-dUTP using terminal transferase, and then hybridized to messenger RNA (mRNA) within cells. An alkaline-phosphatase-conjugated antibody directed to digoxigenin was used with a chromogenic substrate to detect hybridized probe within cells. In all seven cases of nodular sclerosis subtype and nine cases of mixed cellularity subtype with eosinophilia, there was strong hybridization signal localizable to the cytoplasm of morphologically identifiable Reed-Sternberg cells and variants. Similar activity was detected only in rare cells from three normal spleens, and was undetectable in two cell lines used as a negative control and in one case of Hodgkin's disease without eosinophilia. Pretreatment of the cytopreparations with the RNase inhibitor diethylpyrocarbonate greatly increased the hybridization signal. Based on this controlled study, we conclude that mRNA coding for IL-5 is expressed in Reed-Sternberg cells and variants. This observation may explain the eosinophilia associated with Hodgkin's disease and provide insight into the origin of the Reed-Sternberg cell.

Eosinophilia↗

PubMed1989

Prospective analysis of eosinophilia in spontaneously diabetic BB rats: correlation with islet inflammation but not with diabetes development.

A prospective analysis of eosinophil counts in diabetes prone BB rats showed that eosinophilia (greater than 5%) occurred between 70-100 days of age. The presence of eosinophilia did not predict diabetes onset because persistently normoglycaemic animals developed eosinophilia as well. Nevertheless a correlation with the disease process in BB rats was found. Eosinophilia decreases a few weeks after diabetes onset but persists in non diabetic rats. Histological analyzes showed that eosinophilia correlates with eosinophil infiltration of islets (p less than 0.005) and the latter correlates with severe insulitis (p less than 0.005). These findings indicate that eosinophilia is associated with a late stage of islet inflammation in diabetes prone BB rats independent of whether the animals develop diabetes or not.

Animals↗

PubMed1987

Eosinophilia in children. Cytochemical and immunological analysis of increased eosinophils.

Cytochemical and immunological studies of increased eosinophils were performed in three children with marked eosinophilia. These children were diagnosed as having non-Hodgkin's lymphoma, transient eosinophilia, and hyper-eosinophilic syndrome. All showed marked eosinophilia, with eosinophil counts of more than 5,000/mm3 in the peripheral blood and with eosinophils in all maturational stages in the bone marrow. In contrast to normal eosinophils, the increased eosinophils in three patients on cytochemical analysis showed moderately to strongly positive reactions for staining with alpha-naphthyl-butyrate esterase. Also, the mature eosinophils in the patient with lymphoma showed a strongly positive reaction for periodic acid-Schiff staining. The positive reaction for alpha-naphthyl-butyrate esterase and periodic acid-Schiff stain indicates the presence of eosinophilic proliferative disorders in these cases. Surface marker analysis of peripheral eosinophils demonstrated that an increased proportion of eosinophils expressed My7, a marker of granulocytes, in two patients with transient eosinophilia or hyper-eosinophilic syndrome, but not in a patient with lymphoma. In addition, 30-40% of eosinophils expressed Ia antigen, a differentiation marker of eosinophils, in two patients with lymphoma or hypereosinophilic syndrome. Thus, eosinophils in transient eosinophilia showed mature features, and those in hypereosinophilic syndrome showed immature features immunologically. Whereas, eosinophils in lymphoma may have a dysmaturity on the expression of Ia and My7. Cytochemical and immunological analyses of increased eosinophils may play an important role in clarifying the etiology of eosinophilia, especially its association with malignancy or other proliferative disorders.

Antigens, Surface↗

PubMed1986

Eosinophilia in murine trichinellosis.

In both primary and secondary infections using 3 different strains of mice (DBA/1, B10 X D2, and C3H/HeJ), 2 peaks of peripheral blood eosinophilia were noted. Depending upon the strain, the first of the biphasic peaks in primary infections occurred between days 5 and 9, and the second peak occurred between days 16 and 22. The relative heights of the peak varied with the strain. In secondary infections, the initial peak was lower and the larger second peak occurred earlier. Methyridine treatment to eliminate adults prior to release of newborn larvae altered neither the course of eosinophilia in primary infection nor the biphasic distribution of eosinophilia. These studies demonstrate that the adult worm is responsible for inducing eosinophilia in murine infections, that 2 peaks of eosinophilia exist in primary and secondary infections, and that eosinophilia in secondary infections is an anamnestic response.

Animals↗

PubMed1983

Eosinophilia and myocardial ischemia secondary to polyarteritis. A discussion of pathogenesis on the basis of a case history.

The importance of eosinophilia in patients with severe polyarteritis causing myocardial ischaemia is discussed in connection with a case history. A 20 year old man complaining of recurrent episodes of dyspnoea was found to have a very high eosinophil count, and no allergy as assessed by prick test, RAST and histamine liberation test. The eosinophilia responded to steroid treatment. The patient died 2 years later, at which time his eosinophilia had recurred, of heart failure, with pericardial and pleural effusions and a congested liver. Post-mortem examination showed severe ischaemic changes in the myocardium and chronic inflammatory changes in the small branches of the coronary arteries. The pathologic diagnosis was polyarteritis (in some degree of remission) confined to the heart. Since the clinical and electrocardiographic diagnosis of myocardial ischaemia and cardiomyopathy in patients with polyarteritis and/or eosinophilia can be difficult, other non-invasive investigations are indicated when there is a suspicion that the heart may be affected. Echocardiography, and possibly endomyocardial biopsy may be used at an early stage to assess the response to immunosuppressive treatment. Prophylactic treatment of any associated clotting disorder should be considered. The aetiology and pathogenesis of polyarteritis is unknown, but endothelial damage caused by eosinophilia early in the disease process may be important. Adequate treatment should therefore be given in order to reduce the eosinophil count and a close follow-up is essential in order to diagnose a relapse of the eosinophilia early and thereby possibly prevent fatal cardiac complications.

Adult↗

PubMed1995

[A case of tropical eosinophilia associated with pleural effusion].

A 52-year-old man was admitted to Keio University Hospital for determination of the etiology of a bilateral pleural effusion associated with marked eosinophilia (10200 cells/mm3). He had been in Vietnam for three years and had returned to Japan in May 1993. He was suffering from tropical eosinophilia, as clearly indicated by eosinophilia, elevation of serum IgE level (708 IU/ml), the presence of anti-dirofilarial antibodies, and the absence of microfilaria in the blood. The pleural effusion was an exudate and 51% of the cells in the effusion were eosinophils. In the effusion, no parasites were detected but anti-dirofilarial antibodies were found (the titer was as high as that in the serum). Diethylcarbamazine was given, and a steroid had to be superimposed because of wheezing. These treatments successfully reduced the bronchoconstriction, eosinophilia and accumulation of pleural effusion. Tropical eosinophilia has generally been thought not to be associated with pleural effusion. This is only the third case report of tropical eosinophilia with authentic pleural effusion.

Administration, Oral↗

PubMed1993

High risk of eosinophilia in women treated with clozapine.

BACKGROUND: Eosinophilia associated with clozapine treatment has been reported in some studies and limited case reports. Because little is known regarding incidence, course, and relevance of this finding, clozapine therapy has been terminated prematurely in some patients with elevated eosinophil counts. METHOD: Records were reviewed on 118 consecutively hospitalized, acutely psychotic patients treated over a 1-year period with clozapine for at least 3 weeks. Demographic data were obtained on those patients, and white blood cell counts were analyzed. We reviewed the data for predisposing factors, associated medical findings, or clinical sequelae, and performed a two-sided Fisher's exact test to determine if sex or diagnosis was associated with a higher risk of developing eosinophilia. The literature pertaining to this blood dyscrasia and its relationship to clozapine was reviewed. RESULTS: In our population, the cumulative incidence of eosinophilia among women was 23% (13/57), a statistically significant higher risk (p < .01) than that in men (7% [4/61]). In all cases, the eosinophilia was noted between Weeks 3 and 5 of treatment and resolved without medical or psychiatric complications. CONCLUSION: Eosinophilia should be added to the list of commonly observed side effects of clozapine treatment. Women appear to be at significant risk. Eosinophilia usually occurs early in therapy, spontaneously resolves, and is not associated with any known complications. An otherwise healthy person with this blood dyscrasia may continue with treatment but should be monitored closely. Further investigation into this finding may provide insight into the mechanism of neutropenia and other adverse reactions to clozapine.

Acute Disease↗

PubMed1996

Eosinophilia in primary biliary cirrhosis.

OBJECTIVES: Recent studies have shown the occurrence of eosinophilia in patients with primary biliary cirrhosis (PBC). To examine whether eosinophilia is indeed a distinctive feature of PBC, we performed extensive leukocyte differential analysis using a highly sophisticated hematology instrument. We also investigated the relationship between eosinophil dynamics and clinical features of PBC including the effects of ursodeoxycholic acid (UDCA) treatment. METHODS: A flow cytometry-based blood cell analyzer (Technicon H6000) was used to examine peripheral blood eosinophil counts in 38 patients with PBC and 131 patients with various liver deseases. We also performed eosinophil quantitation in 19 PBC patients before and after administration of UDCA for 4 wk. RESULTS: Patients with PBC had significantly higher relative and absolute eosinophil counts when compared with other liver diseases (5.7 +/- 0.5% [p < 0.0001, mean +/- SEM] and 312 +/- 26 cells/microliter [p < 0.01], respectively). Twenty-one of 38 PBC patients (55%) exhibited relative eosinophilia. In patients with PBC, the eosinophil count was: 1) significantly higher in those with early histological stages (stage I-II, 6.5 +/- 0.5% vs stage III-IV, 4.4 +/- 0.7%,p < 0.05), 2) positively correlated with basophil count (p < 0.01), serum IgA levels (p < 0.05), and the degree of eosinophil infiltration in the portal tract (p < 0.01), and 3) markedly reduced by UDCA treatment (before: 5.9 +/- 0.7%, 307 +/- 37 cells/microliter; after: 2.8 +/- 0.03% [p < 0.001], 162 +/- 26 cells/microliter ¿p < 0.001]). CONCLUSIONS: Eosinophilia is a common and distinctive feature of patients with PBC. UDCA ameliorates eosinophilia as well as liver function tests in PBC patients. Eosinophilia may be useful as one of the initial clues in the diagnosis of PBC, especially in its early stage.

Aged↗

PubMed1978

Sputum eosinophilia in chronic bronchitis and asthma.

The occurrence of sputum eosinophilia was investigated in 115 patients with chronic bronchitis and asthma. They were clinically divided into four groups; those with asthma only, those with asthma of equal or greater duration than chronic bronchitis, those with chronic bronchitis recently complicated by asthma and those with chronic bronchitis only. Although sputum eosinophilia was more common in the asthmatic groups there was no significant difference between the groups in the degree of sputum eosinophilia. When the groups were subdivided on the basis of methacholine and isoprenaline response (asthma subgroup, greater than or equal to 20% response to isoprenaline or greater than or equal to 40% response to methacholine; chronic-bronchitis subgroup, less than 10% response to isoprenaline plus less than 20% response to methacholine), there was a significant difference between the groups in the degree of sputum eosinophilia. However, sputum eosinophilia still occurred in the chronic bronchitics. In the asthmatic patients, there appeared to be no difference in the degree of sputum eosinophilia in those with positive skin tests, or on steroid medication, compared with those with negative skin tests or not on steroids.¿

Asthma↗

PubMed2005

[Seropositivity of hydatidosis in cattle with eosinophilia.].

The aim of this study was to investigate the seropositivity of hydatidosis in a group of cattle with and without eosinophilia. Of the 597 cattle, 79 (13.2%) were found to have eosinophilia with absolute eosinophilic counts. Out of 79 cattle, 62 (78.4%) and 48 (60.7%) were found to be positive for hydatidosis by ELISA and IFAT, respectively. Out of 79 cattle without eosinophilia, 38 (48.1%) were found to be seropositive by ELISA and 34 (43.1%) by IFAT. Our data indicated that seropositivity of hydatidosis in cattle with eosinophilia was higher than the group without eosinophilia and it will be useful to investigate livestock with eosinophilia for hydatidosis.

English Abstract↗

PubMed2002

Cysteinyl leukotriene-dependent interleukin-5 production leading to eosinophilia during late asthmatic response in guinea-pigs.

BACKGROUND: Allergic airway eosinophilia is suppressed by cysteinyl leukotriene (CysLT) receptor (CysLT1 receptor) antagonists in several species including humans and guinea-pigs, suggesting that CysLTs are directly or indirectly involved in induction of the response. OBJECTIVE: We examined the effect of CysLT antagonists (pranlukast and MCI-826) on antigen inhalation-induced eosinophilia in peripheral blood and lung, and on IL-5 activity in serum during late increase of airway resistance (late asthmatic response, LAR) in sensitized guinea-pigs. METHODS: Guinea-pigs inhaled ovalbumin (OVA) + Al(OH)3 and OVA mists alternately for sensitization and challenge, respectively, once every 2 weeks. At the fifth challenge, the effects of CysLT antagonists and an anti-IL-5 antibody (TRFK-5) on the occurrence of LAR, and blood and lung eosinophilia, which appeared at 5 h after challenge, were examined. The time-course of IL-5 activity in the serum after the challenge was evaluated by measuring in vitro 'eosinophil survival prolongation activity'. The influence of CysLT antagonists on IL-5 activity was assessed. RESULTS: CysLT antagonists and TRFK-5 completely abolished blood and lung eosinophilia. LAR was suppressed by both MCI-826 and TRFK-5 by 40-50%. Sera obtained from sensitized, challenged animals 3 h and 4 h after challenge induced an obvious prolongation of eosinophil survival. The activity of the sera was completely neutralized by prior exposure to TRFK-5, suggesting that it reflected IL-5 activity. Increased IL-5 activity in the serum was inhibited by both pranlukast and MCI-826 by over 90%. CONCLUSIONS: CysLTs produced after antigen provocation sequentially induced IL-5 production from some immune component cells via CysLT1 receptor activation. Thus, it is likely that CysLTs indirectly cause antigen-induced eosinophilia through IL-5 production.

Animals↗

PubMed1994

Pulmonary eosinophilia in children: report of a school survey in rural Tamil Nadu in India.

During the period of 1981-82 in a survey of 21 schools in four villages of North Arcot Ambedkar District of Tamil Nadu, amongst a population of 4282 children we detected 92 with respiratory symptoms and blood eosinophilia greater than 1000 per cumm. Sixty-eight students had associated worn infestation, majority with hookworm followed by giardia. Altogether 37 children had blood eosinophilia above 2000 per cumm and had symptoms of cough, dyspnoea, and wheeze consistent with pulmonary eosinophilia. Fourteen of the children with pulmonary eosinophilia had eosinopenic remission with deworming alone. Six of them, on the other hand, responded to diethyl carbamazine (DEC) alone and 17 others, following deworming, required further DEC therapy for successful eosinopenic remission, thus warranting a diagnosis of Tropical Pulmonary Eosinophilia (TPE).

Adolescent↗