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PubMedDate not supplied

Eosinophilic explant carditis with eosinophilia: ?Hypersensitivity to dobutamine infusion.

BACKGROUND: Eosinophilic carditis with peripheral eosinophilia has been observed in a number of clinical situations. This report describes this association in patients undergoing heart transplantation and offers a possible explanation. METHODS: The clinical records and explanted hearts of 31 consecutive patients who received primary orthotopic heart transplants were reviewed. Clinical features particularly analyzed included the following: age, cardiac status and assistance devices, catheterizations, medical or surgical disorders including parasites, tryptophane exposure, medications, and peripheral blood counts. Pathologic features particularly studied included the following: dilatation and hypertrophy, fibrosis, mural thrombi, carditis, eosinophils, myocardial necrosis, vasculitis, valvular disease, and coronary artery disease. Prior endomyocardial biopsy specimens were also reviewed. RESULTS: Seven patients had eosinophilic carditis compatible with hypersensitivity carditis. Eight had eosinophilia. All patients with carditis received intravenous dobutamine (Dobutrex solution) continuously for more than 1 month immediately preceding transplantation. All patients with eosinophilia received intravenous dobutamine continuously for 15 days or longer and exhibited eosinophilia only during dobutamine therapy with the exception of one patient in whom eosinophilia was observed 8 days after cessation of 8 days of therapy. Among 13 patients who received dobutamine for more than a month immediately before transplantation, nine had eosinophilic carditis, peripheral eosinophilia, or both. CONCLUSIONS: Prolonged continuous intravenous administration of dobutamine was associated with eosinophilic carditis and eosinophilia. No other clinical factor with a relationship to either eosinophilia or carditis was identified. The responsible agent may have been a preservative in the dobutamine solution, sodium bisulfite.

Adult↗

PubMed1995

Extraordinarily high eosinophilia and elevated serum interleukin-5 level observed in a patient infected with Paragonimus westermani.

OBJECTIVE: Although eosinophilia is one of the typical clinical features of some helminth infections, the degree of eosinophilia in helminthiasis is usually 10% to 30% with a total white blood cell count of 10,000 to 20,000/mm3. Here we report a case of extraordinarily high eosinophilia (91%; absolute eosinophil count, 84,000/mm3) caused by Paragonimus westermani infection. To determine the mechanisms of eosinophilia, the levels of several eosinophilopoietic cytokines in the patient's sera were measured during the course of treatment. METHODS: Serum levels of three cytokines, granulocyte-macrophage colony-stimulating factor, interleukin-3 (IL-3), and IL-5 were measured by enzyme-linked immunosorbent assay using commercial kits or our own assay system for IL-5. RESULTS: Although the kinetic changes of IL-5 correlated well with eosinophilia, the serum IL-3 level remained below the detection level throughout the period examined. Although the granulocyte-macrophage colony-stimulating factor level was twofold to threefold higher than the normal level, its kinetics did not parallel the degree of eosinophilia. CONCLUSIONS: These results show that Paragonimus westermani infection can induce an extraordinarily high level of eosinophilia with an associated increase in IL-5 production. Immunoserologic diagnosis for parasitic diseases should be included in the differential diagnosis of eosinophilia.

Animals↗

PubMed1995

Eosinophilia in chronic childhood sinusitis.

OBJECTIVES: To quantify eosinophilia in sinus tissues obtained from children with chronic sinusitis and to correlate the degree of eosinophilia with history of asthma, allergy, cystic fibrosis, and preoperative computed tomographic (CT) scans. DESIGN: Examination of surgical specimens from children who underwent functional endoscopic sinus surgery and controls. SETTING: Tertiary care medical center. PATIENTS: Thirty-four children who underwent functional endoscopic sinus surgery for chronic sinusitis refractory to medical treatment were divided into three groups: 13 with asthma, 11 without asthma, and 10 with cystic fibrosis. Normal sphenoid sinus mucosa was also obtained from six adults undergoing transsphenoidal hypophysectomies. MAIN OUTCOME MEASURES: Number of lamina propria and intraepithelial eosinophils in surgical specimens, allergic status, presence or absence of asthma, and CT scans obtained preoperatively. RESULTS: There were significantly more lamina propria and intraepithelial eosinophils in the tissue of children with chronic sinusitis compared with normal sphenoid sinus mucosa. More eosinophils were counted in the tissues of patients with asthma and cystic fibrosis compared with patients without concomitant disease, but this did not reach statistical significance. Allergy status did not affect the degree of tissue eosinophilia. Eosinophilia did not correlate with severity of mucosal disease as assessed by CT scans. CONCLUSIONS: Tissue eosinophilia is a characteristic histologic feature of chronic sinusitis in children, especially those with asthma. The presence of allergy does not predict tissue eosinophilia. Furthermore, the degree of tissue eosinophilia does not correlate with the severity of mucosal thickening seen on CT scans.

Adolescent↗

PubMed2000

Eosinophilia of dystrophin-deficient muscle is promoted by perforin-mediated cytotoxicity by T cell effectors.

Previous investigations have shown that cytotoxic T lymphocytes (CTLs) contribute to muscle pathology in the dystrophin-null mutant mouse (mdx) model of Duchenne muscular dystrophy through perforin-dependent and perforin-independent mechanisms. We have assessed whether the CTL-mediated pathology includes the promotion of eosinophilia in dystrophic muscle, and thereby provides a secondary mechanism through which CTLs contribute to muscular dystrophy. Quantitative immunohistochemistry confirmed that eosinophilia is a component of the mdx dystrophy. In addition, electron microscopic observations show that eosinophils traverse the basement membrane of mdx muscle fibers and display sites of close apposition of eosinophil and muscle membranes. The close membrane apposition is characterized by impingement of eosinophilic rods of major basic protein into the muscle cell membrane. Transfer of mdx splenocytes and mdx muscle extracts to irradiated C57 mice by intraperitoneal injection resulted in muscle eosinophilia in the recipient mice. Double-mutant mice lacking dystrophin and perforin showed less eosinophilia than was displayed by mdx mice that expressed perforin. Finally, administration of prednisolone, which has been shown previously to reduce the concentration of CTLs in dystrophic muscle, produced a significant reduction in eosinophilia. These findings indicate that eosinophilia is a component of the mdx pathology that is promoted by perforin-dependent cytotoxicity of effector T cells. However, some eosinophilia of mdx muscle is independent of perforin-mediated processes.

Adoptive Transfer↗

PubMed1983

Eosinophilia caused by iodinated radiographic contrast media.

Statistically significant eosinophilia was noted in the peripheral blood of a group of 108 patients 48 h after the administration of iodinated radiographic contrast medium (RCM). The duration of eosinophilia was approximately 6 days. Eosinophilia had no accompanying clinical symptoms except for two cases where urticaria appeared. The incidence of eosinophilia was irrespective of dosage or type of RCM. Possible mechanisms responsible for eosinophilia have been considered. Since eosinophilias of other aetiologies are common, it is of practical importance to distinguish these from RCM-induced eosinophilias.

Contrast Media↗

PubMed1997

Eosinophilia in nude rats and nude mice after infection with Fasciola hepatica or injection with its E/S antigens.

Peripheral blood and bone marrow eosinophilia occurred in nude rats and nude mice following F. hepatica infection, with the magnitude of the response in nude rats greater than that in nude mice. Injection of E/S antigens induced eosinophilia in nude rats and a limited eosinophilia in nude mice. Bone marrow eosinophilia was greatly enhanced in Fasciola-infected nude rats, particularly 14 days after infection and later. In nude mice, bone marrow eosinophilia developed soon after infection and persisted for the duration of the experiment, but was not as marked as in nude rats. Bone marrow eosinophils in antigen-injected animals were also elevated, and again this was more marked in nude rats. The number of colonies formed in agar culture from bone marrow cells of both nude rats and nude mice also increased following infection and remained significantly elevated throughout the experiment. Bone marrow colonies in antigen-injected nude rats increased on day 8, while in injected nude mice, the number of colonies rose rapidly following injection with antigens. Thus, nude rats and nude mice develop T-cell-independent eosinophilia, which appears to originate in the bone marrow. The magnitude of eosinophilia is greater in nude rats and it has yet to be determined whether these effects have any relevance to the ability of rats, but not mice, to develop resistance to reinfection with F. hepatica.

Animals↗

PubMed1992

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.

Adult↗

PubMed1998

Eosinophilia and gastrointestinal symptoms after ingestion of shiitake mushrooms.

BACKGROUND: Shiitake mushrooms are a dietary staple in Asia and are increasingly popular worldwide. A cholesterol-lowering study with shiitake showed that 17 of 49 participants withdrew because of rash or abdominal discomfort, and two had marked eosinophilia. One of these latter participants was subsequently challenged for 14 days with shiitake powder and again had eosinophilia. OBJECTIVE: We investigated whether ingestion of shiitake mushroom powder induces eosinophilia or symptoms. METHODS: We studied 10 normal persons. Each participant ingested 4 gm shiitake powder (open label) daily for 10 weeks (trial 1), and the protocol was repeated in these same subjects after 3 to 6 months (trial 2). Blood counts and serum samples were obtained biweekly (trial 1) or weekly along with stool specimens (trial 2). Eosinophil major basic protein and IL-5, IgE, and IgG antishiitake antibodies were measured in sera. Eosinophil-derived neurotoxin was measured in stool extracts. We defined responders as subjects having peak eosinophil counts four or more times their average baseline counts. RESULTS: Each trial had four responders, and trial 2 had one new and three repeat responders. Eosinophilia ranged from 400 to 3900/mm3. Responders had increased blood eosinophils, serum major basic protein, stool eosinophil-derived neurotoxin, and factors that enhanced eosinophil viability. Antishiitake IgE was not detected, and antishiitake IgG increased in two responders. Gastrointestinal symptoms coincided with eosinophilia in two subjects. Symptoms and eosinophilia resolved after discontinuing shiitake ingestion. CONCLUSIONS: Daily ingestion of shiitake mushroom powder in five of 10 healthy persons provoked blood eosinophilia, increased eosinophil granule proteins in serum and stool, and increased gastrointestinal symptoms. Shiitake ingestion suggests a model to study the eosinophil's role in the blood and gastrointestinal tract. Finally, our report raises concerns of possible adverse systemic reactions to this increasingly popular food.

Adult↗

PubMed1988

Peritoneal eosinophilia in patients on continuous ambulatory peritoneal dialysis: a prospective study.

A prospective study on peritoneal eosinophilia was conducted in 23 continuous ambulatory peritoneal dialysis (CAPD) patients for a mean period of 7.9 months. Peritoneal eosinophilia as defined by peritoneal eosinophil count exceeding 100/mm3 was found in 60.8% of patients. Most developed peritoneal eosinophilia within 3 months of the initiation of dialysis, although the phenomenon could occur as early as one day or as late as 6 months after dialysis. Fifty-seven percent of those with peritoneal eosinophilia also had peripheral blood eosinophilia. Although most peritoneal eosinophilic episodes subsided in a month, in one patient the process grumbled on for 150 days. The number of peritonitis episodes was not significantly different between patients with peritoneal eosinophilia and those without. The only distinction between the two groups of patients was that those who developed peritoneal eosinophilia had a significantly (P = .002) higher serum IgE concentration initially as well as throughout the period of observation.

Adolescent↗

PubMed2006

Parasitic pulmonary eosinophilia.

Parasitic infections, although common in tropical and subtropical regions, are prevalent worldwide because of changing immigration patterns and in international travel. The burden of worm infection is enormous and the intensity of infection is usually high among the poor and in immunocompromised individuals. Pulmonary eosinophilia occurs in almost all metazoan infections. In the Western world, the most common infections are caused by Strongyloides, Ascaris, Toxocara, and Ancylostoma species. Most of the nematodes multiply within the human host and cause pulmonary eosinophilia during larval migration through the lungs. Despite larval migration through the lungs, there is usually no permanent lung damage. The result is an increased number of eosinophils in the airways or lung parenchyma with or without peripheral eosinophilia. Löffler's syndrome, visceral larva migrans, and tropical pulmonary eosinophilia are the most common infections that cause pulmonary eosinophilia. The most serious parasitic eosinophilic lung disease is tropical pulmonary eosinophilia, a disorder caused by the filarial worms Wuchereria bancrofti and Brugia malayi, in which cases have typically been reported to masquerade acute or refractory bronchial asthma. Increasing awareness, newer diagnostic techniques, preventative measures, and antiparasitic drugs are important in reducing the worldwide morbidity and mortality from parasitic helminths and protozoa. This review focuses on common and some uncommon causes of pulmonary parasitic eosinophilia and their manifestations, diagnosis, and management.

Anthelmintics↗

PubMedDate not supplied

[Prognostic significance of eosinophilia in children with acute myeloid leukemia in the studies AML-BFM-78 and -83].

Initial eosinophilia (greater than or equal to 3%) in the bone marrow was found in 73 out of 269 (27%) patients studied in AML studies BFM-78 and -83. It was predominantly seen in children with FAB types M2 (44%) and M4 (41%). Atypical eosinophils were mostly found in FAB type M4 (20/28 = 71%). Cytogenetic studies in eight children with FAB M4 and eosinophilia showed normal karyotypes in four patients, inversion 16 in one and other aberrations in three children. Study AML-BFM-78 did not demonstrate any differences in prognosis between patients with and without eosinophilia (event-free survival = EFS after 5 years 37%, SD 8%, vs. 38%, SD 6%). In study AML-BFM-83, however, a clear increase in EFS was seen in children with eosinophilia (EFS 72%, SD 8%, vs. 43%, SD 5%, p = 0.001). This improvement of prognosis mainly concerns patients with FAB M4 and eosinophilia (EFS 81%, SD 10%, vs. 23%, SD 11%, p = 0.006). None of the 12 children in study AML-BFM-83 with FAB M4 and atypical eosinophils has suffered a relapse, two patients belong to the early death group. Multivariate analysis shows only eosinophilia as a favorable prognostic factor in FAB type M4. According to these results FAB type M 4 with eosinophilia is a favorable prognostic parameter in children treated according to the therapy protocol of study AML-BFM-83.

Adolescent↗

PubMed2005

Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia.

BACKGROUND: Refugees may arrive for resettlement with asymptomatic parasitic infections, and eosinophilia may be the only clue to the presence of infection. Our aim was to determine the prevalence of eosinophilia and develop a standardized approach to the evaluation of asymptomatic refugees with eosinophilia. METHODS: We reviewed the medical records of refugees seen from October 1998 through May 2002 at Boston Medical Center. Data examined included age, country of origin, absolute eosinophil count, results of stool ova and parasite testing, and results of serological testing for Strongyloides stercoralis, Schistosoma species, and filaria. RESULTS: Eosinophilia--defined as an absolute eosinophil count of >or=450 cells/microL--was present in 266 (12%) of 2224 refugees. Patients with eosinophilia ranged in age from 2 months to 81 years and had arrived from Africa, Eastern Europe, Southeast Asia, South America, the Caribbean, and the Middle East. Absolute eosinophil counts ranged from 450 to 3224 cells/microL. Pathogens were identified in stool samples of 76 (29%) of 265 patients. Serological testing for S. stercoralis, Schistosoma species, and/or filaria was done for 120 (45%) of 266 patients. Results of serological testing were positive for S. stercoralis in 45 (39%) of 115 patients, for Schistosoma species in 15 (22%) of 67 patients, and for filaria in 18 (51%) of 35 patients. Serological evidence of parasitic infection was seen at all levels of eosinophilia and in patients with and without pathogens identified in their stool samples. CONCLUSIONS: Systematic evaluation for parasites in asymptomatic, newly arrived refugees with eosinophilia should include stool ova and parasite examination, serological examination for S. stercoralis for all patients, and serological examination for Schistosoma species and filaria in patients from regions where these organisms are endemic.

Adolescent↗

PubMed1995

Plasma cell myeloma associated with eosinophilia.

The association of plasma cell myeloma and eosinophilia is rare. The authors describe a 49-year-old man with plasma cell myeloma and marked absolute peripheral blood eosinophilia, 109.7 x 10(9)/L. Analysis of his bone marrow revealed cytologically atypical plasma cells that expressed monotypic IgG lambda and marked eosinophilia with normal maturation. A combination of steroids and chemotherapy resulted in a significant and sustained decrease in his absolute eosinophil count and bone marrow plasma cells. Analysis of the patient's pre-therapy serum revealed immunoreactive interleukin-3 (IL-3), but not IL-5 or granulocyte/macrophage colony stimulating factor (GM-CSF). The post-therapy serum sample was negative. Immunohistochemical analysis of the plasma cells for IL-3 and IL-5 was negative. This review of the literature has revealed five cases of plasma cell myeloma associated with eosinophilia described previously. In two patients, the eosinophilia was attributed to drug therapy. In the remaining cases, the pathogenesis of the eosinophilia was unexplained. In this case, IL-3 secreted either by the neoplastic cells at a level below detection by immunohistochemistry or by other cells in response to the presence of plasma cell myeloma may have played a role in causing the eosinophilia.

Bone Marrow↗

PubMed1984

Interrelationship of eosinophilia and IgE antibody production to larval ES antigen in Toxocara canis infected mice.

In order to elucidate the relationship between eosinophilia and IgE antibody production in parasitic infection, the degree of eosinophilia and IgE antibody levels to larval ES antigen of Toxocara canis were investigated in eight inbred strains of mice after infection with T. canis. Eosinophilia was far higher in degree in SJL mice than in the other inbred strains. However, IgE antibody levels to larval ES antigen in SJL mice were the lowest among those inbred strains. Similarly, the degree of eosinophilia in AKR mice was slightly higher than those in the other strains except SJL mice, but IgE antibody levels to larval ES antigen in AKR mice was as low as that in SJL mice. Consequently, high responders for eosinophilia were not always high responders for IgE antibody production to larval ES antigen. Inheritance of the two traits, marked eosinophilia and poor IgE antibody production to larval ES antigen in T. canis infected SJL mice, were investigated using F1 hybrid and back-cross mice. The former was regulated by more than one gene, while the latter was a recessive trait. The degree of eosinophilia after infection showed no relationship with the total numbers of larvae recovered from T. canis infected inbred mice.

Animals↗

PubMed2004

Mohs micrographic surgery for angiolymphoid hyperplasia with eosinophilia.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia is a benign vascular proliferation that typically presents on the head and neck. Multiple treatment modalities have been proposed for angiolymphoid hyperplasia with eosinophilia, each with limited success or undesirable side effects. At this time, standard surgical excision is considered the treatment of choice but carries recurrence rates of 33% to 50%. OBJECTIVE: The objective was to present a case of angiolymphoid hyperplasia with eosinophilia successfully extirpated using Mohs micrographic surgery. METHODS: A 52-year-old woman presented with an ill-defined solitary plaque of angiolymphoid hyperplasia with eosinophilia within her left conchal bowl that enlarged despite conservative therapy with intralesional and topical corticosteroids. Mohs micrographic surgery using the fresh tissue technique and standard hematoxylin and eosin staining was performed. The characteristic histologic features of angiolymphoid hyperplasia with eosinophilia were readily identifiable on frozen sections and complete extirpation required two stages of micrographically controlled resection. RESULTS: Resection of angiolymphoid hyperplasia with eosinophilia of the conchal bowl with complete resolution of symptoms and no evidence of clinical recurrence 8 months after surgery. CONCLUSION: Given the high recurrence rates reported for standard excision, Mohs micrographic surgery with complete margin examination should be considered as a treatment option for angiolymphoid hyperplasia with eosinophilia, particularly for lesions with ill-defined margins or in locations where tissue sparing is desirable.

Angiolymphoid Hyperplasia with Eosinophilia↗

PubMed1986

Blood eosinophilia and ulcerative colitis--influence of ethnic origin.

Blood eosinophilia is an alleged manifestation of ulcerative colitis. To investigate this association and to determine the effect of race, the occurrence of eosinophilia in all 44 Asians presenting between 1968-84 was compared to that in an age- and sex-matched group of indigenous white Caucasian patients presenting over the same period. Nineteen (43%) of the Asians presented with an eosinophilia compared to only 3 Caucasians (P less than 0.0001); similar numbers (14 and 13) in both groups demonstrating transient eosinophilia on occasions during maintenance treatment although not related to clinical relapse. A control group of Asians with other disorders not known to be associated with eosinophilia did not manifest this abnormality on presentation although 3 patients did so transiently during out-patient observation. Eosinophilia is a feature of ulcerative colitis in many Asians possibly due either to an unusual racial response to ulcerative colitis or as a reflection of the underlying pathogenesis of their disease. We have not confirmed earlier suggestions of such a feature in white Caucasians. Eosinophilia occurring during maintenance treatment in both groups may be drug-related.

Adult↗

PubMed2002

Eosinophilia in sick neonates.

Eosinophilia is common in the neonatal period. However, its causes, pathomechanism and clinical significance are still unknown. Previous reports have described that eosinophilia may be associated with numerous conditions (establishment of an anabolic state, drug reactions, response to foreign antigens, chronic lung disease, erythropoietin treatment and infections). The aim of this study was to evaluate the possible association of various conditions, especially infection, with eosinophilia and to clarify whether recognition of increase in eosinophil count is of any clinical significance in the management of a sick neonate. Fifty-six neonates with eosinophilia (absolute eosinophil count > 700/mm3) and 55 control neonates matched for gestational age, birth weight and hospitalization days were included in the study. A significant difference between the two groups was found only in blood transfusions, immuno-globulin treatment, specific antibiotic treatment and infectious disease. However, neonates who develop sepsis and are treated with antibiotics and immuno-globulin are more often transfused. It can thus be concluded that the main relationship observed is between eosinophilia and infection whereas the other associations are secondary. The relative risk factor for infection when the absolute eosinophil count is > 700/mm3, is 1.58, with a confidence interval 1.30-1.91. Eosinophilia seems to be a reliable indicator of sepsis while normal absolute eosinophil count does not exclude infection. Infection should be strongly considered in the evaluation of a sick neonate with eosinophilia.

Case-Control Studies↗

PubMed1999

Dissociation of airway hyperresponsiveness from immunoglobulin E and airway eosinophilia in a murine model of allergic asthma.

Nonspecific airway hyperresponsiveness (AHR) is a hallmark of human asthma. Both airway eosinophilia and high serum levels of total and antigen-specific immunoglobulin E (IgE) are associated with AHR. It is unclear, however, whether either eosinophilia or increased IgE levels contribute directly to, or predict, the development of AHR. Investigations conducted with various murine models of asthma and different mouse strains have resulted in conflicting evidence about the roles that IgE and airway eosinophilia play in the manifestation of AHR. We show that systemic priming with ovalbumin (OVA) in alum, followed by a single day of OVA aerosol challenge, is sufficient to induce AHR, as measured by increased pulmonary resistance in response to intravenously delivered methacholine in BALB/c, but not C57BL/6 or B6D2F1, mice. This was observed despite the fact that OVA-challenged BALB/c mice had less airway eosinophilia and smaller increases in total IgE than either C57BL/6 or B6D2F1 mice, and had less pulmonary inflammation and OVA-specific IgE than B6D2F1 mice. We conclude that airway eosinophilia, pulmonary inflammation, and high serum levels of total or OVA-specific IgE are all insufficient to induce AHR in C57BL/6 and B6D2F1 mice, whereas BALB/c mice demonstrate AHR in the absence of airway eosinophilia. These data confirm that the development of AHR is genetically determined, not only in naive mice, but also in actively immunized ones, and cannot be predicted by levels of airway eosinophilia, pulmonary inflammation, total IgE, or antigen-specific IgE.

Animals↗