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Studies in experimental eosinophilia. XI. Dependence of eosinophilia, apparently induced by histamine, on acidity.

A solution of histamine in saline elicited eosinophil response in both lymph nodes and the blood stream. The lymph node response was not inhibited by the antihistamine, mepyramine maleate, but was inhibited by puromycin. Both the lymph node and the systemic response were essentially abolished when the pH of the solution (5.0 and 4.7, respectively) was brought to neutrality by phosphate buffer. Serum could bring the pH of histamine to neutrality or higher, but the histamine-serum mixture retained in vivo activity, unless the histamine was buffered before addition to the serum. When normal guinea pig gamma-globulin was incubated with histamine, a nondialyzable factor was generated which had the same activity as histamine. Thirteen different amino acids induced lymph node eosinophilia and each was acid in saline solution; when one of them, trytophane, was brought to neutral pH, its activity was considerably reduced. During the period when the circulating level of eosinophils was rising, there was no detectable fall in the bone marrow stores of mature of immature eosinophils. Thus, the activity of histamine, vis-a-vis eosinophils, is nonspecific and is attributable to its acidity. The data suggest that histamine, in the acidic state, generates autoantigens, which, in turn, lead to antibody-mediated eosinophilia in lymph nodes.

Amino Acids

Eosinophilia in premature infants: relationship to weight gain.

Serial eosinophil counts were determined in 38 hospitalized, appropriately grown premature infants whose gestational ages ranged from 27 to 35 weeks. Absolute eosinophilia (greater than 700/mm3) was documented in 76% (29/38). Eosinophilia was mild (700 to 999/mm3) in 9, moderate (1,000 to 2,999/mm3) in 17, and marked (greater than or equal to 3,000/mm3) in 3 patients. The average time of onset was day 19. Peak eosinophilia was usually seen within one week of onset and lasted an average of 16 days. A consistent relationship (r = 0.86) was found between the day of peak eosinophilia (mean = day 27) and the day on which birthweight was regained (mean = day 22). No association was apparent between the occurrence or degree of eosinophilia and gestational age, birth stress, presence of umbilical catheter, parenteral alimentation solution, and time of beginning or type or oral feeds. The data suggest that eosinophilia is strongly associated with the establishment of an anabolic state.

Body Weight

Eosinophilia in Kenyan baboons (Papio anubis) induced by Trichinella spiralis and Schistosoma mansoni.

High primary doses of Trichinella spiralis administered orally to Kenyan baboons (Papio anubis) induced a marked but unpredictable eosinophilia which started 2--3 weeks after infection and persisted as erratic waves for at least 6 months. Low primary oral doses induced no eosinophilia but a later, high challenge gave an accelerated eosinophilic response, although the peak was lower than in high primary infection. Intravenous injection of infective T. spiralis larvae resulted in a predictable, rapid eosinophilic response which persisted for several weeks. Intravenous injection of a particulate material, Sepharose, gave no oesinophilic response. Percutaneous Schistosoma mansoni infection of baboons resulted in a two-stage eosinophilic response: an initial rise occurred about 2/3 of the way through the pre-patent period and was followed by a second rise at the onset of patency. After peaking, the eosinophilia waned erratically over the next 3 or 4 weeks. A strong antibody response, measured by countercurrent immunoelectrophoresis, was given in oral infections with T. spiralis, but intravenous injections elicited little or no antibody formation. Parasitological evidence indicated no cross-resistance to S. mansoni in baboons injected with T. spiralis 9 days previously. Thus, the intravenous injection of infective T. spiralis larvae appears to be a suitable method of inducing experimentally a non-specific eosinophilia to investigate possible immune mechanisms to S. mansoni in the baboon.

Animals

Massive polyclonal hyperimmunoglobulinemia E, eosinophilia and increased IgE-bearing lymphocytes.

A patient (E.M.) with marked eosinophilia and hyperimmunoglobulin E (IgE) has been followed for 4 years. Peripheral blood eosinophilia reached levels in excess of 18,000 cells/mm3 and serum IgE concentration increased to more than 210,000 units/ml (about 0.48 mg IgE/ml). The IgE has both lambda and kappa light chains and is therefore considered polyclonal. The patient has an increase in peripheral blood lymphocytes which stain for surface IgE. Transfer of the patient's plasma (plasmsEM) to a rhesus monkey did not induce peripheral boood eosinophilia. The half life of IgEEM in a rhesus monkey was 2.2 days, which is similar to the half life of myeloma IgE in human subjects. The condition was not associated with defined morbidity except for mild persistent pruritus. Various studies revealed no evidence for atopic parasitic, immune deficiency or neoplastic disease.

Adult

Asthmatic pulmonary eosinophilia: a review of 65 cases.

In a series of 65 patients with asthma with pulmonary eosinophilia 54 were adequately investigated for allergic aspergillosis and this was present in 32 (59%). Asthma with pulmonary eosinophilia was found to carry a relatively poor prognosis in terms of permanent symptoms, impairment of pulmonary function and residual radiographic abnormality. The prognosis was least favourable when allergic aspergillosis was associated with long-standing asthma. On the other hand there was a group of patients with asthma with pulmonary eosinophilia who had relatively little permanent disability. These were mainly women with asthma of recent onset, and in these evidence of allergy to Aspergillus fumigatus was less apparent. Those patients who received long-term daily corticosteroid therapy were less likely to develop further radiographic opacities than those given intermittent corticosteroid therapy. To prevent recurrent pulmonary infiltrates it is probably necessary to give prednisolone in a daily dosage of at least 10 mg for an indefinite period.

Adolescent

Eosinophilia following treatment of patients with schistosomiasis mansoni and Bancroft's filariasis.

Eosinophilia is frequently observed after treatment of patients with infections due to parasitic helminths. For definition of the characteristics and causes of post-treatment eosinophilic responses, 47 patients with Bancroft's filariasis, who were treated with diethylcarbamazine, and eight patients with schistosomiasis mansoni, who were treated with niridazole, were studied. After therapy for eight days, both groups developed significant (P less than 0.05) increases in their levels of eosinophilia, which peaked in two to four weeks. Maximal levels averaged two and one-half to three time the levels before treatment. Before therapy the number of circulating eosinophils was unrelated to intensity of infection in both groups, but after treatment, when the same relationship was examined in the larger group (the patients with filariasis), the degree of post-treatment eosinophilia was significantly correlated with the patients' worm burdens before treatment (r = 0.727; P less than 0.001). Thus, treatment of helminthic infections can provide a unique opportunity for studying eosinophil responses of humans to graded doses of antigen and has shown that acute responses are determined quantitatively by the amount of antigen initially presented to the host.

Adolescent

Endomyocardial disease and eosinophilia. Report of a case.

While an association between blood eosinophilia and endomyocardial disease has been recognized, the role of the eosinophil in the pathogenesis of the cardiac lesions remains uncertain. In a 69-year-old-man with large cell carcinoma of the lung, marked eosinophilia was stimulated by and progressed with the course of the neoplasm which was producing an eosinophil chemotactic factor. Peripheral blood eosinophils were vacuolated and degranulated while those in the bone marrow were morphologically normal. Clinical evidence of cardiac dysfunction developed one month prior to death. At autopsy, 12 months after the onset of symptoms, endomyocardial disease was present. There were numerous eosinophils in the damaged myocardium and surrounding the pulmonary neoplasm. In patients with endomyocardial disease and eosinophilia, the eosinophil may be directly cardiotoxic or a primary mediator of cardiac damage; therapeutic attempts to reduce the number of eosinophils might be benefit.

Aged

[Desquamative interstitial pneumonia. Peripheral eosinophilia in DIP: a new clinical aspect (author's transl)].

It were Liebow et al. (1965) who, for the first time, described the desquamative interstitial pneumonia (DIP) as one clinical and morphological unit. The etiopathology of this disease is still unknown and there exist many controversial opinions as to its role within the interstitial pneumonias. For the clinical-physician the DIP represents a difficult problem because there seems to be no uniform appearance to this disease. So a lung-biopsy is the unique way to make a definitive diagnosis. The following description represents a case of DIP observed at our hospital. At the same time we tried to give a review of our present knowledge concerning the morphology, course and therapy of this disease. We think it should be note that the DIP was accompanied by an extreme peripheral eosinophilia. To our knowledge this is the first time such a phenomenon is described. In the course of the treatment with steroids the eosinophilia disappeared parallel to the normalization of the radiographic findings.

Adrenal Cortex Hormones

Acute lymphoblastic leukemia with eosinophilia and basophilia.

A boy with acute lymphoblastic leukemia showed cerebrospinal fluid and blood eosinophilia and basophilia. No cause for the eosinophilia or basophilia was identified, but they preceded the appearance of leukemic lymphoblasts in both CSF and blood. The first appearance of basophils and eosinophils in the CSF was associated with acute symptomatology and responded completely to antileukemic therapy. Though treatment with intrathecal drugs reversed major neurological signs, there was evidence of generalized cerebral cortical atrophy. The possible mechanisms responsible for this unusual cellular reaction include: 1) reaction to antileukemic therapy; 2) immunological reaction to the lymphoblasts; 3) ectopic hormone production; 4) common stem cell origin of lymphoblasts, basophils, and eosinophils. The last explanation seems the most likely.

Antineoplastic Agents

Angiolymphoid hyperplasia with eosinophilia.

Angiolymphoid hyperplasia with eosinophilia is a recently recognized lesion of skin consisting of atypical vascular paroliferation and variable inflammatory cell infiltration. A case is described here of a similar lesion presenting as an intraoral swelling. In addition to showing the histological features generally associated with angiolymphoid hyperplasia with eosinophilia, the present case exhibited striking smooth muscle proliferation.

Blood Vessels

Angiolymphoid hyperplasia with eosinophilia.

Angiolymphoid hyperplasia with eosinophilia (AHE) is a distinct clinical and pathologic entity that demonstrates proliferation of endothelial cells associated with varying degrees of lymphocytic, histiocytic, and eosinophilic infiltration. Lymphoid hyperplasia with germinal centers often is present in older lesions and the patients may have an associated blood eosinophilia. Multiple deep nodules developed in a young man on the palmar aspect of the left hand, and subsequently the forehead, histologically diagnostic of AHE. Direct immunofluorescence of the tumor removed from the forehead demonstrated granular deposits of IgA, IgM, and C3 associated with small vessels. Cryoglobulins (IgA, IgM, and IgG) were found in the patient's serum. This new information lends support to the hypothesis that AHE is an inflammatory reactive lesion, possibly secondary to an immunologic injury, rather than a true vascular neoplasm with an associated inflammatory reaction.

Adult

[Pulmonary eosinophilia and pulmonary arterial hypertension].

Pulmonary artery hypertension is a rare feature in the eosinophilic pulmonary syndrome, it had been observed only in some cases of tropical pulmonary eosinophilia. A case of prolonged pulmonary eosinophilia with reversible pulmonary hypertension is presented.

Humans

[Severe colitis with eosinophilia].

A 23-year-old woman from the French Antilles was successfully treated for intestinal and hepatic schistosomiasis, as evidenced by the normalization of immunofluorescence titers and many negative histogogical controls. She presented, however, persistent colitis with marked eosinophilia (eosinophils in excess of 50,000/mm3). No precise diagnosis could be established in spite of all parasitological, allergological, hematological and gastroenterological investigations. The colon was the only organ involved and showed colitis of a type unclassifiable both endoscopically and histologically. Massive infiltration by eosinophils was present. Temporary relief was achieved with steroids but the clinical condition of the patient became dramatic. Three years after the onset of the illness total colectomy was performed, sparing the rectum. After surgery all manifestations of disease disappeared and for ten months the number of eosinophils was normal. Ileorectal continuity could be re-established. Ten months after reanastomosis there was recurrence of bleeding from the rectum and eosiophils once again reached levels of 2340/mm3. The differential diagnosis of this colitis associated with eosinophilia is discussed. To our knowledge it does not correspond to any clinical entity described so far.

Adult

Induction of blood eosinophilia by pulmonary embolization of antigen-coated particles: the relationship to cell-mediated immunity.

A method of immunization has been described which consists of the i. v. injection into rats of large latex particles coated with human gamma-globulin (HGG). The coated particles embolize the pulmonary capillary bed and induce blood eosinophilia, which correlated strongly with the development of lymphocyte responsiveness to HGG in vitro. Sequential histologic studies of the lungs including ultrastructural analysis suggest a delayed hypersensitivity reaction to the coated particles. These studies support the concept that the induction of blood eosinophilia may be mediated by T lymphocytes.

Animals

Cytophilic antibodies in bronchopulmonary aspergilloma and cryptogenic pulmonary eosinophilia.

The immunoglobulin class and subclass of cytophilic antibodies have been studied using peripheral leucocytes from twenty-two patients with allergic bronchopulmonary aspergillosis, aspergilloma and cryptogenic pulmonary eosinophilia. In patients with allergic bronchopulmonary aspergillosis, significantly increased histamine liberation occurred following challenge of their leucocytes with antisera to IgE, IgG2, IgG3 and IgG4 as well as with Aspergillus fumigatus antigen. The results were considerably modified if the patient was receiving corticosteroids at the time of the test. The presence of IgG2-specific antibody to A. fumigatus in the serum of one patient, capable of sensitizing donor leucocytes, was demonstrated in passive sensitization experiments. In two patients with uncomplicated aspergillomas no evidence of cytophilic antibody to any class was found although large amounts of precipitating IgG antibody was present in the serum. Two patients with aspergilloma and systemic symptoms of weight loss and fatigue (which have been interpreted by others as 'hypersensitivity' responses) had increased amounts of cytophilic antibody similar to those with allergic bronchopulmonary aspergillosis. Six patients with cryptogenic pulmonary eosinophilia were also studied. No evidence of specific antibody to A. fumigatus was found but, as a group, significantly increased histamine liberation using antisera to IgG2 was demonstrated. Individual patients also showed evidence of other classes of cytophilic antibody, one having IgE, three IgG3 and two IgG4. The relationship between heat-stable short-term sensitizing antibody (IgG STS) inducing immediate skin responses and the pattern of cytophilic antibodies found in our patients with bronchopulmonary aspergillosis having dual (immediate and late reactions) is discussed. Clinically these tests are of diagnostic value and they may be helpful in assessing symptomatic patients with aspergillomas for corticosteroid treatment.

Adult

Diffuse fasciitis with eosinophilia: histological and electron microscopic study.

A female case of diffuse fasciitis with eosinophilia (or eosinophilic fasciitis) is reported. This disease is characterized by suddenly developed circumscribed subcutaneous indurations on the extremities, hyalinized fibrosis of the fascia and peripheral eosinophilia. Our patient further displayed Raynaud's phenomenon preceded by thrombophlebitis, and histological and electron microscopical features of her subcutaneous hyalinized area centering at the fascia closely resembled those of morphaea.

Eosinophilia

Wells' syndrome. Recurrent granulomatous dermatitis with eosinophilia.

Two cases of granulomatous dermatitis with eosinophilla (Wells' syndrome) are reported. With Wells' original four cases, these two cases define a distinctive dermatosis with onset as cellulitis and formation of solid edema and either final spontaneous resolution or resolution with steroid therapy. Microscopic study showed diffuse tissue eosinophilia and fibrinoid flame figures, evolution of associated focal necrobiosis, and formation of focal microgranulomas associated with eosinophils. Biopsy of muscle and fascia showed comparable fasciitis and eosinophilic myositis. Immunofluorescence in one case disclosed fibrin in the dermis and lgM, lgA, and C3 in the blood vessels of the muscle. Recurrences of the lesions often appeared to be related to drug administration or surgery.

Aged