Persistent Eosinophilia is a Challenging Problem
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 3
Abstract
HE is defined as >1.5 x 109/L eosinophils in the blood on 2 examinations (interval >1 mo) and/or tissue HE defined by: eosinophils percentage in BM section exceeding 20% of all nucleated cells; and/or extensive eosinophilic tissue infiltration by pathologist opinion; and/or presence of marked deposition of eosinophil granule proteins (in the absence or presence of major tissue eosinophils infiltration).Eosinophilia is defined as an AEC >500/μL [1]. The severity of eosinophilia has been arbitrarily divided into mild (AEC: 500- 1,500/mm3), moderate (AEC: 1,500-5,000/mm3), and severe (AEC: >5,000/mm3) [2]. HE is defined as >1.5 x 109/L eosinophils in the blood on 2 examinations (interval >1 mo) and/or tissue HE. Subtypes of HE are hereditary (familial); primary (clonal/ neoplastic) HE, secondary (reactive) HE; hypereosinophilic syndrome (HES) and HE of undetermined significance (HEUS) [3]. HEUS is a novel term in lieu of idiopathic hypereosinophilia [4]. Most eosinophilias are reactive [5].1- Secondary (reactive) HE: Is characterized by proliferation of non-clonal, mature eosinophils [2]. HE is cytokine-driven in most cases [3]. It is typically caused by increased IL5 levels. Concomitant elevation in IL4 and IL13 can lead to associated hypergammaglobulinemia (Ig) E [2]. Elevated peripheral eosinophilia can be found in parasitic infection, significant atopic disease, drug hypersensitivity reactions, connective tissue disorders, malignancy, monogenic disorders of immune deficiency or dysregulation with prominent atopy, particularly in the pediatric age group and rare hypereosinophilic syndromes [6]. Infectious disease: Tissue invasive helminthes and burrowing ectoparasites commonly present with eosinophilia. Exclusively intraluminal parasites (e.g. adult tapeworms, protozoa) or those contained in cystic structures (e.g. hydatid cyst, neurocysticercosis) are unlikely to cause eosinophilia [7]. Disseminated coccidioidomycosis and aspergillosis (when presenting as ABPA) are well-known fungal causes of eosinophilia. ABPA is an inflammatory airway disease promoted by presence of fungal-derived proteinases in the lungs, rather than a tissue invasive process. Histoplasmosis and tuberculosis can cause eosinophilia indirectly when they cause adrenal insufficiency. Eosinophilia in HIV may be due to infectious causes, eosinophilic pustular folliculitis, drug reactions (HAART or antimicrobials), malignancies, hypereosinophilic syndromes, toxins among others. HIV itself is thought to cause eosinophilia due a Th1-Th2 shift [7].
Authors and Affiliations
Nahla AM Hamed
Keywords
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- EP ID EP569517
- DOI 10.26717/BJSTR.2017.01.000244
- Views 153
- Downloads 0
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