Benign Disorders of Leukocytes
Harold R. Schumacher, William A. Rock, Sanford A. Stass in Handbook of Hematologic Pathology, 2019
An absolute eosinophil count exceeding the upper limit of normal, usually over 0.5 × 10/L of blood, is defined as eosinophilia. The most common causes of eosinophilia are allergic reactions, parasitic infections, skin disorders, and reactions to drugs. A list of conditions known to be associated with eosinophilia is presented in Table 3. Based on clinical findings, the laboratory evaluation of eosinophilia, particularly persistent eosinophilia, may include any of the following studies:
Blood smear examination
Test(s) for suspected or identified underlying condition(s), e.g., feces examination for ova and parasite, and serum IgE determination
Bone marrow examination, if a malignancy is suspected.
Adverse Reactions to Antibiotics in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
In CCU patients, rashes are common and their etiology can be a challenge to determine. Additionally, skin abnormalities in these CCU patients may vary from mild to life threatening. The cause of rash may be due to disease, pressure, or medications. Identifying an offending agent may be difficult because of the large number of medications administered to CCU patients and the difficulties in temporally associating the rash with the initiation of any single agent [7]. Any antimicrobial agent has the potential to cause an allergic rash, but this problem occurs most commonly with β-lactams, sulfonamides, and fluoroquinolones [28]. Factors that should lead the clinician to suspect a serious drug reaction include facial edema, mucosal involvement, palpable or extensive purpura, pruritic, and fever. The presence of eosinophilia is associated with more severe disease. Maculopapular eruptions associated with antibiotics are especially common, usually occurring within 1‒2 weeks after starting the offending agent and often becoming generalized and pruritic. The sensitivity of skin testing is low for β-lactam-induced maculopapular rashes. In patients with thrombocytopenia or other coagulopathies, hemorrhage into the skin may modify the appearance of the rash. In patients with penicillin-induced mild or moderately severe maculopapular rashes, it is generally safe to use cephalosporins [29]. Stevens-Johnson syndrome is erythema multiforme with mucosal involvement. The most commonly implicated antibiotics are the aminopenicillins and sulfonamides. Onset is typically 1‒3 weeks. The rash can present as maculopapular and/or target lesions [30]. Stevens-Johnson syndrome can involve mucosa of the eyes, mouth, and the genitourinary tract, and up to 25% of cases may only involve the oral mucosa. Diagnosis can be confirmed by skin biopsy with immunofluorescent staining.
Eosinophilic interstitial lung disorders
Muhunthan Thillai, David R Moller, Keith C Meyer in Clinical Handbook of Interstitial Lung Disease, 2017
BAL eosinophilia greater than 25% confirms the diagnosis of eosinophilic lung disease in the appropriate setting. It is present in all patients with ICEP who have not yet received systemic corticosteroids. The BAL eosinophil count is commonly greater than 40%, with a mean of 58% in large series. High-level peripheral blood eosinophilia is common, with mean values of 5000–6000/mm (5), but may be lacking in patients who have received systemic corticosteroids. Blood C-reactive protein and total immunoglobulin (Ig) E levels are elevated but have no specificity. Approximately half the patients with ICEP have airflow obstruction, and the other half have a restrictive ventilatory defect associated with multiple consolidations at imaging. Carbon monoxide transfer factor and coefficient are frequently reduced. Mild hypoxemia may be present (4,5). Working diagnostic criteria for ICEP are found in Table 13.1 (2). In the setting of a characteristic clinical and radiologic presentation, the presence of eosinophilia at BAL (>25% [2]) confirms the diagnosis and obviates the need for lung biopsy. Particular attention must be paid to thoroughly investigate for potential causes of eosinophilia before the condition can be considered idiopathic, especially drug intake, exposure to toxins, illicit drug use and infections with parasites and fungi. Markedly elevated peripheral blood eosinophilia together with typical clinical radiologic features also strongly suggest the diagnosis of ICEP, and BAL may not be mandatory in such cases.
Echinocandin-induced eosinophilia: a case report
Published in Scandinavian Journal of Infectious Diseases, 2014
Nathalie G. Chua, Yvonne P. Zhou, Pushpalatha B. Lingegowda, Andrea L. Kwa, Winnie Lee
Drug-induced eosinophilia is difficult to diagnose. Severe organ damage can occur if it is left untreated. Presently, caspofungin is the only echinocandin that has been reported to cause eosinophilia. A patient who developed eosinophilia after exposure to caspofungin and re-challenge with anidulafungin is presented. Eosinophilia resolved upon discontinuation of both drugs.
Should parasitic disease be investigated in immigrant children with relative eosinophilia from tropical and sub-tropical regions?
Published in Paediatrics and International Child Health, 2017
Moncef Belhassen-García, Javier Pardo-Lledias, Luis Pérez del Villar, Antonio Muro, Virginia Velasco-Tirado, Juan Luis Muñoz Bellido, Belén Vicente, Ana Blázquez de Castro, Miguel Cordero-Sánchez
Background: Immigrants to Spain are mainly from low- and middle-income countries, and around 20% are children. Absolute eosinophilia is defined as >0.45×109 eosinophilic leucocytes/L of peripheral blood. Absolute eosinophilia in travelers and immigrants from tropical and sub-tropical areas is frequently associated with parasitic diseases. However, the significance of relative eosinophilia in immigrant children, defined as >5% eosinophilic leucocytes in those with <0.45×109 eosinophils/L, is unresolved. Objectives: To describe the importance of relative eosinophilia in a cohort of immigrant children (<18 years) from sub-Saharan Africa, North Africa and Latin America. Methods: 176 immigrant children without absolute eosinophilia were prospectively evaluated. Results: 25 of them (14.2%) had relative eosinophilia. 10 patients with relative eosinophilia had no diagnosis. 15 with relative eosinophilia (60%) were diagnosed with a parasitic disease, 7 (46.7%) of whom had only one parasite, while co-infection accounted for 8 of the 15 cases (53.3%). Of the parasitic infections, the most frequent causes of relative eosinophilia were filariasis spp. (7/15, 46.7%), strongyloides spp. (5/15, 33.3%), schistosoma spp. (4/15, 26.6%) and Ascaris lumbricoides (2/15, 13.3%). Conclusion: The findings suggest that relative eosinophilia is frequently associated with helminthic infection in immigrant children from tropical and sub-tropical areas, so a thorough parasitological study is highly advisable in this group of patients.
Eosinophilia after commencement of clozapine treatment
Published in Australian and New Zealand Journal of Psychiatry, 1997
Objective: While clozapine-associated agranulocytosis has received extensive attention, a number of recent publications have identified that the incidence of eosinophilia may also be of concern. This retrospective review identifies the incidence of eosinophilia within a group of people commencing clozapine at a large hospital in Australia. Method: The pathology reports of all people (n = 160) who commenced clozapine within a 3.5–year period were retrospectively reviewed for incidences of eosinophilia. Results: The incidence of eosinophilia was identified as 13%, comprising 17 males and four females. All cases of eosinophilia developed within 4 weeks of commencing clozapine. One male reached a peak eosinophil level of 9 × 109/L, which resolved after clozapine was withdrawn. In all other cases, the eosinophilia resolved without intervention. Conclusions: With a rate of eosinophilia at 13% in this population under review, and given that there have been reports of 25 cases of eosinophilic cardiomyopothy resulting in four deaths worldwide, clinicians should be alert to the incidence and sequelae of eosinophilia in people receiving clozapine treatment.
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