eosinophilia
Table of Contents
eosinophilia
see also:
DDx of eosinophilia on peripheral blood film
- drug reactions:
- asymptomatic eosinophilia:
- drug reactions with eosinophilia and systemic symptoms (DRESS):
- aromatic anticonvulsants and other antiepileptics, sulphonamides, allopurinol, non-steroidal anti-inflammatory drugs (NSAIDs), and certain antibiotics
- eosinophilia-myalgia syndrome:
- an incurable and sometimes fatal flu-like neurological condition that is believed to have been caused by ingestion of poorly produced L-tryptophan supplements1)
- helminth infections (see below for eosinophilia in the returned traveller)
- cholesterol embolism (transiently)
- some vasculitides such as Churg-Strauss syndrome
- coccidioidomycosis - Arizona, southern California, New Mexico, western Texas
- interstitial nephropathy
Churg-Strauss syndrome
- this rare chronic vasculitis can be diagnosed on basis of having 4 of the following 6 conditions with 99% specificity2)
- asthma
- blood eosinophilia > 10%
- paranasal sinus abnormality
- mononeuropathy or polyneuropathy
- non fixed pulmonary infiltrates
- histological evidence of extravascular eosinophils
- 1st and 2nd stages of allergies, sinus problems and asthma may precede stage 3 by many years
- stage 3 includes multi-organ involvement such as severe nerve pain in their legs, arms and hands, renal impairment, etc.
- associated with elevations of p-ANCA (whereas Wegener's granulomatosis is associated with c-ANCA)
eosinophilia in the returned traveller
- incidence in returned travellers from the tropics is ~5%
- it is suggestive of parasite infection such as a helminth infection although the absence of eosinophilia does not exclude helminth infection as less than half have eosinophilia
common helminth infections from the tropics
- strongyloidiasis - may also cause urticarial rash around waist and buttocks
- filariasis
- hookworm
- cutaneous larva migrans
- ascariasis
initial Ix
- three stool examinations for ova, cysts and parasites to detect the more common gastrointestinal helminths, whose eggs may be excreted intermittently
- any macroscopically visible worms (likely to be ascarids or tapeworm) should be sent for laboratory identification
- specific serological testing is available for schistosomiasis, strongyloidiasis, filariasis, echinococcosis, toxocariasis and angio-strongyliasis
empirical Rx of presumed helminth infection
- start Rx after stool collections
- options include mebendazole, pyrantel and albendazole although of these, only albendazole is useful for strongyloidiasis, tapeworm infection or schistosomiasis.
eosinophilia.txt · Last modified: 2019/08/08 15:13 by 127.0.0.1