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Management of eosinophilia cases. (a) The percentage of answers on various diagnostic and therapeutic methods (n = 607). (b) Consultation department selected by physicians (n = 463). (c) Medical history was asked by physicians (n = 419). a, did not know what examinations or tests to order; b, administering glucocorticoids immediately; c, scheduling for targeted examinations; d, ruling out organ dysfunction; e, detailed history taking; f, consultation meeting; g, allergic and medical history; h, history of rashes, pruritus, or lymphadenopathy; i, history of eating food such as sashimi, measly pork, snake gallbladder, and conches; j, history of infectious diseases and symptoms (such as parasites, viruses, bacteria, tuberculosis, and fungi); k, history of the respiratory diseases and symptoms; l, history of hematologic diseases and symptoms; m, travel history, particularly to tropical regions; n, skin nodules or rashes; o, history of having pets or working in the livestock husbandry and slaughter industries; p, fever, night sweats, and weight loss; q, history of the cardiovascular diseases and symptoms; r, history and symptoms of digestive system.
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Background
Patients with incidental eosinophilia is becoming increasingly common in clinical practice. But it remains challenging to diagnose and treat owing to its complex etiology. The awareness of physicians and the strategies of diagnosis and treatment toward eosinophilia are still unclear.
Objective
We aimed to evaluate attention, diagnosis,...
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Citations
... This observation suggests a potential need for more awareness in non-teaching hospitals and rural settings [10]. Additionally, the escalating incidence of patients with incidental eosinophilia in clinical practice underscores the persistent challenge of diagnosing and effectively treating these conditions [21]. Rectifying this lack of awareness necessitates concerted efforts in education and the formulation of comprehensive diagnostic guidelines. ...
This comprehensive review delves into the challenges associated with diagnosing and managing unusual cases of eosinophilic enteritis in rural health settings. Eosinophilic enteritis, characterized by an abnormal accumulation of eosinophils in the gastrointestinal (GI) tract, poses distinct difficulties in diagnosis due to its varied presentations. In rural contexts, limited access to specialized diagnostic tools, a shortage of healthcare professionals, and geographical constraints compound these challenges. This abstract encapsulates the critical issues explored in the review, emphasizing the importance of addressing atypical cases and rural healthcare's unique hurdles. The conclusion is a rallying call for collaborative action, advocating for improved education, telemedicine solutions, and enhanced access to specialized care. The implications extend beyond eosinophilic enteritis, with the potential to instigate systemic improvements in rural healthcare globally. This review is a crucial contribution to understanding eosinophilic enteritis in rural settings and advocates for transformative measures to improve diagnosis, management, and overall healthcare outcomes.
... Historically, BEC cutoff values have been employed in clinical management, particularly in departments such as hematology, allergy, respiratory medicine, and tropical diseases, where this parameter is associated with specific diseases or conditions, such as asthma [40]. Furthermore, BEC is not considered a risk factor by itself; rather, it is evaluated in conjunction with other clinical data [41]. ...
(1) Background: Eosinophilia has traditionally been linked to eosinophilic asthma, for which it is the gold-standard prognostic biomarker. However, the association between eosinophilia and the presence of other diseases and comorbidities is yet unclear. (2) Methods: For this retrospective study, we reviewed the electronic medical records of 49,909 subjects with blood eosinophilia to gather data on the presence of asthma, COPD, sleep apnea, tuberculosis, dyslipidemia, hypertension, and other cardiovascular diseases and severe CRSwNP among these subjects. Demographic features including age, sex, and smoking habits were collected, as well as the number of hospitalizations and emergency department visits. T-tests, ANOVA, Fisher test, and logistic regression models were used. (3) Results: For all age groups studied, eosinophilia was significantly more prevalent among asthmatic subjects than nonasthmatics, especially in patients also presenting CRSwNP, hypertension, and dyslipidemia. The likelihood of developing asthma, COPD, and CRSwNP, and hospitalization, was increased when BEC was above 600 eosinophils/μL. The association between asthma, CRSwNP, and BEC was corroborated by multiple logistic regressions models. (4) Conclusions: We demonstrated the association of having over 600 blood eosinophils/μL with a higher number of hospitalizations and comorbidities (CRSwNP and COPD), which proves that BEC is a highly useful parameter to consider in subjects who present blood eosinophilia.
... In contrast to this, the observation of an increase in eosinophils in a differential count of blood or other samples can be a key piece of information that should be contextualized in advance in the individual (adult) patient. However, a structured approach is required to guide diagnostic and therapeutic decisions clinically, and the task is to isolate the impact of an increased eosinophil count (eosinophilia) from all other etiologic factors in the overall assessment (3)(4)(5)(6)(7)(8). ...
... Secondary or reactive eosinophilia is driven, in particular, by the cytokine interleukin (IL)-5, produced by activated T lymphocytes (15,16). This scenario of immunological crosstalk is associated with autoimmune, infectious, and inflammatory diseases; malignancy; and allergy, including iatrogenic, drug-induced adverse reactions (3)(4)(5)(6)(7)(8). When no congenital, clonal, or reactive cause can be demonstrated, patients with persistent eosinophil counts of at least 1.5 × 10 9 /L are categorized as idiopathic hypereosinophilic. ...
... When no congenital, clonal, or reactive cause can be demonstrated, patients with persistent eosinophil counts of at least 1.5 × 10 9 /L are categorized as idiopathic hypereosinophilic. This group can be subdivided into patients with no manifestations of eosinophilia [iHE, or hypereosinophilia of undetermined significance (iHE US )] or idiopathic hypereosinophilic syndrome (iHES), when organ involvement due to eosinophils is present (3)(4)(5)(6)(7)(8)(17)(18)(19)(20). However, the overlap of symptoms, regardless of whether the cause of the disease is primary, secondary, or idiopathic eosinophilia-or a combination of them-is considerable, and characterizes the patient with an increased eosinophil count in blood as a clinical challenge. ...
Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty—e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.
