Eosinophilia

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2021年4月20日 (火) 15:54時点におけるVaccipedia.admin (トーク | 投稿記録)による版
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Definition

  • Eos. > 450/mcl
  • Helminth infection most common cause in travellers/migrants
    • May be less prominent for migrants having dwelled in endemic area for long time
  • May be the only sign without any symptoms

Cause

  • Allergy/autoimmune
  • Infection
  • Neoplasm
  • Drug
  • Rare eosinophillic disorder
  • Others

Infectious eosinophilia

  • Helminth
    • when migrating to lung
    • tissue invasion
  • Ectoparasites
    • scabies
    • myiasis
  • Protozoa
    • Sarcocystis, Cystoisospora belli
  • Resolving bacterial/viral infection
    • "Eosinophilic dawn" - no need to investigate
  • Fungus
    • Coccidioidomycosis
    • Paracoccidioidomycosis
  • HIV?
    • not by HIV itself? by superinfection?

History taking

  • Where the patient stayed
    • migrantの場合は必ずしも居住地での感染に限らず,移住の過程で感染する可能性もある
  • Time since return in travellers
  • High or moderate or mild
    • mild eosinophilia may be from other than helminth
  • What the patient was exposed with
    • freshwater
    • food, especially raw ones
    • barefoot walking
  • Accompanying symptoms/signs

Test

  • ova in stool
  • helminthのserologyは交叉反応も多く信頼性が低い
    • ただしstronglyoides糞線虫は後の免疫抑制療法で致死的になるのでserologyでスクリーニングすべき
      • stronglyoides serologyが陽性になったら診断を頑張るよりivermectin単回投与で治療してしまえば良い
  • "hypereosinophilia" > 1500/mcL suggests tissue and organ damage

Extent of eosinophilia

  • stage of infection
  • duration of infection
  • tissue invasion
  • immune responce