Eosinophilia: Difference between revisions

Latest revision as of 15:03, 27 October 2023

Background

Any eosinophil count over 0.5
Graded as mild (0.5 to 1.5), moderate (1.5 to 5), and severe (more than 5)
Hypereosinophilia may refer to eosinophils greater than 1.5, which is high enough that the eosinophils can cause tissue damage regardless of underlying trigger
May be primary (either eosinophilic hematologic malignancy or idiopathic) or secondary/reactive

Differential Diagnosis

Hematologic
- Primary: eosinophilic leukemia, CMML, hypereosinophilic syndrome
- Secondary: Non-Hodgkin lymphoma and Hodgkin lymphoma
Infectious
- Parasitic infections
  - Strongyloides stercoralis, hookworms, schistosomiasis, and scabies (most common)
  - Tropical pulmonary eosinophilia from filarial roundworms (Wuchereria bancrofti and Brugia)
  - Many others
    - Protozoa: Isospora belli, Dientamoeba fragilis, Sarcocystis
    - Filarial nematodes: Onchocerca, lymphatic filariasis, tropical pulmonary eosinophilia, Loa loa, Mansonella
    - Non-filarial nematodes: Strongyloides stercoralis, hookworms, whipworm, Ascaris, Trichinella, Toxocara, Gnathostoma, Angiostrongylus cantonensis, Anisakidosis
    - Cestodes: Sparganosis
    - Trematodes: Fasciola, Paragonimiasis, Schistosoma
    - Scabies
- Viruses: HIV, HTLV
- Bacteria: Bartonella, Borrelia, syphilis, scarlet fever (resolving)
- Mycobacteria: tuberculosis, Hansen disease
- Fungi: ABPA, Coccidiodes, Histoplasma, Paracoccidioides, Cryptococcus
Inflammatory
- Eosinophilic pneumonia
- Eosinophilic esophagitis
- Eosinophilic myositis
- Eosinophilic granulomatosis with polyantiitis (eGPA or Churg-Strauss)
Endocrine
- Addison disease
Allergy
- Atopy
- Asthma
- Drugs
  - Hypersensitivity reaction to NSAIDs, antibiotics, allopurinol, aromatic anticonvulsants, sulfasalazine, TMP-SMX, PPIs, vancomycin
  - Drug reaction with eosinophilia and systemic symptoms (DRESS)

Investigations

CBC
Stool for ova and parasites (specifically for helminths rather than protozoa)
Strongyloides serology, +/- Schistosoma serology
ANCAs
Review current medications

@@ Line 1: / Line 1: @@
+== Background ==
+* Any eosinophil count over 0.5
+* Graded as mild (0.5 to 1.5), moderate (1.5 to 5), and severe (more than 5)
+* Hypereosinophilia may refer to eosinophils greater than 1.5, which is high enough that the eosinophils can cause tissue damage regardless of underlying trigger
+* May be primary (either eosinophilic hematologic malignancy or idiopathic) or secondary/reactive
 ==Differential Diagnosis==
@@ Line 5: / Line 12: @@
 **Secondary: [[Non-Hodgkin lymphoma]] and [[Hodgkin lymphoma]]
 *Infectious
+**Parasitic infections
-**Parasitic infections including [[Strongyloides stercoralis]], [[hookworms]], [[schistosomiasis]], and [[scabies]]
+***[[Strongyloides stercoralis]], [[hookworms]], [[schistosomiasis]], and [[scabies]] (most common)
-**[[Tropical pulmonary eosinophilia]] from filarial roundworms ([[Wuchereria bancrofti]] and [[Brugia species]])
+***[[Tropical pulmonary eosinophilia]] from filarial roundworms ([[Wuchereria bancrofti]] and [[Brugia]])
+***Many others
+****Protozoa: [[Isospora belli]], [[Dientamoeba fragilis]], [[Sarcocystis]]
+****Filarial nematodes: [[Onchocerca]], [[lymphatic filariasis]], [[tropical pulmonary eosinophilia]], [[Loa loa]], [[Mansonella]]
+****Non-filarial nematodes: [[Strongyloides stercoralis]], [[hookworms]], [[whipworm]], [[Ascaris]], [[Trichinella]], [[Toxocara]], [[Gnathostoma]], [[Angiostrongylus cantonensis]], [[Anisakidosis]]
+****Cestodes: [[Sparganosis]]
+****Trematodes: [[Fasciola]], [[Paragonimiasis]], [[Schistosoma]]
+****[[Scabies]]
+**Viruses: [[HIV]], [[HTLV]]
+**Bacteria: [[Bartonella]], [[Borrelia]], [[syphilis]], [[scarlet fever]] (resolving)
+**Mycobacteria: [[tuberculosis]], [[Hansen disease]]
+**Fungi: [[ABPA]], [[Coccidiodes]], [[Histoplasma]], [[Paracoccidioides]], [[Cryptococcus]]
 *Inflammatory
 **[[Eosinophilic pneumonia]]
@@ Line 17: / Line 36: @@
 **[[Atopy]]
 **[[Asthma]]
-*Drugs
+**Drugs
+***[[Hypersensitivity reaction]] to [[NSAID|NSAIDs]], [[Antibiotic|antibiotics]], [[allopurinol]], [[Aromatic anticonvulsant|aromatic anticonvulsants]], [[sulfasalazine]], [[TMP-SMX]], [[PPI|PPIs]], [[vancomycin]]
-**[[Drug reaction with eosinophilia and systemic symptoms]] (DRESS)
+***[[Drug reaction with eosinophilia and systemic symptoms]] (DRESS)
 ==Investigations==
@@ Line 24: / Line 44: @@
 *CBC
 *Stool for ova and parasites (specifically for helminths rather than protozoa)
-*[[Strongyloides stercoralis|Strongyloides]] serology
+*[[Strongyloides stercoralis|Strongyloides]] serology, +/- [[Schistosoma]] serology
 *ANCAs
 *Review current medications