Eosinophilia

Introduction to eosinophilia Eosinophilia (eosinophilia) refers to the absolute value of eosinophils in peripheral blood is greater than (0.4 ~ 0.45) × 109 / L (400 ~ 450 / mm3), clinically often associated with a variety of diseases, especially parasitic Insect infections, allergic diseases, connective tissue diseases and non-specific reactions of tumors. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: Asthma Urticaria

Causes of eosinophilia

(1) Causes of the disease

The cause of eosinophilia:

1. Allergic diseases: bronchial asthma, urticaria, angioedema, serum disease, allogeneic protein or drug allergy, hay fever (hay fever) can cause eosinophilia, usually mild or moderate .

2. Parasitic diseases: one of the most common causes of eosinophilia, protozoa (Plastaria, Toxoplasma, Pneumocystis), worms (Aphids, Aphids, Hookworms, Trichinella, Filaria, Liver Capillaries) Nematodes), trematode (schistosomiasis, paragonimiasis, Chinese branch sinus), aphids and infections of aphids and sputum sputum can cause eosinophilia. In general, adults in the intestine do not cause obvious eosinophils. When the cells increase, the invaders invade the organs, or the adult intestines destroy the intestinal mucosa, or the adults that parasitize the extraintestinal tissues cause a significant increase in eosinophils. Therefore, when eosinophils in the peripheral blood increase, It is not always possible to find eggs in the stool.

3. Drugs: Some drugs such as penicillin, streptomycin, cephalosporin, salicylic acid, sulfonamide, phenytoin, chlorpromazine, liver extract (liver extract), iodine, gold, granule-macrophages Colony stimulating factors and the like can cause moderate or severe eosinophilia, and there are no other symptoms of drug allergy in the clinic.

4. Infection: Certain infections such as tuberculosis, especially lymph node cheese-like tuberculosis, cat scratching, infectious mononucleosis, scarlet fever, acute phase of erythema multiforme, AIDS, candida infection, etc. can make eosinophils The number of cells is increased, and some eosinophils are reduced during infection. The temporary increase in recovery period is called rebound eosinophilia after infection.

5. Skin diseases: Eosinophils, exfoliative dermatitis, herpes-like dermatitis, pemphigus, psoriasis, red pityriasis, ichthyosis and other eosinophils can be moderately increased.

6. Hematological diseases: chronic myeloid leukemia, polycythemia vera, acute leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, vascular immunoblastic lymphadenopathy, malignant histiocytosis, systemic mastocytosis, multiple Myeloma, heavy chain disease, etc. may be associated with eosinophilia. Eosinophils in patients with eosinophilic leukemia are severely increased, and their morphology is different. The size is different, the particles are coarse, the distribution is uneven, and there are Basophilic granules, there may be vacuoles in the cytoplasm, too many or too few nuclear lobes, or Dhle bodies. It should be noted that some cytoplasm of acute leukemia cells are golden yellow, large particles, similar to eosinophils. It is called pseudo eosinophils.

7. Tumor: About 0.5% of patients with various malignant tumors have eosinophilia, especially those who metastasize to the serosa and bone, secrete mucinous epithelial cells and tumors with central necrosis. Increased acid granulocytes.

8. Rheumatic diseases: Systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, vasculitis, nodular polyarteritis, Sjogren's syndrome, etc. may have eosinophilia, often reflecting the activity of the disease Rheumatoid arthritis with eosinophilia in addition to severe joint deformity, prone to extra-articular lesions such as vasculitis, pleurisy, subcutaneous nodules, blood in the complement reduction, rheumatoid factor titer significantly increased, eosinophils Membrane also often causes eosinophilia.

9. Endocrine diseases: Single pituitary dysfunction, eosinophilia can be seen in adrenal insufficiency.

10. Eosinophilic lymphogranuloma: mostly occurs in young, young, male than female, involving superficial lymph nodes, manifested as one or more groups or systemic lymphadenopathy, may also affect the skin, parotid gland, breast Muscles, etc. form a mass, no bone lesions, slow onset, long course of disease, itchy skin, pigmentation, papular keratinization, normal or increased white blood cell count, classification: eosinophils often account for more than 10%, can be as high as 77%, sensitive to radiation, corticosteroid treatment is also effective, individual patients can be converted to Hodgkin's disease, the disease needs to be differentiated from Langerhans cell granulomatosis, which generally occurs in children and adolescents More involved in soft tissue and bone, lesions showed foamy tissue cell proliferation with eosinophil infiltration, while eosinophils in peripheral blood generally do not increase.

11. Familial eosinophilia: autosomal dominant, benign, multiple cases in the same family, eosinophilia for life, but good health, no treatment, reported with aplastic anemia Some have thrombocytopenia and sacral dysplasia, as well as familial histiocytosis with eosinophilia.

12. Immunodeficiency syndrome: Wiskott-Aldrich syndrome, high IgE, IgA deficiency, Nezelof syndrome, Wiss type and combined immunodeficiency and graft versus host disease can increase eosinophils.

13. Eosinophilia syndrome (esinophilia): a group of diseases that can be acute, chronic, benign or malignant, involving one or more organs, symptoms and signs of overlapping eosinophilia. , refers to the idiopathic eosinophilia syndrome.

14. Others: Radiation exposure, inflammatory bowel disease, eosinophilic cystitis, eosinophilic cholecystitis, eosinophilic meningitis, idiopathic eosinophilia syndrome, etc.

(two) pathogenesis

Currently, cytokines known to promote eosinophilia include interleukin-3 (IL-3), IL-5, and granulocyte-macrophage colony stimulating factor (GM-CSF). In addition to acting on eosinophils, IL-3 and GM-CSF can also act on other myeloid cell lines, while IL-5 only stimulates eosinophil production, and the body is stimulated by internal and external factors to activate T cells. It is a helper T cell, releasing IL-5 and a small amount of GM-CSF to stimulate bone marrow, producing eosinophilia, eosinophils themselves have IL-5 mRNA transcription, and express IL-5 protein detected by immunohistochemistry. Eosinophils also secrete IL-3 and GM-CSF, which further increase eosinophils, which may explain the increase in neutrophils in some eosinophils.

Eosinophilia, especially in idiopathic eosinophilia syndrome, has specific organ damage. Eosinophil-specific particles contain four kinds of cations: peroxidase, major basic protein (MBP), eosinophilic Both granulocyte cationic protein (ECP) and ethylene glycol dinitrate (EDN) are cytotoxic, and oxidative products are formed during eosinophil metabolism, which alone or in combination with peroxidase further induce oxygen-mediated Damage, destruction of cells, eosinophils can also produce a variety of factors that cause inflammation and fibrosis such as transforming growth factor alpha and beta (TGF-, TGF-), tumor necrosis factor alpha (TNF-), macrophages Cellular inflammatory protein 1 (MIP-1), IL-1, IL-6 and IL-8, etc., patients with eosinophilic syndrome have a neutralized IL-5 antibody. IL-5-like substances can prolong the survival of eosinophils. These combined factors cause organ damage, and the most prominent organs are damaged by the heart, resulting in thrombosis and fibrosis.

Eosinophils accumulate in the heart and adhere to the endocardium or cardiac microvascular endothelium by binding to ICAM-1, ICAM-2, VCAM, E-Selectin and P-selectin. The cationic protein of eosinophil particles can be deposited in the heart. Membrane and myocardium, eosinophil-derived oxidized groups can destroy the endothelium, and its cationic protein MBP can activate platelets, which enhances blood coagulability. The eosinophilic activity of patients with eosinophilia is enhanced, and it is easy to cause thrombosis. Formation, deep vein thrombosis is rare, and endocardial, venule and retinal vein thrombosis is more common, eosinophil cationic protein can stimulate fibroblast proliferation, inhibit fibroblasts degradation of protein aminopolysaccharide, eosinophils The secretion of TGF- and TGF- by cells promotes fibroblast proliferation and extracellular matrix deposition, respectively, further fibrosis of cells, and no cardiac damage such as eosinophilic gastroenteritis and eosinophilic pneumonia. The reason is unclear.

Eosinophil cationic protein, eosinophil-derived neurotoxin can cause damage to the nervous system.

Eosinophilia prevention

At present, there is no relevant information, but it can be prevented in the diet, and at the same time, the patient needs to take certain vitamins.

Eosinophilic complications Complications, asthma, urticaria

Different causes can cause different complications such as asthma, urticaria, and sore dermatitis.

Symptoms of eosinophilia Common symptoms Exfoliative dermatitis herpes joint swelling pain abdominal pain skin itching eczema

Different causes, its clinical manifestations are different, can be expressed as fever, bronchial asthma, urticaria, angioedema, abdominal pain, eczema, exfoliative dermatitis, herpes-like dermatitis, pemphigus, psoriasis, red pityriasis, scales Hemorrhoids, itchy skin, pigmentation, joint swelling and pain.

Examination of eosinophilia

Peripheral eosinophils accounted for >4% of white blood cell counts and an absolute value of >0.45×109/L.

According to clinical manifestations, symptoms, signs combined with medical history, you can choose anti-camping antibodies, anti-DNA, anti-ENA serological examination, bone biopsy, electrocardiogram, X-ray, B-ultrasound, CT, MRI and other tests.

Diagnosis and identification of eosinophilia

Peripheral blood eosinophils can increase the absolute value of the disease to diagnose the disease. The key lies in the diagnosis of the cause. It is necessary to conduct a detailed and comprehensive examination to determine the primary disease. Patients who are not sure about the diagnosis should be followed up regularly.

For the identification of the cause of the disease, detailed and comprehensive medical history should be asked. For example, if you have traveled to a worm-infected area, you should consider parasitic infections such as schistosomiasis; manifest as gasping, rhinitis or eczema suggesting variability; frequent contact with pet dogs , to exclude canine aphid infection; pay attention to the presence or absence of tumor symptoms, signs; pay attention to medication history, to rule out allergic reactions to drugs, drug-induced eosinophilia, generally with the withdrawal of drugs, but in In some cases, such as eosinophil-myalgia syndrome caused by the intake of contaminated tryptophan, the disease persists despite the discontinuation of medication, abnormal eosinophil morphology, bone marrow or peripheral blood. Increased mature cells, or abnormal karyotypes, suggest that eosinophilic leukemia, accumulation of eosinophils, infiltration is limited to specific organs, is a characteristic of special diseases, such as eosinophilic cellulitis (Well syndrome) ), eosinophilic pneumonia, and eosinophilic fasciitis, eosinophilia combined with vasculitis, neurological disease and asthma history, suggesting Churg-Strauss Levy, increased in patients with moderate to severe eosinophilia, if no clear cause, while another organ damage, should be considered in conjunction with hypereosinophilic syndrome (HES).

Patients with moderate to severe eosinophil counts and persistently mild increases should undergo morphological examination of blood smears, urine analysis and a series of stool eggs and parasite examinations for roundworms, etc. The diagnosis of parasites sometimes requires serological tests. Bone marrow, chromosome analysis and tissue biopsy can be selected according to the condition.

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