Role of Eosinophilsin parasitic Infections

Eosinophilia; a pronounced increase of eosinophils in the blood or tissues; occurs in numerous important circumstances; like allergic diseases; parasitic infections; and cancer. Helminthic parasites are usually the common parasitic infections witch cause eosinophilia apart from two enteric protozoans; Isospora belli and Dientamoeba fragilis. Infection with helminthes parasites produces immune effector responses and in a reaction to various stimuli; eosinophils are recruited from the circulation into inflammatory foci; where they modulate immune responses via sequences of mechanisms. The defence against organisms that are too large to be phagocytosed; particularly parasitic helminthes seems to be the primary role of eosinophils. In this article; we will discuss some of the biological features of eosinophils and their role in parasitic infections

Síndrome DRESS inducido por fármacos antituberculosos en un paciente con diabetes mellitus tipo 2 / Antituberculous drugs-induced DRESS syndrome in a patient with type 2 diabetes mellitus

Presentamos el caso de un paciente varón de 48 años de edad, con diagnóstico de diabetes mellitus tipo 2, no controlada, de diez años de evolución, a quien se le diagnosticó tuberculosis pulmonar mediante signos clínicos, radiográficos y cultivo en esputo positivo para Mycobacterium tuberculosis, sensible a drogas antituberculosas de primera línea. Recibió isoniacida, rifampicina, etambutol y pirazinamida. Dos meses después de iniciado el tratamiento presentó hipersensibilidad a medicamentos, con los siguientes signos y síntomas: rash dérmico generalizado, prurito generalizado, anemia Coombs positiva, eosinofilia y síntomas sistémicos, compatibles con el síndrome DRESS (drug rash with eosinophilia and systemic symptoms). Ante ello, se suspendió la medicación antituberculosa y se instaló tratamiento con antihistamínicos y corticoides sistémicos, con remisión y mejoría de síntomas. Posteriormente, recibió un esquema individualizado de tratamiento para tuberculosis consistente en medicamentos mínimamente hemato-hepatotóxicos, similar al indicado en pacientes inmunosuprimidos. Desde entonces presenta baciloscopias negativas.

A case of a 48 year-old male with uncontrolled type 2 diabetes mellitus for the past ten years who presented pulmonary tuberculosis by clinical, radiographic signs and Mycobacterium tuberculosis sputum culture, sensitive to first line treatment drugs, is reported. He received standard treatment with isoniazid, rifampicin, ethambutol, pyrazinamide showing two months later drug hypersensitivity consisting in generalized skin rash, pruritus, positive Coombs anemia, eosinophilia and systemic symptoms compatible with DRESS syndrome (drug rash with eosinophilia and systemic symptoms). The antituberculous drugs were suspended and systemic antihistaminic drugs and corticoids were administered with remission and improvement of symptoms. Afterwards individualized treatment scheme for tuberculosis consisting in minimal hemato-hepatotoxic drugs similar to those indicated to immunosuppressed patients was indicated. Baciloscopies have been negative since.

Insuficiência respiratória aguda como manifestação da síndrome de eosinofilia-mialgia associada à ingestão de L-triptofano / Acute respiratory failure as a manifestation of eosinophilia-myalgia syndrome associated with L-tryptophan intake

A síndrome da eosinofilia-mialgia foi descrita em 1989 em pacientes que apresentavam mialgia progressiva e incapacitante e eosinofilia sérica, nos líquidos e secreções. A maioria dos pacientes relatava uso prévio de L-triptofano. Sintomas respiratórios são relatados em até 80 por cento dos casos, eventualmente como manifestação única. O tratamento inclui suspensão da droga e corticoterapia. Relatamos o caso de uma mulher de 61 anos com insuficiência respiratória aguda após uso de L-triptofano, hidroxitriptofano e outras drogas. A paciente apresentava eosinofilia no sangue, lavado broncoalveolar e derrame pleural. Após a suspensão da medicação e corticoterapia, houve melhora clínica e radiológica em poucos dias.

Eosinophilia-myalgia syndrome was described in 1989 in patients who presented progressive and incapacitating myalgia and eosinophilia in blood, fluids and secretions. Most patients report previous L-tryptophan intake. Respiratory manifestations are found in up to 80 percent of the cases, occasionally as the only manifestation. Treatment includes drug discontinuation and administration of corticosteroids. Here, we describe the case of a 61-year-old female admitted with acute respiratory failure after using L-tryptophan, hydroxytryptophan and other drugs. The patient presented eosinophilia, together with elevated eosinophil counts in the bronchoalveolar lavage and pleural effusion. After discontinuation of the drugs previously used, corticosteroids were administered, resulting in clinical and radiological improvement within just a few days.

A Case of Hypercapnic Respiratory Failurein a Patient with Eosinophilic Polymyositis / 대한류마티스학회지

Eosinophilic infiltration into skeletal muscles has been rarely reported in a variety of conditions such as parasite infection, sarcoidosis, rheumatoid arthritis, eosinophilia-myalgia syndrome, and idiopathic hypereosinophilic syndrome. Eosinophilic myositis (EM) is one of idiopathic inflammatory muscle diseases associated with muscle and/or blood eosiophilia. The case of EM complicated with hypercapnic respiratory failure has been extremely rarely reported. A 61-year-old woman was admitted with sudden-onset pain in both calves. She had elevated serum muscle enzymes and peripheral eosinophil count. Findings of electromyography were consistent with inflammatory myopathy. MRI showed diffuse hyperintensity of calf muscles on T2-weighted and enhanced T1 images. Muscle biopsy showed eosinophils' infiltration in the endomysium and perivascular area. During the diagnostic work-up, she presented with hypercapnic respiratory failure. She was successfully treated with mechanical ventilation and high doses of prednisolone. This case suggests EM can cause respiratory failure secondary to respiratory muscle involvement.

Eosinofilia: las 215 causas mas frecuentes / Eosinofilia: the 215 more frequent causes

Para la clasificación de la eosinofilia se tienen en cuenta varios parámetros, el más utilizado es el recuento de eosinófilos; la cual la clasifica en leve, moderada y severa, también se ha utilizado para la clasificación el mecanismo de producción, que la divide en clonal y no clonal y el grado de infiltración de tejidos, que la clasifica en tisular, medular y periférica; todas estas han sido realizadas de manera arbitraria. Teniendo en cuenta; las diferentes causas de clasificación, se encuentra la eosinofilia clonal, como una manifestación neoplásica derivada de las células madres CD34, y la eosinofilia no clonal como una manifestación reactiva inducida por mecanismos relacionados a las enfermedades con las cuales se encuentran asociadas; entre estas están, las enfermedades infecciosas; en este grupo sobresalen las infestaciones parasitarias como la causa más frecuente, las enfermedades alérgicas; en particular las reacciones de hipersensibilidad tipo I, las enfermedades inmunológicas no alérgicas; que son divididas en tres grupos; enfermedades autoinmunes órgano-específicas, órgano-inespecíficas y las inmunodeficiencias, encontramos también las asociadas a cáncer; de las cuales se hará mención a las más frecuentes, las alteraciones endocrinas y metabólicas; en donde la insuficiencia suprarrenal en pacientes infectados por el virus de la inmunodeficiencia humana es la que más reporte tiene, las de origen farmacológico y los trastornos idiopáticos; en el que entra el síndrome hipereosinofílico, como un conjunto de trastornos heterogéneos que se definen por un recuento de eosinófilos superior a 1.500 por mm3 por más de seis meses, con compromiso de órganos blancos y exclusión de otras posibles causas de eosinofilia y otros casos de eosinofilia más raros como la eosinofilia familiar y la eosinofilia idiopática adquirida. Es importante recordar que independiente de la causa y del nivel de eosinófilos, el paciente tiene el derecho al diagnóstico y tratamiento...

A case of idiopathic eosinophilia-myalgia syndrome / 대한내과학회지

We report the case of a 47-year-old female who developed idiopathic eosinophilia-myalgia syndrome following complete remission of non-Hodgkin's lymphoma. She had been diagnosed extranodal marginal zone B cell lymphoma of nasal cavity and treated with CHOP chemotherapy and radiotherapy. She complained fever, myalgia and the complete blood count showed markedly elevated eosinophil count. Non-Hodgkin's lymphoma was confirmed in complete remission state by PNS CT, nasal septum biopsy and bone marrow biopsy. The patient showed eosinophilia in peripheral blood, myositis in electromyography and muscle biopsy consistent with eosinophilia-myalgia syndrome. The symptoms were improved and the eosinophilia count was decreased after prednisolone medication. We report a case of idiopathic eosinophilia-myalgia syndrome with a review of the literature.

Eosinophilia-Myalgia Syndrome not Associated with the Ingestion of Nutritional Supplements

Eosinophilia-myalgia syndrome(EMS) is a systemic illness that occurred as an epidemic by ingestion of over-the counter L-tryptophan preparation in the United States in October 1989. We report a Korean case of EMS not associated with the ingestion of either L-tryptophan or other nutritional supplements such as lysine and niacin.

A Case of Eosinphilia-Myalgia Syndrome / 대한류마티스학회지

Eosinophilia-myalgia syndrome (EMS) is a multisystemic disorder characterized by severe myalgia and peripheral eosinophilia, and frequently accompanied by fasciitis, neuropathy and various cutaneous manifestations associated with consumption of L-tryptophan. Although EMS has not been uncommon in the United States, it has not been reported in Korea. We experienced a 28-year-old man who presented with severe myalgia, peripheral eosinophilia, right upper extremity motor weakness developed during ingestion of L-tryptophan containing food. He was diagnosed as EMS based on the diagnostic criteria by the Centers for Disease Control. His symptoms and laboratory findings including severe myalgia and eosinophilia rapidly improved after steroid treatment. To our knowledge, this is the first case report of EMS developed in L-tryprophan users in Korea. We report a case of EMS with a review of literature.

The Eosinophilia-Myalgia Syndrome not Associated with L-tryptophan: A case report

We report a case of clinical features corresponding to Eosinophilia-Myalgia syndrome, with no causal relationship with L-tryptophan. Since the epidemic of L-tryptophan associated Eosinoghilia-Myalgia Syndrome in 1989, only 2% of the cases were found not to be related to L-tryptophan in America. We believe that this is the first case report of Eosinophilin-Myalgia Syndrome not related to L-tryptophan in Korea.

Central Nervous System Involvement in Eosinophilia-Myalgia Syndrome Associated with L-tryptophan Ingestion: A case report

We report a case of Eosinophilia- Myalgia syndrome with central nervous system (CNS) involvement following ingestion of the essential amino acid, tryptophan. The Eosinophilia- Myalgia syndrome can be diagnosed when there is a severe myalgia and peripheral eosinophilia in the absence of other diseases causing eosinophilia. This condition has been associated with the ingestion of the tryptophan in many cases, but the amount and duration of ingestion have been yet to be elucidated. Although many cases have been reported, few cases involved the CNS. We present a 28 year- old male who complained of a severe myalgia and disorientation after taking the taken tryptophan for 2 weeks. Thorough examination revealed the peripheral eosinophilia, vasculitis on brain MRI, abnormal VEP, and muscle atrophy on muscle biopsy. Symptoms improved with the steroid pulse after discontinuation of the tryptophan.

Triptofano y su uso en medicina / Medical uses of tryptophan

Ha habido importantes avances en el conocimiento del metabolismo del triptofano, la síntesis de serotonina y los receptores serotoninérgicos encefálicos. Se ha determinado la efectividad terapéutica del 5-hidroxitriptofano en la depresión, insomnio, dolor crónico, mioclonías, etc. Eso sí, ha surgido inquietud al establecerse, como efecto adverso del tratamiento con L-triptofano, la producción del síndrome de mialgia-eosinofilia con compromiso importante de las fuerzas debido a una polineuropatía