Cytologic distinctions between clinical groups using curette-probe compared to cytology brush.

BACKGROUND: We had previously used curette-probe (Rhinoprobe; Arlington Scientific, Springville, UT) to study nasal cytology in various types of patients. Because of the potential sampling ease of using a brush, we sought to compare cytological results obtained with a curette-probe with those obtained using a cytology brush (Cytobrush Plus; Medscand, Malmö, Sweden). OBJECTIVE: To compare the ability of samples of nasal leukocytes obtained with a curette-probe versus a cytology brush to distinguish clinical categories of patients attending an allergy clinic. METHODS: Adult allergy clinic patients were studied by both curette-probe and cytology brush sampling. Quantitation of eosinophils and total leukocytes was performed on samples. Comparisons of cell quantities for each sampling method were made in patients classified into clinical groups. Patients with rhinitis complaints and abnormalities of nasal mucosal appearance with or without aeroallergy were compared with other patients. The adjustment of leukocyte quantities for the numbers of epithelial cells observed was also analyzed. Sampling methods were also compared for receiver operating characteristics. RESULTS: Curette-probe sample leukocyte quantities distinguished patients with symptoms of rhinitis (SR) with abnormal nasal appearance from other patients. This between-group distinction was more significant for leukocyte numbers normalized for the number of epithelial cells. SR patients with both abnormal nasal appearance and aeroallergy had significantly more eosinophils and less goblet cells than other patients. Greater than five curette-probe eosinophils were only observed in patients with SR. Brush samples did not show differences between patients stratified in these ways, and eosinophils were observed in patients without SR. Receiver operating characteristics favored curette-probe samples in terms of leukocyte or eosinophil increases characterizing their respective symptomatic patient subgroups. CONCLUSIONS: Curette-probe-obtained nasal samples allow for leukocyte and eosinophil quantitations which characterize rhinitis patients better than brush-obtained samples. Total leukocyte quantitations obtained by curette-probe may represent a marker of inflammatory nasal disease in adults undergoing allergy evaluation and treatment for rhinitis.

Changes in nasal leukocytes and epithelial cells associated with topical beclomethasone treatment.

BACKGROUND: We had previously observed that changes in nasal cytology were associated with specific clinical patterns in cross-sectional studies of allergy clinic patients. In the present study, we sought to determine whether specific cytologic changes occurred with antiinflammatory therapy in a controlled setting in a prospective manner. OBJECTIVE: To examine changes in nasal leukocytes and epithelial cells associated with topical beclomethasone treatment in allergic rhinitis patients. Specifically we tested the hypothesis that number of nasal leukocytes relative to epithelial cell numbers are altered by topical beclomethasone treatment. METHODS: Adult volunteers (n=26) with symptoms consistent with allergic rhinitis and positive aeroallergen skin tests were enrolled for treatment with either beclomethasone or placebo nasal spray. Sprays were allocated in a double-blind manner and were prescribed to be administered over a 2-week period. Baseline quality of life, nasal cytograms, and mucosal physical appearance scores were obtained at baseline and at the end of the treatment period. Changes in various nasal leukocytes and epithelial cell types were analyzed for association with active treatment using bivariate and multivariate analysis. RESULTS: Total leukocytes showed greater decreases with beclomethasone treatment than with placebo. Total epithelial cells on the other hand showed an increase with active treatment compared with placebo treatment. In multivariate analysis, the changes in both total leukocytes and total epithelial cells showed independent associations with beclomethasone treatment. Combining these two variables into a single leukocyte per epithelial ratio resulted in variable with values showing a significant decreases associated with beclomethasone treatment compared with placebo treatment (P = .03). CONCLUSIONS: The administration of topical corticosteroids results in decreases in total leukocytes and this decrease is of enhanced significance when adjusted for the quantities of associated epithelial cells. Further investigation relating to the quantities of total nasal leukocytes in inflammatory nasal diseases may be helpful in gauging disease activity and monitoring treatment modalities.

Clinical predictors of nasal secretory cell quantities in allergy clinic patients.

BACKGROUND: Nasal cytograms are useful in evaluating patients with inflammatory disease of the nose and paranasal sinuses. When mucosal samples are taken with curette and brush devices, significant numbers of non-leukocytic cells can also be analyzed. OBJECTIVE: To examine two specific morphologic variations in granule-containing epithelial cells in nasal samples obtained from allergy clinic patients and describe their clinical associations. These two cellular variants consisted of goblet cells, with coalesced granules usually displacing the nucleus, and discrete granular mucinous cells (DGMC), which show more discrete granules not displacing the nucleus. METHODS: Patients from an adult allergy clinic were studied prospectively for nasal mucosal cytology, historical clinical data, nasal physical findings, serum IgE levels, and aeroallergen-specific IgE. Proportions and absolute numbers of goblet cells and DGMC in the nasal mucosal samples were related to other data using simple and multivariate analyses. RESULTS: Both goblet cells and DGMC showed absolute number increases in patients with observable nasal secretions. Discrete granular mucinous cell decreases were also observed in patients with IgE levels greater than or equal to 200 IU/mL and in asthmatic patients. In non-asthmatic patients with nasal eosinophilia, a significantly greater proportion of DGMC was observed compared with other patients (19.8 +/- 11.9% versus 8.5 +/- 5.9%, P = .007), while asthmatics with nasal eosinophilia had mean DGMC quantities closer to that observed in patients without nasal eosinophilia. Increases in goblet cell numbers were observed in patients with specific IgE to aeroallergens compared with other patients (46.5 +/- 46.7 versus 27.0 +/- 23.9, P = .014). Multivariate analysis confirmed that (1) the presence of aeroallergen-specific IgE and (2) the presence of nasal eosinophilia in the absence of asthma were differentially associated with increases in goblet cells and DGMC, respectively. CONCLUSIONS: Increases in nasal DGMC and goblet cells differentially relate to specific clinical patterns of nasal cellular inflammation and aeroallergen hypersensitivity. The nasal epithelial cell profile associated with nasal eosinophilia in asthmatics may differ from that observed in non-asthmatic nasal eosinophilia.

Patterns of nasal eosinophilia in allergy clinic patients as determined by swab and curette sampling.

The presence of eosinophils in nasal secretions often characterizes inflammatory disease in the nose and paranasal sinuses. This study analyzed differential associations between various clinical parameters and the presence of nasal eosinophilia in mucosal specimens obtained by two sampling methods (swab and curette-probe). Nasal mucosal secretions were obtained in patients attending an adult allergy clinic using both sampling methods for each patient. The presence of eosinophilia as determined by both methods had significant associations with 1) nasal mucosal pallor, 2) younger age, and 3) the presence of basophilic cells. To examine diagnostic characteristics of the two sampling methods of determining eosinophilia as a characteristic of allergic rhinitis, receiver operating characteristic (ROC) curves were evaluated for patients categorized as having allergic rhinitis on the basis of elevated aero-allergen specific IgE, and rhinitis based on either a) significant nasal mucosal appearance abnormalities, or b) a referring physician's diagnosis of rhinitis. The curette-probe determined nasal eosinophil quantitations had greater areas under the ROC curves when rhinitis was defined on the basis of mucosal appearance. On the other hand, the swab determined eosinophil quantitations had greater ROC curve areas when rhinitis was defined on the basis of referring diagnosis. In summary, nasal eosinophilia determined by curette or swab sampling has differences in strengths of their clinical associations.

Hypocomplementaemic urticarial vasculitis, interstitial lung disease and hepatitis C.

A 42-year-old man developed persistent urticaria and angio-oedema responsive to systemic steroids. A skin biopsy revealed leucocytoclastic vasculitis. C4 levels were consistently decreased in the setting of a mildly elevated erythrocyte sedimentation rate. Pulmonary function studies revealed a restrictive pattern, and there was eosinophilia in bronchial lavage fluid. Antibody to hepatitis C virus was positive, and there was mild elevation of serum aminotransferase. We believe that this case represents another possible manifestation of immunological disease associated with hepatitis C virus infection.

Lack of evidence for craniofacial dysmorphism in perinatal human immunodeficiency virus infection.

Thirty children perinatally exposed to human immunodeficiency virus (HIV) infection and 30 healthy control subjects matched for age, sex, and race were evaluated for growth, head size, craniofacial dysmorphism, dermatoglyphics, and other physical features. Thirteen patients met the criteria for group IV (constitutional, neurologic, and secondary infectious diseases), 14 for group III (persistent generalized lymphadenopathy or hepatosplenomegaly), and three for group II (asymptomatic infection) of the classification of HIV infection established by the Centers for Disease Control, Atlanta. Postnatal growth failure and microcephaly, observed in a significant proportion of patients (46.7% and 30%, respectively), could be attributed to chronic illnesses and to progressive central nervous system lesions in HIV-infected patients. There were however, no significant differences between patients and controls with regard to the incidence of craniofacial features and dermatoglyphics, and the incidence of other anomalies was not different from that expected in the population. The patients born to drug-using mothers were not different from those born to non-drug-using mothers in relation to the studied criteria. We could not confirm the presence of characteristic craniofacial dysmorphism in children exposed to perinatal HIV infection.

Pediatric human immunodeficiency virus infection and its cutaneous manifestations.

Acquired immunodeficiency syndrome was first observed in children in 1982. Human immunodeficiency virus (HIV) is now known to be the etiologic agent of this disease complex. Children acquire the viral infection in utero or perinatally, or by receiving contaminated blood products. The cutaneous manifestations include persistent oral thrush, herpes simplex, herpes zoster, molluscum contagiosum, and a variety of fungal and bacterial skin infections. Vasculitis, unusual drug eruptions, and cutaneous manifestations of nutritional deficiencies are also seen.