Serum eosinophil cationic protein: a marker of disease activity in Churg-Strauss syndrome.

The cytotoxic proteins released by activated eosinophils should play a role in the development of Churg-Strauss syndrome (CSS). Eighteen patients (15 males and 3 females, age 41 +/- 13.3 years) with CSS according to the American College of Rheumatology criteria were included in the study. Thirteen serum samples from 11 patients were obtained at the time of disease flare, and the sera from 6 of them were also obtained at the time of clinical remission. Sera from seven other patients were obtained in clinical remission. Anti-neutrophil cytoplasm antibodies were detected in four (22.2%) patients. Fifteen healthy individuals were used as controls. Mean eosinophil count differed significantly between CSS patients with active disease and patients in clinical remission (3,407/mm(3) vs. 258/mm(3); P < 0.01), between CSS patients with active disease and healthy individuals (3,407/mm(3) vs. 211/mm(3); P < 0.01). Mean serum ECP levels differed significantly between patients with active or inactive disease (219 microg/L vs. 56.8 microg/L; P < 0.0001), between patients with active disease and healthy individuals (219 microg/L vs. 26.2 microg/L; P < 0.0001), but not between patients with inactive disease and healthy individuals (ns). Peripheral blood eosinophils count correlated with serum ECP during CSS flares disease (R = 0.6264; P < 0.05) and during periods of remission (R = 0.4798; P < 0.05). Our results support that ECP might be used as a disease activity marker in CSS.

[Management of blood eosinophilia in an outpatient clinic for tropical diseases]. / Prise en charge des hyperéosinophilies sanguines dans une consultation de maladies tropicales.

OBJECTIVE: We assessed the frequency of parasitic diseases and the efficacy of presumptive treatment when no cause was found. MATERIALS AND METHODS: This prospective study took place in the Tropical Disease department of Bicêtre Hospital over a two-year period and included patients with eosinophil counts exceeding 500/mm(3). RESULTS: The study included 117 patients with blood eosinophilia. A parasitic infection was identified for 48 (41%), and appropriate treatment resulted in a return to normal eosinophil counts for all of them. No parasite was identified in 45 patients (38.5%), but parasitic disease was suspected on the basis of clinical or epidemiologic evidence. These patients received presumptive treatment with antiparasitic drugs (ivermectin, albendazole and praziquantel, alone or in combination). Of the 30 patients in this group not lost to follow-up, eosinophil counts returned to normal for 20. Finally, a cause other than parasitosis was suspected for 15 of the 117 patients (13%): 9 (7.5%) of them were lost to follow-up. DISCUSSION: Parasites remain the leading cause of blood eosinophilia. Because the sensitivity of additional testing for these parasites is low and these antiparasitic drugs are safe (except for patients with loiasis), presumptive treatment appears appropriate.