Low Expression of ICAM-1 in Blood Eosinophils in Patients With Active Eosinophilic Esophagitis.

BACKGROUND AND OBJECTIVE: Eosinophilic esophagitis (EoE) is a chronic and isolated inflammation of the esophagus characterized by a marked infiltration of eosinophilic leukocytes. Diagnosis and course of the disease are based exclusively on histopathology. Therefore, patients must undergo several esophageal biopsies, implying a risk associated with the procedure and considerable use of resources. Objective: The presence of active circulating eosinophils, which are quantifiable through the expression of specific cellular activation proteins in their membrane, could be consistent with histopathological findings, which are currently the only valid parameters in studies on EoE. METHODS: The activity of peripheral blood eosinophils from patients with EoE was analyzed by identifying 5 surface molecules (CD69, IL- 5Rα, CD44, ICAM-1, CD63), which are seen to be expressed by the active eosinophils in flow cytometry. The results were compared with the infiltrate of eosinophils present in patients' esophageal biopsies. RESULTS: ICAM-1 levels decreased significantly in patients with active EoE compared with nonactive EoE patients, allergic patients, and healthy controls. In patients with EoE, an inverse correlation was observed between the number of eosinophils in the esophageal biopsy and the percentage of ICAM-1 expression in peripheral blood eosinophils. No differences were observed for the remaining molecules studied. CONCLUSION: Expression of ICAM-1 in blood eosinophils could be a useful noninvasive marker for the diagnosis and assessment of patients with EoE.

Low Expression of ICAM-1 in Blood Eosinophils in Patients With Active Eosinophilic Esophagitis

Background: Eosinophilic esophagitis (EoE) is a chronic and isolated inflammation of the esophagus characterized by a marked infiltration of eosinophilic leukocytes. Diagnosis and course of the disease are based exclusively on histopathology. Therefore, patients must undergo several esophageal biopsies, implying a risk associated with the procedure and considerable use of resources. Objective: The presence of active circulating eosinophils, which are quantifiable through the expression of specific cellular activation proteins in their membrane, could be consistent with histopathological findings, which are currently the only valid parameters in studies on EoE. Methods: The activity of peripheral blood eosinophils from patients with EoE was analyzed by identifying 5 surface molecules (CD69, IL- 5Rα, CD44, ICAM-1, CD63), which are seen to be expressed by the active eosinophils in flow cytometry. The results were compared with the infiltrate of eosinophils present in patients’ esophageal biopsies. Results: ICAM-1 levels decreased significantly in patients with active EoE compared with nonactive EoE patients, allergic patients, and healthy controls. In patients with EoE, an inverse correlation was observed between the number of eosinophils in the esophageal biopsy and the percentage of ICAM-1 expression in peripheral blood eosinophils. No differences were observed for the remaining molecules studied. Conclusion: Expression of ICAM-1 in blood eosinophils could be a useful noninvasive marker for the diagnosis and assessment of patients with EoE (AU)

Hematemesis secundaria a alergia a proteínas de leche de vaca / Hematemesis induced by cow milk allergy

Introducción: La hematemesis es un proceso pocofrecuente en periodo de lactante, con diferentesetiologías como esofagitis por reflujo, ingesta deAINES, etc. La hematemesis por gastritis alérgica aproteínas de la leche de vaca (GAPLV) es una entidadrara cuya frecuencia va en aumento.Material y métodos: Análisis retrospectivo de lascaracterísticas clínicas, hallazgos endoscópicos yevolución de los lactantes diagnosticados deGAPLV que debutaron con hematemesis.Resultados: Se estudian 7 pacientes (4 niñas),edad media 4,2 meses (2-6). 6 se diagnosticaron enel periodo oct/04-nov/05. Todos referían historia devómitos previa al diagnóstico. El tiempo medio entrela introducción de la fórmula de inicio y el episodiode hematemesis fue de 9 semanas (4-15). Al diagnóstico5 pacientes tenían un peso inferior al paciente3. Se realizó endoscopia digestiva en todoslos niños observándose placas eritematosas en lamucosa gástrica en 5, con erosiones y petequias enlos otros 2. El examen histológico de la mucosamostró infiltrado inflamatorio mixto con aumento delnúmero de eosinófilos. El número de eosinófilos fueinferior a 20 por campo de gran aumento. El estudiode anticuerpos específicos frente a proteínas de lechede vaca (PLV) fue negativo en cinco y en dos seidentificó una sensibilización frente a caseína que senegativizó en la evolución. Ningún paciente presentabaeosinofilia periférica. La respuesta clínica a laexclusión de PLV y realimentación con hidrolizadoextenso de proteínas fue excelente, desapareciendola clínica y normalizándose la curva ponderal.Comentarios: En el diagnóstico diferencial de lahematemesis en el lactante debe valorarse la alergiaa proteínas de leche de vaca. La ausencia deespecificidad de las pruebas diagnósticas séricas yde los hallazgos endoscópicos hace que el diagnósticosea fundamentalmente clínico, con desapariciónde los síntomas tras la exclusión de las proteínas dela leche de vaca de la dieta

Background: Hematemesis is an uncommon entityin infant present several etiologies such as refluxesophagitis, gastritis due to NSAIDs,etc. Hematemesisinduced by cow milk allergy is rare, but increasingin the last years.Material and methods: Restrospectively clinicalcharts analysis endoscopic findings, histology andevolution of hematemesis due to cow’s milkallergy.Results: Seven infants were analized (4 girls). Sixof them were between October 2004 and November2005. The other one in 2000. All patients refered vomitingprevious hematemesis. Time after startingcow milk formulas and bloody vomiting was 9 weeks(4-15). At the time of diagnosis, five patients had lowweight (< 3th percentile). Upper gastrointestinal endoscopywas performed in all patiens showing areasof erythema in the gastric mucosa with erosion intwo infants. Histopathologic examination of biopsyspecimen revealed mixed inflammatory infiltrate withnumerous eosinophils. The number was < 20 perhigh-power field. Plasma measurement of cow milkspecific IgE was negative except in two children withsensibilitation to caseína, that disappear in evolution.Eosinophilia in hemogram was not observed.After diagnosis cow milk protein formula was excluded,replacing it with hidrolized formula. The result was total remission of symptoms and nutricional recovery.Comments: When realizing hematemesis differentialdiagnostic to infants, cow milk allergy must beconsidered. Laboratory test and endoscopic imagesare inespecific so the diagnosis relies on clinicalsuspicion and the cessation of symptoms after withdrawalof cow milk formula

Infectious agents associated with diarrhoea of calves in the canton of Tilarán, Costa Rica.

A case-control study of calves under 3 months of age was carried out by weekly visits to 15 farms in the canton of Tilarán, Costa Rica. Most farms were dedicated to beef or dual-purpose (DP) production. Faecal samples were collected over a 6-month period from a total of 194 calves with clinical signs and from 186 animals without clinical signs of diarrhoea as assessed by a scoring system. The samples were investigated for the presence of viruses, bacteria and parasites. Torovirus was detected for the first time in Costa Rica and was present in 14% of calves with diarrhoea and in 6% of the controls. Coronavirus and Rotavirus were less frequently encountered in either one of the groups (in 9 and 7% of scouring calves and in 1 and 2% of controls, respectively). Escherichia coli was detected in 94% of all the faecal samples, but isolates from only three samples from calves with diarrhoea contained the K99 antigen. Similarly, Salmonella was found only in scouring calves. Cryptosporidium oocysts were detected in animals with signs of diarrhoea, while other coccidia oocysts, Strongylida and Strongyloides eggs were frequently found in animals both with and without diarrhoea. A conditional logistic regression (CLR) analysis to compare healthy and scouring calves showed a significant difference with regard to the presence of Torovirus, Rotavirus and Coronavirus.