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1.
Infect Dis Poverty ; 9(1): 16, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32029005

RESUMO

BACKGROUND: Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa. The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid, Spain. METHODS: A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid, Spain, a reference center, over 19 years. Categorical variables were expressed as frequency counts and percentages. Continuous variables were expressed as the mean and standard deviation (SD) or median and interquartile range (IQR: Q3-Q1). Chi-square tests were used to assess the association between categorical variables. The measured outcomes were expressed as the odds ratio (OR) with a 95% confidential interval. Continuous variables were compared by Student's t-tests or Mann-Whitney U tests. Binary logistic regression models were used. P <  0.05 was considered a statistically significant difference. RESULTS: One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified. Forty-nine patients were male (37.4%). The migrants' mean age (±SD) was 42.3 ± 17.3 years, and 124 (94.7%) were from Equatorial Guinea. The median time (IQR) between arrival in Spain and the first consultation was 2 (1-7) months. One hundred fifteen migrants had eosinophilia, and one hundred thirteen had hyper-IgE syndrome. Fifty-seven patients had pruritus (43.5%), and thirty patients had Calabar swelling (22.9%). Seventy-three patients had coinfections with other filarial nematodes (54.2%), and 58 migrants had only Loa loa infections (45.8%). One hundred two patients (77.9%) were treated; 45.1% (46/102) patients were treated with one drug, and 54.9% (56/102) patients were treated with combined therapy. Adverse reactions were described in 14 (10.7%) migrants. CONCLUSIONS: Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. However, considering that 72.5% of the patients had only positive microfilaremia without any symptoms, we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.


Assuntos
Loíase/epidemiologia , Adulto , Idoso , Anti-Helmínticos/uso terapêutico , Eosinofilia/diagnóstico , Eosinofilia/epidemiologia , Eosinofilia/etiologia , Guiné Equatorial/etnologia , Feminino , Humanos , Loíase/diagnóstico , Loíase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Migrantes , Adulto Jovem
2.
Med Clin North Am ; 104(1): 1-14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757229

RESUMO

Physicians may encounter blood or tissue eosinophilia through a routine complete blood count with differential or a tissue pathology report. In this article, the basic biology of eosinophils is reviewed and definitions of blood eosinophilia, as well as the challenges of defining tissue eosinophilia, are discussed. Conditions associated with eosinophilia are briefly discussed as well as a general approach to evaluating eosinophilia. Future challenges include determining which eosinophil-associated diseases benefit from eosinophil-targeted therapy and identifying biomarkers for disease activity and diagnosis.


Assuntos
Eosinofilia/diagnóstico , Eosinófilos/metabolismo , Biomarcadores/sangue , Eosinofilia/sangue , Eosinofilia/etiologia , Humanos , Contagem de Leucócitos , Índice de Gravidade de Doença
3.
An Bras Dermatol ; 94(6): 724-728, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789265

RESUMO

Eosinophilic spongiosis is a histological feature shared by some distinct inflammatory disorders, and is characterized by the presence of intraepidermal eosinophils associated with spongiosis. Most often, isolated eosinophilic spongiosis indicates the early stages of a subjacent autoimmune bullous dermatosis, such as the pemphigus group and bullous pemphigoid. Herein, the main causes of eosinophilic spongiosis are discussed, as well as the supplementary investigation needed to elucidate its etiology.


Assuntos
Eosinofilia/diagnóstico , Eosinofilia/patologia , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/patologia , Diagnóstico Diferencial , Epiderme/patologia , Técnica Direta de Fluorescência para Anticorpo , Humanos
4.
Korean J Gastroenterol ; 74(3): 163-167, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554032

RESUMO

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm3) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Influenza Humana/diagnóstico , Adulto , Antivirais/uso terapêutico , Ascite , Colonoscopia , Ciclopentanos/uso terapêutico , Enterite/tratamento farmacológico , Enterite/etiologia , Eosinofilia/tratamento farmacológico , Eosinofilia/etiologia , Eosinófilos/citologia , Feminino , Gastrite/tratamento farmacológico , Gastrite/etiologia , Guanidinas/uso terapêutico , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X
6.
Nihon Shokakibyo Gakkai Zasshi ; 116(8): 668-675, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31406072

RESUMO

Eosinophilic gastroenteritis is a rare disease that causes various abdominal symptoms that result from the infiltration of eosinophils in the digestive tract. However, this condition has been poorly explored, and the treatment criteria and prognosis after treatment are still unclear. A 20-year-old man with a refractory duodenal ulcer had been undergoing treatment since 14 years of age at another hospital. He was admitted to our hospital with abdominal pain and anemia (hemoglobin:6.3g/dL). His blood test showed elevated serum immunoglobulin E levels, considering that he was allergic to many foods. Furthermore, endoscopic biopsy detected the occurrence of eosinophilic gastroenteritis with gastritis, duodenal ulcer, and colitis. We treated him by avoiding allergenic foods and prescribing antihistamine and vonoprazan;however, duodenal ulcer and gastrointestinal tract inflammation did not show improvement. Thus, he was diagnosed with wide-ranging and refractory eosinophilic gastroenteritis and treated with 40mg/day of steroids. After 2 months, he recovered from gastritis and duodenal ulcer, and his eosinophil level decreased, as assessed using endoscopic biopsy. Eosinophilic gastroenteritis is poorly investigated, and its treatment standards have not yet been determined. Nonetheless, steroid treatment is often applied in severe cases.


Assuntos
Colite/diagnóstico , Úlcera Duodenal/diagnóstico , Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Adulto , Humanos , Masculino , Adulto Jovem
9.
Medicine (Baltimore) ; 98(28): e16382, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305439

RESUMO

RATIONALE: Type I monoclonal cryoglobulinemia is usually associated with lymphoproliferative disorders, such as monoclonal gammopathy of undetermined significance (MGUS), myeloma, chronic lymphocytic leukemia (CLL) and lymphoplasmocytic lymphoma (LPL). Clinical symptoms related to Type I cryoglobulin (CG) isotype often include skin, neurological and renal manifestations. PATIENT CONCERNS: A 42-year-old woman who initially presented urticaria, palpable purpura in both her upper extremities and legs, eosinophilia and Raynaud phenomenon. Skin biopsy revealed eosinophil infiltration. Monoclonal immunoglobulin (Ig) G-κprotein was detected and CG was also positive. DIAGNOSES: The patient was finally diagnosed as MGUS related Type I CG. INTERVENTIONS: Cyclophosphamide-dexamethasone-thalidomide (CDT) therapy was initiated. OUTCOMES: The treatment relieved the skin symptoms efficiently. LESSONS: To our knowledge, this is a rare case of Type I cryoglobulinemic vasulitis with eosinophilia complicated by MGUS, and the effective treatment of cyclophosphamide combined with thalidomide and prednisone may provide a new therapeutic option for cryoglobulinemic vasulitis.


Assuntos
Crioglobulinemia/complicações , Eosinofilia/complicações , Gamopatia Monoclonal de Significância Indeterminada/complicações , Vasculite/complicações , Adulto , Crioglobulinemia/diagnóstico , Crioglobulinemia/tratamento farmacológico , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Feminino , Humanos , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Gamopatia Monoclonal de Significância Indeterminada/tratamento farmacológico , Vasculite/diagnóstico , Vasculite/tratamento farmacológico
10.
Intern Med ; 58(20): 3045-3050, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31243203

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by asthma, eosinophilia, and diffuse eosinophilic infiltration. Although cardiovascular involvement is common and a leading cause of EGPA-related mortality, severe pericarditis-led cardiac tamponade occurs rarely. We herein report a 72-year-old man with anti-proteinase 3 (anti-PR3) anti-neutrophil cytoplasmic antibody (ANCA)-positive EGPA diagnosed by the presence of cardiac tamponade, which responded quickly to pericardiocentesis and a single administration of prednisolone. This is the first case of anti-PR3 ANCA-positive EGPA with cardiac tamponade; the patient displayed clinical features of both ANCA-positive and ANCA-negative cases.


Assuntos
Tamponamento Cardíaco/etiologia , Eosinofilia/complicações , Granulomatose com Poliangiite/complicações , Mieloblastina/imunologia , Idoso , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Tamponamento Cardíaco/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Eosinofilia/diagnóstico , Eosinofilia/metabolismo , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/metabolismo , Humanos , Masculino , Mieloblastina/metabolismo , Tomografia Computadorizada por Raios X
11.
Intern Med ; 58(20): 3051-3055, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31243218

RESUMO

A 45-year-old man was admitted with acute abdominal pain and eosinophilia. Abdominal computed tomography revealed thickness of the ascending and transverse colon with decreased contrast enhancement and a small amount of ascites. In an emergency operation, the necrotic colon was resected. Histopathology showed subserous medium-sized arteritis with abundant eosinophil infiltrates and thrombosis in the portal vein branches. He was diagnosed with polyarteritis nodosa (PAN), and immunosuppressive therapy improved his condition. Two years later, the disease recurred with ischemic cutaneous lesions and marked eosinophilia. Our experience suggests that marked eosinophilia in PAN may imply severe organ involvement, including gastrointestinal necrosis, as well as the association of venous thrombosis.


Assuntos
Eosinofilia/diagnóstico , Gastroenteropatias/etiologia , Poliarterite Nodosa/diagnóstico , Trombose Venosa/etiologia , Eosinofilia/complicações , Gastroenteropatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Poliarterite Nodosa/complicações , Recidiva , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico
12.
Dtsch Med Wochenschr ; 144(13): 893-896, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31252443

RESUMO

Eosinophilic Gastrointestinal Disease (EGID) is a rare disease of largely unknown etiology. We describe a case of a 79-year-old patient with the initial diagnosis of eosinophilic gastritis with a haemorrhagic-ulcerous course and a rapid recurrence of the disease after discontinuing drug therapy. ANAMNESIS AND CLINICAL FINDINGS: The patient stated that he had melena for several days. He was completely asymptomatic. The existing medication has not been changed lately. EXAMINATIONS AND DIAGNOSIS: Gastroscopy, endosonography and CT scan revealed a tumor suspicious for malignancy in the corpus ventriculi. Histopathological examination revealed the correct diagnosis. THERAPY AND COURSE: The patient was treated with prednisolone and PPI. This led to a regression of the findings and a complete clinical remission. A treatment-free interval led to a fulminant recurrence with again upper GI bleeding. After resumption of drug therapy, the detected gastric ulcer rapidly declined. CONCLUSION: EGID is hardly distinguishable from classic gastroenteritis in its clinical appearance. Diagnosis requires a histopathological examination of the affected tissue. Oral glucocorticoids play a role in the treatment of acute EGID. Both single episodes and chronic recurrent courses have been observed. The drugs used for therapy should therefore be discontinued carefully.


Assuntos
Enterite , Eosinofilia , Gastrite , Hemorragia Gastrointestinal , Úlcera Gástrica , Idoso , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Enterite/complicações , Enterite/diagnóstico , Eosinofilia/complicações , Eosinofilia/diagnóstico , Gastrite/complicações , Gastrite/diagnóstico , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Melena , Prednisolona/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Recidiva , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/etiologia
13.
Ital J Pediatr ; 45(1): 69, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171002

RESUMO

BACKGROUND: Eosinophilic gastrointestinal disorders (EGID) are characterized by eosinophilic inflammation and are subclassified according to the affected site(s) as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. Clinical presentation includes dyspeptic symptoms, vomiting, abdominal pain, diarrhoea and gastrointestinal bleeding. Peripheral eosinophilia is usually found but is not required for the diagnosis. The treatment is based on dietary elimination therapy, consisting of removal of common food triggers, most frequently cow's milk in infants. Corticosteroids are used as first line drug therapy in EG if dietary therapy fails to achieve an adequate clinical response or is impractical. CASE PRESENTATION: A four month old infant was admitted for an episode of melena and hematemesis. An esophagogastroduodenoscopy showed haemorrhagic gastritis with ulcerative lesions and fibrin. A significant gastric bleeding was noted after the procedure. The gastric mucosa biopsies showed an eosinophilic infiltration. CONCLUSIONS: A clinically relevant anaemia is a quite rare complication in infants with eosinophilic gastritis and a biopsy may worsen bleeding, to a potentially severe level of low haemoglobin. In infants with low haemoglobin levels and suspect eosinophilic gastritis a watchful follow up after the biopsy should be considered, as well as the possibility of postponing the biopsy to reduce the bleeding risk.


Assuntos
Anemia/etiologia , Biópsia/efeitos adversos , Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente
15.
Artigo em Inglês | MEDLINE | ID: mdl-31114180

RESUMO

Background: There are currently limited real-world data on the clinical burden of illness in patients with COPD who continue to exacerbate despite receiving triple therapy. The aim of this study was to compare the burden of COPD in patients with and without a phenotype characterized by a high blood eosinophil count and high risk of exacerbations while receiving triple therapy. Methods: This retrospective cohort study (GSK ID: 207323/PRJ2647) used UK Clinical Practice Research Datalink records linked with Hospital Episode Statistics. Eligible patients had a COPD medical diagnosis code recorded between January 1, 2004 and December 31, 2014, and a blood eosinophil count recorded on/after that date. Patients were followed from index date (first qualifying blood eosinophil count) until December 31, 2015. The study phenotype was defined as ≥2 moderate/≥1 severe acute exacerbation of COPD (AECOPD) in the year prior to the index date, current use of multiple-inhaler triple therapy (MITT), and blood eosinophil count ≥150 cells/µL on the index date. Outcomes measured during follow-up included moderate/severe AECOPDs, severe AECOPDs, all-cause mortality, primary care (GP) clinical consultations, and non-AECOPD-related unscheduled hospitalizations. Results: Of 46,814 patients eligible for inclusion, 2512 (5.4%) met the definition of the study phenotype. Adjusted rate ratios (95% CI) of moderate/severe AECOPDs and all-cause mortality in patients with the study phenotype versus those without were 2.32 (2.22, 2.43) and 1.26 (1.16, 1.37), respectively. For GP visits and non-AECOPD-related unscheduled hospitalizations, adjusted rate ratios (95% CI), in patients with the study phenotype versus those without, were 1.09 (1.05, 1.12) and 1.31 (1.18, 1.46), respectively. Conclusion: Patients with COPD and raised blood eosinophil counts who continue to exacerbate despite MITT represent a distinct subgroup who experience substantial clinical burden and account for high healthcare expenditure. There is a need for more effective management and therapeutic options for these patients.


Assuntos
Corticosteroides/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Broncodilatadores/administração & dosagem , Efeitos Psicossociais da Doença , Eosinofilia/sangue , Eosinófilos , Antagonistas Muscarínicos/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Progressão da Doença , Quimioterapia Combinada , Eosinofilia/diagnóstico , Eosinofilia/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Fenótipo , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Reino Unido/epidemiologia
17.
Internist (Berl) ; 60(9): 973-981, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31123761

RESUMO

Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Eosinofilia/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Adulto , Biópsia , Eosinofilia/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Miocardite/patologia
20.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133546

RESUMO

A 31-year-old woman experienced tetany and was diagnosed with Hashimoto thyroiditis and hypoparathyroidism. At 33 years of age, her renal function gradually decreased. At 39 years of age, she moved to our hospital and was diagnosed with tubulointerstitial nephritis by renal biopsy. Simultaneously, she was diagnosed with Sjögren's syndrome by autoantibodies and salivary gland biopsy. At 40 years of age, based on hypoglycaemia and eosinophilia, she was suspected of adrenal insufficiency, and was diagnosed with primary adrenal insufficiency by both corticotropin stimulation and corticotropin-releasing hormone stimulation test. She was diagnosed as autoimmune polyglandular syndrome (APS) (Hashimoto thyroiditis and possible primary adrenal insufficiency) as well as primary hypoparathyroidism and Sjögren's syndrome, which are very rarely complicated in APS-2. Therefore, in this patient, it was helpful to pay attention for new onset of other autoimmune diseases.


Assuntos
Insuficiência Adrenal/diagnóstico , Doença de Hashimoto/diagnóstico , Hipoparatireoidismo/complicações , Poliendocrinopatias Autoimunes/diagnóstico , Síndrome de Sjogren/complicações , Insuficiência Adrenal/sangue , Insuficiência Adrenal/imunologia , Adulto , Autoanticorpos/sangue , Doenças Autoimunes , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Hipoparatireoidismo/diagnóstico , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/etiologia , Poliendocrinopatias Autoimunes/imunologia , Doenças Raras , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/imunologia
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