Understand a high eosinophilia of peripheral blood which can be combined or alternate with a fabric (organ) eosinophilia as the big eosinophilias of blood which are found at certain diseases and syndromes, it is accepted to carry states at which the percent of eosinophils in peripheral blood reaches 15 and above to big eosinophilias of blood.
Epidemiology Among diseases at which there are big eosinophilias of blood the greatest place is taken by parasitic diseases, especially migratory stage of an ascaridosis, a strongyloidosis in migratory and intestinal stages, a fascioliasis, trichinosis, an opisthorchosis, a lambliasis, helminthic invasions, migration in a human body of larvae of cat's and dog ascarids. Also hyper eosinophilic reactions of medicinal genesis are widespread. They accompany the course of immunodeficiency, some diseases (bronchial asthma, collagenoses, tumors, etc.) and eosinophilias proceed in the form of organ.
Etiology and pathogeny Among big eosinophilias of blood the leading place is taken by hypereosinophilia of reactive character. There is an opinion that their pathogeny is connected with influence of the special factor, hemotaksichesky for eosinophils, produced at some parasitic diseases and tumors. Its action at parasitic diseases can be shown in the presence of serum, antibody-containing to antigen of the biological structures allocating a chemotactic factor or to be result of a direct impact at patients with lymphocytic and not lymphocytic tumors.
Eosinophilic reactions at a medicinal allergy and some immunodeficiency are caused by influence of a chemotactic factor which is allocated with mast cells at their damage to IgE. Believe that the hypereosinophilia is also connected with fermental activity of eosinophils. Allergic genesis of a medicinal hypereosinophilia takes place at use of antibiotics, acetylsalicylic acid, streptocides, an Euphyllinum, Dimedrol and other medicines,
Classification Distinguish eosinophilias at the parasitic diseases caused by medicines at malignant tumors, bronchial asthma, immunodeficiency, collagenoses from big eosinophilias of blood and organ eosinophilias.
Approximate formulation of the diagnosis: Big eosinophilias against an ascaridosis, proceeding with fever, a skin itch, muscle and joints pains, increase in blood of quantity of leukocytes and eosinophils.
Clinic Among many diseases proceeding with a hypereosinophilia parasitic diseases, especially meet more often when the parasite or his larva, having been in contact with the patient's tissues, are in a migratory stage. From anamnestic data pay attention to accommodation or stay of the patient in areas of a zone ochagovost of certain parasites, the use in food of a crude liver, the crude or insufficiently processed fresh-water fish.
The skin itch, the rashes like small tortoiseshell migrating a joint pain and muscles, cough with department of a "canary" phlegm, temperature increase can occur at patients with parasitic diseases.
The syndrome of a tropical eosinophilia is considered as one of filariasis forms (the person can catch larvae of dog or monkey filarias). This syndrome proceeds with sharply expressed hypereosinophilia reaching 75 — 90%, a considerable leukocytosis, the asthmatic phenomena, pulmonary infiltrates, the high IgE level in blood serum.
The medicinal allergy caused by many medical drugs often proceeds with an eosinophilia of the peripheral blood which is quite often combined with damage of skin. It can precede development of eosinophilic infiltrates in various bodies. There are data that acetylsalicylic acid promotes increase of an eosinophilia and emergence of attacks of bronchial asthma.
The expressed eosinophilia of peripheral blood is observed at malignant tumors, including hemoblastoses (acute leukoses, a myelosis, malignant lymphoma, etc.), sometimes as the first symptom of a disease. It is noted that at the patient operated concerning a lymphoma of a head or spinal cord in 24 h after its removal the high eosinophilia of peripheral blood disappeared, however it arose again at a recurrent tumor.
The high eosinophilia at bronchial asthma quite often is the symptom preceding development of a nodular periarteritis, it is observed at immunodeficiency. Against an immunodeficiency staphylococcal and pneumocystic infections can provoke an eosinophilia.
The considerable eosinophilia of peripheral blood can accompany a current of separate forms of kollagenoz and, first of all classical forms — a nodular periarthritis and a pseudorheumatism. At these patients hypodermic small knots, pleural or plevroperikardialny changes, damage of heart and lungs come to light.
Frequent localization of an organ eosinophilia are lungs that is probably connected with high content in them the mast cells cooperating with eosinophils in an immune response (eosinophilic pulmonary infiltrates, eosinophilic pneumonia and granulomas, vasculites of various etiology). The pleural eosinophilia is observed at pleurisy of various etiology, a thicket at malignant new growths, combined with an eosinophilia of peripheral blood approximately in half of cases, with an eosinophilia in marrow at all patients.
Damages of a myocardium meet an eosinophilia of peripheral blood in the form of diffusion forms and focal eosinophilic infiltrates. The diffusion eosinophilic infiltration of bodies of a digestive tract with a high eosinophilia of blood is a rarity. Eosinophilias of peripheral blood at damages of skin are observed — violent and herpetiform dermatitis, universal eczema, a pempigus and pemphigoid. At the last two diseases in liquid of bubbles eosinophils, an eosinophilic chemotactic factor come to light.
Verification of the diagnosis Big eosinophilias of blood demand a specification of the nosological forms and syndromes which are followed by a high eosinophilia of peripheral blood and a fabric eosinophilia which as it was already noted, can be combined or alternate. Data on the sizes of peripheral lymph nodes, a liver and spleen, a condition of heart and lungs, existence of hypodermic and intradermal educations are for this purpose necessary; results of parasitological researches (repeated duodenal sounding and research calla, serological researches); studying of a miyelogramma, bioptat of the increased lymph nodes; research of protein fractions and the IgE level in blood serum; radiological studying of a condition of lungs and digestive tract, etc.
Treatment The patient with big eosinophilias of blood carries out adequate therapy concerning a basic disease. Now the clinic has the highly effective means which are applied at parasitic diseases. Giperzozinofiliya of peripheral blood of a medicinal origin is the absolute indication to drug withdrawal, it caused.