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DDx of eosinophilia on peripheral blood film

Churg-Strauss syndrome

  • this rare chronic vasculitis can be diagnosed on basis of having 4 of the following 6 conditions with 99% specificity2)
    • asthma
    • blood eosinophilia > 10%
    • paranasal sinus abnormality
    • mononeuropathy or polyneuropathy
    • non fixed pulmonary infiltrates
    • histological evidence of extravascular eosinophils
  • 1st and 2nd stages of allergies, sinus problems and asthma may precede stage 3 by many years
  • stage 3 includes multi-organ involvement such as severe nerve pain in their legs, arms and hands, renal impairment, etc.
  • associated with elevations of p-ANCA (whereas Wegener's granulomatosis is associated with c-ANCA)

eosinophilia in the returned traveller

  • incidence in returned travellers from the tropics is ~5%
  • it is suggestive of parasite infection such as a helminth infection although the absence of eosinophilia does not exclude helminth infection as less than half have eosinophilia

common helminth infections from the tropics

initial Ix

  • three stool examinations for ova, cysts and parasites to detect the more common gastrointestinal helminths, whose eggs may be excreted intermittently
  • any macroscopically visible worms (likely to be ascarids or tapeworm) should be sent for laboratory identification
  • specific serological testing is available for schistosomiasis, strongyloidiasis, filariasis, echinococcosis, toxocariasis and angio-strongyliasis

empirical Rx of presumed helminth infection

  • start Rx after stool collections
  • options include mebendazole, pyrantel and albendazole although of these, only albendazole is useful for strongyloidiasis, tapeworm infection or schistosomiasis.
eosinophilia.txt · Last modified: 2019/08/08 15:13 by

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