413 results on '"Pulmonary Eosinophilia complications"'
Search Results
2. Case Report: Allergic Bronchopulmonary Aspergillosis and Tropical Pulmonary Eosinophilia Co-Occurrence Masquerading as Refractory Allergic Bronchopulmonary Aspergillosis.
- Author
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Singh M, Peter DK, Gupta S, Rani V V, and Singh S
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- Male, Humans, Eosinophils, Aspergillosis, Allergic Bronchopulmonary complications, Aspergillosis, Allergic Bronchopulmonary diagnosis, Aspergillosis, Allergic Bronchopulmonary drug therapy, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Pulmonary Eosinophilia drug therapy, Asthma complications, Asthma diagnosis
- Abstract
Pulmonary infiltrates with eosinophilia are a heterogeneous group of disorders that are characterized by pulmonary infiltrates on chest radiograph and elevated levels of eosinophils in the peripheral blood. Among patients with these disorders, reports of either allergic bronchopulmonary aspergillosis (ABPA) or tropical pulmonary eosinophilia (TPE) are common. However, the simultaneous occurrence of ABPA and TPE is not often reported. We present the case of a young man with a history of asthma who was diagnosed with ABPA and TPE. Initially, the patient exhibited a partial response to treatment of ABPA, but persistent symptoms and eosinophilia led to suspicion and subsequent diagnosis of TPE. With implementation of antifilarials and steroids, the patient experienced satisfactory clinical and serological improvements. This case underscores the importance of considering multiple diagnoses in patients with overlapping symptoms and highlights the need for comprehensive management strategies in complex lung diseases.
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- 2024
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3. Monoclonal antibodies in idiopathic chronic eosinophilic pneumonia: a scoping review.
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Murillo AD, Castrillon AI, Serrano CD, and Fernandez-Trujillo L
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- Adult, Humans, Child, Antibodies, Monoclonal therapeutic use, Quality of Life, Retrospective Studies, Neoplasm Recurrence, Local, Steroids therapeutic use, Recurrence, Pulmonary Eosinophilia drug therapy, Pulmonary Eosinophilia complications, Asthma complications
- Abstract
Background: Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disease characterized by pulmonary radiological alterations, peripheral eosinophilia, and demonstrated pulmonary eosinophilia. Oral steroids (OSs) are the standard management, but relapses occur in up to 50% of patients during the decrease or suspension of steroids, usually requiring reinitiation of treatment, exposing patients to secondary events derived from the management. Management with monoclonal antibodies has been proposed in these cases to control the disease and limit the secondary effects. The objective is to describe the extent and type of evidence regarding the use of monoclonal antibodies for ICEP., Methods: A panoramic review of the literature was performed. Observational and experimental studies of pediatric and adult populations that managed recurrent ICEP with monoclonal antibodies were included. Data search, selection, and extraction were performed by two independent reviewers., Results: 937 studies were found. After applying the inclusion and exclusion criteria, 37 titles remained for the final analysis: a retrospective, observational, real-life study, two case series publications, and 34 case reports published in academic poster sessions and letters to the editor. In general, the use of monoclonal antibodies approved for severe asthma could be useful for the control of ICEP, since most of the results show a good response for clinical and radiological outcomes. Biological drugs seem to be a safer option for controlling relapses in ICEP, allowing lowering/suspension of OSs, and sometimes replacing them in patients intolerant to them, patients with significant comorbidities, and patients who have already developed adverse events., Conclusion: The extent of the evidence supporting management of ICEP with monoclonal antibodies against IL-5 and IgE (omalizumab) is limited, but it could be promising in patients who present frequent relapses, in cortico-dependent individuals, or in patients in whom the use of steroids is contraindicated. The extent of the evidence for management with dupilumab is more limited. Studies with better design and structure are needed to evaluate quality of life and outcomes during a clear follow-up period. To our knowledge, this is the first scoping review of the literature showing the extent of the evidence for the management of ICEP with monoclonal antibodies., (© 2024. The Author(s).)
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- 2024
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4. Dupilumab suppresses relapsing chronic eosinophilic pneumonia with severe asthma.
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Masumoto N, Oshikata C, Nakadegawa R, Motobayashi Y, Osada R, Manabe S, Kaneko T, and Tsurikisawa N
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- Humans, Female, Adolescent, Adult, Prednisolone therapeutic use, Chronic Disease, Recurrence, Fluticasone-Salmeterol Drug Combination therapeutic use, Pulmonary Eosinophilia drug therapy, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Churg-Strauss Syndrome complications, Churg-Strauss Syndrome drug therapy, Granulomatosis with Polyangiitis complications, Asthma drug therapy, Asthma complications
- Abstract
Dupilumab-induced hypereosinophilia is mediated by blockade of the IL-4/IL-13 pathway, which reduces eosinophil migration from peripheral blood. The increase in peripheral blood eosinophils may lead to chronic eosinophilic pneumonia (CEP) and/or eosinophilic granulomatosis with polyangiitis, but a direct causal connection between dupilumab and eosinophilic lung diseases has not been established. A 33-year-old Japanese woman with bronchial asthma since age three was treated with fluticasone propionate plus salmeterol twice daily after several asthma exacerbations at age 17. Her course was complicated by CEP at age 33 which resolved without the need for systemic steroids. However, in the four months following resolution of her CEP, the patient had three asthma exacerbations, and a recurrence of CEP, with blood leukocytes of 8500/µL, of which 25.0% were eosinophils. She was treated with prednisolone 50 mg/day, but she could not continue this dose due to the onset of myalgia. Then she had relapsing CEP twice within three months. She was treated with prednisolone 15 mg/day for CEP, but she had persistent asthma for more than one month; dupilumab was added at 600 mg, followed by 300 mg every two weeks. In the first month of treatment with dupilumab, the patient's asthma symptoms resolved completely, and she had only one relapse of CEP. In 12 months of follow-up, she had neither an asthma exacerbation nor another relapse of CEP. Dupilumab may be a promising treatment for patients with refractory asthma complicated by recurring CEP and undesirable steroid side effects., Competing Interests: No author has any conflict of interest to disclose.
- Published
- 2023
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5. A case of bullous pemphigoid developing under treatment with benralizumab for bronchial asthma.
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Tanaka A, Fujimura Y, Fuke S, Izumi K, and Ujiie H
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- Humans, Blister, Antibodies, Monoclonal therapeutic use, Prednisolone therapeutic use, Pemphigoid, Bullous chemically induced, Pemphigoid, Bullous drug therapy, Pemphigoid, Bullous complications, Asthma drug therapy, Pulmonary Eosinophilia complications
- Abstract
Bullous pemphigoid (BP) is an autoimmune disease characterized by itchy erythema and tense blisters on the whole body. Recent reports have unveiled the pathogenic roles of eosinophils in BP (e.g., dermal-epidermal separation, generation of pruritus). Thus, eosinophils are considered a therapeutic target. Benralizumab is an anti-IL-5 receptor alpha (IL-5Rα) monoclonal antibody (mAb) that is widely used to treat severe eosinophilic asthma. By affecting IL-5Rα, benralizumab depletes eosinophils and basophils due to apoptosis through antibody-dependent cell-mediated cytotoxicity. The efficacies of benralizumab and other biologics, including bertilimumab (anti-eotaxin-1 mAb) and mepolizumab (anti-IL-5 mAb), were evaluated in several clinical trials. Also, reslizumab, an anti-IL-5 mAb, was reported as a successful treatment option in a case of BP. We present a case of severe asthma treated with benralizumab at 8-week intervals for 3 years before BP developed. Histologically, subepidermal blisters without eosinophilic infiltration were observed. Methylprednisolone pulse therapy followed by 40 mg/day (1 mg/kg/day) of oral prednisolone (PSL) was initiated, but the skin lesions worsened. Additional intravenous immunoglobulin and oral azathioprine enabled the oral PSL to be tapered. The benralizumab was discontinued after the onset of BP because the asthma did not worsen. To the best of our knowledge, there have been no reports of BP developing during anti-eosinophil therapy. BP may occur paradoxically via various pathways during treatment with drugs that are typically effective against BP., (© 2023 Japanese Dermatological Association.)
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- 2023
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6. The clinical features of asthma exacerbations in early-onset and eosinophilic late-onset asthma may differ significantly.
- Author
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Rothe T, von Garnier C, Bridevaux PO, Charbonnier F, Clarenbach C, Gianella P, Jochmann A, Kern L, Nikolay P, Steurer-Stey C, and Leuppi JD
- Subjects
- Adult, Humans, Asthma complications, Asthma epidemiology, Asthma drug therapy, Pulmonary Eosinophilia complications, Anti-Asthmatic Agents therapeutic use
- Abstract
Over 20 years ago, the concept of asthma control was created and appropriate measurement tools were developed and validated. Loss of asthma control can lead to an exacerbation. Years ago, the term "clinically significant asthma exacerbation" was introduced to define when a loss of control is severe enough to declare it an asthma exacerbation. This term is also used by health insurances to determine when an exacerbation is eligible for reimbursement of biologics in clinical practice, however, it sometimes becomes apparent that a clear separation between loss of "asthma control" and an exacerbation is not always possible. In this review, we attempt to justify why exacerbations in early allergic asthma and adult eosinophilic asthma can differ significantly and why this is important in clinical practice as well as when dealing with health insurers., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2023
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7. Prevalence of eosinophilic, atopic, and overlap phenotypes among patients with severe asthma in Saudi Arabia: a cross-sectional study.
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Al-Jahdali H, Wali S, Albanna AS, Allehebi R, Al-Matar H, Fattouh M, and Beekman M
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- Adrenal Cortex Hormones therapeutic use, Adult, Aged, Asthma drug therapy, Asthma epidemiology, Cross-Sectional Studies, Female, Humans, Hypersensitivity, Immediate epidemiology, Male, Middle Aged, Prevalence, Pulmonary Eosinophilia epidemiology, Saudi Arabia epidemiology, Severity of Illness Index, Asthma complications, Hypersensitivity, Immediate complications, Phenotype, Pulmonary Eosinophilia complications
- Abstract
Background: Eosinophilia is a significant factor in asthma severity; however, the prevalence of severe eosinophilic asthma in Saudi Arabia is largely unknown. We aimed to determine the prevalence of the eosinophilic (defined in this study as ≥ 300 cells/mm
3 in blood), atopic (atopic phenotype 1, defined in this study as > 100 IU/mL total serum IgE; atopic phenotype 2, defined in this study as > 150 IU/mL), and overlap phenotypes among patients with severe asthma in Saudi Arabia., Methods: A cross-sectional study was conducted in centers specialized in severe asthma management. Patients aged ≥ 12 years with severe asthma were enrolled. Study patients responded to the Global Initiative for Asthma 2018 assessment of asthma control questionnaire and provided study investigators with current information related to the study objectives. Additional medical record data and a blood sample for total serum IgE and complete blood count were collected., Results: A total of 101 patients were enrolled; 83% were female and the mean (standard deviation) age was 48.7 (13.2) years. Forty-five (45%) patients had the eosinophilic phenotype, 50 (50%) had atopic phenotype 1, and 25 (25%) had phenotypic overlap (eosinophilic and atopic 1). Forty-one (41%) patients had atopic phenotype 2 and 23 (23%) had phenotypic overlap (eosinophilic and atopic 2). Asthma control and oral corticosteroid use patterns were similar and there were no significant differences in number of asthma exacerbations across phenotypes., Conclusions: In Saudi Arabia, 45% of patients with severe asthma had the eosinophilic phenotype, which is most likely an underestimation as no clinical features of eosinophilia were taken into account in the definition of eosinophilia. Approximately half of them had phenotypic overlap with the atopic phenotype. Trial registration NCT03931954; ClinicalTrials.gov, April 30, 2019., (© 2022. The Author(s).)- Published
- 2022
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8. Severe eosinophilic asthma in Chinese C-BIOPRED asthma cohort.
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Zhang Q, Fu X, Wang C, Shen H, Zhu L, Shi G, Qiu Z, Wen Z, Gu W, Luo W, Zhao L, Chen Y, Lim S, Xiao C, Kang J, Zhang Y, Huang M, Xu J, Huang K, Li Q, Zhang X, Zhao J, Liu X, Sun S, Tang H, He B, Cai S, Chen P, Wei C, Wang G, Chen P, Xie L, Lin J, Tang Y, Han Z, Chung KF, and Zhong N
- Subjects
- Adult, Asthma classification, Asthma epidemiology, China epidemiology, Cohort Studies, Female, Humans, Male, Middle Aged, Pulmonary Eosinophilia diagnosis, Pulmonary Eosinophilia epidemiology, Surveys and Questionnaires, Asthma diagnosis, Pulmonary Eosinophilia complications
- Published
- 2022
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9. SARS-CoV-2 as a trigger of eosinophilic pneumonia.
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Araújo M, Correia S, Lima AL, Costa M, and Neves I
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- Adrenal Cortex Hormones therapeutic use, COVID-19 diagnosis, COVID-19 Nucleic Acid Testing, Cough etiology, Fever etiology, Humans, Male, Middle Aged, Myalgia etiology, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia drug therapy, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, Tomography, X-Ray Computed, COVID-19 complications, Lung diagnostic imaging, Pulmonary Eosinophilia diagnosis
- Abstract
Competing Interests: Conflicts of interest The authors have no conflict of interest to declare.
- Published
- 2022
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10. Diagnostic possibility of the combination of exhaled nitric oxide and blood eosinophil count for eosinophilic asthma.
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Li JH, Han R, Wang YB, Cheng M, Chen HY, Lei WH, Li L, Gao C, Zhao NN, Nie NF, Li ZY, Yin GQ, Huang S, and He Y
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- Adult, Asthma blood, Asthma complications, Cohort Studies, Female, Humans, Leukocyte Count, Male, Middle Aged, Pulmonary Eosinophilia complications, Retrospective Studies, Asthma diagnosis, Eosinophils, Fractional Exhaled Nitric Oxide Testing
- Abstract
Background: Tests to identify reversible airflow limitation are important in asthma diagnosis, but they are time-consuming and it may be difficult for patients to cooperate. We aimed to evaluate whether the combination of fractional exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) can be used to distinguish some asthma patients who could avoid objective tests., Methods: We conducted a retrospective cohort study on 7463 suspected asthma cases between January 2014 and December 2019 in Chongqing, China, and identified 2349 patients with complete FeNO, B-Eos count, and spirometry data. Asthma was diagnosed by clinicians by the criteria of recurrent respiratory symptoms and a positive bronchial-provocation or bronchodilation test (BPT, BPD). We evaluated the diagnostic accuracy of FeNO or B-Eos alone or both in combination for asthma using receiver operating characteristic (ROC) curve analysis., Results: In this study, 824 patients were diagnosed with asthma. When FeNO and B-Eos counts were used in combination, the area under the ROC curve (AUC) for diagnosing asthma increased slightly (0.768 vs. 0.745 [FeNO] or 0.728 [B-Eos]; both P < 0.001). The odds ratio for having asthma increased progressively with a gradual increase in FeNO or B-Eos count (both P < 0.001; assessed using the Cochran-Armitage trend test). Further analysis of in-series combinations of different threshold values for these biomarkers indicated that moderately elevated biomarker levels (FeNO > 40 ppb and B-Eos > 300 cells/μl) support a diagnosis of asthma because diagnostic specificity was > 95% and the positive likelihood ratio (PLR) was > 10. This conclusion was verified when selecting the 2017-2019 data as the internal validation dataset., Conclusion: FeNO or B-Eos count alone is insufficient to accurately diagnose asthma. Patients with moderately elevated biomarkers (FeNO > 40 ppb and B-Eos > 300 cells/μl) could be diagnosed with asthma and avoid objective tests when such tests are not feasible., (© 2021. The Author(s).)
- Published
- 2021
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11. Eosinophilic annular erythema associated with eosinophilic pneumonia and asthma.
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Yanagihara S, Oiso N, and Kawada A
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- Erythema etiology, Humans, Asthma complications, Asthma diagnosis, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Skin Diseases, Genetic
- Published
- 2021
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12. Chronic eosinophilic pneumonitis due to the inhalation of aerosolized face lotion: A case report.
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Shimoda M, Morimoto K, Tanaka Y, Takemura T, Oka T, Yoshimori K, and Ken O
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- Adult, Female, Hemorrhage complications, Humans, Lung Diseases complications, Pulmonary Alveoli pathology, Pulmonary Eosinophilia complications, Aerosols adverse effects, Pulmonary Eosinophilia chemically induced, Skin Cream adverse effects
- Abstract
Rationale: Inhalation of toxic agents can induce eosinophilic pneumonia. However, only a few case reports demonstrate that exposure to materials can induce chronic eosinophilic pneumonia (CEP). Here, we describe a rare case of CEP with mild alveolar hemorrhage due to the inhalation of aerosols from face lotion. This is the first report of eosinophilic pneumonia caused by face lotion exposure., Patient Concerns: A 39-year-old woman was admitted to our hospital with cough and dyspnea for 2 months, which coincided when she started to use a new aerosolized face lotion. Laboratory findings showed high blood eosinophil levels, and chest computed tomography (CT) scans revealed bilateral peripheral consolidation and ground-glass opacity mainly in the left upper lobe. She underwent flexible bronchoscopy. Eosinophils in bronchoalveolar lavage fluid (BALF) were slightly elevated, and the gross appearance of BALF was bloody. The histological examination of the transbronchial lung biopsy showed infiltration of eosinophils and macrophages in alveolar septa with edema and without vasculitis and granuloma formation; a small number of hemosiderin-laden macrophages were also observed. An inhalation challenge test involving the face lotion was performed. Six hours after the test, the blood test showed an increased white blood cell (WBC) count, and chest radiography showed slight exacerbation. Forced vital capacity decreased the following day., Diagnosis: According to histological analysis and positive result of an inhalation challenge test, she was diagnosed with CEP with mild alveolar hemorrhage due to inhalation of aerosols from the face lotion., Interventions and Outcomes: She gradually improved without medication after stopping the use of face lotion., Lessons: To the best of our knowledge, this is the first report of CEP with mild alveolar hemorrhage due to the inhalation of face lotion. Various inhaled agents, such as face lotion, can induce CEP in rare cases., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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13. Diffuse alveolar haemorrhage in the setting of eosinophilic pneumonia.
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Ladzinski AT, Mehta A, Dykstra BJ, and Sharghi SM
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- Aged, Female, Hemoptysis etiology, Hemorrhage etiology, Humans, Lung, Lung Diseases, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Pulmonary Eosinophilia drug therapy
- Abstract
A 65-year-old woman who presented with a constellation of symptoms, including cough with haemoptysis, fever, chills and hypoxia along with weight loss, was found to have diffuse alveolar haemorrhage. After a myriad of investigations returned normal, an open lung biopsy was performed, which revealed the diagnosis to be subacute eosinophilic pneumonia. This is one of its kind of rare presentations where eosinophilic pneumonia presents as diffuse alveolar haemorrhage and has been reported only five times prior to this., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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14. Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma.
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Carpagnano GE, Resta E, Povero M, Pelaia C, D'Amato M, Crimi N, Scichilone N, Scioscia G, Resta O, Calabrese C, Pelaia G, and Barbaro MPF
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- Aged, Anti-Asthmatic Agents economics, Antibodies, Monoclonal, Humanized economics, Asthma complications, Asthma economics, Female, Humans, Male, Middle Aged, Omalizumab economics, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia economics, Retrospective Studies, Anti-Asthmatic Agents therapeutic use, Antibodies, Monoclonal, Humanized therapeutic use, Asthma drug therapy, Omalizumab therapeutic use, Pulmonary Eosinophilia drug therapy
- Abstract
Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS), which worsen patients' health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab (OMA) to mepolizumab (MEP) in patients eligible for both biologics, but not optimally controlled by omalizumab. We retrospectively enrolled uncontrolled severe asthmatic patients who switched from OMA to MEP during the last two years. Information included blood eosinophil count, asthma control test (ACT), spirometry, serum IgE, fractional exhaled nitric oxide (FeNO), OCS intake, drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-MEP 12-month standardized total cost per patient was calculated. 33 patients were enrolled: five males, mean age 57 years, disease onset 24 years. At OMA discontinuation, 88% were OCS-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to MEP improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03-0.14), OCS-dependent patients (OR = 0.02, 95% CI 0.005-0.08), and number of lost working days (Δ = - 7.9, 95% CI - 11.2 to - 4.6). Pulmonary function improved, serum IgE, FeNO and eosinophils decreased. Mean annual costs were €12,239 for OMA and €12,639 for MEP (Δ = €400, 95% CI - 1588-2389); the increment due to drug therapy (+ €1,581) was almost offset by savings regarding all other cost items (- €1,181). Patients with severe eosinophilic asthma, not controlled by OMA, experienced comprehensive benefits by switching to MEP with only slight increases in economic costs.
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- 2021
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15. Efficacy and safety of mepolizumab in a real-world cohort of patients with severe eosinophilic asthma.
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Pertzov B, Unterman A, Shtraichman O, Shitenberg D, Rosengarten D, and Kramer MR
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- Adult, Aged, Antibodies, Monoclonal, Humanized adverse effects, Asthma complications, Cohort Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Eosinophilia complications, Severity of Illness Index, Treatment Outcome, Antibodies, Monoclonal, Humanized therapeutic use, Asthma drug therapy, Pulmonary Eosinophilia drug therapy
- Abstract
Background: The interleukin 5 (IL-5) pathway is an important component in the pathophysiology of severe eosinophilic asthma. Mepolizumab is a monoclonal antibody that targets the IL-5 pathway. Clinical trials showed efficacy of Mepolizumab in patients with severe eosinophilic asthma. However, reports on experience with treatment in a real-world cohort are limited., Objectives: Evaluation of the efficacy and safety of Mepolizumab for treatment of severe eosinophilic asthma in a real-world cohort of patients., Methods: A clinical prospective observational trial included all patients >18 years treated with Mepolizumab between March 2016 to March 2019 at Rabin Medical Center. The composite primary outcome measures evaluated: increase in FEV1 by≥ 200 ml and/or decrease in exacerbation rate of ≥50% and/or cessation of oral corticosteroids (OCS) treatment or ≥50% decrease in dosage. Also evaluated: blood eosinophil count, adverse events and quality of life., Results: Of 61 patients, 50 (82.0%) achieved the primary outcome. The number of patients who suffered from frequent exacerbations decreased from 52 (85.2%) to 8 (13.1%) ( p < 0.001). Twenty-two patients (68%) stopped OCS treatment or received >50% reduced dosage ( p < 0.001). Mean FEV1 increased from 1.72 ± 0.78 liters to 1.87 ± 0.85 liters ( p = 0.043). Response to therapy was seen within six months. Forty-nine patients (80%) reported an improvement in quality of life ( p < 0.001). Only minor adverse events were reported., Conclusion: Treatment with mepolizumab was well tolerated and significantly lowered the exacerbation rate and OCS dependence in a real-world cohort of severe eosinophilic asthma patients. Response to therapy was within six months and treatment effect was sustained over time.
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- 2021
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16. [Eosinophilic pneumonia: A rare complication of sodium divalproate].
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Ruuth-Praz J, Faure M, Gomez E, Petit I, Petitpain N, Chaouat A, and Chabot F
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- Bipolar Disorder drug therapy, Dyspnea chemically induced, Dyspnea diagnosis, Dyspnea etiology, Female, Humans, Iatrogenic Disease, Middle Aged, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Withholding Treatment, Pulmonary Eosinophilia chemically induced, Valproic Acid adverse effects
- Abstract
Introduction: Eosinophilic pneumonias are characterized by an increase in lung eosinophils. These disorders can be induced by drug reactions., Case Report: A 57-year-old woman suffering from bipolar disorder and treated by sodium divalproate for more than 2 years was hospitalised in the department of respiratory medicine for dyspnoea and cough. The investigations showed severe hypoxaemia, airflow limitation, multiple ground-glass opacities and crazy paving on the chest CT-scan and a blood eosinophilia. A significant alveolar eosinophilia was found in the broncho-alveolar lavage. A complete assessment of possible causes was made. Finally, we made the diagnosis of eosinophilic pneumonia secondary to sodium divalproate. The treatment was stopped and systemic corticosteroid therapy was not introduced. The patient showed an improvement of her dyspnoea in a few days. Lung function and the CT-scan were normal within a few months., Conclusions: Sodium divalproate, frequently used in the treatment of bipolar disorder, is a rare cause of eosinophilic lung disease, even years after its introduction. Rapid diagnosis and withdrawal of treatment led to complete resolution in the reported case., (Copyright © 2020. Published by Elsevier Masson SAS.)
- Published
- 2020
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17. Real-World Effectiveness and the Characteristics of a "Super-Responder" to Mepolizumab in Severe Eosinophilic Asthma.
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Kavanagh JE, d'Ancona G, Elstad M, Green L, Fernandes M, Thomson L, Roxas C, Dhariwal J, Nanzer AM, Kent BD, and Jackson DJ
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- Adult, Aged, Asthma etiology, Cohort Studies, Female, Humans, Male, Middle Aged, Pulmonary Eosinophilia drug therapy, Treatment Outcome, United Kingdom, Antibodies, Monoclonal, Humanized therapeutic use, Asthma drug therapy, Pulmonary Eosinophilia complications
- Abstract
Background: Mepolizumab was the first licensed anti-IL5 monoclonal antibody for severe eosinophilic asthma (SEA). To date there are few data to confirm its efficacy in the real-world setting or assessment of baseline characteristics associated with response., Research Question: How do patients with severe eosinophilic asthma respond to mepolizumab in the real world setting and which characteristics are associated with a super-response to this therapy?, Study Design and Methods: We conducted a retrospective review of all patients who received at least 16 weeks of treatment with mepolizumab (100 mg subcutaneously) for SEA at our regional asthma center in the United Kingdom. Clinical data were collected at each 4-week visit. At 16, 24, and 52 weeks, patients were classified as "responders" or "nonresponders." A response was defined as ≥50% reduction in exacerbations; for patients whose condition requires maintenance oral corticosteroids (mOCS), a response was defined as ≥50% reduction in prednisolone dose. Super responders were defined as exacerbation-free and off mOCS at one year., Results: Ninety-nine patients were included in the analysis. Asthma exacerbations decreased from a baseline of 4.04 ± 2.57 to 1.86 ± 2.17 per year at one year (54% reduction; P < .001). Sixty-eight patients were receiving mOCS at the time of commencing mepolizumab. By one year, the daily median dose fell from 10 mg (interquartile range, 10 to 15) to 0 mg (interquartile range, 0 to 10; P < .001). Fifty-seven percent of them were able to discontinue mOCS; 72.7% (95% CI, 63.0 to 80.7) of the patients were classified as responders, and 28.3% (95% CI, 20.2 to 38.0) of the patients were classified as super responders. Baseline characteristics associated with responder and super responder status included the presence of nasal polyposis (P = .012), lower baseline Asthma Control Questionnaire 6 (P = .006), a lower BMI (P = .014), and, in those patients receiving mOCS, a significantly lower prednisolone dose at baseline (P = .005). At 16 weeks, the one-year responder status was correctly identified in 80.8% patients; by 24 weeks, this status rose to 92.9%., Interpretation: In a real-world SEA cohort, treatment with mepolizumab reduced exacerbation frequency and mOCS requirements. Nasal polyposis, a lower BMI, and a lower maintenance prednisolone requirement at baseline were associated with better outcomes. Twelve-month response was identifiable in >90% of patients by week 24., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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18. [Daptomycin-induced eosinophilic pneumonia associated with an early endoprosthesis infection].
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Zimmer MA, Haffner E, Weisser CW, and Mols G
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- Acute Disease, Aged, Anti-Bacterial Agents adverse effects, Female, Humans, Lung, Prostheses and Implants, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Renal Insufficiency, Daptomycin adverse effects, Pulmonary Eosinophilia chemically induced
- Abstract
Acute eosinophilic pneumonia (AEP) is a rare disease characteristically involving eosinophilic infiltration of lung parenchyma as well as fever, dyspnea, and coughing. A differentiation is made between primary and secondary AEP depending on the underlying etiology. Substances that most frequently cause secondary AEP are antibiotics, such as the lipopeptide daptomycin. This is a case report about a 69-year-old female patient who underwent antibiotic treatment with daptomycin for an infection of a knee prosthesis. During the treatment, signs of pneumonia developed and included the increased dependence on mechanical ventilation of the previously intubated patient, infiltrates on a chest X‑ray, fever, and an increase in serum inflammation markers. Proof of bacteria as an underlying pathogen was not possible. A thoracic computed tomography (CT) scan showed opacities that are commonly seen in interstitial lung disease. Termination of daptomycin treatment due to renal failure led to an improvement of pulmonary symptoms. Re-exposure to daptomycin resulted in a recurrence of the symptoms. The diagnostic criteria for AEP according to Uppal et al. include 1) current exposure to daptomycin, 2) dyspnea with increased oxygen requirements or necessity for mechanical ventilation, 3) new infiltrates on chest X‑ray or CT scan, 4) bronchoalveolar lavage with eosinophilia >25%, 5) improvement of clinical symptoms following daptomycin withdrawal, and 6) fever. With 5 out of the 6 criteria by Uppal et al. positive-an eosinophilia >25% being the only unmet criteria-an AEP induced by daptomycin was diagnosed. Withdrawal of daptomycin as well as high-dose cortisol bolus treatment led to a rapid recovery.
- Published
- 2020
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19. Biologics for oral corticosteroid-dependent asthma.
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Yılmaz İ
- Subjects
- Administration, Oral, Asthma complications, Asthma immunology, Asthma physiopathology, Biological Products therapeutic use, Drug Resistance, Humans, Nasal Polyps complications, Nasal Polyps drug therapy, Omalizumab therapeutic use, Phenotype, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia drug therapy, Adrenal Cortex Hormones administration & dosage, Anti-Asthmatic Agents therapeutic use, Antibodies, Monoclonal, Humanized therapeutic use, Asthma drug therapy
- Abstract
Background: Oral corticosteroid (OCS) dependent asthma is one of the severe asthma phenotypes that requires personalized treatment. Objective: To review the role of biologic treatments in OCS-dependent asthma. Methods: A nonsystematic review was performed of emerging multiple novel biologics for potential treatment of OCS-dependent asthma. Results: The serious adverse effects of OCS can be seen as a result of their regular long-term administration. Anti-interleukin (IL) 5 (mepolizumab), anti-IL-5R (benralizumab), and anti-IL-4Rα (dupilumab) are the therapies of choice for OCS-dependent severe asthma. Results of studies showed the efficacy of mepolizumab, benralizumab, and dupilumab, especially in patients with the OCS-dependent severe eosinophilic asthma phenotype and with nasal polyps. Dupilumab may be the therapy of choice of monoclonal antibodies in cases of moderate-severe atopic dermatitis accompanied by OCS-dependent severe asthma. For reslizumab and omalizumab, placebo controlled double-blind studies conducted with OCS-dependent patient populations are needed. Conclusion: Biologics are effective in the "OCS-dependent asthma" phenotype as add-on therapy. It seems that chronic OCS use in OCS-dependent asthma will be replaced by biologic agents that specifically target type 2 inflammation, along with a much better safety profile. However, real-life studies that compare these biologics in OCS-dependent severe asthma are urgently needed.
- Published
- 2020
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20. Promising Effects of Benralizumab on Chronic Eosinophilic Pneumonia.
- Author
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Isomoto K, Baba T, Sekine A, Aiko N, and Ogura T
- Subjects
- Chronic Disease, Diagnosis, Differential, Female, Humans, Middle Aged, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnostic imaging, Anti-Asthmatic Agents therapeutic use, Antibodies, Monoclonal, Humanized therapeutic use, Asthma complications, Pulmonary Eosinophilia diagnosis
- Abstract
We herein report a case of refractory chronic eosinophilic pneumonia (CEP) complicated with uncontrolled bronchial asthma, in which remission was successfully induced with single dose of benralizumab, a monoclonal antibody against the alpha-chain of the interleukin-5 receptor. Resolution of the patient's symptoms and consolidation on chest X-ray were observed at 2 weeks and lasted for 8 weeks after the administration of benralizumab. Benralizumab would be a novel alternative choice of treatment for CEP patients who are at risk of potential toxicity due to long-term corticosteroid therapy.
- Published
- 2020
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21. Permutation inference methods for multivariate meta-analysis.
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Noma H, Nagashima K, and Furukawa TA
- Subjects
- Algorithms, Antihypertensive Agents pharmacology, Asthma complications, Computer Simulation, Confidence Intervals, Data Interpretation, Statistical, Diabetes Mellitus epidemiology, Humans, Likelihood Functions, Models, Statistical, Monte Carlo Method, Multivariate Analysis, Network Meta-Analysis, Outcome Assessment, Health Care statistics & numerical data, Probability, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Biometry methods, Meta-Analysis as Topic
- Abstract
Multivariate meta-analysis is gaining prominence in evidence synthesis research because it enables simultaneous synthesis of multiple correlated outcome data, and random-effects models have generally been used for addressing between-studies heterogeneities. However, coverage probabilities of confidence regions or intervals for standard inference methods for random-effects models (eg, restricted maximum likelihood estimation) cannot retain their nominal confidence levels in general, especially when the number of synthesized studies is small because their validities depend on large sample approximations. In this article, we provide permutation-based inference methods that enable exact joint inferences for average outcome measures without large sample approximations. We also provide accurate marginal inference methods under general settings of multivariate meta-analyses. We propose effective approaches for permutation inferences using optimal weighting based on the efficient score statistic. The effectiveness of the proposed methods is illustrated via applications to bivariate meta-analyses of diagnostic accuracy studies for airway eosinophilia in asthma and a network meta-analysis for antihypertensive drugs on incident diabetes, as well as through simulation experiments. In numerical evaluations performed via simulations, our methods generally provided accurate confidence regions or intervals under a broad range of settings, whereas the current standard inference methods exhibited serious undercoverage properties., (© 2019 The International Biometric Society.)
- Published
- 2020
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22. Idiopathic acute eosinophilic pneumonia: A rare cause of hypoxic respiratory failure.
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Spaulding KH, Ng PC, and April MD
- Subjects
- Computed Tomography Angiography, Humans, Male, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnostic imaging, Respiratory Insufficiency etiology, Young Adult, Extracorporeal Membrane Oxygenation methods, Pulmonary Eosinophilia therapy, Respiratory Insufficiency therapy
- Abstract
Idiopathic Acute Eosinophilic Pneumonia (IAEP) is a life-threatening cause of hypoxic respiratory failure. IAEP is challenging to diagnose as it may mimic infectious pneumonia or acute respiratory distress syndrome. Distinguishing IAEP from these alternatives is important; the mainstay of treatment for IAEP is corticosteroids, a therapy which might not otherwise be indicated. Patients treated appropriately usually experience a full recovery. In this case report we describe the presentation, evaluation, and management of a 19-year old male who presented to the emergency department (ED) in respiratory failure from IAEP. The patient was a military trainee who recently moved to the United States from Saudi Arabia. He also recently began smoking cigarettes for the first time, a known risk factor for IAEP. Upon initial presentation, the patient was in respiratory distress and had an oxygen saturation of 82% on room air. His ED diagnostic workup included chest X-ray showing diffuse interstitial thickening and chest computed tomography that demonstrated diffuse nodular opacification of pulmonary parenchyma. The patient was admitted to the intensive care unit (ICU) where bronchoscopy yielded cytology with 30% eosinophilia. The patient ultimately required 3 days of extra corporeal membrane oxygenation (ECMO) due to worsening hypoxic respiratory failure. After both intravenous and outpatient oral steroid treatments, the patient went on to have a full recovery with no ongoing respiratory issues. To our knowledge, this is the first case of IAEP requiring ECMO reported in the emergency medicine literature., (Published by Elsevier Inc.)
- Published
- 2019
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23. The role of type 2 innate lymphoid cells in eosinophilic asthma.
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Salter BM, Aw M, and Sehmi R
- Subjects
- Animals, Cytokines metabolism, Hematopoiesis, Humans, Asthma complications, Asthma immunology, Immunity, Innate, Lymphocytes immunology, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia immunology
- Abstract
Eosinophilic asthma has conventionally been proposed to be a T helper 2 driven disease but emerging evidence supports a central role of type 2 innate lymphoid cells (ILC2s). These are non-T, non-B cells that lack antigen specificity and produce more IL-5 and IL-13 than CD4
+ T lymphocytes, on a cell per cell basis, in vitro. Although it is clear that ILC2s and CD4+ T cells work in concert with each other to drive type 2 immune responses, kinetic studies in allergic asthma suggest that ILC2s may act locally within the airways to "initiate" eosinophilic responses, whereas CD4+ T cells act locally and systemically to "perpetuate" eosinophilic inflammatory responses. Importantly, ILC2s are increased within the airways of severe asthmatics, with the greatest number of IL-5+ IL-13+ ILC2s being detected in sputum from severe asthmatics with uncontrolled eosinophilia despite high-dose steroid therapy. Although the precise relationship between ILC2s and steroid sensitivity in asthma remains unclear, controlling the activation of ILC2s within the airways may provide an effective therapeutic target for eosinophilic inflammation in airways diseases., (©2019 Society for Leukocyte Biology.)- Published
- 2019
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24. 10-Year Follow-Up of Frequently Relapsed Chronic Eosinophilic Pneumonia Starting at 15 Years Old; Attempts to Treat with Inhaled Corticosteroid (A Case Report).
- Author
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Murayama N, Doi S, and Kameda M
- Subjects
- Administration, Inhalation, Adolescent, Asthma complications, Chronic Disease, Female, Follow-Up Studies, Humans, Long-Term Care, Pulmonary Eosinophilia complications, Radiography, Thoracic methods, Risk Assessment, Severity of Illness Index, Time Factors, Treatment Outcome, Adrenal Cortex Hormones administration & dosage, Asthma diagnostic imaging, Asthma drug therapy, Pulmonary Eosinophilia diagnostic imaging, Pulmonary Eosinophilia drug therapy
- Abstract
BACKGROUND Eosinophilic pneumonia is recognized both as an eosinophil-associated disease and as bronchial asthma. In eosinophilic pneumonia, the site of eosinophilic infiltration is mainly the alveolus and the peripheral airway; the disability of pulmonary function is restrictive, as opposed to from bronchial asthma, which has a relatively central side bronchus region and obstructive function. Differences in inflammatory region and the activation degree of T-cell and eosinophil parameters were predicted. CASE REPORT To determine the extent of inflammation and the region showing the inflammation in eosinophilic pneumonia, parameters like HLADRCD4/CD4 (%), CD25CD4/CD4 (%), ECP, soluble IL2R, and IL5 were examined in BALF and in peripheral blood during the active phase and remission phase. The percentage of HLADRCD4/CD4, IL-5, and the percentage of CD25CD4/CD4 were extremely high during the acute phase in BALF as compared to that in peripheral blood during the active and the remission phase. To avoid the adverse effects of systemic administration of steroids, we tried 5 different kinds of steroid through inhalation. We used%FVC by spirometry as a parameter to determine the recurrence of the disease. However, the inhaled steroids could not control the remission for long. This is the first report in which frequent recurrence of the disease was seen despite treatments and in which%FVC was used to determine the disease condition. CONCLUSIONS The principle site of inflammation in eosinophilic pneumonia is the peripheral bronchus and the alveolar area. Percent FVC can be a useful parameter for assessment of recurrence of the disease. In the present case, the disease could not be kept under control despite treatment with 5 different steroids through the inhalation route.
- Published
- 2019
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25. Case 16-2019: A 53-Year-Old Man with Cough and Eosinophilia.
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Simmons RP, Dudzinski DM, Shepard JO, Hurtado RM, and Coffey KC
- Subjects
- Animals, Cardiomyopathy, Hypertrophic, Familial complications, Cough etiology, Diagnosis, Differential, Electrocardiography, Elephantiasis, Filarial diagnosis, Eosinophilia diagnosis, Humans, Lung Diseases, Fungal diagnosis, Lung Diseases, Parasitic complications, Male, Microfilariae, Middle Aged, Pulmonary Eosinophilia complications, Radiography, Thoracic, Symptom Assessment, Lung diagnostic imaging, Lung Diseases, Parasitic diagnosis, Pulmonary Eosinophilia diagnosis
- Published
- 2019
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26. Diagnostic pitfalls of acute eosinophilic pneumonia in an adolescent boy following cigarette smoking: A case report.
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Choo CYW, Wong KS, Lai SH, Chiu CC, and Chiu CY
- Subjects
- Adrenal Cortex Hormones therapeutic use, Bronchoalveolar Lavage Fluid cytology, Humans, Male, Pulmonary Eosinophilia drug therapy, Taiwan, Young Adult, Cigarette Smoking adverse effects, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis
- Abstract
Rationale: Acute eosinophilic pneumonia (AEP) is characterized by acute febrile respiratory symptoms, bilateral lung infiltrates, and pulmonary eosinophilia. AEP is closely related to cigarette smoking but is rarely suspected in pediatric cases despite the fact that there is a relatively high incidence of cigarette smoking among adolescents in Taiwan., Patient Concerns: We report a case of a previously healthy 15-year-old boy who presented with fever and acute progressive dyspnea. Due to lack of awareness of cigarette smoking history in adolescents and the nonspecific signs and symptoms of AEP at early stages, the patient was initially treated as community-acquired pneumonia (CAP) but was unresponsive to antibiotics treatment., Diagnoses: A combination of a recent onset smoking history and pulmonary eosinophilia on bronchoalveolar lavage confirmed the diagnosis of cigarette-induced AEP., Interventions: Corticosteroid treatment was prescribed., Outcomes: The condition improved within 24 hours, with resolution of alveolar infiltrates on chest radiographs., Lessons: With the increasing incidence of smoking amongst adolescents in Taiwan, careful history questioning regarding cigarette smoking is necessary. Due to similarities in initial clinical and radiographic features of AEP and CAP, adolescents with suspected CAP who are unresponsive to antibiotic treatment but have a subsequent rise in peripheral eosinophils should raise the clinician's suspicion of AEP related to cigarette smoking.
- Published
- 2019
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27. Treatment of severe, uncontrolled eosinophilic asthma: Where we are heading.
- Author
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Bernstein JA and Panettieri R Jr
- Subjects
- Asthma complications, Asthma physiopathology, Humans, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia physiopathology, Severity of Illness Index, Asthma therapy, Pulmonary Eosinophilia therapy
- Abstract
Objective: We sought to highlight how our understanding of the pathophysiology of severe asthma has evolved over time and discuss the role of biomarkers in treatment advances and emerging new therapies., Data Sources: Nonsystematic PubMed literature search., Study Selection: Articles were selected based on areas of relevance to the classification of asthma by endotype, with an emphasis on the evolution of current treatment guidelines for severe asthma., Results: Unlike older guidelines for the treatment of severe asthma, recent updates now distinguish between asthma severity and control. Moreover, asthma classification is shifting from phenotype to endotype with the development of biomarkers used to determine the mechanism driving a patient's disease. Many cases of severe asthma are associated with type-2 inflammation with elevated eosinophil counts in the airways. In recent studies, patients with severe, uncontrolled asthma and high eosinophil counts respond to biologic therapies targeting the type-2 signaling pathway and eosinophils themselves (eg, anti-IL-5 therapy). New treatments that address the pathophysiology of asthma offer a promising alternative to control severe asthma for patients who do not respond to traditional therapies., Conclusion: Understanding and using new treatment guidelines that separate the concepts of asthma severity and control may help clinicians to identify patients with severe, uncontrolled asthma who may benefit from new treatment options, such as anti-IL-5 therapies.
- Published
- 2019
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28. Cough in the Immunosuppressed Patient.
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Fehily SR, Partsanis NM, and Christensen B
- Subjects
- Adult, Female, Humans, Immunocompromised Host, Immunosuppressive Agents therapeutic use, Pulmonary Eosinophilia complications, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Colitis, Ulcerative drug therapy, Cough etiology, Mesalamine adverse effects, Pulmonary Eosinophilia chemically induced, Pulmonary Eosinophilia pathology
- Published
- 2019
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29. Cutaneous Larva Migrans with Löeffler's Syndrome.
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Gao YL and Liu ZH
- Subjects
- Adult, Albendazole therapeutic use, Anthelmintics therapeutic use, Female, Humans, Larva Migrans complications, Larva Migrans drug therapy, Pulmonary Eosinophilia complications, Larva Migrans pathology, Pulmonary Eosinophilia pathology
- Published
- 2019
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30. Last station in the eosinophilic asthma with chronic rhinosinusitis and/or nasal polyposis march: Eosinophilic asthma with radiological findings associated with blood eosinophilia.
- Author
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Yılmaz I, Bahçecioğlu SN, Türk M, Tutar N, Oymak FS, and Gülmez İ
- Subjects
- Adult, Asthma diagnostic imaging, Chronic Disease, Female, Humans, Male, Middle Aged, Pulmonary Eosinophilia diagnostic imaging, Retrospective Studies, Tomography, X-Ray Computed, Asthma blood, Asthma complications, Eosinophils, Nasal Polyps blood, Nasal Polyps complications, Pulmonary Eosinophilia blood, Pulmonary Eosinophilia complications, Rhinitis blood, Rhinitis complications, Sinusitis blood, Sinusitis complications
- Abstract
Objective: Eosinophilic asthma with chronic rhinosinusitis and/or nasal polyposis (EA-CRS/NP) is a subphenotype of adult-onset eosinophilic asthma. Blood eosinophil levels are shown to be highly elevated in patients with EA-CRS/NP and have potential for tissue infiltration. We aimed to demonstrate the clinical features of the patients who have a blood eosinophil level above 10% and have thorax computed tomography findings due to blood eosinophilia., Methods: Patients who were followed up in our clinic between 2012 and 2017 were retrospectively evaluated. Inclusion criteria were as follows: 1) Eosinophilic severe asthma, 2) eosinophilia >10%, 3) chronic sinusitis and/or nasal polyps, 4) patients with pathologic findings on thorax computed tomography, 5) regular follow-up for at least 1 year., Results: We identified 36 patients who met the above criteria. We defined this group as "Eosinophilic Asthma with chronic Rhinosinusitis and/or nasal polyposis with Radiological findings related to blood eosinophilia" (EARR). The mean age was 44.9 ± 11 years and 64% were females. Nasal polyps, aspirin exacerbated respiratory disease, and atopy, were present in 81%, 47%, and 25% of the patients, respectively. The mean blood eosinophil count was 1828.6 cells/mm
3 (19%). The majority of EARR patients had upper lobe dominant ground-glass opacities. The mean follow-up period was 3.2 ± 2.5 years. EARR patients did not evolve into eosinophilic granulomatous polyangiitis in the follow-up., Conclusions: This phenotype is the first eosinophilic asthma sub-phenotype reported in the literature. EARR is the final stage of the allergic march of EA-CRS/NP.- Published
- 2019
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31. Eosinophilic asthma, according to a blood eosinophil criterion, is associated with disease severity and lack of control among underprivileged urban Brazilians.
- Author
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Lima-Matos A, Ponte EV, de Jesus JPV, Almeida PCA, Lima VB, Kwon N, Riley J, de Mello LM, and Cruz ÁA
- Subjects
- Adult, Biomarkers blood, Brazil, Case-Control Studies, Female, Humans, Male, Middle Aged, Severity of Illness Index, Urban Population, Asthma diagnosis, Asthma etiology, Eosinophils, Leukocyte Count, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis
- Abstract
Background: Asthma is a syndrome with multiple phenotypes. Peripheral blood eosinophil counts might be the ideal biomarker to identify subjects with eosinophilic asthma. It is available, inexpensive, and it is associated with eosinophilia in sputum., Objective: The aim of this study was to evaluate whether blood eosinophilia is associated with asthma severity and to evaluate whether blood eosinophilia is associated with lack of control of asthma symptoms and airway obstruction., Methods: Case control study. The cases were subjects recruited from a cohort of patients with severe asthma, in Salvador-BR, demanding continuous inhaled corticosteroids and LABA. There were two control groups: 1) subjects with mild/moderate asthma, 2) subjects with no asthma. Subjects enrolled in the study answered questionnaires, had their blood and stool samples collected, performed spirometry and SPT. We established a cutoff ≥ 260 cells/mm3 for blood eosinophilia., Results: We evaluated 544 subjects in the case group, 452 subjects with mild to moderate asthma and 450 subjects with no asthma. The subjects of the case group had higher odds of presenting the eosinophilic phenotype in comparison to subjects with mild to moderate asthma [OR 1.60 95CI(1.19-2.16)] and no asthma [OR 3.93; 95CI(2.90-5.33)]. The eosinophilic phenotype, according to blood count, is associated with uncontrolled asthma [OR 1.56; 95CI(1.06-2.28)], but it is not associated with airway obstruction [OR 0.87; 95CI(0.61-1.24)]., Conclusion: We conclude that the blood eosinophilia is a biomarker associated with asthma severity and poor symptom control, but we found no association with reduced lung function., (Published by Elsevier Ltd.)
- Published
- 2018
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32. Increased Sputum IL-17A Level in Non-asthmatic Eosinophilic Bronchitis.
- Author
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Zhan C, Xu R, Liu J, Zhang S, Luo W, Chen R, and Lai K
- Subjects
- Adult, Asthma complications, Asthma metabolism, Breath Tests, Bronchitis complications, Bronchitis physiopathology, Eosinophils, Female, Forced Expiratory Volume, Humans, Male, Maximal Midexpiratory Flow Rate, Middle Aged, Neutrophils, Nitric Oxide analysis, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia physiopathology, Sputum cytology, Vital Capacity, Bronchitis metabolism, Interleukin-17 metabolism, Pulmonary Eosinophilia metabolism, Sputum metabolism
- Abstract
Background: Non-asthmatic eosinophilic bronchitis (NAEB) is one common cause of chronic cough which is characterized as airway eosinophilic inflammation like asthma but lack of airway hyper-responsiveness. Previous studies showed that Th2-pathway plays a role in NAEB, but the role of non-Th2 pathway in mechanism of NAEB remains unknown. Recently, IL-17A, a Th17-pathway cytokine, has been demonstrated to be involved in asthma development. However, the relationship between Th17-pathway and NAEB is unknown., Methods: We aim to assess the airway level of IL-17A in the subjects with NAEB. Relationships between the IL-17A level and airway function in NAEB or asthma are also observed. We measured IL-17A concentrations in the sputum supernatant from 12 subjects with EB, 16 subjects with asthma [9 eosinophilic asthmatic (EA) and 7 non-eosinophilic asthmatic (NEA) according to the sputum eosinophil ≥ 3%], and 9 healthy control subjects., Results: Increasing IL-17A level was found in NAEB group (29.65 ± 8.13 pg/ml), EA group (32.45 ± 3.22 pg/ml), and NEA group (29.62 ± 6.91 pg/ml) compared with the healthy control group (17.05 ± 10.30 pg/ml) (P < 0.05, P < 0.01, P < 0.05, respectively). The sputum IL-17A level was correlated with FENO (r = 0.44, P < 0.01), FEV1/FVC% (r = - 0.38, P < 0.05), MMEF%pred (r = - 0.34, P < 0.05), and sputum neutrophil% (r = 0.33, P < 0.05) in total., Conclusion: Th17-pathway may play a role not only in asthmatics, but also in subjects with NAEB, as reflected by increasing IL-17A concentrations in sputum supernatant.
- Published
- 2018
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33. Indeterminate dendritic cell neoplasm accompanied by eosinophilic pneumonia successfully treated by systemic steroid therapy: Report of the first case with muscular and parotid involvement and review of published work.
- Author
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Kiyohara T, Nakamaru S, Miyamoto M, Shijimaya T, Nagano N, Makimura K, Takama H, Akiyama M, and Tanimura H
- Subjects
- Adult, Biopsy, Humans, Lung diagnostic imaging, Lung pathology, Lymph Nodes pathology, Male, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia pathology, Skin Neoplasms complications, Histiocytosis, Langerhans-Cell pathology, Langerhans Cells pathology, Muscle, Skeletal pathology, Parotid Gland pathology, Pulmonary Eosinophilia diagnostic imaging, Skin Neoplasms pathology
- Abstract
A 34-year-old Japanese man presented with an indolent nodule on the right flank. Computed tomography of the chest and abdomen demonstrated a large nodule measuring 55 mm × 50 mm in the abdominal oblique muscle layer of the right flank, and several small nodules were seen in the muscle layer throughout the body and subcutaneous tissue of the lower abdomen.
18 F-fluorodeoxyglucose-positron emission tomography/computed tomography revealed nodular lesions in the bilateral parotid glands, bilateral cervical lymph nodes and lower lobe of the right lung. Intermittently, ground-glass shadows developed in the bilateral lungs. Histologically, sheet-like nodules in the abdominal oblique muscle layer and parotid gland were composed of large polygonal cells with convoluted nuclei and ample eosinophilic cytoplasm. Several lymphocytes and considerable eosinophils were intermingled. Lung biopsy demonstrated an inflammatory infiltrate of lymphocytes and considerable eosinophils in the alveoli. Immunohistochemically, polygonal cells were positive for S100 protein and CD1a, but negative for langerin and BRAFV600E . Some cells were positive for CD68. Electron microscopy demonstrated histiocytic cells with phagosomes and interdigitating processes. However, no Birbeck granules were observed. Eosinophilia was seen in the peripheral blood. Multifocal nodules and ground-glass shadows gradually diminished following systemic administration of oral prednisolone. We describe a case of indeterminate dendritic cell neoplasm with multifocal involvement of the muscle, subcutis, lymph node and parotid gland accompanied by chronic eosinophilic pneumonia that was successfully treated by systemic steroid therapy. Neither muscular nor parotid indeterminate dendritic cell neoplasms accompanied by eosinophilic pneumonia have been previously reported., (© 2018 Japanese Dermatological Association.)- Published
- 2018
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34. Molecular Confirmation of Ascaris suum: Further Investigation into the Zoonotic Origin of Infection in an 8-Year-Old Boy with Loeffler Syndrome.
- Author
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Avery RH, Wall LA, Verhoeve VI, Gipson KS, and Malone JB
- Subjects
- Albendazole therapeutic use, Animals, Anthelmintics therapeutic use, Ascariasis complications, Ascaris suum classification, Ascaris suum genetics, Ascaris suum immunology, Child, Feces, Humans, Immunoglobulin E analysis, Male, Risk Factors, Sanitation, Soil parasitology, Swine, Zoonoses, Ascariasis parasitology, Ascaris suum isolation & purification, Pulmonary Eosinophilia complications
- Abstract
An 8-year-old male from south Louisiana was diagnosed with Loeffler syndrome of suspected Ascaris origin. Further investigation of the farm recovered larvated, infective Ascaris eggs from the soil in drains surrounding pens on the family's small hog farm. Molecular analysis of the recovered eggs, in conjunction with Ascaris-specific IgE, inadequate farm management and sanitation, and behavioral risk factors indicate the patient had an Ascaris suum soil-transmitted infection.
- Published
- 2018
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35. Reflux aspiration in lungs of dogs with respiratory disease and in healthy West Highland White Terriers.
- Author
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Määttä OLM, Laurila HP, Holopainen S, Lilja-Maula L, Melamies M, Viitanen SJ, Johnson LR, Koho N, Neuvonen M, Niemi M, and Rajamäki MM
- Subjects
- Animals, Bile Acids and Salts analysis, Bronchitis complications, Bronchitis veterinary, Bronchoalveolar Lavage Fluid chemistry, Case-Control Studies, Cross-Sectional Studies, Dogs, Female, Gastroesophageal Reflux etiology, Idiopathic Pulmonary Fibrosis complications, Idiopathic Pulmonary Fibrosis veterinary, Laryngeal Diseases complications, Laryngeal Diseases veterinary, Male, Pneumonia, Bacterial complications, Pneumonia, Bacterial veterinary, Prospective Studies, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia veterinary, Respiratory Tract Diseases complications, Dog Diseases etiology, Gastroesophageal Reflux veterinary, Respiratory Tract Diseases veterinary
- Abstract
Background: Gastroesophageal reflux and microaspiration (MA) of gastric juice are associated with various human respiratory diseases but not in dogs., Objective: To detect the presence of bile acids in bronchoalveolar lavage fluid (BALF) of dogs with various respiratory diseases., Animals: Twenty-seven West Highland White Terriers (WHWTs) with canine idiopathic pulmonary fibrosis (CIPF), 11 dogs with bacterial pneumonia (BP), 13 with chronic bronchitis (CB), 9 with eosinophilic bronchopneumopathy (EBP), 19 with laryngeal dysfunction (LD), 8 Irish Wolfhounds (IWHs) with previous BPs, 13 healthy WHWTs, all privately owned dogs, and 6 healthy research colony Beagles METHODS: Prospective cross-sectional observational study with convenience sampling of dogs. Bile acids were measured by mass spectrometry in BALF samples. Total bile acid (TBA) concentration was calculated as a sum of 17 different bile acids., Results: Concentrations of TBA were above the limit of quantification in 78% of CIPF, 45% of BP, 62% of CB, 44% of EBP, 68% of LD, and 13% of IWH dogs. In healthy dogs, bile acids were detected less commonly in Beagles (0/6) than in healthy WHWTs (10/13). Concentrations of TBA were significantly higher in CIPF (median 0.013 μM, range not quantifiable [n.q.]-0.14 μM, P < .001), healthy WHWTs (0.0052 μM, n.q.-1.2 μM, P = .003), LD (0.010 μM, n.q.-2.3 μM, P = .015), and CB (0.0078 μM, n.q.-0.073 μM, P = .018) groups compared to Beagles (0 μM, n.q.)., Conclusion and Clinical Importance: These results suggest that MA occurs in various respiratory diseases of dogs and also in healthy WHWTs., (© 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)
- Published
- 2018
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36. Conjunctival Eosinophilic Masses With Chronic Eosinophilic Pneumonia.
- Author
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Nagamoto T, Mizuno Y, Shigeyasu C, Fukui M, and Yamada M
- Subjects
- Conjunctival Diseases drug therapy, Humans, Male, Middle Aged, Conjunctival Diseases etiology, Pulmonary Eosinophilia complications
- Abstract
Purpose: To report a case of ocular findings associated with chronic eosinophilic pneumonia (CEP)., Case: A 63-year-old man was referred to the National Institution of Hospital Organization Tokyo Medical Center with bilateral eyelid swelling due to giant papillomatous changes, each measuring approximately 10 mm in diameter with severe hyperemia on the tarsal conjunctiva. He was followed for CEP for 8 years and systemically treated with 6 mg oral prednisolone for an average of 5 years. Because the lesions did not respond to topical 0.1% tacrolimus and 0.025% levocabastine treatment and because an increase in intraocular pressure was found to occur as a side effect of 0.01% betamethasone instillation for several months, we performed surgical resection of the bilateral conjunctival lesions. Histopathological findings revealed extreme eosinophil, plasma cell, and lymphocytic infiltration and interstitial fibrosis. These conjunctival specimen findings were similar to those seen in the alveolar lesions in CEP. Topical antiinflammatory therapy using 0.1% tacrolimus eye drops was administered after surgery, which relieved the patient's lid swelling and itching. However, the lesions concurrently changed to be consistent with exacerbation and remission of systemic CEP., Conclusions: Based on the clinical course and histopathology, the conjunctival proliferative masses in our case were assumed to be associated with CEP.
- Published
- 2018
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37. [Vasculitides and eosinophilic pulmonary diseases].
- Author
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Kroegel C, Foerster M, Quickert S, Slevogt H, and Neumann T
- Subjects
- Humans, Lymphocytes, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis complications, Churg-Strauss Syndrome complications, Microscopic Polyangiitis complications, Pulmonary Eosinophilia complications
- Abstract
Eosinophilic granulocytes form peripheral effector cells controlled by Th2 lymphocytes, which cause local cell, tissue, and functional disorders of infiltrated organs via the release of cytotoxic basic proteins and oxygen radicals. Diseases associated with eosinophilia include systemic and organ-related forms. The lungs are involved in eosinophilic granulomatosis with polyangiitis (EGPA, formerly known as Churg-Strauss syndrome), acute and chronic eosinophilic pneumonia, as well as in an organ manifestation in hypereosinophilic syndrome and certain parasitic diseases. In particular, the lungs are frequently affected in vasculitis of small vessels, including EGPA, granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA). Among these, EGPA is the most frequent pulmonary eosinophil vasculitis representative. In addition, there are various overlap syndromes in which characteristic features of EGPA can be detected in the context of other anti-neutrophil cytoplasmic antibody (ANCA-)associated vasculitides. Occasionally, non-ANCA-associated pulmonary vasculitides occur with eosinophilia (e.g., Schönlein-Henoch purpura, Kawasaki disease, drug-induced hypersensitivity, and paraneoplastic syndrome). Herein, the pulmonary vasculitides accompanying eosinophilia are presented with respect to both the lung manifestations and pulmonary eosinophilia.
- Published
- 2018
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38. BILATERAL CENTRAL RETINAL VEIN OCCLUSIONS IN A YOUNG PATIENT WITH A HISTORY OF EOSINOPHILIC PNEUMONIA AND THALAMIC STROKE.
- Author
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Yu G, Sun P, van Zyl T, Tandias R, and Arroyo JG
- Subjects
- Angiogenesis Inhibitors therapeutic use, Bevacizumab therapeutic use, Female, Humans, Light Coagulation, Middle Aged, Retinal Vein Occlusion therapy, Retrospective Studies, Pulmonary Eosinophilia complications, Retinal Vein Occlusion etiology, Stroke complications, Thalamic Diseases complications
- Abstract
Purpose: To describe a case of a central retinal vein occlusion in a young patient with a history of eosinophilic pneumonia., Methods: A retrospective case report of a 45-year-old woman with acute painless vision loss for 9 days after multiple episodes of eosinophilic pneumonia and thalamic stroke. Fluorescein angiography, spectral domain optical coherence tomography, and clinical examination were performed. She was then treated with intravitreal bevacizumab and pan-retinal photocoagulations., Results: Retinal examination revealed tortuosity and dilatation of all branches of the central retinal vein and flame-shaped hemorrhages in all four quadrants of the right eye associated with cystoid macular edema, optic disc edema, and cotton wool spots. The left eye had mild venous dilatation and tortuosity with a few dot retinal hemorrhages in the far temporal periphery. The cystoid macular edema resolved after one intravitreal injection of bevacizumab and remained resolved at the most recent follow-up. Fluorescein angiography at the most recent follow-up revealed vasculitis in the far periphery of the nontreated eye., Conclusion: Central retinal vein occlusion in young patients is a rare condition often presenting as a manifestation of an underlying inflammatory or hematological disorder. Combined anti-vascular endothelial growth factor treatment and pan-retinal photocoagulation may have resolved the associated cystoid macular edema in this case, although continued observation is necessary.
- Published
- 2018
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39. Longitudinal profiling of the lung microbiome in the AERIS study demonstrates repeatability of bacterial and eosinophilic COPD exacerbations.
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Mayhew D, Devos N, Lambert C, Brown JR, Clarke SC, Kim VL, Magid-Slav M, Miller BE, Ostridge KK, Patel R, Sathe G, Simola DF, Staples KJ, Sung R, Tal-Singer R, Tuck AC, Van Horn S, Weynants V, Williams NP, Devaster JM, and Wilkinson TMA
- Subjects
- Aged, Female, Haemophilus isolation & purification, Humans, Longitudinal Studies, Male, Middle Aged, Moraxella isolation & purification, Observational Studies as Topic, Phenotype, Prevotella isolation & purification, Pulmonary Disease, Chronic Obstructive virology, Pulmonary Eosinophilia pathology, RNA, Ribosomal, 16S analysis, Recurrence, Severity of Illness Index, Sputum cytology, Sputum microbiology, Streptococcus isolation & purification, Veillonella isolation & purification, Disease Progression, Lung microbiology, Microbiota, Pulmonary Disease, Chronic Obstructive microbiology, Pulmonary Disease, Chronic Obstructive pathology, Pulmonary Eosinophilia complications
- Abstract
Background: Alterations in the composition of the lung microbiome associated with adverse clinical outcomes, known as dysbiosis, have been implicated with disease severity and exacerbations in COPD., Objective: To characterise longitudinal changes in the lung microbiome in the AERIS study (Acute Exacerbation and Respiratory InfectionS in COPD) and their relationship with associated COPD outcomes., Methods: We surveyed 584 sputum samples from 101 patients with COPD to analyse the lung microbiome at both stable and exacerbation time points over 1 year using high-throughput sequencing of the 16S ribosomal RNA gene. We incorporated additional lung microbiology, blood markers and in-depth clinical assessments to classify COPD phenotypes., Results: The stability of the lung microbiome over time was more likely to be decreased in exacerbations and within individuals with higher exacerbation frequencies. Analysis of exacerbation phenotypes using a Markov chain model revealed that bacterial and eosinophilic exacerbations were more likely to be repeated in subsequent exacerbations within a subject, whereas viral exacerbations were not more likely to be repeated. We also confirmed the association of bacterial genera, including Haemophilus and Moraxella , with disease severity, exacerbation events and bronchiectasis., Conclusions: Subtypes of COPD have distinct bacterial compositions and stabilities over time. Some exacerbation subtypes have non-random probabilities of repeating those subtypes in the future. This study provides insights pertaining to the identification of bacterial targets in the lung and biomarkers to classify COPD subtypes and to determine appropriate treatments for the patient., Trial Registration Number: Results, NCT01360398., Competing Interests: Competing interests: TMW has received reimbursement for travel and meeting attendance from Boehringer Ingelheim and AstraZeneca, outside of the submitted work. SC received a grant from Pfizer, outside of the submitted work. KJS received grants from Asthma UK (08/026) and BMA HC Roscoe Award, outside of the submitted work, and he has a patent PCT/GB2010/050821 ’Ex Vivo Modelling of Therapeutic Interventions' pending. BEM, CL, DFS, DM, GS, J-MD, JRB, ND, MM-S, RS, RT-S, SVH and VW are employees of the GSK group of companies. RP was an employee of the GSK group of companies at the time the study was conducted. BEM, JRB, J-MD, ND, RT-S and VW own shares/restricted shares in the GSK group of companies. KJS, VK, KO, ACT, SC and TMW received an institutional grant from the GSK group of companies to conduct this study., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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40. The Onset of Eosinophilic Pneumonia Preceding Anti-synthetase Syndrome.
- Author
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Hachisu Y, Koga Y, Sunaga N, Kashiwagi C, Sawada Y, Saito Y, Tsukagoshi Y, Kasahara N, Sakurai R, Tsurumaki H, Yatomi M, Kaira K, Ono A, Maeno T, and Hisada T
- Subjects
- Autoantibodies, Cough complications, Dyspnea complications, Humans, Lung Diseases, Interstitial diagnosis, Male, Middle Aged, Syndrome, Tomography, X-Ray Computed, Amino Acyl-tRNA Synthetases immunology, Lung Diseases, Interstitial complications, Lung Diseases, Interstitial immunology, Pulmonary Eosinophilia complications
- Abstract
A 66-year-old man had been treated with prednisolone for eosinophilic pneumonia for 8 years. His slowly progressing cough and dyspnea were accompanied by elevated levels of fibrotic serological markers and an increased reticular shadow on chest computed tomography images. The patient had recently tested positive for anti-EJ antibodies, a type of anti-aminoacyl-tRNA synthetase antibody; therefore, we diagnosed him with an exacerbation of interstitial pneumonia due to anti-synthetase syndrome (ASS). He was treated with tacrolimus and an increased prednisolone dosage. We herein present the first reported case of eosinophilic pneumonia preceding anti-EJ antibody-positive ASS.
- Published
- 2018
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41. Pneumatosis Cystoides Intestinalis.
- Author
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Sugihara Y and Okada H
- Subjects
- Female, Humans, Middle Aged, Pneumatosis Cystoides Intestinalis etiology, Pulmonary Eosinophilia complications, Tomography, X-Ray Computed, Colon diagnostic imaging, Pneumatosis Cystoides Intestinalis diagnostic imaging
- Published
- 2017
- Full Text
- View/download PDF
42. Impact and associations of eosinophilic inflammation in COPD: analysis of the AERIS cohort.
- Author
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Kim VL, Coombs NA, Staples KJ, Ostridge KK, Williams NP, Wootton SA, Devaster JM, Aris E, Clarke SC, Tuck AC, Bourne SC, and Wilkinson TMA
- Subjects
- Aged, Female, Humans, Inflammation immunology, Inflammation pathology, Male, Middle Aged, Predictive Value of Tests, Prognosis, Severity of Illness Index, Sputum diagnostic imaging, Sputum microbiology, Symptom Flare Up, Blood Cell Count methods, Glucocorticoids administration & dosage, Glucocorticoids adverse effects, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive drug therapy, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis, Respiratory Tract Infections diagnosis, Respiratory Tract Infections etiology
- Abstract
Eosinophilic inflammation in chronic obstructive pulmonary disease (COPD) predicts response to treatment, especially corticosteroids. We studied the nature of eosinophilic inflammation in COPD prospectively to examine the stability of this phenotype and its dynamics across exacerbations, and its associations with clinical phenotype, exacerbations and infection.127 patients aged 40-85 years with moderate to very severe COPD underwent repeated blood and sputum sampling at stable visits and within 72 h of exacerbation for 1 year.Blood eosinophils ≥2% was prevalent at baseline, and predicted both predominantly raised stable-state eosinophils across the year (area under the curve 0.841, 95% CI 0.755-0.928) and increased risk of eosinophilic inflammation at exacerbation (OR 9.16; p<0.001). Eosinophils ≥2% at exacerbation and eosinophil predominance at stable visits were associated with a lower risk of bacterial presence at exacerbation (OR 0.49; p=0.049 and OR 0.25; p=0.065, respectively). Bacterial infection at exacerbation was highly seasonal (winter versus summer OR 4.74; p=0.011) in predominantly eosinophilic patients.Eosinophilic inflammation is a common and stable phenotype in COPD. Blood eosinophil counts in the stable state can predict the nature of inflammation at future exacerbations, which when combined with an understanding of seasonal variation provides the basis for the development of new treatment paradigms for this important condition., Competing Interests: Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2017.)
- Published
- 2017
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43. Dust in the Wind.
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Holmes-Maybank KT, Schreiner AD, Houchens N, and Brzezinski WA
- Subjects
- Anti-Inflammatory Agents therapeutic use, Dyspnea drug therapy, Female, Humans, Middle Aged, Prednisone therapeutic use, Pulmonary Eosinophilia drug therapy, Dyspnea diagnosis, Dyspnea etiology, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia diagnosis
- Published
- 2017
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44. In vivo neutralization of α4 and β7 integrins inhibits eosinophil trafficking and prevents lung injury during tropical pulmonary eosinophilia in mice.
- Author
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Sharma P, Sharma A, and Srivastava M
- Subjects
- Animals, Cell Movement, Cells, Cultured, Cytokines metabolism, Elephantiasis, Filarial immunology, Humans, Inflammation Mediators metabolism, Integrin alpha4 immunology, Integrin beta Chains immunology, Lung Injury etiology, Lung Injury immunology, Mice, Mice, Inbred Strains, Proto-Oncogene Proteins c-bcl-2 genetics, Proto-Oncogene Proteins c-bcl-2 metabolism, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia immunology, T-Lymphocytes, Regulatory immunology, Antibodies, Neutralizing therapeutic use, Brugia malayi immunology, Elephantiasis, Filarial therapy, Eosinophils immunology, Immunotherapy methods, Lung Injury prevention & control, Pulmonary Eosinophilia therapy
- Abstract
Integrins regulate leukocyte trafficking during homeostasis and inflammatory conditions. However, the role of α4 and β7 integrins in guiding eosinophil transmigration into the lungs during filarial manifestation of Tropical Pulmonary Eosinophilia (TPE) has not been explored. In this study, mice exhibiting TPE manifestations were administered with in vivo neutralizing antibodies against integrins α4 and β7 or their combination and immuno-pathological parameters were evaluated. Results show an intact lung barrier, significantly lower lung inflammation and reduced eosinophil counts in the Bronchoalveolar lavage fluid and lungs of mice receiving anti-α4
+ β7 treatment. Reduced eosinophil peroxidase and β-hexosaminidase activity, downregulation of inflammatory genes, lower production of inflammatory lipid intermediates like prostaglandins E2 and D2, leukotriene B4 and cysteinyl leukotrienes were also noted in anti-α4+ β7 treated mice. Reduced accumulation of central memory, effector memory, regulatory T cells and lower production of IL-4, IL-5, and TGF-β were other cardinal features of anti-α4+ β7 treated mice lungs. Flow cytometry-sorted lung eosinophils from anti-α4+ β7 treated mice showed higher apoptotic potential, downregulated anti-apoptotic gene Bcl-2, and exhibited reduced F-actin polymerization and calcium influx as compared to IgG controls. In summary, neutralization of α4+ β7 integrins impairs the transmigration, activation and survival of eosinophils and reduces TPE induced pathology in mice lungs., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)- Published
- 2017
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45. A 29-Year-Old Woman With Acute Respiratory Failure and Eosinophilic Lung Disease.
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Chalhoub NE and Hernandez DA
- Subjects
- Acute Disease, Adult, Aspergillus isolation & purification, Bronchoscopy, Female, Humans, Lung diagnostic imaging, Lung microbiology, Mycoses microbiology, Penicillium isolation & purification, Pulmonary Eosinophilia chemically induced, Respiratory Insufficiency diagnosis, Dietary Supplements adverse effects, Mycoses complications, Obesity diet therapy, Plant Preparations adverse effects, Pulmonary Eosinophilia complications, Respiratory Insufficiency etiology
- Published
- 2017
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46. Emerging Therapies in Severe Eosinophilic Asthma.
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Pang PH and Brightling CE
- Subjects
- Asthma etiology, Humans, Anti-Asthmatic Agents therapeutic use, Antibodies, Monoclonal therapeutic use, Asthma drug therapy, Pulmonary Eosinophilia complications
- Published
- 2017
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47. Invasive pulmonary mucormycosis: rare presentation with pulmonary eosinophilia.
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Hirano T, Yamada M, Sato K, Murakami K, Tamai T, Mitsuhashi Y, Tamada T, Sugiura H, Sato N, Saito R, Tominaga J, Watanabe A, and Ichinose M
- Subjects
- Aged, Antifungal Agents therapeutic use, Aortic Aneurysm, Abdominal surgery, Asthma complications, Bronchoalveolar Lavage Fluid microbiology, Bronchoscopy, Cross Infection drug therapy, Cross Infection microbiology, Cunninghamella isolation & purification, Disease Progression, Fatal Outcome, Humans, Male, Postoperative Complications drug therapy, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Eosinophilia diagnosis, Pulmonary Eosinophilia drug therapy, Radiography, Thoracic, Tomography, X-Ray Computed, Amphotericin B therapeutic use, Mucormycosis diagnosis, Mucormycosis drug therapy, Postoperative Complications microbiology, Pulmonary Eosinophilia complications
- Abstract
Background: Fungi can cause a variety of infectious diseases, including invasive mycosis and non-invasive mycosis, as well as allergic diseases. The different forms of mycosis usually have been described as mutually exclusive, independent entities, with few descriptions of overlapping cases. Here, we describe the first reported case of a patient with the complication of pulmonary eosinophilia in the course of invasive mucormycosis., Case Presentation: A 74-year-old Japanese man with asthma-COPD overlap underwent emergency surgery for a ruptured abdominal aortic aneurysm. The surgery was successful, but fever and worsening dyspnea appeared and continued from postoperative day (POD) 10. A complete blood count showed leukocytosis with neutrophilia and eosinophilia, and the chest X-ray showed consolidation of the left upper lung at POD 15. We suspected nosocomial pneumonia together with an exacerbation of the asthma-COPD overlap, and both antibiotics and bronchodilator therapy were initiated. However, the symptoms, eosinophilia and imaging findings deteriorated. We then performed a bronchoscopy, and bronchoalveolar lavage (BAL) fluid analysis revealed an increased percentage of eosinophils (82% of whole cells) as well as filamentous fungi. We first suspected that this was a case of allergic bronchopulmonary mycosis (ABPM) caused by Aspergillus infection and began corticosteroid therapy with an intravenous administration of voriconazole at POD 27. However, the fungal culture examination of the BAL fluid revealed mucormycetes, which were later identified as Cunninghamella bertholletiae by PCR and DNA sequencing. We then switched the antifungal agent to liposomal amphotericin B for the treatment of the pulmonary mucormycosis at POD 29. Despite replacing voriconazole with liposomal amphotericin B, the patient developed septic shock and died at POD 39. The autopsy revealed that filamentous fungi had invaded the lung, heart, thyroid glands, kidneys, and spleen, suggesting that disseminated mucormycosis had occurred., Conclusions: We describe the first reported case of pulmonary mucormycosis with pulmonary eosinophilia caused by Cunninghamella bertholletiae, which resulted in disseminated mucormycosis. Although it is a rather rare case, two important conclusions can be drawn: i) mycosis can simultaneously cause both invasive infection and a host allergic reaction, and ii) Cunninghamella bertholletiae rarely infects immunocompetent patients.
- Published
- 2017
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48. Tropical pulmonary eosinophilia: effect of addition of corticosteroids after failure of diethylcarbamazine therapy.
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Madan M, Gupta P, Mittal R, and Chhabra SK
- Subjects
- Cough etiology, Female, Humans, Middle Aged, Pulmonary Eosinophilia complications, Respiratory Function Tests, Adrenal Cortex Hormones therapeutic use, Diethylcarbamazine therapeutic use, Pulmonary Eosinophilia diagnostic imaging, Pulmonary Eosinophilia drug therapy
- Abstract
Successful response in diethylcarbamazine (DEC) therapy in tropical pulmonary eosinophilia (TPE) is not universal with a 20-40% failure rates in chronic cases. Corticosteroids have been used in such patients. However, their role in management remains ill-defined. A patient of TPE with incomplete clinical, haematological and physiological response to a standard 3 weeks DEC therapy received additional corticosteroids for the next two cycles, after which complete remission occurred. However, there was a relapse two months later with evidence of a chronic state requiring further treatment with corticosteroids with good response.
- Published
- 2017
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49. [Eosinophilic pneumonia, how to differentiate: classification and diagnostic approach].
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Djakovic T, Ribeiro D, Brossard C, and Nicod LP
- Subjects
- Humans, Pulmonary Eosinophilia complications, Pulmonary Eosinophilia drug therapy, Vasculitis diagnosis, Vasculitis drug therapy, Adrenal Cortex Hormones therapeutic use, Immunosuppressive Agents therapeutic use, Pulmonary Eosinophilia diagnosis
- Abstract
Eosinophilic pneumonia is characterized by pulmonary eosinophilia associated with and/or alveolar eosinophilia. Furthermore, blood eosinophilia may be absent particularly in patients who have benefited beforehand of corticosteroids. The most common causes are parasites and drugs. According to the classification, we distinguish idiopathic pneumonia with eosinophils, those related to vasculitis and those of known etiology. Extrapulmonary involvement is frequently found in the subgroup of vasculitis. It is important to diagnose and start treatment quickly to reduce the risk of complications. The primary treatment is based on corticosteroids and in severe cases of vasculitis immunosuppressants are necessary., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2016
50. Blurred lines. Eosinophilic COPD: ACOS or COPD phenotype?
- Author
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Loureiro CC
- Subjects
- Asthma blood, Eosinophils, Humans, Phenotype, Pulmonary Disease, Chronic Obstructive blood, Pulmonary Disease, Chronic Obstructive genetics, Pulmonary Eosinophilia blood, Syndrome, Asthma complications, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Eosinophilia complications
- Abstract
Because asthma and COPD are both inflammatory chronic obstructive airway diseases, there are several clinical expressions which can cause confusion, such as: eosinophilic asthma with fixed obstruction, which is a risk factor and might progress to COPD; eosinophilic COPD; COPD with partial reversible obstruction with no asthmatic component and also eosinophilic asthma-COPD overlap syndrome (ACOS). While at the two extremes of these disorders the pathoimmunological processes are clearly different, in some patients there is overlap and the pathophysiological border between asthma and COPD is fused (or diffuse). The current guidelines are clearly insufficient for classification of the obstructive patients and, taking into account that binary separation between the two diseases is not completely clear, we should resist the temptation to label patients as ACOS and consider new airway disease taxonomy. Regardless of the condition concerned, eosinophils should be considered in the algorithm approach to obstructive patients: in COPD, as in asthma, they are related to the underlying pathological process; they have prognostic value and are related to therapeutic response. Therefore, eosinophils should be valued as useful biomarkers and included in a multidimensional diagnostic and therapeutic approach, bearing in mind the phenotypic, immunopathological and functional complexity of chronic obstructive airway disease., (Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
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