Management of hypereosinophilia in tropical settings

Abstract

Hypereosinophilia includes a group of commonly encountered clinical situations with symptoms ranging from mild and clinically innocuous to devastating presentations with high morbidity and mortality. The presentations and complications can be easily missed if the clinician is unaware of the diverse entities responsible for hypereosinophilia. The hypereosinophilic syndromes encompass entities that are associated with varying degrees of organ dysfunction either directly due to eosinophilic infiltration or as a result of substances secreted by the eosinophils. These conditions may be neoplastic or reactive in aetiology and a diligent search for secondary causes is essential. Evaluation and management algorithms in the tropical setting and in developing countries may differ from elsewhere. A review of hypereosinophilia and hypereosinophilic syndromes is presented with a diagnostic and therapeutic decision making algorithm modified for use in the tropical setting.

Idiopathic hypereosinophilic syndrome presenting as monoplegia

“…If no reactive causes are identified, it is recommended to proceed with a bone marrow examination to look for any neoplastic causes for hypereosinophilia 1. Further molecular studies like fluorescent in-situ hybridization or PCR for BCR/ABL, JAK2 V617F transcripts, FIP1L1-PDGFRA, PDGFRB and FGFR1 genetic rearrangements should be undertaken.…”

“…The criteria for the diagnosis and classification of hypereosinophilia have been constantly changing. A recent consensus on terminology defined hypereosinophilia (HE) as eosinophilia more than 1.5×10 9 /L in the peripheral blood on two occasions more than 1 month apart with or without tissue hypereosinophilia 1. Hypereosinophilic syndrome (HES) is defined as peripheral blood hypereosinophilia with organ damage and/or dysfunction attributable to tissue HE and the exclusion of other disorders or conditions as major reason for organ damage 2…”

“…Hypereosinophilic syndrome (HES) is defined as peripheral blood hypereosinophilia with organ damage and/or dysfunction attributable to tissue HE and the exclusion of other disorders or conditions as major reason for organ damage 2Box 1 1 lists the various causes of hypereosinophilia. HESs have also been separated into subcategories depending on their aetiology.…”

“…HESs have also been separated into subcategories depending on their aetiology. These include primary neoplastic (HES N ), secondary or reactive (HES R ) and idiopathic HES 1…”