Kimura's disease is a chronic inflammatory disorder which affects the subcutaneous tissues of the head and neck, axilla and upper limb as well as the groin region. In the head and neck region, major salivary glands and regional lymph nodes are mainly involved with associated eosinophilia and an elevated IgE concentration. Three cases of Kimura's disease involving the parotid glands, lymph nodes and cheek are presented with a brief review of the literature.
Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia
Kimura's disease is a chronic inflammatory disorder of unknown etiology commonly seen among orientals and characterized histologically by lymphatic follicles, vascular proliferation, and marked eosinophilic infiltration. It has a predilection for the head and neck region. The lesion is benign but can be mistaken to be a malignant lesion.
Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/drug therapy*; Angiolymphoid Hyperplasia with Eosinophilia/pathology; Angiolymphoid Hyperplasia with Eosinophilia/surgery*
The aim of this study was to determine the prevalence and extent of diseases present among migrant workers. A total of 809 migrant workers were examined. The mean BMI (Body Mass Index) was 22.3 kg/m2. Only 4.9% of the respondents had blood pressure greater than 140/90 mmHg. Generally the migrant workers examined were healthy, except for subjects with abnormal eosinophilia coutns, which may indicate occult parasitic infestation. Non-communicable disease in particular hypertension and diabetes mellitus are not major problems among migrant workers. Perhaps the target to aim at are the illegal migrant workers where more illness could be detected.
Kimura's disease (KD) is an uncommon chronic inflammatory condition of unknown aetiology involving subcutaneous tissue, presenting as a tumor like lesion with a predilection for the head and neck region. Clinically it is often confused with parotid tumor with lymph node metastasis. It is difficult to diagnose before tissue biopsy. Fine needle aspiration cytology has only limited value. Unless the pathologists are aware of this entity, it might be misdiagnosed. Surgery, radiotherapy and steroid therapy have been tried but none is proved best and recurrence is common. Three cases of KD seen in our hospital and the problems encountered in them are presented.
Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/diagnosis*
Seven members of a 15-man U.S. military team that had operated in rural Malaysia developed an acute illness consisting of fever, myalgias, bronchospasm, fleeting pruritic rashes, transient lymphadenopathy, and subcutaneous nodules associated with eosinophilia, elevated erythrocyte sedimentation rate, and elevated levels of muscle creatinine kinase. Sarcocysts of an unidentified Sarcocystis species were found in skeletal muscle biopsies of the index case. Albendazole ameliorated symptoms in the index case; however, his symptoms persisted for more than 5 years. Symptoms in 5 other men were mild to moderate and self-limited, and 1 team member with laboratory abnormalities was asymptomatic. Of 8 team members tested for antibody to Sarcocystis, 6 were positive; of 4 with the eosinophilic myositis syndrome who were tested, all were positive. We attribute this outbreak of eosinophilic myositis to accidental tissue parasitism by Sarcocystis.
The association of mast cells with typical lesions of Kimura's disease was investigated by quantitative methods after immunohistochemical staining for Factor VIII-related antigen and counterstaining with toluidine blue. Formalin-fixed, paraffin-embedded, tissue sections from 9 confirmed cases of Kimura's disease were examined after staining to estimate mast cell and blood vessel densities by counting 100 random fields under oil immersion. There was a statistically significant increase of both mast cells and blood vessels in Kimura's disease (p<0.01) compared with normal skin and reactive lymph node controls. However, as far as the individual Kimura's disease lesion is concerned, there was generally no correlation between areas with mast cell increase and the degree of vascularity. Moreover, when lesions of less than 1 year's duration were compared with older lesions, there appeared to be a relative decrease in mast cells and a concomitant increase in vascularity in the latter. These results confirmed that mast cells are associated with Kimura's disease, and suggest that they may be involved in its early pathogenesis, although its possible role in angiogenesis may not be direct.
Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/metabolism; Angiolymphoid Hyperplasia with Eosinophilia/pathology*
Lymphatic filariasis is endemic in Asia. The infections persist as a major cause of clinical morbidity and a significant impediment to socioeconomic development. Its prevalence is increasing world wide, largely because of rapid unplanned urbanization in many endemic areas. It is estimated that at least 120 million people are infected. In our study on foreign workers, a total of 241 day time blood samples were collected. The countries represented were Bangladesh (134), Indonesia (103), Pakistan (3) and Myanmar(1). The tests conducted on blood samples were thick blood film for microfilaria and thin blood film for malaria and quantitation of eosinophiles using the Giemsa stain. Out of the 241 blood samples tested, one was positive for Wuchereria bancrofti and one other was positive for malaria (Plasmodium falciparum) each from Bangladesh and Indonesia respectively. As for the blood eosinophiles, 39 (16.18%) blood samples showed high eosinophilia. Fifteen (6.22%) were from Banglandesh and 24 (9.96%) were from Indonesia. The Bangladeshi male who was positive for Witcherrria bamuofti also showed eosinophilia of 22%. We believe that some of these cases with high eosinophilia, may be positive for microfilaria. We may have missed some cases because of the methodology we chose. Lymphatic filariasis is endemic in Bangladesh and Indonesia. In Malaysia W. brancrofti, especially in the cities have been eliminated. However their vectors for the transmission of W. bancrofti is rampant in the cities. With the influx of immigrants with W. bancrofti and in relation to their occupational nature, W. bancrofti may eventually be introduced into the community and change the whole facet of the disease in Malaysia.
This section only examines the clinical findings and some blood chemistly in these workers. A total of 222 men and 28 women were studied. Their ages ranged from 12 to 57 years, the mean being 30.1 (±7.4). Generally most of the physical examination was normal and no external features of infectious diseases were seen. The mean systolic and diastolic blood pressure was 120 (±13) and 76(±8.7) nun Hg respectively. About 8.4% of the population had elevated blood pressure of 140/90 mmHg or greater. About 12.4% of these man and women were underweight (Body mass index (EMI) less than 19 kg/m2) while 11.2% were either overweight or obese (BMI>25) with the mean being 21.8 (±2.7). Only 3 had BMI greater than 30. Three subjects had a lnitral regurgitation murmur thought to be due to mitral valve prolapse. Four others had tinea cruris, six had insignificant axillary lymph-nodes, five had cervical lymph-nodes of which one was due to carcinoma of the tonsil 30 with shotty inguinal lymph-nodes which was thought to of no pathological significance. Four subjects had crepitations and five had rhonchi in their lungs. A full blood count revealed that 16.65% of the man and 32.1°/o of the women had haemoglobin levels of less than 14gm/dl and 12gm/dl respectively. The most striking abnormality was the high prevalence of eosinophilia. 37% of the subjects had eosinophilia counts of greater than 450/dl. About 19.4% of this study population had fasting blood glucose of greater than 6mmol/l but only 1.3% with fasting blood glucose of greater than 7.8 mmo/l. About 22% of the urine examined revealed pro- teinuria but were otherwise unremarkable for the other parameters. This group of foreign workers was made up of a presumably fairly healthy young population. Attempts to look for infectious disease on physical examination, not surprisingly did not reveal any remarkable findings. It could be that the majority of these subjects already had a examination prior to coming into the country and another one soon after arrival. However an indirect measurement of infectious diseases via the eosinophilic count revealed a high prevalence of parasitic infestations. Attempts to examine the end results of social hardship, be it intrinsic before or appearing after arrival indirectly shoved some degree of suffering. There was a fairly high prevalence of anaemia, especially amongst the women. The body mass index also revealed this population to be generally less obese than other populations. The value of medical check-ups has been debated, especially if it were done as a pre-employment procedure. This pilot study has shown that it is not cost-effective to do physical examination or blood chem- istry and urine analysis in hying to identify infectious diseases in the migrant workers. In the light of the paucity of clinical findings in this pilot study, it would be prudent to review the strategy for examining the health status of migrant workers. Perhaps the physical examination can be dispensed with, and blood andurine analysis beveryfocused and directedin order to maximise the cost- effectiveness of this programme. Certainly the high prevalence of eosinophilia needs further evalua- tion.
Tropical pulmonary eosinophilia (TPE) is considered to be a variant of human filarial infection. The pulmonary manifestations of TPE have been well described. Extra-pulmonary features of the disease, although not commonly seen, have been reported previously. A 9-year-old Malay girl with a history of recurrent cough and wheezing was admitted because of cardiac failure. Physical examination revealed a very sick girl with tachypnoea, central cyanosis, finger clubbing, elevated jugular venous pulse, generalized crackles and rhonchi in the chest, a loud second heart sound and hepatosplenomegaly. A chest radiograph showed cardiomegaly and right pleural effusion. Laboratory investigations revealed hypochromic, microcytic anaemia with persistent blood eosinophilia (absolute eosinophil counts varied from 1.9 to 5.5 x 10(9)/1). The ELISA test for antifilarial IgG antibodies was strongly positive. She responded promptly to treatment with diethylcarbamazine. In summary, this is a patient with TPE who presented with cor pulmonale, probably due to late-stage interstitial pulmonary fibrosis. In order to prevent the long term morbidity of cardiorespiratory disability, the early signs of TPE should be recognized and the infection treated.
The term 'tropical' refers to the region of the Earth lying between the Tropic of Cancer and the Tropic of Capricorn. Located between these equatorial parallels demarcating the Torrid Zone are several underdeveloped and developing countries: Thailand, the Philippines, Malaysia, Singapore, Indonesia, southern India, Sri Lanka, Brazil, Cuba, Ethiopia, Sudan and Nigeria, to name but a few considered to be 'tropical'. The climate in most of these countries is characterized by high temperatures and high humidity. The tropical climate and general state of socio-economic underdevelopment in such countries provide an ideal environment for pathogenic organisms, their vectors and intermediate hosts to flourish. Furthermore, the cultural habits and educational background of the people living in such countries expose them to pathogens and, when these people become infected, they readily become reservoirs for, or carriers of, those organisms. Ultimately, the adverse socioeconomic conditions of underdeveloped countries impede attempts to eradicate or control tropical diseases.
Three patients presenting with parotid, submandibular, and/or lymph node masses were subjected to fine-needle aspiration cytology. Smears showed dissociated and clustered endothelial cells, eosinophils, lymphocytes, and Warthin Finkeldey giant cells. In two cases a diagnosis of Kimura's disease was suggested from the FNA cytologic smears. In the third case the presence of mononucleate cells with prominent nucleoli led to a suspicion of Hodgkin's disease. Excision biopsy and histopathologic study established a diagnosis of Kimura's disease in all three cases.
Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/pathology*
Acquired platelet dysfunction associated with eosinophilia has been described mainly in indigenous Southeast Asian and East Indian children. We describe two white boys in whom this disorder developed after they had lived in Malaysia for 12 to 18 months. Acquired platelet dysfunction associated with eosinophilia should therefore be considered in children who, after a visit to this region, have easy bruising and esoinophilia.
The distribution of anti-toxoplasma antibodies among the aborigines in Malaysia and its association with other soil transmitted infections and eosinophilia were studied. A total of 415 serum samples were collected and tested by IFA test. Overall prevalence was 10.6%, lower than previously reported. The antibody titers showed a unimodal distribution peaking at 1:8 dilution. There was a higher proportion of high antibody titer (> 1:128) in the adult compared to the children with no significant difference in prevalence rate by sex. The pattern of infection does not differ from other soil transmitted infections and there was no association between raised Toxoplasma antibodies with eosinophilia.
The principal etiologic agent of human eosinophilic meningitis, Angiostrongylus cantonensis, was first detected in rats in Canton, China in 1933. The first human case was detected on Taiwan in 1944. Epidemic outbreaks were noted on Ponape (E. Caroline Is.) from 1944 to 1948. The disease may present as transient meningitis or a more severe disease involving the brain, spinal cord and nerve roots, with a characteristic eosinophilia of the peripheral blood and CSF. Since 1961 it has been known that human infections are usually acquired by purposeful or accidental ingestion of infective larvae in terrestrial mollusks, planaria and fresh-water crustacea. There is no effective specific treatment. The African land snail, Achatina fulica played an important role in the panpacific dispersal of the organism: it will be important in Africa in the future as well. Rats were, and will continue to be the principal agents of expansion of the parasite beyond the Indopacific area. During and just after WWII the parasite was introduced, and/or spread passively from South and Southeast Asia into the Western Pacific islands and eastward and southward through Micronesia, Melanesia, Australia and into Polynesia, sequestered in shipments of war material and facilitated by post-war commerce. In the 1950s numerous cases were identified for the first time on Sumatra, the Philippines, Taiwan, Saipan, New Caledonia, and as far east as Rarotonga and Tahiti. Then cases were detected in Vietnam, Thailand, Cambodia, Java, Sarawak, the New Hebrides, Guam and Hawaii during the 1960s. Subsequently in the Pacific Basin the disease has appeared on Okinawa, other Ryukyu islands, Honshu, Kyushu, New Britain, American Samoa and Western Samoa, Australia, Hong Kong, Bombay, India, Fiji and most recently in mainland China. The parasite in rats now occurs throughout the Indopacific Basin and littoral. Beyond the Indopacific region, the worm has been found in rodents in Madagascar (ca 1963), Cuba (1973), Egypt (1977), Puerto Rico (1984), New Orleans, Louisiana (1985) and Port Harcourt, Nigeria (1989). Human infections have now been detected in Cuba (1973), Réunion Island (1974) and Côte d'Ivoire (1979) and should be anticipated wherever infected rats of mollusks have been introduced. Caged primates became infected in zoos in Hong Kong (1978) and New Orleans and Nassau, Bahamas (1987). The use of mollusks and crustacea as famine foods, favored delicacies and medicines has resulted in numerous outbreaks and isolated infections. Economic and political instability, illicit trade, unsanitary peridomestic conditions and lack of health education promote the local occurrence and insidious global expansion of parasitic eosinophilic meningitis.(ABSTRACT TRUNCATED AT 400 WORDS)
Matched MeSH terms: Eosinophilia/diagnosis; Eosinophilia/etiology*; Eosinophilia/prevention & control
Hematological changes were monitored in the leaf-monkey, Presbytis cristata, infected experimentally with 200 subperiodic Brugia malayi infective larvae. Prepatent periods were 54-86 days and peak microfilarial geometric mean counts (GMCs) were 1324 per ml blood. Total leukocyte and differential counts were measured at pre-infection, and then at weakly intervals before and during patency. Blood eosinophil level increased to about thrice the initial level at 3 weeks post-infection and this was maintained for the next 13 weeks before it started to rise again, increasing to more than 5 times the initial level at 20 weeks post-infection. The observed pattern of eosinophilia is probably related to the level of microfilaremia and the destruction of microfilariae in the spleen. There was no significant change in the total leukocyte counts during the period of observation.
Thirty one patients were investigated for the main complaint of easy bruising. These patients had normal platelet count with no past history of immune thrombocytopenia or systemic disorders known to predispose to bruising and a negative drug history. The evaluation of these patients included clinical review (history and physical examination) plus coagulation tests consisting of bleeding time, prothrombin time, partial thromboplastin time, thrombin time, fibrinogen level, FXIII screen and platelet functions test. Seven of the paediatric patients had acquired platelet dysfunction with eosinophilia (APDE). In 17 (94.4%) of the 18 adult patients no abnormality was demonstrated. Hence APDE was the commonest cause of easy bruising in children while the haemostatic defect contributing to easy bruising in adults remained unknown.
A 44-year-old Indian housewife presented with prolonged cough, intermittent fever, loss of weight and shortness of breath on exertion. Physical examination revealed a thin lady with fine crackles on both lungs. Marked eosinophilia and elevated erythrocyte sedimentation rate were noted on peripheral blood. Chest radiograph showed characteristic bilateral infiltrates affecting the periphery of both lungs. Treatment with corticosteroid resulted in dramatic improvement in symptoms, signs and radiographic changes within a few days.
A 72 year old man developed acute organic brain syndrome associated with marked eosinophilia following self medication with a variety of drugs. Investigations revealed no other known causes of eosinophilia. Withdrawal of drugs resulted in dramatic drop in eosinophil count paralleled by clinical resolution of neurological problems. To our knowledge drug-induced eosinophilia has not previously been associated with acute organic brain syndrome.
We present three cases of Acquired Platelet Dysfunction with Eosinophilia (APDE). The importance of recognising this benign condition, which usually does not require any specific therapy, is stressed to avoid the pitfalls of diagnosing more serious bleeding disorders in children presenting with ecchymosis.
Quantitation of serum immunoglobulin M, G, A, D and E levels was carried out in Malaysians with Brugia malayi infections. Results showed highly elevated levels of IgM and IgE as well as moderately elevated levels of IgG. These were most significant in patients with tropical pulmonary eosinophilia or elephantiasis. Serum IgE levels were extremely high in microfilaraemic patients (6,060 +/- 3,958 IU ml) probably due to a constant antigenic stimulation by dead and dying microfilariae.