Dr Rajesh SwarnakarMD,DTCD,DNB,FCCP(USA) Consultant Pulmonologist &DirectorGetwell Hospital & Research Institute, NAGPURRaised Eosinophill Count :Clinical Significance

-Two-lobed, polymorphonuclear leukocyte 12 to 15 um diameter

- Created by IL-3, Il-5 and GM-CSF -Three granule types, largest made up of MBP (major basic protein)

- Kills Parasites, tumor cells, -Circulates

Can happen in Blood&TissueBronchoscopy (BAL) EOS Percentage (%) rather than absolute number Normal volunteers = < 1% Raised Eosinophill Count:Blood Eosinophillia : Sampling peripheral blood

Pulmonary Eosinophillia:Measured in BAL Eosinophils count: Whats Normal?Blood EOS (#) = up to 600/cmm

Eosinophil associated diseases and disorders

The degree of Blood eosinophilia can be categorized into : Mild 500 to 1500 cells/microL Moderate 1500 to 5000 cells/microL Severe >5000 cells/microLCategories of Eosinophilia Peripheral eosinophilia can be divided into categories of ,primary, secondary, or idiopathic eosinophilia

Eosinophils can also be seen in Hodgkin's and non Hodgkin lymphoma and other metastatic cancers, but the associated eosinophils are not of a clonal nature in this situationPrimary eosinophiliaUsually occurs in the context of hematologic malignancies, such as acute leukemias or chronic myeloid disorders, when there is evidence of clonal expansion of eosinophils

The most common cause for secondary eosinophilia : is parasitic lung infection. Noninfectious causes of secondary eosinophilia include allergic disorders, medications, toxins, autoimmune diseases, and endocrine disorders such as Addison's disease.

A diagnosis of idiopathic eosinophilia is considered when a thorough evaluation does not identify either a primary or secondary cause of eosinophilia

Diseases Associated with Blood & Pulmonary Eosinophilia

Pulmonary Eosinophilic Syndromes of Known Cause:Parasitic-induced eosinophilic pneumonias (including Loefflers syndrome) Drug-or toxin-induced eosinophilic pneumonias Tropical pulmonary eosinophilia Allergic bronchopulmonary mycosis.Pulmonary Eosinophilic Syndromes of Unknown Cause:Idiopathic acute eosinophilic pneumonia Chronic eosinophilic pneumonia Churg-Strauss syndrome (allergic granulomatosis and angiitis) Idiopathic hypereosinophilic syndrome

Interstitial lung disease -Idiopathic pulmonary fibrosis -Collagen-vascular disease associated -Sarcoidosis -Eosinophilic granuloma (pulmonary histiocytosis X) Malignancy -Nonsmall-cell cancer of lung -Non-Hodgkins lymphoma -Myeloblastic leukemia Miscellaneous (e.g., lung transplantation, ulcerative colitis

Treatment of primary disease suffices to bring down raised eosinophil count.

Bronchocentric granulomatosis Bronchiolitis obliterans-organizing pneumonia Infections Fungal (esp.Coccidioidomycosis, Aspergillus,Pneumocystis jirovecii) -Tuberculosis

Other Lung Diseases Variably Associated with Eosinophilia:Asthma/allergy

Algorithmic approach to evaluation patients with pulmonary/blood eosinophillia :

( Am J Respir Crit Care Med 150:1423-138,1994.)

History & Physical ExamCollagen Vascular DiseaseHIV RisksDrugsAsthma HistoryTravel History Stool Ova & Parasite ExamStrongyloidesAscaris SchistosomaAncylosiomaPulmonary Function TestsObstructionNon- PulmonaryOrgan InvolvementPulmonary Involvement OnlyChurg-StraussChest x-ray NormalIgE < 1.000Chest x-ray Abnormal IgE > 2.000AsthmaAllergic Bronchopulmonary Aspergillosis Bronchocentric GranulomatosisRestrictionBronchoalveolar LavagePneumocystisStrongyloidesAspergillusCryptococcus> 20% Eosinophils< 20% EosinophilsBlood Eosinophil Count Interstitial Lung DiseaseDrug ReactionHighModerateLow/NormalHypereosinophilic SyndromeChronic Eosinophilic Pneumonia Simple Pulmonary EosinophiliaAcute Eosinophilic Pneumonia

CEPABPACSSHISSubacuteAcute, subacute, chronicAcute, subacute, chronic Subacute, chronic + (30 60 %)Nearly 100%100%-Mild mod. In mostTypicalExtreme, fluctuating Extreme, persistent Striking In someProminent Striking

Mod. elev. In 30%Marketed elev. , fluctuates w/diseaseMod. elev. Mod. elev. In some

UnknownAspergillus (or other fungus)UnknownUnknown

Predominately, peripheral consolidation and GGOs photographic negative of pulmonary edemaUpper lobe predominant proximal bronchiectasisTransient. Migratory peripheral, rarely diffuse: patchy peribronchial and septal thickening, patchy parenchymal GGO or consolidation Transient, focal or diffuseNormal. OVD, or RVDOVD +/- RVDOVD +/- RVDMild RVD in someNoneSee Table 72 4Histopathology plus appropriate clinical settingExtreme persistent eosinophilia and multi-organ dysfunction (no other evident cause) Occasionally mild, non necrotic NoneCharacteristic (see text)NoneVery rare reportedNoneTypical of vasculitic phase Cardiac, neurological. GI, hematological, other CorticosteroidsCorticosteroids, bronchodilators, antibiotics, antifungals Corticosteroids, other immunosuppressive (see text)Corticosteroids, other immunosuppressive (see text)

CommonTypicalInfrequent after RxChronicity typical

Thank you for your Kind attention

This presentation is available on www.lungscare.com/ppt Email : drrajeshswarnakar@gmail.com

1st -2nd February, 2014Hotel Hyatt Regency, Pune, IndiaInternational Conference on Insights and Management of COPDOn behalf of the organising committee, it gives us immense pleasure to welcome you to the first international conference on COPD ICONIC 2014, to be held on 1st and 2nd February, 2014 at Hotel Hyatt Regency, Pune.

The scientific programme will cover insights on the burden, pathophysiology, risk factors for COPD, advances in disease management and new directions for research in COPD, and a discussion on the much needed policy change in the management of COPD practices in India.

Come listen to some of the internationally acclaimed leaders in Respiratory Medicine from across the globe including Prof. P. J. Barnes, Prof. James Hogg, Dr. John Walsh, Dr. Robert A. Wise, Dr. Sonia Buist, Dr. John R. Balmes and others.

Once again we extend a cordial welcome to you all and look forward to your active participation in ICONIC 2014!!! Dear friends and colleagues, Organizing committee office:Chest Research Foundation, Kalyani Nagar, Pune 411014, INDIASecretariat contact: Telephone (Contact):+91 22 2494 0518 Fax:+91 22 2494 0517Email:secretariat@iconic2014.com Website: :www.iconic2014.comICONIC - 2014 Organized by: Chest Research Foundation, India and Johns Hopkins University, USAICONIC is Endorsed by: