Prevalence and management of eosinophilia based on periodic health examinations in primary care clinics

Figure 1.

Prevalence of possible causes of eosinophilia stratified by diagnosis (n = 204)_

Possible causes	Total	Known underlying disease (n = 91)	Diagnosed by the primary physician (n = 66)	Diagnosed by an internist (n = 11)	Diagnosed by a doctor on another visit† (n = 36)
Atopic disease	105 (51.5)	84 (80.0)	7 (6.7)	2 (1.9)	12 (11.4)
Allergic rhinitis	65 (31.9)	56 (86.2)	2 (3.1)	0	7 (10.7)
Asthma	23 (11.3)	20 (87.0)	0	1 (4.3)	2 (8.7)
Allergic rhinitis and asthma	7 (3.4)	7 (100.0)	0	0	0
Atopic dermatitis	3 (1.5)	1 (33.3)	1 (33.3)	0	1 (33.3)
Urticaria	4 (2.0)	0	2 (50.0)	0	2 (50.0)
Food allergy	2 (1.0)	0	1 (50.0)	1 (50.0)	0
Allergic conjunctivitis	1 (0.5)	0	1 (100.0)	0	0
Infection	75 (36.8)	1 (1.3)	55 (73.4)	7 (9.3)	12 (16.0)
Parasite infestation	70 (34.3)	0	53 (75.7)	7 (10.0)	10 (14.3)
Viral infection	3 (1.5)	0	1 (33.3)	0	2‡ (66.7)
TB	2 (1.0)	1 (50.0)	1 (50.0)	0	0
Solid tumor	13 (6.4)	2 (15.4)	0	0	11 (84.6)
Breast cancer	5 (2.5)	1 (20.0)	0	0	4 (80.0)
Prostate cancer	3 (1.5)	1 (33.3)	0	0	2 (66.7)
Lung cancer	2 (1.0)	0	0	0	2 (100.0)
Rectal cancer	1 (0.5)	0	0	0	1 (100.0)
Ovarian cancer	1 (0.5)	0	0	0	1 (100.0)
Parotid cancer	1 (0.5)	0	0	0	1 (100.0)
Drug reaction: allopurinol	4 (2.0)	0	4 (100.0)	0	0
Autoimmune disease	3 (1.4)	3 (100.0)	0	0	0
Rheumatoid arthritis	1 (0.5)	1 (100.0)	0	0	0
Psoriasis	1 (0.5)	1 (100.0)	0	0	0
Autoimmune thyroid disease	1 (0.5)	1 (100.0)	0	0	0
Hematologic disease	3 (1.4)	1 (33.3)	0	2 (64.7)	0
HES	1 (0.5)	1 (100.0)	0	0	0
Chronic myeloid leukemia	2 (1.0)	0	0	2 (100.0)	0
Adrenal insufficient	1 (0.5)	0	0	0	1 (100.0)

Factors associated with the primary physician’s management and identified cause of eosinophilia (n = 988)_

Factor	Diagnosis of eosinophilia		Sending laboratory diagnostic work-up of eosinophilia		Internist consultation		Identified cause of eosinophilia
	Adjusted OR (95% CI)	P	Adjusted OR (95% CI)	P	Adjusted OR (95% CI)	P	Adjusted OR (95% CI)	P
Age ≥60 years (n = 289)	0.93 (0.62, 1.41)	0.747	0.40 (0.11, 1.44)	0.163	1.15 (0.40, 3.25)	0.798	0.91 (0.57, 1.46)	0.704
Sex: Female (n = 468)	0.91 (0.63, 1.33)	0.625	0.58 (0.19, 1.78)	0.339	0.78 (0.30, 2.07)	0.625	1.29 (0.84, 1.96)	0.243
Clinic
GP (n = 757)	1		1		1		1
PCU (n = 34)	0.82 (0.19, 3.55)	0.789	0 (0, Inf)	0.995	0 (0, Inf)	0.993	0.42 (0.06, 2.75)	0.367
Premium checkup (n = 197)	4.59 (1.57, 13.42)	0.005*	0.33 (0, 26.89)	0.619	2.06 (0.06, 67.49)	0.685	0.88 (0.21, 3.73)	0.860
Physician
Intern (n = 765)	1		1		1		1
Resident FM (n = 11)	0 (0, Inf)	0.975	0 (0, Inf)	0.997	0 (0, Inf)	0.996	1.76 (0.17, 18.62)	0.640
Staff FM (n = 212)	2.39 (0.82, 6.98)	0.110	2.76 (0.03, 227.88)	0.652	6.01 (0.18, 199.46)	0.315	1.40 (0.33, 5.91)	0.646
CBC results
WBC ≥10,000 cells/μL (n = 104)	0.85 (0.47, 1.54)	0.593	0 (0, Inf)	0.991	1.54 (0.44, 5.31)	0.497	0.51 (0.22, 1.15)	0.105
Severity of eosinophilia
Mild (n = 908)	1		1		1		1
Moderate to severe (n = 80)	3.52 (1.97, 6.32)	<0.001*	17.13 (5.74, 51.11)	<0.001*	6.38 (1.95, 20.93)	0.002 *	1.94 (0.98, 3.83)	0.056
Anemia† (n = 102)	1.63 (0.91, 2.94)	0.102	1.79 (0.43, 7.40)	0.422	1.78 (0.48, 6.63)	0.392	0.65 (0.30, 1.40)	0.271
Abnormal platelet count‡ (n = 27)	1.11 (0.40, 3.11)	0.840	3.35 (0.58, 19.44)	0.178	0.76 (0.08, 7.19)	0.810	1.005 (0.29, 3.47)	0.994

Type of management received by patients with eosinophilia classified by clinic that analyzed CBC results (n = 174)_

Type of management	GP (n = 73)	Primary care unit (n = 4)	Premium checkup (n = 97)	Total (n = 174)
History	20 (27.4)	0	12 (12.4)	32 (18.4)
Atopic history	14 (19.2)	0	10 (10.3)	24 (13.8)
Risk of parasite infection†	10 (13.7)	0	2 (2.1)	12 (6.9)
Photosensitive rash, polyarthritis	1 (1.4)	0	0	1 (0.6)
Family history of eosinophilia	0	0	0	0
Physical examination	63 (86.3)	2 (50.0)	97 (100.0)	162 (93.1)
Abnormal lung sound	60 (82.2)	2 (50.0)	96 (99.0)	158 (90.8)
Skin lesion	21 (28.8)	1 (25.0)	14 (14.4)	36 (20.7)
Hepatosplenomegaly	18 (24.7)	0	91 (93.8)	109 (62.6)
Abdominal mass	18 (24.7)	0	5 (5.2)	23 (13.2)
Lymphadenopathy	4 (5.5)	0	17 (17.5)	21 (12.1)
Laboratory investigation	13 (17.8)	0	3 (3.1)	16 (9.2)
Repeat CBC	2 (2.7)	0	0	2 (1.1)
Stool examination	11 (15.1)	0	3 (3.1)	14 (8.0)
Others‡	0	0	0	0
Anthelmintic drug was prescribed	51 (69.9)	4 (100.0)	77 (79.4)	132 (75.9)
No request for stool examination	44 (60.3)	4 (100.0)	77 (79.4)	125 (71.8)
Stool examination returning a normal result	5 (6.8)	0	0	5 (2.9)
Stool examination returning an abnormal result	2 (2.7)	0	0	2 (1.1)
Internist consultation	10 (13.7)	0	16 (16.5)	26 (14.9)

Baseline characteristics of the study participants (n = 10,299)_

Characteristics	Without eosinophilia (n = 9311)	With eosinophilia (n = 988)
		Having management (n = 174)	No management (n = 814)	P
Sex, n (%)				0.625†
Male	6287 (67.5)	95 (54.6)	425 (52.2)
Female	3024 (32.5)	79 (45.4)	389 (47.8)
Age, years, median (Q1, Q3)	51.0 (40.0, 60.0)	53.0 (41.2, 61.0)	53.0 (43.0, 61.0)	0.676‡
Clinic that analyzed CBC results, n (%)				<0.001†
GP	6927 (74.4)	73 (42.0)	684 (84.0)
Premium checkup clinic	1978 (21.2)	97 (55.7)	100 (12.3)
Primary care unit	406 (4.4)	4 (2.3)	30 (3.7)
AEC, cells/uL, median (Q1, Q3)	152.6 (88.5, 250.0)	811.7 (602.5, 1178.0)	666.4 (567.5, 926.9)	<0.001‡