Prevalence and management of eosinophilia based on periodic health examinations in primary care clinics
, , , , , , , e | 16 giu 2023
INFORMAZIONI SU QUESTO ARTICOLO
Article Category: Original article
Pubblicato online: 16 giu 2023
Pagine: 273 - 282
DOI: https://doi.org/10.2478/abm-2022-0030
Parole chiave
© 2022 Thareerat Ananchaisarp et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Figure 1.
Prevalence of possible causes of eosinophilia stratified by diagnosis (n = 204).
| 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 |
| 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).
| 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 |
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 |
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).
| 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).
| Sex, n (%) | 0.625 |
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| 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 |
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| 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 |