İlknur KÜLHAŞ ÇELİK, Betül BÜYÜKTİRYAKİ, Filiz GÜLTEKİN AÇIKGÖZ, Mehmet Orhan ERKAN, Zeliha GUZELKUCUK, Namık Yaşar ÖZBEK, Muge TOYRAN, Emine DİBEK MISIRLIOĞLU, Ersoy CİVELEK

Çocuklarda Hipereozinofiliye Neden Olan Etiyolojik Faktörlerin Değerlendirilmesi

Amaç: Hipereozinofili hastaları, paraziter enfeksiyonlar gibi nispeten iyi huylu hastalıklardan yaşamı tehdit eden ciddi hastalıklara kadar pek çok duruma sahip olabilir. Çalışmamızda çocuklarda hipereozinofilinin etiyolojik nedenlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi pediatri kliniklerinde Ocak 2013 - Ocak 2016 tarihleri arasında tam kan sayımı yapılan 18 yaş altı hastalar retrospektif olarak incelendi. En az iki tam kan sayımı ölçümünde periferik kan mutlak eozinofil sayısının 1500/mm3 veya daha büyük olması hipereozinofili olaral kabul edildi. Hastane kayıtlarından hipereozinofili tespit edildiğinde yapılan tetkik ve tanıların sonuçları kaydedildi. Bulgular: Tam kan sayımı yapılan çocuk hastaların 340’ında hipereozinofili olduğu tespit edildi. Dosya kayıtlarına ulaşılamayan 70 hasta çalışma dışı bırakıldı. Çalışmamıza, yaşları ortanca 5 (1-12) [ortanca (çeyrekler arası aralık (ÇAA)] yıl olan 270 (%56’sı erkek) hasta dahil edildi. Hastalara konulan tanılar incelendiğinde: 48’ine (%17.8) alerjik hastalık, 21’ine (%7.8) immün yetmezlik, 14’üne (%5.2) paraziter hastalık, 15’ine tümör (%5.6), 4’üne (%1.5) lösemi, 2’sine (%0.7) hipereozinofilik sendrom, 2’sine (%0.7) adrenal yetmezlik, 2’sine (%0.7) yanık tanısı konulduğu tespit edildi. Doksan dokuz (%36.7) hastada ise herhangi bir hastalık için (akut veya kronik) ilaç kullanımı (antibiyotik, antiepileptik, demir şelatörü gibi) olduğu tespit edildi. Altmış üç (%23.3) hastada ise yapılan tetkikler sonucunda hipereozinofiliyi açıklayacak bir neden bulunamadığı görüldü. Sonuç: Kanda eozinofil sayısı pek çok durumda da yükselebilir. Eozinofil yüksekliğinin sebebi her zaman bulunamayabilir. Bu hastaların uzun dönem prognozları hakkında yapılacak ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

çocukluk çağı, hipereozinofili, alerjik hastalıklar, immünolojik hastalıklar, paraziter enfeksiyonlar

Evaluation of Etiological Factors Causing Hypereosinophilia in Children

Objective: Patients with persistent eosinophilia may have many conditions ranging from relatively benign diseases such as parasitic serious infections to life-threatening serious diseases. We aimed to determine the etiological causes of hypereosinophilia in children. Material and Methods: Patients under 18 years of age who had complete blood counts in Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital’s pediatric clinics between January 2013-January 2016 were retrospectively analyzed. Hypereosinophilia was defined as having at least two peripheral blood absolute eosinophil counts greater than or equal to 1500/mm3.The results of the examinations and diagnoses when the patients were detected with hypereosinophilia were recorded from the hospital records. Results: Three hundred and forty patients who underwent complete blood count were found to have hypereosinophilia. Seventy patients whose file records could not be accessed were excluded from the study. Two-hundred seventy patients (56% male) with a median age of 5 (IQR:1-12) years were included in our study. When the diagnoses of patients were examined, 48 (17.8%) had allergic diseases, 21 (7.8%) had immunodeficiency, 14 (5.2%) had parasitic disease. 15 (5.5%) had tumor, 4 (1.5%) had leukemia, 2 (0.7%) had hypereosinophilic syndrome, 2 (0.7%) had adrenal insufficiency and 2 (0.7%) had burn. Ninety-nine (36.7%) patients were found to use medication for any disease (acute or chronic). As a result of the examinations performed in 63 (23.3%) patients, it was found that there was no reason to explain hypereosinophilia. Conclusion: The number of eosinophils may increase in many conditions. The cause of increase in eosinophil may not always be found. Further studies are needed on the long-term prognosis of these patients.

Keywords:

hypereosinophilia, childhood, parasitic infections, allergic diseases, immunologic diseases,

PDF

___

References 1. Mejia R, Nutman TB. Evaluation and differential diagnosis of marked, persistent eosinophilia . Semin Hematol. 2012;49:149-159
2.Bellamy GJ, Hinchliffe RF, Crawshaw KC, Finn A, Bell F. Total and differential leucocyte counts in infants at 2, 5 and 13 months of age. Clin Lab Haematol 2000;22:81-7.
3. Florence Roufosse , Peter F Weller. Practical approach to the patient with hypereosinophilia J Allergy Clin Immunol . 2010;126(1):39-44.
4. Ayalew Tefferi. Blood eosinophilia: a new paradigm in disease classification, diagnosis, and treatment. Mayo Clin Proc. 2005 Jan;80(1):75-83
5. Chen YY, Khoury P, Ware JM, Holland-Thomas NC, Stoddard JL, Gurprasad S et al. Marked and persistent eosinophilia in the absence of clinical manifestation. J Allergy Clin Immunol 2014 Apr;133(4):1195-202.
6. Valent P, Klion AD, Horny HP, Roufosse F, Gotlib J, Weller PF, et al. Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes. J Allergy Clin Immunol 2012;130: 607-612.e9
7. Schwartz JT, Fulkerson PC. An approach to the evaluation of persistent hypereosinophilia in pediatric patients. Front Immunol 2018;9:1944.
8. Williams KW, Ware J, Abiodun A, Holland-Thomas NC, Khoury P, Klion AD. Hypereosinophilia in children and adults: a retrospective comparison. J Allergy Clin Immunol Pract 2016;4:941-947.e1
9.Burris D, Rosenberg CE, Schwartz JT, Zhang Y, Eby MD, Abonia JP et al. Pediatric Hypereosinophilia: Characteristics, Clinical Manifestations, and Diagnoses.J Allergy Clin Immunol Pract. 2019 ;7(8):2750-2758 10. Katz HT, Haque SJ, Hsieh FH. Pediatric hypereosinophilic syndrome (HES) differs from adult HES. J Pediatr 2005;146:134-6.
11.Chilcote RR, Pergament E, Kretschmer R, Mikuta JC. The hypereosinophilic syndrome and lymphoblastic leukemia with extra C-group chromosome and q14þ marker. J Pediatr 1982;101:57-60.
12.Egesten A, Hagerstrand I, Kristoffersson U, Garwicz S. Hypereosinophilic syndrome in a child mosaic for a congenital triplication of the short arm of chromosome.Br J Haematol 1997;96:369-73.
13. Farruggia P, Giugliano E, Russo D, Trizzino A, Lorenzatti R, Santoro A, et al. FIP1L1-PDGFRalpha-positive hypereosinophilic syndrome in childhood: a case report and review of literature. J Pediatr Hem Onc 2014;36:28-30 . 14. Guitard AM, Horschowski N, Mozziconacci MJ, Michel G, George F, Capodano AM, et al. Hypereosinophilic syndrome in childhood: trisomy 8 and transformation to mixed acute leukaemia. Nouv Rev Fr Hematol 1994;35:555-9
15. Rothenberg ME, Epstein FH. Eosinophilia. New Eng J Med 1998, 388(22): 1592-1600
16. Munzer D. New perspectives in the diagnosis of Echinococcus disease. J Clin Gastroenterol 1991;13:415-23.
17. Aleman K, Noordzij JG, de Groot R, van Dongen JJ, Hartwig NG. Reviewing Omenn syndrome.Eur J Pediatr. 2001 Dec;160(12):718-25.
18. Grimbacher B, Holland SM, Puck JM.Hyper-IgE syndromes. Immunol Rev. 2005;203:244-50.
19. Orange JS, Stone KD, Turvey SE, Krzewski K. The Wiskott-Aldrich syndrome. Cell Mol Life Sci. 2004;61(18):2361–85.
20. Navabi B, Upton JE. Primary immunodeficiencies associated with eosinophilia.Allergy Asthma Clin Immunol. 2016;24:12-27.
21.Boyle JM, Buckley RH. Population prevalence of diagnosed primary immunodeficiency diseases in the United States. J Clin Immunol 2007;27(5):497–502
22.Kilic SS, Ozel M, Hafizoglu D, Karaca NE, Aksu G, Kutukculer N. The prevalences and patient characteristics of primary immunodeficiency diseases in Turkey-two centers study.J Clin Immunol. 2013;33(1):74-83
23.Criado PR, Criado RF, Avancini JM, Santi CG. Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) / Drug-induced Hypersensitivity Syndrome (DIHS): a review of current concepts. An Bras Dermatol 2012;87:435-49.