Kan H, Ogata T, Taniyama A, Migita M, Matsuda I, Nawa Y
Department of Pediatrics, Minamata City General Hospital and Medical Center, Kumamoto, Japan.
Pediatrics. 1995 Aug;96(2 Pt 1):351-4.
Although eosinophilia is one of the typical clinical features of some helminth infections, the degree of eosinophilia in helminthiasis is usually 10% to 30% with a total white blood cell count of 10,000 to 20,000/mm3. Here we report a case of extraordinarily high eosinophilia (91%; absolute eosinophil count, 84,000/mm3) caused by Paragonimus westermani infection. To determine the mechanisms of eosinophilia, the levels of several eosinophilopoietic cytokines in the patient's sera were measured during the course of treatment.
Serum levels of three cytokines, granulocyte-macrophage colony-stimulating factor, interleukin-3 (IL-3), and IL-5 were measured by enzyme-linked immunosorbent assay using commercial kits or our own assay system for IL-5.
Although the kinetic changes of IL-5 correlated well with eosinophilia, the serum IL-3 level remained below the detection level throughout the period examined. Although the granulocyte-macrophage colony-stimulating factor level was twofold to threefold higher than the normal level, its kinetics did not parallel the degree of eosinophilia.
These results show that Paragonimus westermani infection can induce an extraordinarily high level of eosinophilia with an associated increase in IL-5 production. Immunoserologic diagnosis for parasitic diseases should be included in the differential diagnosis of eosinophilia.
虽然嗜酸性粒细胞增多是某些蠕虫感染的典型临床特征之一，但蠕虫病中的嗜酸性粒细胞增多程度通常为10%至30%，白细胞总数为10,000至20,000/mm³。在此，我们报告一例由卫氏并殖吸虫感染引起的异常高嗜酸性粒细胞增多症（91%；嗜酸性粒细胞绝对计数为84,000/mm³）病例。为了确定嗜酸性粒细胞增多的机制，在治疗过程中检测了患者血清中几种嗜酸性粒细胞生成细胞因子的水平。
使用商业试剂盒或我们自己的IL-5检测系统，通过酶联免疫吸附测定法检测三种细胞因子，即粒细胞-巨噬细胞集落刺激因子、白细胞介素-3（IL-3）和IL-5的血清水平。
虽然IL-5的动力学变化与嗜酸性粒细胞增多密切相关，但在整个检测期间血清IL-3水平一直低于检测水平。虽然粒细胞-巨噬细胞集落刺激因子水平比正常水平高两到三倍，但其动力学与嗜酸性粒细胞增多程度并不平行。
这些结果表明，卫氏并殖吸虫感染可诱导异常高水平的嗜酸性粒细胞增多，并伴有IL-5产生增加。寄生虫病的免疫血清学诊断应纳入嗜酸性粒细胞增多症的鉴别诊断中。
