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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can Eosinophilia cause high EOS levels?

Answered by
Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3922 Questions

Posted on Mon, 23 Apr 2018 in Medicines and Side Effects
Question: I had a CBC with Diffential/Platelet blood test done and have an EOS (absolute) of 0.5 which is called "high" .... there is also this designation x10E3/ul ....... associated with this reading. I am 70 years old, in (apparently) good condition. I wonder if I have some form of Eosinophilia. This high EOS reading has been present for at least the last 10 months.
Answered by Dr. Ivo Ditah 54 minutes later
Brief Answer:
There is no reason to worry about this!

Detailed Answer:

I have reviewed both lab reports. These are borderline elevated values and in the absence of any concerning symptoms suggestive of a disease, I will not bother any further.

Present treatment guidelines recommend that persons with eosinophil counts of less than 1500/microliter should be observed only. You are well below this with 500 and 600 only.

Moreover, this is stable and even reducing from 600 to 500. I will recommend monitoring only and only request for aggressive investigation if the numbers rise beyond 1500 or you develop any new symptoms that may lead us there.

I hope this helps. I wish you well. Feel free to follow up with me if need be.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 5 hours later
Dear Dr. Ditah,

THANK YOU for your report. I do have some questions to ask and some symptoms to report that go back at least 12 months.

First, I think you have interpreted the EOS readings somewhat incorrectly:

•     In February 2017 the reading was HIGH at 0.5 where the Reference Interval indicated for this test was from 0.0 to 0.4 and my reading at the time of 0.5 is what the laboratory considered to be HIGH.
•     Then in late October I retested (this is what I am calling the November 2017 blood test) and this reading was a HIGH of 0.6.

It seems the reading is getting higher – from 0.5 in February to 0.6 in Nov 2017. Where the reference interval for this test should be between 0.0 and 0.4, both my February reading and my November reading are higher than that, AND the November reading is EVEN HIGHER THAN THE FEBRUARY READING, where the reading is not reducing from 600 to 500, but INCREASED from 500 to 600.

Second, could help me understand the math and how you arrive at the numbers you refer to in your message to me? My lab tests show 00.00 - 00.40 as the reference range, which I guess means this is the EXPECTED range of normal test results, is this correct? Your figures are 500, 600, and less than 1500, and I’d like you to show and explain to me the math that you used to arrive at 500 and at 600, which you are saying is LOW, whereas the lab reports say these readings are HIGH.

Third, I do have some troubling physical symptoms going back to early January, or even earlier:

•     Headaches that NEVER go away but are with me 24/7. Prior to this problem, my experience with headaches has for decades been that I’ll get 1 or at most 2 headaches a year. Now I have headaches A-L-L the time. I go to bed with them at night / I wake up with them in the morning. This has never happened before in 70 years!
•     pain around the eyes, specifically pressure behind the eyes and in the eye cage area, and the forehead, which I am also experiencing 24/7.
•     slight to moderate dizziness (and I don’t mean dizziness when one is sitting down and gets up quickly off the floor) I mean slight to moderate dizziness just adjusting my head form one position to another, dizziness turning my body from left to right, an overall sense of imbalance, even when simply standing still.
•     memory loss – or what might be called “brain fog”.
•     mood swings and irritability.

I am not aware of any inflammation or infection on my body but the pressure behind the eyes does seem to indicate something is inflamed in this region of the head.

In February of this year I went in to my primary care physician and discussed these symptoms with him. He first had me take a CT scan (with no contrast) of my head and that came back negative; then I asked for and they ran a CT scan with contrast of my head and that also came back negative.

The symptoms I describe are not psychosomatic – they are not my mind playing tricks on me – but are significant, physical symptoms of some as yet undiagnosed illness or disease.

What questions do you have for me, to help us continue to work towards a diagnosis for what I describe?


Ron Yoder
Answered by Dr. Ivo Ditah 18 hours later
Brief Answer:
See below!

Detailed Answer:

1. Your values were reported as 0.6*10E3 which is equal to 0.6*1000= 600. This is how they have been converted and discussed above.

2. I note it has increased from 500 to 600 and not the other way around as initially stated. However, this is well below the threshold of 1500 that calls for further aggressive investigations.

3. With thorough investigation of your symptoms and all organ related causes excluded, I will recommended that you be managed for the headaches. I recommend nortrptylline for use as this addresses headaches and improves sleep.

4. For the dizziness,I strongly recommend you avoid switching positions too fast. This is because the heart normally reacts to adjust to the reduced blood flow to teh brain as we switch positions from sitting to standing. With increased age, this is not as fast as in younger persons and requires that we stay aware and limit rapid changes. Try this and let me know how you do.

I wish you well and hope you find this helpful. Keep me updated and posted about this.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 21 hours later
Dear Dr. Ditah,

THANK YOU for your reply, which I mostly understand.

There is one remaining question that I have with the EOS test results, be they 00.5 or be they 00.6.

You kindly reply with the math (and thank you for explaining the math to me!) that these readings are “well below the threshold of 1500 that calls for further aggressive investigations”.

What I’m having a hard time understanding is your reference to these readings being LOW yet the lab (both in February and in late October) refer to the readings as HIGH.

You say my reading is LOW, well below the threshold of 1500 / the lab results both say my reading is HIGH. That’s what I can’t get my head around. You say LOW and Lab say HIGH

One would think one of these designations is incorrect, wouldn't you?

Lab results have a NORMAL reference range of 00.00 to 00.40, meaning a reading no higher than 0.4*1000 = 400, is a normal reading. So the lab is expecting a NORMAL reading to be anywhere from 000 to 400, is that right?

But my test result is showing 500 or 600, which the LAB is saying is HIGH, but you are saying is LOW …….

You can see where I might be confused here?

Can you please help me understand this one point? Low? High? Which is it??

Best regards,

Answered by Dr. Ivo Ditah 5 hours later
Brief Answer:
See below!

Detailed Answer:

There is a high eosinophil count which falls in the gray zone (between 500-1500) which in itself does not represent a big concern unless there are glaring symptoms pointing to a disease that you clearly don't have at this time.

Your numbers are out of the expected normal range of less than 400, but not on the troublesome high side. Hope this sounds clearer to you. Feel free to follow up with me if you are not totally clear.

I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 25 hours later
Hello, Dr. Ditah,

THANK YOU for your answer. This point is now clear to me.

I want to return our discussion to the possibility of intestinal parasites. My chiropractor/functional medicine doctor was the person who originally said there was a strong possibility of parasites, and that’s when I started looking into this matter and found you.

For 5 years I lived in Uruguay, South XXXXXXX a small country sandwiched between Argentina and Brazil, on the Atlantic Ocean. I often visited Argentina during these 5 years, as the country was “just across the river” from where I lived.

In fall 2015 I returned to the USA and in fall 2016 I started having the symptoms I described to you in earlier correspondence.

In fall/winter 2016 I went to my primary care physician at KAISER PERMANENTE and, as mentioned previously, had CT Scans, with and without contrast. This got me nowhere, as nothing was discovered out of what they considered to be the ordinary.

In January 2017 I began weekly treatments with my chiropractor/functional medicine doctor, who I have used for many years, primarily for chiropractic adjustments, nutritional supplements, etc. These treatments were twice monthly and produced little positive result. Only recently did my chiropractor conclude that I had parasites.

Now, on the subject of intestinal parasites, I wonder what you would make of the two attached photos. These photos were taken on Day # 3 and Day # 4 of an intestinal cleanse I did in September.

This is a 7-day detox cleanse, with no food and no liquids (other than drinking lots of water and specific nutritional supplements in pill form) for a full 7 days. What is taken 5 times a day is a mixture of food grade bentonite liquid clay and powdered psyllium; the two ingredients are combined in an 8 oz glass of water and then drunk quickly before the mixture has a chance to congeal.

What you see in these photos are what I call fluke worms. The day # 3 worm (when it was alive) was about 4 feet long; the day # 4 worm was slightly smaller. Each worm had been exploded from the bentonite/psyllium mixture I was taking 5 times a day. This bentonite/psyllium mixture is all I ate for the full 7 days, besides many glasses of water and the pill form nutritional supplements previously mentioned. By day # 3 all of the food waste (from eating solid food prior to the start of the cleanse) had passed through the system and what we get are ONLY worms that have eaten the mixture and been killed by it and the worms are now being passed through the waste canals of the body.

You can look at this detox program here: On these cleanses one usually passes worms DAILY from day # 3 onwards and by day # 7 most of, if not all of, the worms have passed.

I re-did this same 7-day cleanse in early October and AGAIN passed worms from day # 3 to day # 7.

I re-contacted KAISER PERMANENTE in early November about the possibility of parasites, and they have requested I do a stool test. My concern is that, from all of my reading, stool tests are accurate in diagnosing intestinal parasites with only 20 – 25% accuracy, meaning the tests fail to detect worms present in the stool 75 – 80% of the time.

I believe I have intestinal parasites. My chiropractor believes I have parasites. My CBC blood count with differential shows there is S-O-M-E abnormality in my system, even if only of moderate intensity, whether we call it an infection or an inflammation, as my white blood count is higher than normal and IS rising.

I am trying to figure out how to proceed. Yes, I can give KAISER PERMANENTE a stool sample, but I assume this will be negative, given the highly inaccurate nature of the test.

If I have the honor of corresponding with Dr. Ivo Ditah from Cameroon, now practicing Gastroenterology in Saint XXXXXXX MN, I wonder what your next investigative steps might be?

See also the attached “Approach to the patient with unexplained eosinophilia”, especially page 8 under “Testing for other parasites and infections”, and the reference to Argentina.

Take the position, for a moment, that you believe I have intestinal parasites.

How would you suggest I proceed with KAISER PERMANENTE primary care physicians, who I doubt come in contact with intestinal parasites very often?

Best wishes, and if you celebrate it, Happy Thanksgiving to you and your family.

My regards,

Ron Yoder

P.S. to my earlier message, it appears I am not able to upload WORD files to your site. Instead I provide here a link to the article I refer to in my above remarks.

See especially the section titled "Testing for other parasites and infections" and the reference to Argentina. In part quoted here:

●Trichinella serology – Trichinella species have been reported worldwide; human infections are seen most commonly in China, Thailand, Mexico, Argentina, Bolivia, and parts of Eastern and Central Europe. Infection results from ingestion of undercooked meat, especially pork. (See "Trichinellosis".)


Ron Yoder
Answered by Dr. Ivo Ditah 12 hours later
Brief Answer:
Empiric treatment!

Detailed Answer:

Concluding you have intestinal parasites, I will recommends 400mg of albendazole to be taken one day 1 and day 8. All intestinal helminths would be eradicated by this.

I will bypass testing as this will not necessarily change my treatment plan. It is cheap, effective and without worrisome side effects.

Let me know how this goes!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 36 hours later
Hello Dr. Ditah,

THANK YOU for your reply. This reply is quite helpful.

Several follow along questions:

1. Will Albendazole target and kill parasites that I may have picked up SPECIFICALLY in Argentina and/or Uruguay? Fluke worms, etc. or will this drug target and kill >A-L-L< forms and types of intestinal parasites?

2. You mention that this drug has no worrisome side effects. This web site says common side effects may include: •stomach pain, nausea, vomiting; •dizziness, spinning sensation;
•headache; or •temporary hair loss. Question: are there A-N-Y other side effects I should be aware of, or that might occur?

2A. By the way, my current weight is 172 - 175 pounds, and I include this information because I read somewhere that the mg dose is determined by the WEIGHT of the patient. So I assume the dose of 400 mg is based on my weight, correct?

3. Regarding side effects, a question: WHEN (if side effects occur at all) should I be expecting side effects, to occur AFTER taking the drug? Immediately? Within a couple of hours? Within a couple of days?

4. Question: After the treatment plan, WHEN will the drug be out of my system? (For my own piece of mind, I'd simply like to know when any remaining residual effects of the drug be flushed out of my body?

5. On your recommendation of 400 mg Albendazole, a question: I'm unclear on your recommendation. Is this 1 tablet of 400 mg Albendazole on Day 1 and a second table of 400 mg Albendazone on Day 8? Or is this a recommendation to take 1 table of 400 mg Albendazole on Day, 1, another on Day 2, another on Day 3, etc. etc. with the last tablet being taken on Day 8? I assume - but correct me please if I'm wrong - that the tablet is to be taken with a meal?

6. I think our discussion here has been productive and I would like to stay in touch with you, as you suggest in your above comment. How do I go about staying in touch with YOU? For example, if/when I close out this conversation, and then come back into the healthcaremagic website to continue our conversation, how will I be able to locate you and continue the conversation with YOU?? (and not have to educate and bring up to speed a brand new internal medicine/gastroenterologist?).

I hope you are having an enjoyable weekend.


Ron Yoder

Answered by Dr. Ivo Ditah 2 days later
Brief Answer:
Seel below!

Detailed Answer:

1. Targets and kills all forms of helminths that can which cause increased eosinophils.

2. Yes, this is the adult dosage. Well adapted for you.

3. I know of them but these are mild and never a concern compared to other significant side effects with medications.

4. At most, within a week.

5. NO. Day 1: 1tablet of 400mg. Day 8: 1 tablet of 400mg.

6. THis link allows you to ask a question directly to me. This way, no one but me would respond. If you don't do so, chances are high that other colleagues might provide responses to you.

I hope this addresses your worries. Am sorry for the tardy response but be rest assured you are a priority.

Until next, I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivo Ditah 2 days later
No worries on what some might call a tardy response. You're a doctor and I'm not your only patient. I completely understand.

I'll be sending you some follow along questions in the next day or so.

I appreciate and thank you for your help. More from me in the next day or so.

; ) Ron
Answered by Dr. Ivo Ditah 3 hours later
Brief Answer:
THanks for understanding!

Detailed Answer:
Hi and thanks for understanding.

I will be on the lookout for your message(s).

Until then, I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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