A set of studies was designed in order to better understand the exposure of horses in Canada to Ixodes-borne diseases, namely equine granulocytic anaplasmosis (EGA, caused by Anaplasma phagocytophilum) and Lyme borreliosis (LB, caused by Borrelia burgdorferi). In the first study, equine serum samples submitted to veterinary diagnostic laboratories in SK, MB and ON were tested for antibodies against A. phagocytophilum and B. burgdorferi, using the point-of-care SNAP® 4Dx® ELISA. Horses seropositive to EGA were found in SK and MB and horses seropositive to LB were found in SK, MB and ON. Overall seroprevalence according to the SNAP® 4Dx® ELISA was 0.53% for EGA and 1.6% for LB. Samples that tested positive for antibodies against A. phagocytophilum (n=2) and B. burgdorferi (n=6) by SNAP® 4Dx® ELISA and 2 randomly selected subsets of samples that tested negative (n=92 each) were then re-tested using currently recommended serologic methods, and test results were compared. A lack of agreement was found between the SNAP® 4Dx® ELISA and indirect immunofluorescent assay (IFA) for EGA (McNemar test p = 0.000001). Agreement of the SNAP® 4Dx® ELISA and ELISA confirmed with Western Blot (WB) for LB was only fair (Kappa 0.23). Due to the lack of agreement between serologic tests for EGA and LB in the first study, another study to further evaluate the agreement among available serologic tests was conducted. A set of 50 convenience serum samples submitted to the veterinary diagnostic laboratory in SK was tested by SNAP® 4Dx® Plus ELISA for antibodies against A. phagocytophilum and B. burgdorferi. Samples were also tested by IFA for antibodies against A. phagocytophilum in two referral laboratories, and by IFA, ELISA confirmed with WB and Equine Lyme multiplex assay for antibodies against B. burgdorferi in three referral laboratories. Again, test results varied between the different tests. For EGA, all 3 pair-wise test comparisons lacked agreement. For LB, agreement between tests ranged from poor to fair. Differences in test methodology and antigens used, cut-off settings between the laboratories and false positive or false negative results are likely the cause for the different assessment of the same sample as seropositive or seronegative. In the third study, the goal was to describe potential risk factors for exposure of horses in Canada to EGA and LB. Management factors in horses that tested seropositive or seronegative for EGA or LB, respectively, in the previous studies were evaluated. Horse owners were surveyed with regard to their horses’ signalment, timing of pasture housing, and province of residence, travel history, tick infestation history, history of Lyme vaccination and history of previously diagnosed tick-borne disease. Response rate (11.5%) and the number of seropositive horses available for evaluation were low, which precluded statistical analysis. The majority of seropositive horses resided in SK, was pastured in the fall, did not have a recent travel history and had not had visible tick infestation. These observations supported exposure of horses to tick-borne diseases within Canada. Potential risk factors require further investigation. As information about tick infestation in horses is scarce in general, a passive surveillance study of horse ticks in SK was conducted in 2012 and 2013. A total of 833 ticks from over 86 horses were received. All ticks were Dermacentor species, i.e. D. albipictus, D. andersoni and D. variabilis. D. albipictus ticks were mostly received in February and March, D. andersoni mainly in April and June and D. variabilis mostly in May and June. Geographic distribution of the species in SK was similar to that previously reported based on active and passive surveillance. No Ixodes species were received.

Background: Equine granulocytic anaplasmosis (EGA), caused by the organism Anaplasma phagocytophilum, is a tick-borne disease of clinical importance in Southwest Virginia. The disease is recognized worldwide and causes pyrexia, anorexia, limb edema, and lethargy. Diagnosis in endemic areas is often based on clinical signs, but confirmation of infection can be made via detection of morulae on a peripheral blood smear or polymerase chain reaction analysis (PCR) at the time of disease or by serologic detection of antibodies 2-4 weeks post infection. There is growing interest in stall-side methods for diagnosis of various equine diseases which has led to an increased use of the SNAP 4DX Plus Test® for vector-borne diseases. Objectives: Determine seroprevalence of antibodies to A. phagocytophilum in the equine population of Southwest Virginia and changes in seroprevalence compared to samples taken 6 years earlier. Determine the percentage of horses with clinical signs consistent with EGA that were positive for A. phagocytophilum infection and assess common presenting clinical signs, hematologic variables, and confirmatory diagnostic test results. Animals: Seroprevalence was evaluated in horses presented for routine annual Coggins testing in 2013 and 2019-2020. Clinical features of disease and diagnostic test results were evaluated in horses presenting with clinical signs compatible with A. phagocytophilum infection from September 2019-August 2020. Methods: Seroprevalence was determined using the IDEXX SNAP 4DX Plus Test® on serum collected from horses presenting for annual Coggins testing in 2013 and 2019-2020. Samples collected in 2013 had been stored at -7580 degrees F since collection. Age, sex, county of residence, and month of sampling were statistically analyzed in the seroprevalence population. Horses presenting with clinical disease consistent with EGA from September 2019-August 2020 had the following diagnostic tests performed: complete blood count (CBC), blood smear for morulae detection, polymerase chain reaction (PCR) analysis, immunofluorescence antibody testing (IFAT), and the IDEXX SNAP 4DX Plus Test®. Results: Seroprevalence of A. phagocytophilum in the equine population of Southwest Virginia increased from 8.5% in 2013 to 11.2% in 2019-2020, although this increase was not statistically significant. In the 2019-2020 population, month of sampling was significantly associated with presence of antibodies to A. phagocytophilum. Positive samples were more common from November-February than other times of the year. When the two sample time periods were combined, sex was significantly associated with presence of antibodies to A. phagocytophilum with geldings more likely to be seropositive. Within the clinical case population, 35% of horses with clinical signs compatible with equine granulocytic anaplasmosis had confirmed infection. The most common hematologic abnormality in affected horses was thrombocytopenia. PCR analysis was the most sensitive diagnostic test to diagnose infection followed by identification of morulae on blood smears. Conclusions: Seroprevalence of A. phagocytophilum is similar to other endemic areas in the United States and appears to be increasing over time. In active clinical cases, diagnosis is best made via PCR or detection of morulae on a blood smear. The SNAP 4DX Plus Test® was not appropriate for diagnosis of active EGA in acute cases. Seroprevalence of Anaplasma phagocytophilum in the equine population of Southwest Virginia / Master of Science / Equine granulocytic anaplasmosis (EGA) is a common tick-borne disease in the United States and worldwide. The causative bacteria, Anaplasma phagocytophilum, also infects humans, dogs, and various domestic animal species. In horses, signs of disease include fever, decreased appetite, leg swelling, and depression. Diagnostic testing that is both accurate and timely is still lacking. The point-of-care SNAP 4DX Plus Test® used to diagnose vector-borne infectious disease in dogs has been suggested for similar use in horses. The objectives of the current study were to determine seroprevalence of antibodies to A. phagocytophilum in the equine population of Southwest Virginia and to characterize the clinical signs and diagnostic test findings of horse with clinical signs of EGA. Seroprevalence was determined using the SNAP 4DX Plus Test®. Serum samples were obtained from horses presenting for annual Coggins testing in 2019-2020. Samples from 2013 were also tested to determine if seroprevalence had increased. Horses presenting with clinical signs consistent with A. phagocytophilum were examined by a veterinarian and had blood drawn for a complete blood count (CBC), blood smear evaluation, polymerase chain reaction analysis (PCR), immunofluorescent antibody testing (IFAT), and the SNAP 4DX Plus Test®. Seroprevalence in 2019-2020 was 11.2% and 8.5% in 2013. This is similar to other endemic areas in the United States and Europe. In horses sampled from 2019-2020, the month of sampling was significantly associated with presence of antibodies to A. phagocytophilum with most of the positive samples being identified in November through February. Geldings were more likely to be seropositive than mares. Thirty five percent of horses with signs consistent with EGA were confirmed to have the disease. Within this population, PCR analysis and/or detection of morulae on the blood smear were reliable indicators of disease while diagnostic techniques utilizing serology were unreliable. This is the first study to determine seroprevalence of A. phagocytophilum in Southwest Virginia. In the actively infected population, PCR and blood smear evaluation remain the most sensitive methods of diagnosis. While the SNAP 4DX Plus Test® is useful for serologic data collection, it was not appropriate for acute diagnosis of EGA.

Lyme borreliosis was first described some 30 years ago in the USA. Today, it is the most common vector borne disease in Europe and the USA. The disease can have multiple stages and symptoms can manifest from various parts of the body; joints, skin heart and nervous system. In Europe, neuroborreliosis is the most frequent late stage diagnosis. Although Lyme borreliosis is treatable with antibiotics and the causative spirochete has not been shown to be resistant to drugs, some patients do not recover completely. They have persistent symptoms and are diagnosed with chronic or persistent Lyme borreliosis. The mechanism behind the lingering symptoms is unclear but might be due to tissue damage caused by the immune system. The aim of this thesis was to study the immunological differences between patients with different outcome of Lyme borreliosis, i.e. chronic, subacute and asymptomatic, and various factors that might influence the course of the disease. The Borrelia-specific IFN-γ and IL-4 secretion was detected in blood and cerebrospinal fluid from patients with chronic and subacute neuroborreliosis during the course of the disease. Blood samples were also obtained from patients with erythema migrans (EM) and acrodermatitis chronicum atrophicans. An early increase of IFN-γ with a later switch to an IL-4 response was observed in patients with a subacute disease course whereas the IFN-γ secretion continued to be elevated in chronic patients. The Borrelia-specific Th1-response was further investigated in chronic, subacute and asymptomatic individuals by studying the expression of the Th1-marker IL-12Rβ2, on a protein and mRNA level. The cytokine secretion and Foxp3, a marker for regulatory T-cells, were also analyzed. Chronic patients had a lower IL-12Rβ2 expression on CD8+ T-cells and a lower number of Borrelia-specific IFN-γ secreting cells compared to asymptomatic individuals. Chronic patients also displayed a higher expression of Borrelia-specific Foxp3 than healthy controls. The conclusions for these tow studies were that a strong Th1-response early in the infection with a later switch to a Th2-response is beneficiary whereas a slow or weak Th1-response corresponds to a prolonged disease course. The influence of a previous infection with another pathogen, seen to suppress the immune response in animals, and the possible gender difference in immune response was also investigated. Patients with EM were screened for antibodies to Anaplasma phagocytophilum (Ap) as a sign of a previous exposure to these tick-borne bacteria. Blood lymphocytes from Ap seronegative, Ap seropositive and healthy controls were stimulated with Borrelia antigen and the secretion of IL-4, IL-5, IL-12, IL-13 and IFN-γ was detected by ELISPOT. Ap seropositive patients had a lower number of cells responding with IL-12 secretion compared to the other groups which might indicate an inhibited Th1-response. Reinfections with Lyme borreliosis was in a previous study, done by Bennet et al, found to be more frequent in postmenopausal women than in men. To investigate if there was an immunological explanation to the gender discrepancy, blood lymphocytes from individuals reinfected with Lyme borreliosis and individuals infected only once were stimulated with various antigens. The cytokine secretion was detected by ELISPOT, ELISA and Immulite. There were no differences between reinfected and single infected individuals. However, women, regardless of times infected, displayed a Th2-derived and anti-inflammatory spontaneous immune response compared to men. A previous infection with the bacteria Ap might possibly have a long term effect on the immune system and might be of disadvantage when mounting a Th1-response to a Borrelia infection. Also, the Th2-derived response displayed by postmenopausal women could indicate why more women than men get reinfected with Borrelia burgdorferi. / On the day of the public defence date of the doctoral thesis the status of article III was Accepted; the status of article IV was Submitted and the title was "Importance of induction and secretion of interferon-gamma for optimal resolution of human Lyme borreliosis: differencesbetween different outcomes of the infection".

Patients can develop malignancies due to various reasons including genetic factors, chemical carcinogens, radiation, and defects in their immune system. The immune system is postulated to carry out routine surveillance for malignancy. Patients who have defective immune responses may be susceptible to malignancies due to complicated underlying mechanisms. These include defective immune response to cancer-causing bacteria, transforming viruses, and concomitant molecular, cellular and immunoregulatory defects. Common variable immune deficiency (CVID) is characterized by hypogammaglobulinemia, impaired antibody responses and an increased susceptibility to infections. A disorderly immune response, or immune dysregulation, may also lead to autoimmune complications and possibly to malignancy. The treatment of CVID involves infusion of replacement doses of immunoglobulin, either intravenously (IGIV) or subcutaneously (SCIG). However, it is unclear whether adequate replacement of immunoglobulins is sufficient to prevent the increased risk of malignancy seen in this disease. We present two cases of unusual solid tumors complicating CVID treated with adequate doses of intravenous immunoglobulins. In this study we review the occurrence of malignancy in patients with CVID and postulate mechanisms that may be involved indigent to this disease. We will also review the role of replacement immunoglobulin and discuss cancer screening in these high risk individuals.

No description available.

Introduction: A subgroup of severe asthmatics (SA) remain uncontrolled with persistent airway eosinophilia despite high dose glucocorticosteroids (GCS) termed “steroid insensitivity.” A significant proportion of this subgroup get recurrent airway infections. Phosphoinositide-3 kinase (PI3K) pathway may contribute to both GCS insensitivity and further susceptibility to recurrent infections. Objectives: The effect of GCS and PI3K antagonism was evaluated on GCS induced eosinophil apoptosis as a mechanism of GCS insensitivity in healthy, mild to moderate and severe asthmatics. Furthermore, we investigated the relationship between PI3K activation, histone deacetylase (HDAC) and macrophage receptor with collagenous structure (MARCO) expression in SA±recurrent bacterial bronchitis. Methods: Blood eosinophils, isolated from healthy subjects (HS) and asthmatics, were incubated with increasing concentrations of dexamethasone (0.1, 1 and 10 uM) and a pan-PI3K antagonist (LY294002 at 1 and 2 uM). Cell viability was assessed using PrestoBlue cell viability assay, Trypan Blue exclusion test and PE-Annexin-V/7-AAD apoptosis detection (flow cytometry). Furthermore, PI3K activity, MARCO and HDAC levels were measured in macrophages isolated from healthy subjects and SA (±history of recurrent bacterial bronchitis). In a subgroup, sputa were examined for in situ PI3K activity and gene expression of PI3K isoforms by digital PCR. Results: In HS, a time-dependent increase in eosinophil apoptotic% was observed (1.9% at baseline, 25.7% at 16h and 31% at 24h) (p=0.06, p=0.005 respectively). Dexamethasone 10uM increased it to 40.1% at 16h (p=0.03). Dexamethasone induced eosinophil apoptosis was less in severe asthmatics (34.2%) vs. to mild-to-moderate asthmatics (46.7%) (p=0.05) suggesting steroid insensitivity. This was not reversed by co-incubation with LY294002 2uM (39.9% vs. 53.3%) (p=0.04) (Fig. 1B). Asthmatics with recurrent lung infections had higher blood PI3K activity (demonstrated as inverse of biotinylated-PIP3, p=0.02), MARCO expression (p=0.01), and trend for lower HDAC expression (p=0.067) vs. healthy donors. PI3KCD (encoding catalytic 𝛿 isoform) gene expression relative to HPRT1 (housekeeping gene) was increased in SA-infection group (p=0.03). A higher number of asthmatics with recurrent lung infections were on oral corticosteroids (p=0.015) and replacement immunoglobulins (p=0.016). Conclusions: Evaluating dexamethasone-induced apoptosis in blood eosinophil can assess GCS sensitivity ex vivo. Severe asthmatics demonstrate GCS insensitivity, which was not reversed by a pan-PI3K antagonist. PI3K activity is increased in SA with a previous history of recurrent lung infections, which is associated with a decrease in HDAC and MARCO expression. Targeting PI3K pathway, specifically the 𝛿 isoform, may be a potential therapeutic target in SA with mixed-granulocytic bronchitis. / Thesis / Master of Science in Medical Sciences (MSMS) / Eosinophils are a type of blood cell that is responsible for causing asthma symptoms and flare-ups. Steroids (in both inhaled and oral forms) decrease eosinophils and so are the main treatment for asthma. But a group of asthmatics continues to have symptoms and eosinophils in their lung secretions even with maximum dose of steroids. Some of these asthmatics also get repeated bacterial lung infections. In blood samples, we studied one of the proteins (phosphoinositide-3 kinase, PI3K), which may be responsible for poor response to steroids and repeated infections. We looked at the effect of steroids on eosinophils extracted from blood samples of healthy people, asthmatics with mild disease and asthmatics with severe disease. We also measured PI3K levels and related proteins in blood and sputum samples from healthy people, asthmatics who get repeated bacterial lung infections (more than two in the previous two years) and asthmatics without recurrent lung infections. We found that eosinophils obtained from asthmatics with severe disease were harder to kill with steroids. But, this was not reversed with a PI3K blocking agent. We also found that asthmatics with a previous history of repeated bacterial lung infections had a higher PI3K level. High PI3K activity was associated with a decrease in two other proteins – histone deacetylase (HDAC) and macrophage receptor with collagenous structure (MARCO). Decrease in HDAC can result in a lower response to steroids, which may result in an increase in eosinophils in the lungs. Lower levels of MARCO can cause a patient to have higher sensitivity to recurrent bacterial infections. Overall, this may lead to a dangerous cycle where repeated lung infection will lead to high PI3K activity, which will cause worse asthma control and more infections. More studies are needed to evaluate drugs that block PI3K, which may be helpful in asthmatics who are less responsive to steroids and also get repeated infections.

Regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSC) have been extensively studied in the past 30-40 years. Their potent suppressive capacity shown in several pathological and clinical settings, such as cancer and transplantation, has made it evident that better understanding their development and function is critical. Specifically, Tregs play a pivotal role in preventing autoimmunity, graft-versus-host disease (GvHD), and organ graft rejection. We previously demonstrated that germline or induced SH2 domain-containing inositol 5-phosphatase (SHIP) deficiency in the host abrogates GvHD. Here we show that SHIP-deficiency promotes an increase of FoxP3+ cells in both the CD4+CD25+ and the CD4+CD25- T cell compartments with increased expression of Treg-associated markers. Importantly, SHIP-deficiency does not compromise Treg function. Interestingly, like conventional Tregs, SHIP-/- CD4+CD25- T cells are unresponsive to allogeneic stimulators and suppress allogeneic responses by T cells in vitro, and can mediate reduced lethal GvHD in vivo. Thus, SHIP limits the immunoregulatory capacity of CD4+ T cell, particularly in allogeneic settings. SHIP-deficiency expands the number of immunoregulatory cells in both the T lymphoid and myeloid lineages. Here, we examined if these increases are interrelated. Specifically, we found that myeloid specific SHIP-deficiency leads to expansion of both MDSC and Treg numbers. Conversely, T lineage specific ablation of SHIP leads to expansion of Treg numbers, but not expansion of MDSC, indicating an intrinsic role for SHIP in limiting Treg numbers. Interestingly, MDSC lack SHIP expression suggesting that another SHIP-deficient myeloid cell promotes MDSC and Treg expansion. Also, increased levels of G-CSF, a myelopoietic growth factor, in SHIP-/- mice may extrinsically promote MDSC expansion since we found that G-CSF is required for the expansion of splenic MDSC in mice with induced SHIP-deficiency. MDSC consist of two distinct subsets, granulocytic-MDSC (G-MDSC), and monocytic-MDSC (M-MDSC) that differ in morphology, phenotype, suppressive capacity and differentiation potential. Importantly, M-MDSC can further differentiate into dendritic cells, macrophages and preferentially into G-MDSC, in the presence of tumor-derived factors (TDF). The retinoblastoma gene (Rb1), a tumor suppressor gene and central regulator of the cell cycle and differentiation, has been shown to influence monocytic and neutrophilic lineage commitment and to limit myeloproliferative disease. Here, we examined the role of Rb1 in the biology of MDSC subsets in tumor-bearing mice. Firstly, M-MDSC expressed high levels of Rb1 which remained relatively stable in culture with GM-CSF. Conversely, freshly isolated G-MDSC initially expressed undetectable levels of Rb1 that increased over time in culture, which correlated with increased histone acetylation at the Rb1 promoter. This increased Rb1 expression and histone acetylation was accelerated by histone deacetylase inhibitors (HDACi) treatment, suggesting Rb1 expression may be controlled by histone modification. Furthermore, when treated with HDACi, M-MDSC did not differentiate into G-MDSC in culture, even with TDF present. Finally, induced Rb1 deficiency in vivo promoted an expansion of splenic CD11b+Ly6G+Ly6Clo cells, similar to G-MDSC in tumor-bearing mice. Although further studies are required, these results strongly suggest that Rb1, like SHIP, plays a role in MDSC accumulation, particularly G-MDSC in cancer.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This doctoral thesis involved the study of diseases in pigs, including the description of a case of granulocytic sarcoma and outbreaks of eosinophilic salt poisoning. The study of the characteristics and frequency of disease in swine population in the region covered by the Laboratório de Patologia Veterinária (LPV), Universidade Federal de Santa Maria (UFSM) was conducted through a retrospective study of all autopsy diagnoses. Five hundre and sity four with conclusive diagnoses were set apart. The pig population in the region covered by the study is predominantly family and diagnosed diseases reflect this reality. The infectious and parasitic diseases were the most prevalent [384 (68.1%)], followed, in descending order, nutritional and metabolic diseases [64 (11.,3%)], poisoning and toxi-infections [33(5,8%)] and developmental disorders [17(3.1%)]. Other changes to various etiologies, especially trauma, were cause of death in just over 11% of the protocols examined. Bacterial diseases were responsible for more than half of the causes of death or reason for euthanasia of animals studied, pointing to the influence of management, environmental and nutritional regional husbundry . The main disease diagnosed in pigs in the region covered by the study is the edema disease and along with other forms of infection by Escherichia coli is responsible for 23% of deaths of viral diseases and cancer are not major causes of death in pigs in the region studied. Nutritional hepatose and aflatoxicosis are important diseases in the region and and there cuasation are mainly linked to nutritional management. For description of eosinophilic granulocytic sarcoma, a set of techniques (cytology, histology, histochemistry and immunohistochemistry)were used and which proved to be essential for the confirmation of macroscopic tentive diagnosis. Salt poisoning is a condition recognized in pigs as far back as the first half of the last century and still remains as an important cause of mortality; the large amount of salt accumulated in the body in cases of poisoning can be demonstrated by determination of sodium ion in the liver, muscle, CSF, serum and aqueous humor, and these are acillary data to confirm the diagnosis. Pigs affected by salt poisoning have eosinopenia due to severe meningoencephalitis and infiltration of eosinophils in tissues, acute neuronal necrosis which develops into deeplaminar cortical necrosis as the clinical progresses. / Esta tese envolveu o estudo de doenças de suínos, incluindo a descrição de um sarcoma granulocítico eosinofílico e surtos de intoxicação por sal. O estudo das características e frequência das doenças na população suína na região de abrangência do Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM) foi realizado através de um estudo retrospectivo de todos os diagnósticos de necropsias. Foram separados 564 casos com diagnósticos conclusivos. A população suína na região de abrangência do estudo é predominantemente familiar e as doenças diagnosticadas, refletem esta realidade. As doenças infecciosas e parasitárias foram as mais prevalentes [384 (68,1%)], seguidas, em ordem decrescente, das doenças metabólicas e nutricionais [64 (11,3%)], intoxicações e toxiinfecções [33 (5,8%)], e distúrbios do desenvolvimento [17 (3,1%)]. Outras alterações de diversas etiologias, sobretudo de trauma, foram causa de morte em pouco mais de 11% dos protocolos examinados. Doenças bacterianas são responsáveis por mais da metade das causas de morte ou razão para eutanásia dos suínos estudados, revelando a influência de fatores de manejo, ambientais e nutricionais do modo de vida local. A principal doença diagnosticada em suínos na região de abrangência do estudo é a doença do edema e juntamente com outras formas de infecção por Escherichia coli é responsável por 23% das mortes Doenças de etiologia viral e neoplasias não são importantes causas de morte em suínos na região estudada. Hepatose nutricional e aflatoxicose são importantes doenças da região e se devem, sobretudo, a fatores de manejo nutricional. Para descrição do sarcoma granulocítico eosinofílico, foi utilizado um conjunto de técnicas (citologia, histologia, histoquímica e imuno-histoquímica), indispensáveis para a confirmação da suspeita macroscópica. Intoxicação por sal é uma condição reconhecida em suínos desde a primeira metade do século passado e continua uma importante causa de mortalidade e a grande quantidade de sal acumulada em casos de intoxicação pode ser comprovada pelas dosagens do íon sódio no fígado, músculo, líquor, soro e humor aquoso, e esses dados servem como forma de diagnóstico. Suínos intoxicados por sal apresentam eosinopenia devido a grave infiltração de eosinófilos e a meningoencefalite eosinofílica evolui para uma necrose neuronal laminar, à medida que se desenvolve o curso clínico da doença.