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The Eosinophilic
PneumoniasDr Rajesh Padhi MD,DipCard,FCCP
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The Eosinophilic Pneumonias
Definition: Eosinophilic pneumonias
includes all disorders characterized byinfiltration of the lungs with eosinophils, withor without an excess of eosinophils in theperipheral blood.
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Diseases Associated with PulmonaryInfiltrates and Eosinophilia
Pulmonary Eosinophilic Syndromes of KnownCause
1. Parasitic-Drug-or toxin induced eosinophilicpneumonias (including Loefflers syndrome)
2. Tropical pulmonary eosinophilia
3. Allergic bronchopulmonary mycosis/Aspergilosis
(ABPA)
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Pulmonary Eosinophilic Syndromes ofUnknown Cause
1. Idiopathic acute eosinophilic pneumonia
2. Chronic eosinophilic pneumonia
3. Churg-Strauss syndrome (allergicgranulomatosis and angiitis)
4. Idiopathic hypereosinophilic syndrome
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Parasitic Infections Associated withEosinophilic Pneumonia
Ancylostoma spp.
Opisthorchis spp.
Ascaris spp.
Paragonimus westermaniBrugia malayi
Schistosoma spp.
Clonorchis sinensisStrongyloides stercoralis
Toxocara gondii
Wuchereria bancrofti
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Loefflers Syndrome (Simple PulmonaryEosinophilia
Definition:
Loefflers Syndrome is a clinicalsyndrome characterized by mild respiratorysymptoms, peripheral blood eosinophilia,and transient, migratory pulmonaryinfiltrates.
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Etiolopathogenesis
Immune hypersensitivity toAscaris lumbricoidesAscaris larvae.
Exposures to numerous drugs and other
agents
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Ingestion
Lava inSI
Crossintestinal
Enter alveoli->adult worm
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The pulmonary manifestations of Loefflerssyndrome begin approximately 9 to 12 daysfollowing ingestion, and occur during the
migration of larvae through the lung.
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CLINICAL FINDINGS
1. Affects people of all ages.
2. Low-grade fever
3. Nonproductive cough, dyspnea4. hemoptysis.
5. self-limited (1 to 2 weeks)
6. PSC: moderate to extremeeosinophilia
7. Sputum: contains eosinophils.
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8. CXR: Transient, migratory, nonsegmentalinterstitial and alveolar infiltrates (oftenperipheral or pleural based)
9. PFT: reveals a mild to moderate restrictiveventilatory defect
10. DLCO: reduced diffusing capacity for carbonmonoxide
11. Lung biopsy: eosinophilic infiltration of
interstitium and alveolar-capillary units
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RX
Search for an etiologic agent (e.g., parasitic infectionor drug reaction)
Causative Drugs & agents to be stopped
Bronchodilators
rarely corticosteroids may be used for alleviation ofsymptoms (self-limited)
Ascaris, treatment with oral mebendazole(100 mg twice a day for 3 days)
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Drugs and Other Exposures CausingEosinophilic Pneumonia
Rapeseed oil
Red spider antigen
Acetylsalicylic acid
Amiodarone
Captopril
CarbamazepinePhenytoin
Sulfasalazine
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Diagnostic Criteria for AllergicBronchopulmonary Aspergillosis
Major CriteriaAsthma
Positive immediate hypersensitivity skin-prick test toAspergillus
Precipitating antibodies againstAspergillus
Elevated total IgE
Elevated serumAspergillusspecific IgE, IgG
History of pulmonary infiltratesPeripheral blood eosinophilia
+/ Proximal bronchiectasis
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Diagnostic Criteria for AllergicBronchopulmonary Aspergillosis
Minor Criteria
Mucous plugs containingAspergillus
Dual cutaneous reaction toAspergillus