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December 11, 2016 00:05

Pulmonary eosinophilia .Causes.Symptoms .Diagnostics.Treatment

pulmonary eosinophilia - a group of diseases and syndromes characterized by transient pulmonary infiltrates and blood eosinophilia greater than 1.5 x 109 / L.

are the following groups of pulmonary eosinophilia:

  1. Local pulmonary eosinophilia
    • Simple pulmonary eosinophilia (Loeffler's syndrome).
    • Chronic eosinophilic pneumonia (prolonged pulmonary eosinophilia, Leroy-Kindberg syndrome).
    • pulmonary eosinophilia with asthmatic syndrome (atopic asthma, non-atopic asthma, allergic bronchopulmonary aspergillosis, tropical eosinophilia).
  2. pulmonary eosinophilia with systemic manifestations
    • allergic eosinophilic granulomatous vasculitis (Churg-Strauss syndrome).
    • myeloproliferative hypereosinophilic syndrome.

Local pulmonary eohinofilii

Simple pulmonary eosinophilia

Simple pulmonary eosinophilia (Loeffler's syndrome) - a combination of transient "volatile" pulmonary infiltrates with eosinophilia high 1.5 h109 / l.

Causes of pulmonary eosinophilia

main etiological factors Leffler syndrome

are:

  • sensitization to pollen allergens;
  • sensitization to allergens fungi, especially Aspergillus;
  • helminths infestation (. Ascariasis, strongyloidiasis, schistosomiasis, hookworm, paragonimiasis, toksakaroz, etc.) - are agents of helminthiases phase of larval migration and enter the lung tissue;
  • work in industries related to the use of nickel (nickel carbonade sniffing);
  • drug allergy (to antibiotics, sulfonamides, nitrofuran compounds, salicylates, anti-media, other drugs);
  • allergic to various foods;

If it is impossible to establish the cause should speak of cryptogenic (idiopathic) syndrome Leffler.

pathogenesis of pulmonary eosinophilia

When pulmonary eosinophilia is observed accumulation of eosinophils in the lung tissue in response to the above-mentioned etiologic factors - antigens.There are receptors for chemotactic factors that cause accumulation of eosinophils in the lung membrane on the surface of eosinophils.The main chemotactic factors for eosinophils are:

  • eosinophilic chemotactic factor of anaphylaxis (scroll to mast cells and basophils);
  • factor that stimulates the migration of eosinophils (released by T lymphocytes);
  • eosinophilic neutrophil chemotactic factor.

chemotaxis of eosinophils is stimulated and activated components of the complement system;histamine and other mediators released during mast cell degranulation (tannins, leukotrienes);helminth antigens;antigens of tumor tissue.

flocked into the lung tissue eosinophils have both protective and immunopathological effects.Protective effect

eosinophils involves the separation of enzymes that inactivate kinins (kininase), histamine (histaminase), leukotrienes (arylsulfatase), platelet activating factor (phospholipase A) - i.e.mediators involved in the development of inflammatory and allergic reactions.In addition, eosinophils produce eosinophil peroxidase, which destroys Schistosoma, Toxoplasma, trypanosomes, causes destruction of tumor cells.These effects are mediated by production of large amounts of hydrogen peroxide under the influence of the enzyme peroxidase.

Along with eosinophils protective effects have also pathological effect, highlighting the great basic protein and eosinophil cationic protein.

Large main protein of eosinophilic granule cells damages the ciliated epithelium of the bronchial mucosa, which, of course, violates the mucociliary transport.In addition, under the influence of large granules eosinophilic basic protein activates the release of histamine from mast cell granules, which exacerbates the inflammatory response.

eosinophilic cationic protein activates the kallikrein-kinin system, the formation of fibrin, at the same time neutralize the anticoagulant effect of heparin.These effects may enhance platelet aggregation and disturbance of microcirculation in the lungs.

eosinophils in large numbers are also allocated prostaglandins E2 and R, has a regulating effect on the inflammatory and immune processes.

Thus, the major pathogenetic mechanisms of pulmonary eosinophilia in general and simple pulmonary eosinophilia (Loeffler's syndrome) in particular, are associated with functional activity accumulated in the bronchopulmonary system of eosinophils.Starting torque of eosinophilic alveolitis is exposed to the antigen activation of the complement system in the lungs due to the fact that in the light of possible local production of complement components C3 and C5.Later develops immunocomplex reaction (most common) or an allergic reaction of immediate type (IgE-dependent).

main pathologic features Leffler syndrome are:

  • filling alveolar eosinophils and large mononuclear cells;
  • infiltration mezhalveolyarnyh partitions eosinophils, plasma cells, mononuclear cells;
  • eosinophil infiltration of blood vessels;
  • formation of platelet aggregates in the microvasculature, but without evidence of necrotizing vasculitis, and the development of granulomas.

Symptoms of pulmonary eosinophilia

Patients suffering from the syndrome Leffler, providing enough specific complaints of dry cough (sometimes with sputum "canary" in color), weakness, decreased performance, a significant sweating, increased body temperature (generallynot higher than 38 ° C).Some patients complain of pain in the chest, worse by coughing and breathing (usually in combination with Leffler syndrome dry pleurisy).Occurrence hemoptysis possible with helminth infections (larvae phase migration and their penetration into the lungs).There may be itching, suddenly emerging and recurrent angioedema, urticaria.However, the disease is often asymptomatic and is detected only at a random examination of the patient on any other occasion.

general condition of patients is satisfactory in most cases.Physical examination of lungs is determined dullness over the area of ​​infiltration location.In the same zone auscultated wet finely wheezing in the weakening of vesicular breathing.With the combination of "volatile" eosinophilic infiltrate and dry (fibrinous) pleurisy pleural friction auscultated.Characterized by fast dynamics (rapid decrease and disappearance) of physical symptoms.

Laboratory data

  1. Complete blood count - feature - eosinophilia, Moderate leukocytosis, increased erythrocyte sedimentation rate possible.
  2. Biochemical analysis of blood - increased content seromucoid, sialic acid, fibrin (as a manifestation of non-specific biochemical "inflammatory syndrome"), at least increases the level of a2 and y-globulins.
  3. Immunological studies - may reduce the number of T-lymphocytes suppressors, increase in the level of antibodies, the appearance of circulating immune complexes, but these changes are not natural.
  4. Urinalysis - without significant changes.
  5. clinical tests of sputum - with cytological examination revealed a large number of eosinophils.

Instrumental studies

  1. X-ray examination of the lungs.In the lungs revealed inhomogeneous, with indistinct contours infiltration foci of various sizes.They are located in one or more segments of both lungs, in some patients, the infiltration center is small and can occupy only one segment.A characteristic feature of these infiltrates is their "volatility" - in 7-8 days infiltrates resolve, in rare cases, they are stored for 3-4 weeks, but then disappear.Some patients on the spot disappeared infiltrate can persist increased pulmonary pattern within 3-4 days."Volatility" infiltration is the main differential-diagnostic feature that distinguishes this disease from pneumonia and pulmonary tuberculosis.If Leffler syndrome due to helminth infections, formation of lesions in the destruction of lung tissue, slow their disappearance, and in some patients the formation of cysts with the deposition of calcium salts.
  2. study lung ventilation function.As a rule, significant violations of the external breathing function there.With extensive infiltrates in the lungs may occur moderately severe respiratory distress mixed restrictive-obstruktivnogotipa (reduced vital capacity, FEV1).

flow simple pulmonary eosinophilia favorable, complications are not observed, there is complete recovery.If you can not remove the allergen, relapses of the disease.

survey program

  1. General blood, urine, stool (on helminths), sputum (cytological analysis).
  2. Biochemical analysis of blood - definition content seromucoid, sialic acid, fibrin, total protein, protein fractions.
  3. Immunological studies - definition of the content of B and T lymphocyte subpopulations of T-lymphocytes, immunoglobulins, circulating immune complexes.
  4. ECG.
  5. Radiography of the lungs in three projections.
  6. Spirography.
  7. Allergy examination for detection of sensitization to pollen, food, fungus, helminth, drugs and other allergens.