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Pneumonia eosinophilic: description, symptoms, causes and characteristics of treatment

Severe lung disease, such as pneumonia, is not always caused by a bacterial flora. Disrupt the homeostasis of the upper and lower respiratory tract may parasites, fungi, medicines, immunodeficiency states, allergic reactions. And in such cases, pneumonia eosinophilic develops.

Definition

Eosinophilic pneumonia is a pathological process in the lungs, which is characterized by excessive accumulation of eosinophils in the alveoli. There are several types or variants of this pathology, which can develop at any age.

Clinically, it is virtually indistinguishable from a similar disease caused by bacteria, so the main focus in diagnosis is on laboratory tests: general blood analysis, sputum microscopy. In most cases, after determining the type of disease, therapy with steroid hormones begins with the adrenal cortex. This helps reduce the inflammatory response and level the symptoms of pneumonia. The prognosis for such patients is usually favorable.

History

Chronic eosinophilic pneumonia, the causes of which at that time were not known, was first described in the middle of the twentieth century, in 1969, by a doctor Harrington. He was not very shy, so he appropriated the disease to his name, and after publication, the entire scientific world began to refer to the new pathology as Harrington syndrome.

Prior to this historical article, eosinophilic pneumonia was known as a disease that develops in the lungs when parasites are infected or uncontrolled drug intake. Twenty years later, in 1989, the term "acute eosinophilic pneumonia" appeared in medicine.

Etiology

There are several factors that influence the development of eosinophilic pneumonia. Causes, symptoms are closely related. For example, acute forms of pneumonia are caused by smoking (both active and passive), allergy to medicines, or a decrease in body defenses in HIV or AIDS. If none of the reasons are appropriate, then pneumonia is considered idiopathic.

Chronic eosinophilic pneumonia may be caused by a fungal infection (aspergillosis, pneumomycosis), helminthic invasion (ascariasis, echinococcosis), long-term administration of drugs that depress immunity (glucocorticosteroids, cytotoxic drugs), chronic autoimmune connective tissue diseases (rheumatoid arthritis, sarcoma).

Eosinophils perform protective functions of the body, but since inflammation is a typical pathological process, in case of excessive and turbulent flow it can negatively affect the state of human health.

Pathogenesis

The etiological factor largely determines how eosinophilic pneumonia will develop. Causes, symptoms, treatment - it all depends on it. The cornerstone of this type of pneumonia is the accumulation of a large number of eosinophils in the tissues of the lungs. Many diseases, among them eczema and bronchial asthma, are caused by too violent reaction of the body with the release of biologically active substances.

Taking medications and other toxic substances changes the reactivity of eosinophils, making them more susceptible. Anti-inflammatory substances, antibiotics, drugs cause allergies that lead to the development of secondary pneumonia. In addition, the factors that provoke the appearance of a large number of eosinophils in tissues include cigarette smoke and chemical vapor.

Parasitic infections

Physicians distinguish three mechanisms of development of pneumonia during parasitosis. The first is a helminthic invasion in the lungs, the second is part of the life cycle of worms, and the third is a random screening with blood flow. To combat them, the body sends eosinophils. They should provoke the release of cytokines, prostaglandins, leukotrienes and other active substances for the elimination of worms. But instead they cause pneumonia.

Specially introduced into the tissues of the lower respiratory tract are tapeworms, such as echinococcus and pork tapeworm, as well as pulmonary flukes. Stay in the lungs and access to atmospheric oxygen is necessary for ascarids, intestinal ugliness, hookworms and nekatorov. Pneumonia is eosinophilic, which is caused by the above causative agents, otherwise called Loeffler's syndrome. Through the bloodstream into the lungs, eggs of trichinella and schistosome enter.

Clinic

As a rule, it is difficult to answer the question, which patient has eosinophilic pneumonia, at the first sight to a therapist, a pulmonologist or even an infectious disease specialist. Symptoms, even with different etiologies, are very similar to each other. The patient complains of cough, fever, dyspnea and sweating at night. A couple of weeks after the appearance of the cough, if nothing is done, you can see the symptoms of decompensated respiratory failure. In this case, the patient must be transferred to artificial ventilation.

Chronic pneumonia eosinophilic progresses slowly, months. Patients lose weight, they have shortness of breath, wheezing and cough, body temperature does not fall below the low-grade figures. Sometimes the symptoms of the disease mimic bronchial asthma, making it difficult to diagnose and choose the wrong treatment tactics.

Many difficulties for diagnosis are created by medical eosinophilic pneumonia. Symptoms, treatment and prevention of it strongly resemble aspirin asthma, which misleads the doctor. Parasitic infections have a specific prodromal period that can lead to thoughts about helminthic invasions.

Diagnostics

Since clinically pneumonia eosinophilic practically does not differ from other pneumonias, the diagnosis is made on the basis of laboratory and instrumental studies. In the general analysis of blood, eosinophilia is strongly pronounced, when visualizing the lungs on fluoroscopy or computed tomography, characteristic pathological changes are noted. For confirmation, you can take a biopsy of the lung tissue, and also make flushing from the surface of the bronchi during bronchoscopy.

To identify the relationship with taking medications, staying in chemically contaminated areas or oncological disease, you need to carefully study the patient's medical history, and also collect a detailed history of life and illness. If, after all the research, to identify the cause still failed, the diagnosis is recorded as idiopathic eosinophilic pneumonia.

Be sure to indicate the degree of respiratory failure in the map. Within a week from the onset of the disease, its first signs appear:
- Multiple lesions of lung tissue;
- accumulation of fluid in the pleural cavity;
- leukocytosis and increased erythrocyte sedimentation rate in the general blood test;
- increase in the level of immunoglobulin E;
- spirometry shows a decrease in the respiratory volume of the lungs.

Treatment

Even before the final diagnosis is made - eosinophilic pneumonia, the treatment starts from the moment the patient turns to the doctor.

If pneumonia is secondary, then the underlying disease should be treated: a tumor or a helminthic invasion. This will help reduce pulmonary symptoms and speedy recovery.

If the cause of the disease could not be identified, glucocorticosteroid therapy is prescribed. They well remove the inflammatory reaction, stabilize the cell membranes, lower the temperature. The remission is achieved quickly - on the third-fourth day. But this does not end with the medication. The disappearance of the symptoms does not mean that the disease is cured. Therefore, the patient takes a corticosteroid for another month, with a gradual decrease in the dose until the moment when the instrumental methods of diagnosis do not confirm recovery.

The chronic form of the disease requires therapy for three months or more, even after the disappearance of clinical signs. Relapses of pneumonia are possible against a background of abrupt corticosteroid withdrawal. In some cases, the patient may need to switch to artificial ventilation.

Forecast

If eosinophilic pneumonia is a secondary disease in the background of a cancer or parasitosis, the outcome of the disease depends on the course of the underlying pathology. A fatal outcome, provided adequate and timely treatment is unlikely.

Chronic eosinophilic pneumonia prone to recurrence with glucocorticosteroid withdrawal. Therefore, some patients take these drugs for life. But this situation has a downside. The side effects of treatment, such as prednisolone, can greatly impair the quality of life of a person. These include: peptic ulcer, osteoporosis, cushingoid, decreased immunity.

Epidemiology

As a rule, pneumonia caused by parasites is more common in regions endemic for these pathogens. It can be the tropics, the Siberian taiga, the Mediterranean or the basin of a particular river.

Acute eosinophilic pneumonia can develop at any age, even in very young children, but most often they suffer from middle-aged people: from twenty to forty. The disease has some kind of sexual discrimination - men suffer more often than women, because the disease is caused by smoking. In modern medical literature, there are descriptions of the development of eosinophilic pneumonia after radiation therapy for breast cancer.

Eosinophilic pneumonia in dogs

Animals also have eosinophilic pneumonia. The causes, symptoms, prevention of this disease are very similar to human. Similarly, the causes of the disease: parasites in the lungs, fungi, pollen and insect allergy, chemical and medicines.

The dog has an uncontrolled immune response, which causes infiltration of lung tissue with eosinophils. Airiness of the lower parts decreases, there develop pathogenic fungi that cause pneumonia. The animal dies from acidosis and hypoxia. The clinic is similar to the human: cough, shortness of breath, weakness, fever, lack of appetite, weight loss.

For diagnostics use the analysis of a blood, a roentgenography of lungs, a cytologic research of bronchoalveolar washings, serological examination. On the roentgenogram visible swelling of the lung tissue, the presence of cellular granulomas, an increase in the lymph nodes of the mediastinum and the root of the lung, an expansion of the shadow of the heart. After clarifying the etiology of eosinophilic pneumonia, the veterinarian prescribes a specific treatment aimed at eliminating the primary disease. The most effective are corticosteroids, in combination with antibiotics and bronchodilators. As a rule, animals remain on lifelong therapy.

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