Pulmonary Eosinophilia

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It is a group of disorders of different aetiology in which lesions in the lungs produce a chest radiograph abnormality associated with an increase in the number of the eosinophil leucocytes in the peripheral blood.

Categories:

  1. Exterinsic pulmonary eosinophilia.
  2. Intrinsic pulmonary eosinophilia.

Causes:

[A] Extrinsic: (Know cause)
1. Helminths-
• Ascaris lumbricoids.
• Ankylostoma duodenale.
• Toxocara canis.
• Microfilaria.
2. Drugs:
• Nitrofurantoin.
• Para-amino-salicylic acid.
• Sulphasalazine.
• Impiramine.
• Chlorpropamide.
3. Fungi- Aspergillus fumigates.

[B] Intrinsic: (unknown causes)
1. Cryptogenic eosinophilic pneumonia.
2. Churg-strauss syndrome.
3. Hypereosinophilic syndrome.
4. Polyarthritis nodosa (rare)

Pathophysiology: IgE mediated eosinophil production is induced by compounds released by basophils and mast cells, including eosinophil chemotactic factor of anaphylaxis, leukotriene B4, complement complex (C5-C6-C7), interleukin 5, and histamine (though this has a narrow range of concentration).

Treatment of pulmonary eosinophilia:
1. Symptomatic treatment: Antipyretic & bronchodilators etc.
2. Treatment of the cause:
a) Antihelminthic (if due to helminthes)
b) Withdraw of drug (if due to drugs)
c) Diethylcarbamazine (if due to microfilaria)
d) Prednisolone (if cryptogenic)

Complications of pulmonary eosinophilia:

  1. Bronchial asthma.
  2. Bronchiectasis.
  3. Broncho-pneumonia.
  4. Pleural effusion.
  5. Fibrosing alveolitis.
  6. Bronchiolitis.

Reference:

  1. Davidson’s Principles and Practice of Medicine, 21st edition.
  2. Wikipedia free encyclopedia.

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