Eosinophilic pneumonia: symptoms and treatment
Eosinophilic pneumonia is a disease of the lungs of an infectious-allergic nature, in which eosinophils accumulate in the alveoli, and eosinophilia in the blood is also observed. Eosinophils are components of the human immune system. Their number increases in those cases when the lungs develop inflammatory and allergic processes. Including increasing the number of eosinophils in bronchial asthma, often accompanying this pathology.
In addition, it should be noted that eosinophils are found not only in respiratory vesicles of the lungs (alveoli), but also in the blood. Until now, scientists have not established why the alveoli are filled with eosinophils, but there are suggestions that it can cause a pathology such as eosinophilic pneumonia.
The most common cause of this disease is helminthic invasions. This type of eosinophilic pneumonia was described in the century before last by Loeffler, who discovered that volatile infiltrates in the lungs are caused by the fact that larvae of helminths migrate through the body and, getting into the alveoli, cause irritation, to which the immune system responds by producing eosinophils.
The disease most often develops in people of young age — from 19 to 40 years, and people of both sexes are ill.
Almost any helminth can cause the development of such a disease. In particular, it is known that eosinophils are produced in the lungs when they get into the organ of larvae of schistosomiasis, toxocar, ascaris, trichinella and other helminths. Eggs of worms are brought into the lungs through the blood vessels, and adults go to the lungs along the ascending path.
In addition to helminthic invasions, other factors can also cause the disease, for example, a fungal infection. In addition, a frequent cause of the development of the disease is an allergic reaction to various effects:
- inhalation allergens (pollen of flowers, animal hair)
- Professionals (dust, loose substances, toxic fumes, etc.)
The drugs that most often can cause a causal development of this disease are:
- Sulfonamide preparations
- Acetylsalicylic acid;
- hormonal medications.
As for inhalation allergens, it is most often pollen of plants and flowering trees (lily of the valley, lily, linden and others). The chemical components that occur in production and can also cause the development of this disease in humans include nickel salts.
In rare cases, eosinophilic pneumonia may become a manifestation of serum sickness when injected with tuberculin. Treatment in most cases involves the exclusion of contact with the allergen.
This pathology can be of three types:
With a simple form, the symptoms are not too pronounced. Patients complain of weakness, fatigue, increased body temperature to subfebrile indicators, the appearance of an inadvertent cough, the nature of which is dry, and also a minor soreness in the trachea. Sometimes when coughing, patients can get sputum, in which there are impurities of blood. If the helminthization of the body has become widespread, a rash and itching can appear on the human body, and dyspnea with a bronchial component develops.
In cases where helminth eggs fall into other organs, symptoms of their involvement in the inflammatory process may be observed, which disappear quickly enough — an increase in the liver, spleen, inflammation of the gastric mucosa with the appearance of symptoms of gastritis, the development of pancreatitis,
Acute eosinophilic pneumonia is a condition that begins suddenly with an increase in body temperature. In this case, the disease is severe, with a marked symptom of intoxication. Patients complain about:
- muscle pain;
- chest pain
- violation of breathing and the appearance of dyspnea.
Very quickly, just a few days, may develop respiratory failure or respiratory distress syndrome. The treatment of this pathology is much more difficult to perform than in other forms, and hospitalization of the patient is required.
Chronic eosinophilic pneumonia is a disease that lasts more than four weeks, and is characterized by less severe symptoms. The chronic form of pathology is most often found in women with bronchial asthma in the anamnesis. The disease is subacute — with increased sweating, loss of body weight and increased dyspnoea.
Sometimes the symptoms of the disease just as suddenly disappear, as they did, and the self-healing of the body occurs without the use of drug therapy. Especially often it occurs with a simple form of pathology. In other cases, the disease lasts from a few days to 2 weeks. In chronic form, the disease progresses and leads to the development of infiltrates, impaired breathing function and the development of pulmonary fibrosis.
Making the diagnosis
It is difficult to diagnose eosinophilic pneumonia, based only on x-ray or CT. Therefore, in this case, blood tests in which eosinophilia and a strong increase in ESR are determined are indicative. Also, to confirm the diagnosis, the analysis of feces for eggs of worms, the taking of an allergic test and the conduct of serological tests are shown. Auscultation allows you to hear wet finely bubbling rales or crepitations. In the case of multiple foci of infiltration in the affected organ, percussion is determined by a shortening of the pulmonary sound.
Since this disease causes the most common worm infestations, treatment involves the appointment of antihelminthic drugs. Antibiotic treatment in this case is not effective, therefore antibiotics are not prescribed for patients with a pathology such as eosinophilic pneumonia.
It is very important to treat the disease after determining and eliminating the allergen that caused it. Therefore, if the pathology has developed against the background of other allergic effects (not helminths), then these effects must be eliminated in order to begin effective therapy. Often, the use of glucocorticosteroids in this disease gives a positive effect within two days — there is a regression of inflammation. Therefore, the treatment of glucocorticosteroids is also a diagnostic criterion in case of doubt about the correctness of the diagnosed diagnosis — if the effect is absent, then the patient does not have eosinophilic pneumonia, and if the effect of therapy is present, then the diagnosis is correct.
In severe cases and with the development of complications (respiratory failure, pulmonary fibrosis), it is necessary to carry out mechanical ventilation, as well as the appointment of long-term hormonotherapy.