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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