eosinophilic pneumonia


Eosinophilic Pneumonia

 

Definition

Eosinophilic pneumonia is a group of diseases in which there is an above normal number of eosinophils in the lungs and blood.

Description

Eosinophilia is an increase in the number of eosinophils. Eosinophilic pneumonia is characterized by a large number of eosinophils in the lungs, usually in the absence of an infectious disease. Eosinophils are one of the white blood cells and are classified as a granulocyte. They are part of the non-specific immune system and participate in inflammatory reactions. Eosinophils contain cationic molecules that are useful for destroying infectious agents, especially heiminthic parasites (worms). There are several types of eosinophilic pneumonia. Loffler's pneumonia is a temporary infiltration of eosinophils into the lungs. The patient will feel tired, have a cough, spasms of the bronchial airway, and difficulty breathing. Loffler's pneumonia will clear spontaneously, but slowly over the course of about a month. Another form of eosinophilic pneumonia, pulmonary infiltrates with eosinophilia (PIE), is a more serious and potentially fatal disease. In PIE, the patient experiences asthma, pulmonary infiltrates, disorders of the peripheral nervous system, central nervous systems symptoms, and periarteritis nodosa.

Causes and symptoms

Pneumonia with eosinophils occurs as part of a hypersensitivity reaction. A hypersensitivity reaction is an over-reaction of the immune system to a particular stimulus. As part of the hypersensitive reaction, cells of the immune system are produced in increased numbers and migrate into areas targeted by the hypersensitivity reaction. In the case of eosinophilic pneumonia, the lungs are the target. Generally, eosinophilia pneumonia is not a reaction to an infection. There is a correlation between asthma and eosinophilic pneumonia. Eosinophilic pneumonia can also be caused by drugs and, in some people, by polluted air. The symptoms range from mild (coughing, wheezing, and shortness of breath) to severe and life threatening (severe shortness of breath and difficulty getting enough oxygen). The symptoms may resolve spontaneously or can persist for long periods of time. In a few cases, the disease may rapidly produce life-threatening pneumonia.

Diagnosis

Since eosinophilia is common to a number of conditions, the physician must rule out asthma and infection by helminths when diagnosing eosinophilic pneumonia. A whole blood count will reveal an increased number of eosinophils in the blood. An x ray of the lungs may show the presence of infiltrates (the eosinophils and fluid). If sputum is produced in coughing, eosinophils will be seen instead of the more normal profile of granulocytes seen when an infectious agent is present.

Treatment

Eosinophilic pneumonia may not respond to drugs used to treat asthma. Eosinophilic pneumonia is usually treated with steroids, particularly glucocorticosteroids. Steroids are not effective against infectious agents, but the main disease process in eosinophilic pneumonia is an inflammatory reaction, not a response to infection. When eosinophilia is produced as a consequence of asthma or an infection by helminths, treatment of the asthma or helminths will reduce the eosinophilia.

Resources

Books

Berkow, Robert, editor. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Key terms

Infiltrates — Cells or body fluids that have passed into a tissue or body cavity.Sputum — Material coughed up from the throat or lungs.

Löff·ler syndrome I

(lŏrf'lĕr), eosinophilic pulmonary infiltrates, often associated with parasitic migration; also associated with reactions to some antibiotics, to L-tryptophan, or to crack cocaine. Synonym(s): eosinophilic pneumonia, eosinophilic pneumonopathy

Acute Pulmonary Eosinophilia

A self-limiting non-infectious inflammation in the lungs accompanied by increased eosinophils in tissue and peripheral blood.
Aetiology Unknown, or various drugs, parasitic infestation (especially ascariasis in children), nickel exposure, recent blood transfusion, or lymphangiography.
Clinical findings Chest pain, dry cough, fever, malaise, tachypnoea, dyspnoea, rash, wheezing.
Imaging Diffuse infiltrates on plain AP film.
Bronchoscopy Increased eosinophils.
Management APE may respond to corticosteroids.
Complications Restrictive cardiomyopathy due to pericardial fibrosis
Prognosis Often resolves without therapy; less commonly, it evolves to acute idiopathic eosinophilic pneumonia.

eosinophilic pneumonia

Clinical medicine A nonspecific term for disease processes in which the lung parenchyma is inflamed and diffusely infiltrated with eosinophils and histiocytes, ± PMNs, lymphocytes, plasma cells, mast cells Etiology Ancylostoma duodenale, Ascaris lumbricoides, Dirofilaria immitis, Fasciola hepatis, Necator americanus, Strongyloides stercoralis, Toxocara canis, Trichinella spiralis, Wuchereria malayi, drugs;1⁄3 are idiopathic Clinical From mild and transient–Löffler syndrome with fever, cough, and wheezing to severe and progressive–chronic EP with weight loss, dyspnea; an acute form is accompanied by respiratory failure and recuperation Clinical forms Loeffler syndrome, tropical eosinophilia, drug-induced pulmonary eosinophilia, EP associated with asthma Lab Eosinophils in BAL, peripheral blood Management Treat cause if known–eg, stop offending drug, kill offensive parasite, default to corticosteroids if idiopathic

e·o·sin·o·phil·ic pneu·mo·ni·a

(ē'ō-sin-ō-fil'ik nū-mō'nē-ă) 1. An immunologic disorder characterized by radiologic evidence of infiltrates accompanied by either peripheral blood eosinophilia or histopathologic evidence of eosinophilic infiltrates in lung tissue. 2. Eosinophilic infiltration of the lung secondary to infection or allergic reaction.