Pulmonary eosinophilic infiltrate. Symptoms and therapy for various pathologies

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Lung infiltration - a condition in which an accumulation occurs in a local part of the organ cellular elements, liquids, and other components that are not characteristic of a healthy person.

Compare this phenomenon possible with edema, but in the latter case there is an accumulation of biological fluids, and infiltrative changes include almost any element.

What may precede this disease and what kind of therapy do doctors prescribe in this situation?

General information about infiltration

Infiltrates– these are any organic and inorganic compounds that tend to penetrate through soft tissues.

They can form in the body for a whole range of reasons, ranging from malignant neoplasm ending in defeat lymphatic system, in which dead infection cells and their waste products accumulate in the lungs.

The accumulation of infiltrate can occur without any changes in the functioning of the body. That is, the person will feel healthy.

It happens that the infiltration process is accompanied by the following symptoms:

Cough;
Slight increase in body temperature;
Chest pain;
Chills;
Headache;
Clear signs of edema lung tissue;
Inflammation of soft tissues in the chest area;
Weakening of natural immunity.

The scope of symptoms is actually significantly higher than indicated above. But, if you believe the words of doctors, most often the infiltrative formation does not manifest itself in any way.

It is discovered by chance when undergoing a comprehensive examination medical examination(in particular, fluorography).

Moreover, it can also be homogeneous and heterogeneous. That is why doctors, first of all, exclude the possibility of a malignant neoplasm (for this, X-rays and punctures are used).

Main causes of lung infiltration

The main cause of infiltrates– this is the development of pathology in the lung tissue, due to which the permeability of the organ membranes changes.

The process of edema development can be accelerated by:

Pneumonia (pneumonia);
Bronchitis;
Inflammation of the lymph nodes;
Recently rescheduled long-term treatment using injections;
Tuberculosis;
Weakened immunity;
Oncological diseases(regardless of the location of the neoplasm itself);
Purulent pathologies (gangrene, abscess).

There is also such a concept as infiltrative pneumonia . This is when damage to the lung tissue occurs as the body fights infection.

In this case, the infiltrate includes the remains of bacteria, the administered drug (mainly intramuscularly), dead lung cells, and sputum.

The infiltrating element may disappear on its own over time, but more often than not, it retains its size and location, without in any way affecting the functioning of the respiratory system.

Peribronchial infiltration, as the name suggests, affects a collection of bronchial tubes. According to doctors, in most cases this is preceded by the penetration of infections into the lungs from oral cavity, nasopharynx, as well as susceptibility to swelling of the respiratory tubes (for example, with allergies).

The key symptom of infiltration is shortness of breath even after minor physical exertion.

Infiltrative cancer- worst case scenario. Indicates that inflammation has been detected in the lung, caused by the accumulation of cells produced from the tumor. It could be like benign neoplasm, and malignant. And in many cases this is provoked by long-term smoking and living in an environmentally poor region.

Prescribed therapy

For each case, a treatment algorithm is drawn up individually.

If fields without focal and infiltrative shadows are identified, then conservative treatment is quite acceptable;
If the size of the infiltrate increases over time or there is high probability disruption of normal blood flow, then it will not be possible to do without surgery;
If the stage of the disease is high (that is, there is a threat to the patient’s life), then it may also be necessary to temporarily install a pulmonary shunt, which will prevent subsequent physiological changes in lung tissue.

Infiltration is almost impossible to cure unless the provoking factor is determined. Even performing an operation does not guarantee that re-inflammation will not occur in the future.

In total, this is local lesion or edema, in which the permeability of soft tissues is disrupted and an accumulation of cellular elements, organic and inorganic fluids occurs.

Most often this is caused by infectious diseases And pathological changes in lung tissue (which is a precursor oncological pathologies). Detected by X-ray and detailed comprehensive research the patient's body.

Initially, the specialist must determine that the patient actually has a pulmonary infiltrate. It can be detected using clinical x-ray studies. Various view physical changes in the lungs are observed depending on the nature of the pulmonary infiltrate.

What is pulmonary infiltrate

The most pronounced changes are in the case of pulmonary infiltrate of infectious inflammatory in nature, mainly with pneumonia of a nonspecific type: crepitus, bronchial or hard breathing, dullness or dullness of percussion sound, increased local voice tremors. With a productive pulmonary infiltrate, wheezing and crepitus, increased vocal tremors, and in the presence of tumors, weakened breathing can be heard. In this case, based on the results clinical trials it is impossible to determine pulmonary infiltrate.

The decisive step to confirm the presence of infiltrate in the lungs is radiography. If the image shows a darkening of more than 1 cm in diameter of medium or low intensity. IN rare cases darkening with a more dense infiltrate.

The darkening contours directly depend on the examination projection, pathological process and place of its localization. The structure can be homogeneous or heterogeneous. It is determined by the presence of complications, stage and nature of the pathological process.

The second stage of the differential diagnostic study includes finding the boundary between tumor and inflammatory infiltrates. Infiltrate inflammatory type lobar character is mainly observed in tuberculosis and pneumonia. Tumor infiltrates do not cover the entire lobe.

Lobar darkening in the presence of tumors is most often observed with bronchogenic cancer in the lung.

Microorganisms can enter the lung in the following ways:

contagious;
by airborne droplets;
lymphogenous;
hematogenous;
bronchogenic.

Factors of occurrence

Factors that can provoke the development of pulmonary infiltrate are:

viral infections;
hypothermia;
operations;
elderly age;
alcohol;
smoking.

Classification of pneumonia

Pneumonia is classified into atypical, nosocomial, and community-acquired.

They are also classified according to the following criteria:

Pathogens of pneumonia in the lungs

Gr+ microorganisms:

Pyogenic streptococcus up to 4%. Complications of diseases such as pericarditis, pleurisy and during a seasonal influenza epidemic are common;
Staphylococcus aureus up to 5%. Tendency to destruction, during epidemic outbreaks up to 40%;
Pneumococcus from 70 to 96%.

Gr-organisms:

Anaerobic pathogens

It occurs very rarely and is accompanied by foul-smelling sputum.

Protozoa

It is observed in people after radiation therapy, with immunodeficiency, after transplantation, in those weakened after illness and in HIV-infected people. Staging - atelectatic, edematous, emphysematous. Determined by Romanovsky-Giemsa smears.

Viruses

This includes viruses after transplantation, during suppressive therapy, respiratory syncytial, parainfluenza and influenza.

Mycoplasma

Most often present in crowded places. Discrepancy between symptoms of lung damage, catarrhal symptoms and severe intoxication.

Signs of infiltration in the lungs according to X-ray examination

Infiltration is characterized by a moderate increase in lung tissue and its increased density. Exactly because of this reason radiological signs infiltration in the lungs has its own characteristics.

With infiltration in the lungs of the inflammatory type, uneven outlines and irregular shapes of darkening are observed. At acute stage infiltration in the lungs, blurred contours are observed, gradually turning into the tissue that surrounds the lungs. At chronic inflammation the contours are jagged and uneven, but more clearly defined. With the inflammatory form of infiltration in the lungs, you can often see branching light stripes - these are the bronchi filled with air.

Due to the fact that the pathogen causes damage to the respiratory system in a number of inflammatory diseases, tissue necrosis can be observed varying degrees, which, in turn, significantly increases the severity of the disease.

In order to prevent the development of necrosis and restore the integrity of bronchial and pulmonary tissue, it can be recommended next view treatment: marsh dried grass, medicinal clover, yarrow, birch leaves and buds, aloe and medicinal medicine.

Symptoms of infiltration in the lungs

Complaints that arise most often with pulmonary infiltrate

Most often with pulmonary infiltration the following complaints arise:

Increased sweating;
Headache;
Weakness;
Chills;
Increased body temperature;
At chronic form pulmonary infiltrate may result in exhaustion of the body, and consequently, weight loss.

The cough character completely depends on the etiology and stage of the pulmonary infiltrate, and also on how pronounced the changes accompanying the pleura and bronchi are.

At the initial stage of development of pulmonary infiltrate, a dry cough is observed, in which sputum is not expectorated. But after a short amount of time, scanty sputum begins to separate, and later the cough becomes more productive. A short, weak and silent cough may indicate the beginning of infiltration of the lungs, which is located on the periphery of their tissues.

Pulmonary eosinophilic infiltrate

The pathogenesis of these changes is not well understood. There is an idea about the leading role of sensitization and allergies that arise when helminthic infestation. One of the proofs of this point of view is the increase in the level of IgE in the blood serum of patients.

Pathoanatomical changes consist of the appearance of infiltration foci in the lungs, which upon microscopic examination represent alveolar exudation with a large number of eosinophils. In some cases, perivascular infiltration of leukocytes and minor thrombosis were observed.

Symptoms of pulmonary eosinophilic infiltrate:

In most patients, pulmonary eosinophilic infiltrate associated with ascariasis and other helminthic infestations is asymptomatic and is detected during preventive fluorographic studies. Body temperature, as a rule, is normal, sometimes it rises to subfebrile levels with normalization within several days. In some patients, the appearance of pulmonary eosinophilic infiltrate is accompanied by malaise, headache, night sweats, cough without sputum or with a small amount of colored sputum. yellow sputum.

Physical examination may reveal a slight shortening of the percussion tone and moist rales over the area of infiltration in the lungs. All of the above symptoms and physical signs disappear quickly, within 1-2 weeks.

Diagnosis of pulmonary eosinophilic infiltrate:

At x-ray examination non-intensive, homogeneous shading of various parts of the lungs without clear boundaries is determined. Shadows can be localized in both or one of the lungs, they can disappear in one place and appear in others. More often the shadows are small in size, but sometimes they spread to almost the entire lung. In most cases, shading disappears after 6-12 days. The formation of cavities in the pulmonary parenchyma and pleural changes are not typical.

Differential diagnosis includes tuberculosis, pneumonia and pulmonary infarction. Distinctive features of pulmonary eosinophilic infiltrate are the ease of the disease, “volatility” and rapid disappearance of pulmonary infiltrates and eosinophilia in the peripheral blood.

The flow must include a destination special means for deworming. Any treatment aimed directly at the pulmonary infiltrate is usually not required, since the infiltrate in most patients disappears after a few days and without special treatment. If the manifestations of the disease are pronounced or persist long time may be treated with corticosteroid hormones.

The clinical picture is characterized by a latent onset with the appearance and constant intensification of a cough - dry or with the appearance of a small amount of mucous sputum. The cough is sometimes paroxysmal in nature and is especially pronounced at night. When coughing, some patients experience wheezing and a feeling of shortness of breath. Some patients develop hemoptysis and an undetermined nature of pain in chest. Lung auscultation reveals scattered dry rales.

In half of the patients, diffuse small-focal changes in both lungs are noted on radiographs. Some patients have localized infiltrates in the lungs.

At functional research lung revealed predominantly obstructive changes.

Characterized by pronounced eosinophilia in the peripheral blood, leukocytosis, the presence of eosinophils in the sputum and a positive reaction of complement fixation with filarial antigen. Filariae can be detected on a lymph node biopsy.

Treatment of Pulmonary eosinophilic infiltrate:

Diegylcarbamazine is the most effective antifilarial drug. In some patients, spontaneous recovery is possible, but in patients who have not received special treatment, the disease can last a long time - months and years, with repeated exacerbations, leading to the development of pneumosclerosis.

Pulmonary eosinophilic infiltrates may occur from drug exposure and chemical compounds. Pulmonary eosinophilic infiltrates developing under the influence of furadoin have been described. acetylsalicylic acid, azathioprine, chlorpropamide, chromoglycate, isoniazid, metatrexate, penicillin, streptomycin, sulfonamides, beryllium, gold and nickel salts and other compounds. In addition, eosinophilic pulmonary infiltrates may appear after inhalation of pollen from certain plants.

The clinical picture of pulmonary eosinophilic infiltrate that occurs after the use of furadonin is described in particular detail. Lung reactions to furadonin can be acute or chronic. In the acute version of the reaction, 2 hours to 10 days after starting to take furadonin, fever, dry cough, runny nose, and shortness of breath appeared. Radiographs usually reveal diffuse changes in the lungs, sometimes focal irregular shape infiltrates in the lungs, the rapid disappearance and migration of infiltrates typical of Loeffler’s syndrome were absent, sometimes appears effusive pleurisy, and in pleural fluid contains many eosinophils. An increased level of eosinophils in the blood is characteristic. In the acute course of the disease, soon after discontinuation of the drug, the eosinophilic infiltrate in the lung disappears. In the chronic course of the disease, the resorption of the pulmonary eosinophilic infiltrate is delayed, and in some cases pneumosclerosis develops in its place.

Treatment. Acute reactions to medications and chemical agents special therapy are not required, and cessation of the action that caused the pulmonary infiltrate of the factor leads to the complete disappearance of signs of the disease. In some cases, with a protracted course of the disease, it is necessary to take glucocorticosteroid drugs.

Pulmonary eosinophilic infiltrates in patients with bronchial asthma are associated in half of the cases with exposure to Aspergillus fumigatus. In some cases, eosinophilic infiltrates are caused by inhalation of plant pollen, house dust, animal dander. Dry air contributes to the occurrence of this condition, which causes drying of the mucous membrane of the respiratory organs, the formation of thick mucus in the bronchi and impaired mucus secretion. Changes more often occur in patients with bronchial asthma over 40 years of age and mainly in women.

A morphological examination reveals areas of the lungs filled with exudate containing a large number of eosinophils, which are also present in the lumen of the bronchi and sometimes infiltrate their walls.

The clinical picture in a significant proportion of patients is characterized by a severe course bronchial asthma. An exacerbation of the disease is accompanied by an increase in body temperature, sometimes to high numbers. A characteristic symptom is a cough that can be paroxysmal and is accompanied by the discharge of thick sputum in the form of plugs and casts of the bronchi.

Pulmonary eosinophilic infiltrates occur in systemic lesions connective tissue: periarterin nodosa (see p. 379), Wegener's granulomatosis (see p. 357), J. Churg and L. Strauss syndrome (see p. 384).

Which doctors should you contact if you have Pulmonary Eosinophilic Infiltrate:

Pulmonologist

Therapist

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Other diseases from the group Respiratory diseases:

Agenesis and Aplasia

Actinomycosis

Alveococcosis

Alveolar proteinosis of the lungs

Amoebiasis

Arterial pulmonary hypertension

Ascariasis

Aspergillosis

Gasoline pneumonia

Blastomycosis North American

Bronchial asthma

Bronchial asthma in a child

Bronchial fistulas

Bronchogenic cysts of the lung

Bronchiectasis

Congenital lobar emphysema

Hamartoma

Hydrothorax

Histoplasmosis

Wegener's granulomatosis

Humoral forms of immunological deficiency

Accessory lung

Echinococcosis

Idiopathic pulmonary hemosiderosis

Idiopathic fibrosing alveolitis

Infiltrative pulmonary tuberculosis

Cavernous pulmonary tuberculosis

Candidiasis

Pulmonary candidiasis (pulmonary candidiasis)

Cystic Hypoplasia

Coccidioidosis

Combined forms of immunological deficiency

Coniotuberculosis

Cryptococcosis

Laryngitis

Leiomyomatosis

Cystic fibrosis

Mucorosis

Nocardiosis (atypical actinomycosis)

Reversed lung position

osteoplastic tracheobronchopathy

Acute pneumonia

Acute respiratory diseases

Acute abscess and gangrene of the lungs

Acute bronchitis

Acute miliary pulmonary tuberculosis

Acute nasopharyngitis (runny nose)

Acute obstructive laryngitis (croup)

Acute tonsillitis (tonsillitis)

Focal pulmonary tuberculosis

Paragonimiasis

Primary bronchopulmonary amyloidosis

Primary tuberculosis complex

Pleurisy

Pneumoconiosis

Pneumosclerosis

Pneumocytosis

Subacute disseminated pulmonary tuberculosis

industrial gas damage

Lung damage due to side effects of medications

lung damage due to diffuse connective tissue diseases

Lung damage due to blood diseases

Lung damage due to histiocytosis

Lung damage due to a1-antitrypsin deficiency

lung damage due to lymphogranulomatosis

Lung damage in Marfan syndrome

Lung damage in Stevens-Johnsons syndrome

Lung damage from toxic substances

Lung tissue infiltration is a thickening in the lungs that is caused by the accumulation of fluid, cells or certain chemicals in the tissues. At the same time, the size of the fabric increases and takes on a different shade. Soreness appears in the diseased lung, the density of the lung tissue increases. The tumor infiltrate consists of cancer cells, the main sign of cancer will be infiltration. With chemical infiltration, a compaction is formed due to tissue saturation with drugs or medical alcohol.

Causes of pathology

Infiltrative changes in the lungs are pathological condition which can develop at any age. The main causes of the disease are:

pathogens;
lung injuries;
severe hypothermia;
surgical intervention;
purulent appendicitis;
incorrectly performed injections of medications.

The causative agents of the disease are microorganisms that every person has in the oral cavity.. The infection can enter the lungs through contact and lymphogenous routes. In the latter case, the cause of the disease can be any infection that is in the body.

Older people and smokers are more prone to the formation of infiltrates.

Symptoms

Infiltration in the lungs is inflammatory process, which occurs with compaction of the lung tissue. This pathological process develops over several days. The disease manifests itself with specific symptoms:

The body temperature is slightly elevated, but this condition continues for a long time.
In some cases, a small tumor is found in the infiltrate area.
Pain appears in the area of the affected lung.
Compared with pneumonia, infiltration of the lungs occurs with less severe symptoms and more smoothly.
The main symptom of the disease is the release of blood when coughing, although coughing occurs very rarely. The presence of blood in the sputum indicates that the infiltrate has begun to decompose.
With this disease the patient skin very pale. This symptom most often indicates infiltrative tuberculosis.

Eosinophilic infiltrates most often occur in upper lobes lungs. It is impossible to immediately determine whether there is liquid in the seal; for this, a series of examinations must be carried out.

Infiltration most often appears with tuberculosis and pneumonia.

Types of infiltration

There are several types of infiltrative changes in the lungs, each of them has its own characteristics of course and treatment:

Inflammatory form. In this case, the seal consists of different cells– leukocytes, erythrocytes, lymphoid cells and others. During treatment, such infiltrates resolve or melt, although they may undergo sclerosis, with further education connective tissue.
Tumor form. This compaction consists of cancer cells of various types. This phenomenon happens when malignant tumors, while the infiltrate quickly increases in size.
Chemical form. This condition is typical after lung surgery. Compaction occurs due to the introduction of drugs into the tissue.

With infiltration of the lung tissue, part of the lungs is switched off from the respiratory process.. If the tissues are compacted in a large area of the lung, then this creates a great threat to human life.

When examining a patient, the doctor may note rapid breathing and a slight lag in the respiratory process of that part of the sternum where the focus of tissue damage is located.

Diagnostics

The disease is diagnosed based on X-ray data. In the picture, the seal looks like a darkened area, larger than 1 cm. With lobar infiltration, a large area of the affected tissue can be seen in the image. The contours of the blackouts depend on the form of the disease, as well as on the location of the seal.

With an inflammatory form of infiltration in the picture, you can see uneven outlines and a completely irregular shape of the dark part. A similar infiltrate in the lungs occurs with pneumonia. In the acute phase of the disease, the contours of the outline are not sharp and gradually pass into the tissues that surround the lungs.

At chronic form diseases of the edge of the infiltrate are jagged, but are visible much more clearly. With a pneumonic form of infiltration, two light stripes are often found in the picture, these are air-filled bronchi.

If the disease is caused pathogenic microorganisms, tissue necrosis is often observed varying degrees gravity. This aggravates the course of the disease.

The main task in diagnosing the disease is to determine the nature of the infiltration in the patient. Lobar inflammation is most often observed with tuberculosis or pneumonia. If the nature of the compaction is tumor, then the entire lobe is not captured by the inflammatory process.

When a patient’s image shows a non-lobar compaction, this condition is differentiated from a malignant tumor. Wherein initial stage The disease is completely asymptomatic, and the person has absolutely no complaints.

On x-ray an inflammatory infiltrate differs from a malignant tumor. Seals of an inflammatory nature are always irregular in shape, while oncological diseases always manifest themselves with standard outlines. If the inflammation has spread to the outer layer of bronchial tissue, then peribronchial infiltration of the lungs is diagnosed.

In addition to X-rays, bronchoscopy is used for diagnosis. This method allows you to detect changes in respiratory organs and exclude some diseases.

What pathologies can cause infiltrates in the lungs?

Infiltrates in the lungs of various types can occur in a number of diseases, both inflammatory and infectious:

Besides, infiltrates can be due to a cyst or gangrene of the lungs. Areas of compaction may continue for some time after treatment for tuberculosis.

Only a correct diagnosis can be made experienced doctor. Therefore, if you have any suspicious symptoms, you should immediately go to the hospital.

Features of treatment

Before starting treatment of infiltration in the lung, it is necessary to properly organize the patient’s daily routine and eliminate excessive physical activity. Doctors recommend that patients with this pathology follow bed rest before full recovery . Throughout the illness, the patient should eat healthy and easily digestible food. Products must contain sufficient quantity vitamins, microelements and carbohydrates.

Antibiotics must be prescribed during treatment different groups. Antibiotic monotherapy is very effective, but caution must be exercised.

You cannot take bacteriostatic and bactericidal drugs at the same time. In this case there may be serious consequences, sometimes already irreversible. When drugs from these two groups interact, the body is exposed to severe toxic effects.

Assign medications taking into account the sensitivity of the pathogen. This is determined by culture of sputum or taking samples of biomaterial during bronchoscopy. Antibiotics are most often prescribed wide range actions, many doctors prefer drugs penicillin group. The patient takes antibiotics until the infiltrate completely resolves.

Antibiotics of the same drug group can be taken for no more than 10 days. After this time, if necessary, the drugs are changed to another drug group. The course of treatment is determined by the attending physician; this indicator can vary significantly depending on the course of the disease.

At long-term use Using the same antibiotics can cause a superinfection that is difficult to treat.

For the treatment of infiltrates in the lungs, the following medications can be prescribed:

antiviral;
diuretics;
expectorants;
mucolytic.

Antiviral drugs can be prescribed together with antibiotics if it is proven that the disease was triggered by viruses, but then complicated by bacteria.

Diuretics are prescribed to eliminate swelling of inflamed tissues. Together with mucolytics, these drugs help restore bronchial function and improve sputum discharge.

Play an important role in the treatment of pulmonary infiltrates physical exercise. The course of exercises is indicated by the attending physician; they must be performed several times a day, while the patient should lie on the side of the infiltrate. The depth of inspiration when performing a set of exercises should be limited. Due to this, respiratory processes in the undamaged lung are activated and peripheral blood circulation improves.

When treating infiltrates in the lungs, it is very important to follow all the doctor’s recommendations. For malignant tumors, surgery is often indicated.

Traditional methods of treatment

You can supplement the treatment prescribed by the doctor by folk recipes. One of the most preferred methods of treatment is inhalation of garlic vapors.. Garlic contains special components that have a detrimental effect on many pathogens.

To prepare, take several large cloves of garlic, peel them and grate them. The resulting pulp is poured into a small jar and inhaled in pairs for 5-10 minutes. In this case, you need to alternately breathe through your nose and mouth. This procedure must be carried out several times a day.

To strengthen general immunity, the patient can take a mixture of aloe leaves, lemon and honey. To prepare the medicine, take 5 large aloe leaves, keep them in the refrigerator for 3-4 days, then twist them together with one lemon and add 1 glass of honey. Mix everything thoroughly and take 1 teaspoon 3 times a day.

Before using any traditional methods treatment, consultation with a doctor is necessary!

With timely treatment, the prognosis is good, especially if there is inflammatory form diseases. Oncological diseases of the lungs are initially asymptomatic, so the diagnosis may be made late. In order to exclude late diagnosis, you need to make it a rule to undergo fluorography once a year.

is an allergic-inflammatory lesion of the lung tissue, accompanied by the formation of unstable migrating infiltrates of an eosinophilic nature and the development of hypereosinophilia. The disease usually occurs with malaise, low-grade fever, a slight dry cough, and sometimes with scanty sputum; at acute form- with chest pain, myalgia, development of acute respiratory failure. Eosinophilic pneumonia can be established using X-ray and CT scan data of the lungs, general analysis blood, bronchoalveolar lavage, allergy tests, serodiagnosis. The basis of treatment is specific hyposensitization and hormone therapy.

ICD-10

J82 Pulmonary eosinophilia, not elsewhere classified

General information

Causes

Eosinophilic pneumonia may result allergic reaction for taking medications (penicillin, acetylsalicylic acid, sulfonamides, nitrofurans, isoniazid, hormonal and X-ray contrast agents, gold compounds), for contact with chemical agents at work (nickel salts). Atopic sensitization of the respiratory tract to fungal spores (especially Aspergillus genus), pollen (lily of the valley, lily, linden) also contributes to the development of eosinophilic pulmonary infiltrates. Eosinophilic pneumonia may be a manifestation of serum sickness and may be associated with an allergy to tuberculin.

Pathogenesis

The development of eosinophilic pneumonia is mediated by hypersensitivity reactions immediate type. In addition to hypereosinophilia, patients’ blood often reveals elevated level IgE (hyperimmunoglobulinemia). Mast cells activated by immune (IgE) and non-immune (histamine, complement system) mechanisms and producing allergy mediators (mainly eosinophilic chemotactic factor of anaphylaxis) are responsible for the formation of allergic-inflammatory foci in the lung tissue. In some cases, eosinophilic pneumonia develops due to the production of precipitating antibodies to antigens (Arthus phenomenon-type reactions).

Symptoms of eosinophilic pneumonia

The clinical picture is very variable. Allergic inflammation lungs may have an asymptomatic course with the absence or very mild severity of complaints and can be determined only by x-ray and clinical laboratory methods. Often Loeffler's pneumonia occurs with minimal symptoms, manifesting itself with symptoms of catarrhal nasopharyngitis. Patients feel slight malaise, weakness, fever up to subfebrile, slight cough, often dry, sometimes with slight viscous or bloody sputum, pain in the trachea. With massive hematogenous spread of eggs and larvae of worms in the body, a skin rash, itching, and shortness of breath with an asthmatic component occur. Eosinophilic infiltration of other organs is accompanied by mild, quickly disappearing signs of their damage - hepatomegaly, symptoms of gastritis, pancreatitis, encephalitis, mono- and polyneuropathy.

Acute eosinophilic pneumonia is severe, with intoxication, febrility, chest pain, myalgia, rapid (within 1-5 days) development of acute respiratory failure, respiratory distress syndrome. Typical for the chronic form subacute course with sweating, loss of body weight, increasing shortness of breath, development of pleural effusion.

Eosinophilic pneumonia usually lasts from a few days to 2-4 weeks. Recovery may occur spontaneously. In the chronic form, the prolonged existence of infiltrates and relapses contribute to the gradual progression of the disease, the development of pulmonary fibrosis and respiratory failure.

Diagnostics

Diagnosis of eosinophilic pneumonia includes x-rays and CT scans of the lungs, complete blood count, fecal analysis for worm eggs, bronchoalveolar lavage, allergy tests, serological (RP, RSK, ELISA) and cellular tests (reactions of degranulation of basophils and mast cells). Patients with eosinophilic pneumonia usually have a history of allergy history. Auscultation reveals a small amount of moist fine bubbling rales or crepitus. With extensive infiltrates, there is a noticeable shortening of the pulmonary sound during percussion.

In the acute form of eosinophilic pneumonia, glucocorticoids are used, against which a rapid (within 48 hours) regression of inflammation occurs. The dose of GC is selected individually and reduced gradually to avoid exacerbation. In severe cases, mechanical ventilation and long-term hormonal therapy are required. For bronchial obstruction, inhaled GCs and beta-agonists are indicated. For better discharge expectorants are used for phlegm breathing exercises. Concomitant bronchial asthma is treated.

Prognosis and prevention

The prognosis of eosinophilic pneumonia is generally favorable, spontaneous resolution of infiltrates is possible. Correct treatment and observation by a pulmonologist allows you to avoid chronicity of the process and relapses. Prevention of eosinophilic pneumonia comes down to hygiene measures to prevent infection of the body with helminths, monitoring medication intake, limiting contact with aeroallergens, and carrying out specific hyposensitization. If necessary, it is recommended to change jobs.