Pediatric Tropical Eosinophilia
Introduction
Introduction to pediatric tropical eosinophilia Tropical tropicalesinophilia is a clinical syndrome characterized by eosinophilia. This type of eosinophilia is associated with some tropical diseases, mainly parasitic diseases and parasitic infections. A type of pulmonaryeosinophilia. basic knowledge The proportion of illness: 0.001%-0.003% Susceptible people: seen in children Mode of infection: fecal-mouth transmission Complications: Asthma, hemoptysis, liver enlargement
Cause
Causes of pediatric tropical eosinophilia
(1) Causes of the disease
The more certain diseases are the following: parasitic infections, respiratory infections (including bacterial infections, viral infections and fungal infections), various pollen, drugs (such as penicillin, sulfa drugs, ammonia salicylic acid, methionine, etc.) and smoke , dust, animal waste, etc., in the etiology of pulmonary eosinophilia, parasitic infection is the most common, aphid, hookworm infection can cause simple pulmonary eosinophilia (Löffer syndrome); Larvae, larvae of Toxoplasma gondii, Toxoplasma gondii, Angiostrongylus, etc. cause persistent eosinophilia; the most typical tropical eosinophilia is caused by cryptic filariasis, except for the above parasites In addition, clonorchiasis, schistosomiasis, ginger worm, liver fluke, aphids, mites, whipworms, trichinella, swine mites, filariasis and other helminth infections may be associated with eosinophilia.
(two) pathogenesis
Pulmonary eosinophilia has many pathogens and is closely related to allergic reactions. Parasitic infection can cause simple pulmonary eosinophilia (Löeffer syndrome). For example, aphids and hookworm larvae migrate in the human body. And transient eosinophilia caused by the developmental stage; there is persistent eosinophilia caused by visceral larval migration caused by long-term migration of larvae of animal parasites in the human body. Nematodes, Paragonimus, Toxoplasma gondii, Angiostrongylus elegans; the most typical tropical eosinophilia is caused by cryptic filariasis, which is characterized by the difficulty in finding microfilariae in the blood after infection with filarial worms. .
When the parasite larva migrates to the lungs, it causes lung damage and local bleeding. In the lung interstitial, alveolar wall and terminal bronchial wall, there are inflammatory cells and eosinophil infiltration, and sometimes granulomas can form around the worm body. X-ray chest radiographs often have increased lung texture or diffuse reticular plaque shadows, mostly temporary or migratory inflammatory changes.
Prevention
Prevention of pediatric tropical eosinophilia
Prevention of parasitic infection caused by acid granulocytosis, children should develop good hygiene habits, cut nails, wash hands before meals, do not eat unclean food, do not drink raw water, less contact with soil, sewage, prevent parasites Infect the human body through the mouth or through the skin, strengthen the management of human and animal waste.
Complication
Pediatric tropical eosinophilia complications Complications, asthma, hemoptysis, liver enlargement
Can occur asthma, hemoptysis, swollen lymph nodes and liver, lung dysfunction.
Symptom
Symptoms of tropical eosinophilia in children Common symptoms Eosinophilia fatigue chest pain wheezing voice dyspnea lymph node enlargement hemoptysis with bloodshot breath sounds weakened
There is no clear incubation period in tropical eosinophilia. The incidence is generally slow. The patients with mild reaction may have no obvious symptoms. The patient may have fever, fatigue, fatigue, general malaise, headache, chest pain and other symptoms similar to cold, and may have cough. However, there are fewer sputum, and even blood can be found in the sputum. In severe cases, asthma can occur, even hemoptysis. A small number of patients have weakened breath sounds, sputum turbidity, and tropical eosinophilia caused by filamentous infection. The clinical symptoms of the disease are obvious, the disease course can be as long as 3 years or even longer. Typical cases can be manifested as paroxysmal dry cough and asthma, difficulty in breathing, aggravation at night, snoring and wheezing sounds in both lungs, tropical hobby Patients with acid agranulocytosis may be associated with lymphadenopathy and hepatomegaly. Some patients may have pulmonary dysfunction. The course of simple acid granulocytosis caused by hookworms, aphids, etc. is usually within 1 month, without treatment. Self-healing, the course of acid neutrophilia caused by visceral larval migration is 2 to 6 months or longer, and the prognosis of eosinophilia caused by parasitic infection is better.
Examine
Examination of pediatric tropical eosinophilia
1. Blood examination: the total number of peripheral white blood cells is increased, often >10×10 9 /L, eosinophils can be as high as 20% to 80%, in rare cases more than 90%, in most cases, eosinophils are absolutely The value is 0.4×10 9 /L or more, and a few can reach (2.0 to 3.0)×10 9 /L or more, and serum IgE is increased.
2. Immunological detection: microfilariae in blood is generally difficult to detect, and serum anti-filaria antibody is more positive. Some of the children's feces can be found in eggs such as aphid eggs. Allergen skin tests can show certain allergens. Have an allergic reaction.
3. Fecal examination: If it is suspected to be an intestinal parasite infection, the feces should be carefully examined for eggs, and the eggs are positive, so that the diagnosis can be confirmed, but in the early stage of intestinal parasitic infection or parasitic infection that causes only larval migration, The eggs are not found in the feces, and the corresponding immunological tests are performed. The anti-parasitic antibodies should be positive.
4. X-ray examination of the lungs: It can show the increase of lung texture, thickening, disorder, and low density. It is often in the lungs and the pleura near the pleura, showing a small piece of shadow or large piece of shadow, which can be migratory. It disappears within 1 to 2 weeks, and chronics can last for a long time.
Diagnosis
Diagnosis and diagnosis of tropical eosinophilia in children
diagnosis
Detailed medical history and physical examination should be carried out, especially on the skin, liver, spleen, lymph nodes and cardiovascular system to exclude skin lesions, eosinophilic leukemia, bone eosinophilic granuloma, familial eosinophils Hyperplasia, nodular polyarteritis, etc., bone marrow aspiration has a definite diagnosis value for eosinophilic leukemia, for some reasons unknown, involving one or more organs, eosinophilic diseases with diverse symptoms and signs, Sometimes differential diagnosis is often difficult, and finally it is necessary to rely on tissue biopsy to confirm the diagnosis.
Differential diagnosis
Peripheral blood eosinophils increased significantly, IgE levels increased, such as suspected intestinal parasite infection, feces to find eggs positive, can be diagnosed, but not found in the feces, the corresponding immunological test Anti-parasitic antibodies should be positive for diagnosis. According to clinical symptoms, blood, X-ray examination, immunological test results, combined with medical history and local parasitic epidemiology, diagnosis can be established. X-ray changes in the lungs should be related to pneumonia. Identification of pulmonary infections such as tuberculosis.
