tropical pulmonary eosinophilic pneumonia
Introduction
Introduction to tropical pulmonary eosinophilic pneumonia Tropical lung eosinophilic pneumonia (TPE) is a combination of fever, discomfort, anorexia, weight loss, paroxysmal dry cough and asthma or asthma, markedly elevated peripheral blood eosinophils, and self-remission after a few weeks. In the 1950s and 1960s, silkworm infection was considered to be the cause. TPE is mainly distributed in India, Africa and Southeast Asia, Sri Lanka and South America, and has been reported in Nanjing and other regions of China. basic knowledge The proportion of illness: 0.006% Susceptible people: 25 to 40 years old is a good age, mostly young women. Mode of infection: non-infectious Complications: pulmonary fibrosis, pulmonary heart disease
Cause
Tropical pulmonary eosinophilic pneumonia
(1) Causes of the disease
The incidence is related to allergic reactions caused by filarial infection, and is type I and type III allergic reactions, and may also be associated with type IV allergies.
(two) pathogenesis
The larva enters the human body through a bite and develops into a mature adult. The adult settles in the lymph nodes, produces microfilarias, and then migrates to the pulmonary blood vessels. The degenerated microfilariae release antigens, resulting in strong local and systemic inflammatory reactions, significant antibody increase and acidophilia. Granulocyte response, found in peripheral blood and lung tissue, increased total cell count, increased eosinophil classification (up to 50%), total IgE in blood and BALF, filarial-specific IgG, IgM and IgE liters High, antibody-dependent and eosinophils play an important role in this, in vitro, granulocytes and macrophages can inhibit microfilariae, leading to pathogen death, in the presence of IgG and IgE or complement, micro-worm tissue The infiltration of a large number of surrounding lymphocytes and plasma cells indicates that lymphocytes play an important role in the removal of microorganisms. In vitro, microfilament antigens can cause lymphocyte migration, IgE and eosinophils, mast cells or basophils. The induced product may be the cause of asthma.
Early stage of disease (2 weeks) is typical of alveolar, interstitial, peri-bronchial and perivascular tissue cells, lung tissue structure is normal, micro-nodules can be seen in lung tissue, symptoms are not cured after 1 to 3 months In patients with alveolar and interstitial infiltration of eosinophils and histiocytes, eosinophilic necrotic substances, and can find the residue of microfilaria (mostly in the center of the abscess with alveolar wall destruction), sometimes alveolar necrosis and Eosinophilic abscess, local bronchial edema, and destruction of epithelial cells, some chronic patients with long-term treatment can form nodules and pulmonary interstitial fibrosis, which may be related to the presence of chronic mixed cell inflammation, often showing foreign body granulation Swelling, lymph node biopsy can detect degenerating microfilariae or adults, eosinophils and their granular products and giant cells gather around.
Prevention
Tropical lung eosinophilic pneumonia prevention
1 Usually keep cold and warm, in case of climate change, change clothing at any time, physically susceptible, you can always wear drugs such as Yupingfeng San to prevent external sensation.
2 quit smoking, avoid inhaling dust and all toxic or irritating gases.
3 Strengthen physical exercise and enhance physical fitness.
4 When eating or feeding, the concentration should be concentrated, requiring the patient to chew slowly, avoid eating and speaking, and paying food to inhale the lungs.
Complication
Tropical pulmonary eosinophilic pneumonia complications Complications pulmonary fibrosis pulmonary heart disease
Long-term disease can lead to pulmonary fibrosis and pulmonary heart disease.
Symptom
Tropical pulmonary eosinophilic pneumonia symptoms Common symptoms Low fever eosinophilia Lung sounds Lymph nodes swollen lungs can be smelled and wet...
Any age can be ill, 25 to 40 years old is a good age, mostly young women, insidious onset, low fever (1 to 2 weeks), weight loss, weakness, chest pain, muscle numbness, anorexia and paroxysmal night dry cough, Cough a small amount of glass transparent viscous sputum, asthma (severe can be persistent asthma) and cardiovascular and nervous system involvement, physical examination, audible and thick wet voice, dry voice and asthma sound, may have The lymph nodes and hepatosplenomegaly of the whole body are common in children.
Examine
Examination of tropical pulmonary eosinophilic pneumonia
Blood eosinophilia (up to 20% to 90%, >3000/cm3), which is not proportional to clinical severity and X-ray, serum total IgE is significantly increased (>1000 U/m1), and serum complement binding test is strongly positive. The erythrocyte sedimentation rate is moderately increased, the eosinophils are increased in the sputum, and the electrocardiogram is abnormal in 50% of the patients. The high titer of the filarial-specific IgE and IgG can be determined by the hemagglutination test and the complement-binding test. Microfilariae can be found in lymph nodes and lungs, but no microfilarias are found in the sputum and in the blood. Obstructive ventilatory dysfunction is indicated early in the lung function. Symptoms persist for more than 1 month or long-term untreated. Restrictive ventilatory dysfunction and decreased carbon monoxide diffusion or associated with obstructive ventilatory dysfunction.
X-ray findings: typical diffuse, more consistent, unclear small nodules, net nodules and patchy fuzzy shadows, 2 to 5 mm in diameter, can also be fused into a piece, mostly in the bilateral middle and lower lungs Wild, treated to dissipate, chronic formation of more fibrosis, also see hilar lymphadenopathy, pleural effusion or cavity formation, there have been reports of concurrent bronchiectasis and normal X-ray.
Diagnosis
Diagnosis and identification of tropical pulmonary eosinophilic pneumonia
Diagnostic criteria
1. The area where filariasis is endemic.
2. Paroxysmal cough and asthma.
3. Chest film performance.
4. Blood eosinophilia.
5. Filaria complement complement test was positive.
6. Anti-filaria drug treatment is effective.
Differential diagnosis
Differential diagnosis includes Ruffler syndrome, chronic eosinophilic pneumonia, allergic bronchopulmonary fungal disease, drug reactions, other parasitic infections, eosinophilic syndrome, lymphatic dissemination of cancer, etc., in non-popular District, the disease can be misdiagnosed as asthma, atypical pneumonia, sarcoidosis, Churg-Stauss syndrome, Wegenes granulomatosis or tuberculosis, lymph node biopsy (oblique deltoid muscle) and rapid response to treatment is conducive to diagnosis.
