Pulmonary eosinophilic infiltrates
Introduction
Introduction to pulmonary eosinophilic infiltration Pulmonary infiltration with eosinophilia (PIE) or eosinophilic lung disease (eosinophilic lung disease) is a group of diseases characterized by increased eosinophils in the circulation or tissue. In fact, inflammatory cells that cause lung tissue damage in such diseases include alveolar macrophages, lymphocytes, and neutrophils in addition to eosinophils. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: heart failure
Cause
Causes of pulmonary eosinophil infiltration
Aphid infection (35%):
Aphid infection is the most common cause, and many substances in the aphid body are highly antigenic. Experiments have shown that after eating aphid eggs, the larvae migrate to the lungs and the typical lung manifestations and eosinophils increase. Other parasites causing this disease include hookworms, filarial worms, aphids, ginger worms, trichinella, and amoeba. The drugs include salicylic acid, aspirin, penicillin, nitrofurantoin, phenylbutazone, chlorpropamide, hydralazine, mecamylamine, sulfa drugs and methotrexate. There are reports of inhalation of pollen, fungal spores and other diseases.
Eosinophilia (29%):
Simple pulmonary eosinophilic insufficiency is mild, fatigue, and mild dry cough. In severe cases, acute symptoms such as high fever, paroxysmal cough, and asthma may occur, and respiratory failure may occur. There is a wet or dry rales on the chest, and sometimes a percussion can result in dullness. The spleen can be slightly enlarged. Eosinophilia, sometimes as high as 60% to 70%, is larger than normal eosinophils and contains large particles. In severe cases with systemic vasculitis, multiple systemic lesions can occur.
Other (10%):
X-ray chest radiographs can be seen in the cloud-like patch, and the size, shape and position are not constant. It is a migratory pattern, disappearing in a short period of time and recurring in another part. Occasionally, diffuse granular shadows in both lungs need to be differentiated from miliary tuberculosis.
Prevention
Pulmonary eosinophilic infiltration prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. To treat the primary disease, it should not be involved in the killing of eosinophils. Primary high eosinophilic syndrome can be treated with adrenocortical hormone to reduce eosinophil infiltration. If necessary, add hydroxyurea, vincristine or chlorambucil. It may be effective for those who are refractory or unable to tolerate the above-mentioned therapeutic agents.
Complication
Pulmonary eosinophilic infiltration complications Complications heart failure
Sometimes itchy rashes appear. When the condition is serious, it may be life-threatening due to bronchi, capillary bronchial obstruction and heart failure.
Symptom
Pulmonary eosinophilic infiltration symptoms Common symptoms, shortness of breath, chest tightness, fatigue, low fever
There are varying degrees of chest tightness, shortness of breath, fatigue, low fever, cough and wheezing, etc., can be acute, subacute or chronic onset, the course of the disease is also very different, in addition to acute eosinophilic pneumonia (AEP) and chronic addiction Acidic granulocyte pneumonia (CEP).
There are currently three main criteria for diagnosing such diseases:
1 Increased peripheral blood eosinophils and infiltrative changes in the lung X-rays were found.
2 The proportion of eosinophils in bronchoalveolar lavage fluid (BALF) was significantly increased.
3 Transbronchial lung biopsy (TBLB), the common pathological changes are pulmonary parenchyma, extensive infiltration of eosinophils in interstitial and peribronchial tissues, and BAL and TBLB are also large in eliminating infections caused by various microorganisms and tumors. value.
Examine
Examination of pulmonary eosinophilic infiltration
1. Peripheral blood eosinophils were significantly increased.
2. X-ray changes in the lungs are often transient.
3. Increased serum total IgE, except for parasites.
4. Bronchoalveolar lavage: Eosinophils in the lavage fluid were significantly increased.
5. Bronchopulmonary biopsy: extensive infiltration of eosinophils in the lung parenchyma and peribronchial tissues.
Diagnosis
Diagnosis and identification of pulmonary eosinophilic infiltration
According to its clinical characteristics, the disease can be divided into the following six types, but sometimes it is difficult to distinguish between them, and there is also the possibility of mutual transformation in the course of the disease.
Note that it should be differentiated from acute and chronic eosinophilic pneumonia. The main pathological change of acute and chronic eosinophilic pneumonia is acute diffuse alveolar damage. Significant eosinophil infiltration was observed in the alveolar space, interstitial and bronchial walls. In most cases, hyaline membrane formation was observed, and type II alveolar epithelial cells proliferated. In the later stage, interstitial edema, massive infiltration of inflammatory cells, and fibrous tissue hyperplasia were observed. No vasculitis and impaired lung function.
