Asthmatic pulmonary eosinophilic infiltrates
Introduction
Introduction to asthmatic pulmonary eosinophilic infiltration Asthmatic pulmonary eosinophilic infiltration, also known as asthmatic eosinophilia (also known as bronchocentric granulomatosis), or broinchopulmonary aspergillosis. The main feature of repeated asthma attacks is that most patients have a history of personal or family allergies, mostly in the 40 to 60 years old, and more common in women. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: lobar pneumonia
Cause
Causes of asthmatic pulmonary eosinophilic infiltration
Most patients are allergic to Aspergillus fumigatus, and some patients are allergic to Candida, pollen or certain drugs. About 80% of patients are positive for Aspergillus sojae, and elevated IgE and IgG precipitated antibodies can be detected in serum. The Aspergillus extract can be biphasic in the bronchial provocation test, so it is speculated that the disease involves type I and type III allergies. It is also believed that type IV allergic reactions are also involved.
There are plasma cells around the bronchi and alveolar septa, mononuclear cells and a large number of eosinophils infiltrating, bronchiole mucinous glands and goblet cells proliferating, terminal bronchioles dilated and sputum filled in, sometimes can find fungal hyphae .
Prevention
Asthma-induced pulmonary eosinophilic infiltration prevention
Avoid contact with allergens.
Complication
Complications of asthmatic pulmonary eosinophilic infiltration Complications lobar pneumonia
Lobar pneumonia, lobular pneumonia.
Symptom
Symptoms of asthmatic pulmonary eosinophilic infiltration common symptoms, shortness of breath, difficulty, asthma, pulmonary dyspnea, wheezing, shrugging
Most of them are middle-aged onset, more common in women, and their clinical symptoms are similar to endogenous asthma. Some patients may have small sputum or bronchial tube type, containing a large number of eosinophils and/or fungal hyphae. With the development of the disease course, 5 clinical stages can be seen: 1 acute phase, mainly manifested as asthma, ige is often greater than 2500ng/ml, skin test positive with chest x-ray changes; 2 remission phase, clinical remission, ige and x-ray The performance is normal; 3 aggravation period, the symptoms are similar to the acute phase, or only ige is elevated and new lung infiltration changes occur; 4 hormone-dependent phase, asthma symptoms need to be controlled with hormones, ige levels continue to rise; 5 fibrosis Period, due to fibrosis, often shows uncontrollable shortness of breath.
The x-ray appears as a proximal bronchiectasis with visible migratory shadows, sometimes with finger-like or finger-like shadows.
At the time of the examination, a pale yellow plug can be found, which contains the mycelium of Aspergillus fumigatus and the mucus of eosinophils. The ige is elevated, and the test of the fumigatus and the bronchial provocation test are often positive.
Pulmonary function tests have obvious obstructive ventilatory dysfunction. Compared with general bronchial asthma, the obstructive reversibility of this disease is poor, so the symptoms of asthma are more stubborn.
Examine
Examination of asthmatic pulmonary eosinophilic infiltration
X-ray findings are proximal bronchiectasis, visible migratory shadows, and sometimes visible finger-like or finger-like shadows.
At the time of sputum examination, light yellow plugs can be found, which contain Aspergillus fumigatus mycelium and eosinophilic mucus, etc., IgE is elevated, and the fumigatus skin test and bronchial provocation test are often positive.
Pulmonary function tests have obvious obstructive ventilatory dysfunction. Compared with general bronchial asthma, the obstructive reversibility of this disease is poor, so the symptoms of asthma are more stubborn.
Diagnosis
Diagnosis and identification of asthmatic pulmonary eosinophilic infiltration
The diagnosis is mainly based on bronchial asthma, pulmonary infiltration changes or proximal bronchiectasis, eosinophilia in sputum and blood, positive skin test for Aspergillus fumigatus, and elevated IgE or precipitated antibodies in the blood.
Mainly should be identified with endogenous asthma.
