Eosinophilic pneumonia causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]
Overview
Causes
Transpulmonary passage of helminth larvae (Löffler syndrome)
Three types of helminths, Ascaris (A. lumbricoides, A. suum), hookworms (Ancylostoma duodenale, Necator americanus), and Strongyloides stercoralis, have life cycles in which infecting larvae reach the lungs via the bloodstream, penetrate into alveoli, mature, and ascend the airways before descending the alimentary tract into the small bowel [10].
The syndrome of transient pulmonary radiographic opacities and peripheral blood eosinophilia was originally described by Löffler; Ascaris infection acquired from the use of contaminated human night-soil as fertilizer was determined to be the cause [11]. Subsequent investigations have confirmed that Ascaris is the most common cause of Löffler syndrome worldwide.
Tropical pulmonary eosinophilia
Tropical pulmonary eosinophilia results from a distinct immune response to the bloodborne microfilarial stages of the lymphatic filariae, Wuchereria bancrofti and, less commonly, Brugia malayi [16-18]. The typical symptoms are cough, breathlessness, wheezing, fatigue, and fever. Pulmonary function tests may show a mixed restrictive and obstructive abnormality with a reduction in diffusion capacity [18]. Chest radiographs typically show diffuse opacities (image 2), although approximately 20 percent of affected patients have a normal chest radiograph [18,19]. CT scans are more sensitive than chest radiography; typical findings include reticular and small nodular opacities, bronchiectasis, air trapping, calcification, and mediastinal adenopathy [18,19].
EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS
Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss) is a vasculitic disorder often characterized by sinusitis, asthma, and prominent peripheral blood eosinophilia [49]. It is the sole form of vasculitis that is associated with both eosinophilia and frequent lung involvement. In addition to the lungs, the skin and the cardiovascular, gastrointestinal, renal, and neurologic systems may also be involved.
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction that occurs when airways become colonized by Aspergillus [51]. Repeated episodes of bronchial obstruction, inflammation, and mucoid impaction can lead to bronchiectasis, fibrosis, and respiratory compromise. Immunologic responses elicited by Aspergillus fumigatus are responsible for this syndrome.