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Loeffler's syndrome (Simple pulmonary eosinophilia)

Loeffler's syndrome (Simple pulmonary eosinophilia)



Alternative Names

Pulmonary infiltrates with eosinophilia; Loeffler's syndrome


Definition

Simple pulmonary eosinophilia is inflammation of the lungs associated with an increase in eosinophils, a type of white blood cell.


Causes

Most cases of simple pulmonary eosinophilia are due to an allergic reaction, either from a drug, such as sulfonamide, or infection from a fungus or parasite, including Ascaris lumbricoides.


Symptoms

General ill feeling
Fever
Dry cough
Chest pain
Shortness of breath
Wheezing
Rapid respiratory rate
Rash

The symptoms can range from none at all to severe. They may go away without treatment.


Exams and Tests

The health care provider will listen to your chest with a stethoscope. Crackle-like sounds called rales may be heard. Rales suggest inflammation of the lung tissue.

A blood count test shows increased white blood cells, particularly eosinophils.

Chest x-ray usually shows abnormal shadows called infiltrates. They may disappear with time or reappear in different areas of the lung.

A bronchoscopy with washing may show a large number of eosinophils.

Gastric lavage may show signs of the ascaris worm.


Treatment

If you are allergic to a drug, the doctor may have you stop taking it. (But, never stop a medication without consulting with your doctor first.)

If the condition is due to an infection, you may be treated with an antibiotic or anti-parasitic medication.

Sometime, corticosteroids (powerful anti-inflammatory medicines) may be needed.


Outlook (Prognosis)

The disease often goes away without treatment. If treatment is needed, the response is usually good. However, relapses can occur.


Possible Complications

A rare complication of simple pulmonary eosinophilia is a severe type of pneumonia called acute idiopathic eosinophilic pneumonia.


When to Contact a Medical Professional

See your health care provider if you have symptoms that may be linked with this disorder.


Prevention

This is a rare disorder. Many times, the cause cannot be found. Minimizing exposure to possible risk factors (certain medicines, some metals) may reduce risk.


Loeffler's syndrome caused by parasites (Lung parasites)


List of Nematodes (roundworms) involved in Löffler's syndrome:

Ascaris lumbricoides
Ancylostoma braziliense (cutaneous larva migrans)
Ancylostoma duodenale (hookworm)
Necator americanus (hookworm)
Strongyloides stercoralis
Trichinella spiralis
Toxocara canis, Toxocara cati (visceral larva migrans)


Description:
The roundworm Ascaris lumbricoides and the hookworms Ancylostoma duodenale and Necator americanus may cause pulmonary symptoms during their migration through the lung. This acute disorder also known as Löffler's syndrome is most commonly caused by infection with Ascaris spp. It is characterized by migratory pulmonary infiltrates accompanied by peripheral blood eosinophilia and minimal pulmonary symptoms.

Ascaris is transmitted by the ingestion of the fertilized eggs, while hookworm transmission occurs via oral or skin penetration by infective larvae.

The migration of the parasite larvae from the pulmonary capillaries results in low-grade fever, blood-streaked sputum, cough, wheezing, dyspnea, and substernal chest discomfort. These symptoms are caused by transient allergic pneumonitis in response to parasite antigens.

Löffler's syndrome generally tends to occur 1 to 2 weeks after ingestion of the larval eggs. The sputum examination reveals eosinophilia and Charcot-Leyden crystals. The chest radiograph shows fleeting infiltrates that resolve over days. Ascaris or hookworm ova may be absent from stool at the time of pneumonitis, but larvae can often be seen in sputum or gastric lavage.

The appearance of Ascaris or hookworm ova in the stool within 3 months of self-limited eosinophilic pneumonitis suggests this diagnosis. Occasionally, Löffler's syndrome may be drug-induced, and approximately one third of cases are idiopathic.

Although severity of symptoms correlates with larval burden, this disorder is self-limited and tends to resolve spontaneously. Symptomatic patients may be treated with bronchodilators.

Prevention of infection and treatment of the intestinal phase are the mainstays of management. The drug of choice for intestinal infestation is mebendazole, although pyrantel pamoate or albendazole can also be used. Albendazole is a newer benzimidazole with activity similar to that of mebendazole, but it is used as a single dose. It is not licensed for general use in the United States.

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