Eosinophilic pneumonia (EP) is a disease in which a certain type of white blood cell called an eosinophil accumulates in the lung. These cells cause disruption of the normal air spaces (alveoli) where oxygen is extracted from the atmosphere. Several different kinds of eosinophilic pneumonia exist and can occur in any age group. The most common symptoms include cough, fever, difficulty breathing, and sweating at night. EP is diagnosed by a combination of characteristic symptoms, findings on a physical examination by a health provider, and the results of blood tests and x-rays. Prognosis is excellent once most EP is recognized and treatment with corticosteroids is begun. A disease is an abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person afflicted or those in contact with the person. ... White blood cells (a. ... Eosinophils are white blood cells that are responsible for combating infection by parasites in the body. ... The lungs flank the heart and great vessels in the chest cavity. ... The alveoli (singular:alveolus), tiny hollow sacs which are continuous with the airways, are the sites of gas exchange with the blood. ... General Name, Symbol, Number oxygen, O, 8 Chemical series Nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless Atomic mass 15. ... Layers of Atmosphere (NOAA) Air redirects here. ... The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... A medical/clinical thermometer showing the temperature of 38. ... Dyspnea (Latin dyspnoea, Greek dyspnoia from dyspnoos, short of breath) or shortness of breath (SOB) is perceived difficulty breathing or pain on breathing. ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... A medical laboratory or clinical laboratory is a laboratory where tests are done on biological specimens in order to get information about the health of a patient. ... It has been suggested that medical imaging be merged into this article or section. ... ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ...

Types of eosinophilic pneumonia

Eosinophilic pneumonia is divided into different categories depending upon whether a cause can be determined or not. Known causes include certain medications or environmental triggers, parasitic infections, and cancer. EP can also occur when the immune system attacks the lungs, a disease called Churg-Strauss syndrome. When a cause can not be found, the EP is labeled "idiopathic." Idiopathic EP can be divided into "acute eosinophilic pneumonia" (AEP) and "chronic eosinophilic pneumonia" (CEP) depending on the symptoms a person is experiencing.^[1] Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... Parasitic pneumonia is an infection of the lungs by parasites. ... Infection is also the title of an episode of the television series Babylon 5, and the English title of the Japanese film Kansen. ... When normal cells are damaged beyond repair, they are eliminated by apoptosis. ... The immune system is the system of specialized cells and organs that protect an organism from outside biological influences. ... Churg-Strauss syndrome is a necrotizing vasculitis characterized by eosinophilia. ... Idiopathic is a medical adjective that indicates that a recognized cause has not yet been established. ...

Symptoms

Most causes of eosinophilic pneumonia have similar symptoms. Cough, fever, increasing breathlessness, and night sweats are prominent and almost universal. Acute eosinophilic pneumonia typically follows a rapid course. Fever and cough may develop only one or two weeks before difficulties breathing progress to the point of respiratory failure requiring mechanical ventilation. Chronic eosinophilic pneumonia usually follows a slower course. Symptoms accumulate over several months and include fevers, cough, breathlessness, wheezing, and weight loss. Individuals with CEP are often diagnosed with asthma before CEP is finally recognized. A medical/clinical thermometer showing the temperature of 38. ... Dyspnea (Latin dyspnoea, Greek dyspnoia from dyspnoos, short of breath) or shortness of breath (SOB) is perceived difficulty breathing or pain on breathing. ... Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. ... Respiratory failure is a medical term for inadequate gas exchange by the respiratory system. ... Ambulance ventilation equipment A medical ventilator is a device designed to provide mechanical ventilation to a patient. ...

EP due to medications or environmental exposures is similar and occurs after an exposure to a known offending agent. EP due to parasitic infections has a similar prodrome in addition to a host of different symptoms related to the variety of underlying parasites. EP in the setting of cancer often develops in the context of a known diagnosis of lung cancer, cervical cancer, etc. In medicine, a prodrome is an early symptom indicating the development of a disease, or indicating that a disease attack is imminent. ...

Pathophysiology

Image of an eosinophil

Eosinophilic pneumonia can develop in several different ways depending on the underlying cause of the disease. Eosinophils are thought to play a central role in defending the body against infection by parasites. Many diseases, such as asthma and eczema, are caused when eosinophils overreact to environmental triggers and release an excess of chemicals (cytokines) such as histamine. The common characteristic among different causes of EP is eosinophil overreaction or dysfunction in the lung. Image File history File linksMetadata Eosinophil. ... Image File history File linksMetadata Eosinophil. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Cytokines are small protein molecules that regulate communication among immune system cells and between immune cells and those of other tissue types. ... Histamine is a biogenic amine chemical involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. ...

Medications and environmental exposures

Medications, drugs of abuse, and environmental exposures may all trigger eosinophil dysfunction. Medications such NSAIDs (ie ibuprofen), nitrofurantoin, phenytoin, L-tryptophan, and ampicillin and drugs of abuse such as inhaled heroin and cocaine may trigger an allergic response which results in EP. Chemicals such as sulfites, aluminum silicate, and cigarette smoke can cause EP when inhaled. A New York City firefighter developed EP after inhalation of dust from the World Trade Center on September 11, 2001.^[2] A drug of abuse is a substance implicated in drug abuse. ... Wikipedia does not yet have an article with this exact name. ... Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) widely marketed under various trademarks including Act-3, Advil (A portmanteau of Advise and Pill)[citation needed], Brufen, Motrin, Nuprin, and Nurofen. ... Nitrofurantoin (trade names Furadantin, Macrobid, Microdantina, and Macrodantinis) is an antibiotic drug. ... Phenytoin sodium (marketed as Dilantin® in the USA and as Epanutin® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. ... Tryptophan is an amino acid and essential in human nutrition. ... Ampicillin is an aminopenicillin and, as such, is a broad-spectrum antibiotic and has been used extensively to treat bacterial infections since 1961. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... This article is about the drug cocaine. ... An allergy can refer to several kinds of immune reactions including Type I hypersensitivity in which a persons body is hypersensitised and develops IgE type antibodies to typical proteins. ... Sulfites (also sulphite) are compounds that contain the sulfite ion SO32-. They are often used as preservatives in wines (to prevent spoilage and oxidation), dried fruits, and dried potato products. ... In chemistry, a silicate is a compound consisting of silicon and oxygen (SixOy), one or more metals, and possibly hydrogen. ... A lit cigarette A full ashtray. ... Smoke from a wildfire Smoke is a suspension in air (aerosol) of small particles resulting from incomplete combustion of a fuel. ... Flag Seal Nickname: The Big Apple, The Capital of the World[1], Gotham Location Location in the state of New York Government Counties (Boroughs) Bronx (The Bronx) New York (Manhattan) Queens (Queens) Kings (Brooklyn) Richmond (Staten Island) Mayor Michael Bloomberg (R) Geographical characteristics Area    - City 1,214. ... It has been suggested that Firefighter Assist and Search Team be merged into this article or section. ... After just three years of use dust has blocked this laptop heat sink, making the computer unusable Dust is a general name for minute solid particles with diameter less than 500 micrometers (otherwise see sand or granulates) and, more generally, for finely divided matter. ... , This article is about the former World Trade Center complex in New York City. ... The World Trade Center on fire The September 11, 2001 attacks were a series of coordinated terrorist attacks against the United States on September 11, 2001. ...

Parasitic infections

Parasites cause EP in three different ways. Parasites can either invade the lung, live in the lung as part of their life cycle, or be spread to the lung by the bloodstream. Eosinophils migrate to the lung in order to fight the parasites and EP results. Important parasites which invade the lung include Paragonimus lung flukes and the tapeworms Echinococcus and Taenia solium. Important parasites which inhabit the lung as part of their normal life cycle include the worms (helminths) Ascaris lumbricoides, Strongyloides stercoralis and the hookworms Ancylostoma duodenale and Necator americanus. When EP is caused by this last group, it is often called "Löffler's syndrome". The final group of parasites cause EP when a large number of eggs are carried into the lungs by the bloodstream. This can include Trichinella spiralis, Strongyloides stercoralis, Ascaris lumbricoides, the hookworms, and the schistosomes.^[3] A life cycle includes the major sexual stages of a species, especially in regard to its ploidy. ... Species Paragonimus is an important genus of flatworms, or platyhelminths, that includes Paragonimus westermani, a lung fluke endemic to Asia. ... It has been suggested that this article or section be merged with Paragonimus westermani. ... The genus Echinococcus includes the following species of cyclophyllid tapeworms of the family Taeniidae. ... Cysticercosis is a the most common parasitic infection of the central nervous system worldwide. ... A worm is an elongated soft-bodied invertebrate animal. ... Binomial name Ascaris lumbricoides Ascaris lumbricoides is a human parasitic roundworm, which causes the disease of ascariasis. ... Strongiloides stercoralis. ... The hookworm is a nematode parasite that lives in the small intestine of its host, which may be a mammal such as a dog, cat, or human. ... Hookworm is interesting. ... Categories: Animal stubs | Roundworms | Parasitology ... Löfflers syndrome or Loefflers syndrome is a disease in which a certain type of white blood cell called an eosinophil accumulates in the lung in response to a parasitic infection. ... Trichinosis, also called trichinellosis, is a parasitic disease caused by eating raw or undercooked pork and wild game products infected with the larvae of a species of roundworm Trichinella spiralis, commonly called the trichina worm. ... A genus of trematodes, Schistosoma spp. ...

AEP and CEP

The causes for both AEP and CEP are unknown as of 2005. There is some suspicion that at least AEP is the result of the body's response to some unidentified environmental agent. 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ...

Diagnosis

Eosinophilic pneumonia is diagnosed in one of three circumstances: when a complete blood count reveals increased eosinophils and a chest x-ray or computed tomography (CT) identifies abnormalities in the lung, when a biopsy identifies increased eosinophils in lung tissue, or when increased eosinophils are found in fluid obtained by a bronchoscopy (bronchoalveolar lavage (BAL) fluid). Association with medication or cancer is usually apparent after review of a person's medical history. Specific parasitic infections are diagnosed after examining a person's exposure to common parasites and performing laboratory tests to look for likely causes. If no underlying cause is found, a diagnosis of AEP or CEP is made based upon the following criteria. AEP is most likely with respiratory failure after an acute febrile illness of usually less than one week, changes in multiple areas and fluid in the area surrounding the lungs on a chest x-ray, and greater than 25% eosinophils on a BAL. Other typical laboratory abnormalities include an elevated white blood cell count, erythrocyte sedimentation rate, and immunoglobulin E level. Pulmonary function testing usually reveals a restrictive process with reduced diffusion capacity for carbon monoxide. CEP is most likely when the symptoms have been present for more than a month. Laboratory tests typical for CEP include increased blood eosinophils, a high erythrocyte sedimentation rate, iron deficiency anemia, and increased platelets. A chest x-ray can show abnormalities anywhere, but the most specific finding is increased shadow in the periphery of the lung, away from the heart. A complete blood count (CBC) or full blood count (FBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... CT apparatus in a hospital Computed tomography (CT), originally known as computed axial tomography (CAT or CAT scan) and body section roentgenography, is a medical imaging method employing tomography where digital geometry processing is used to generate a three-dimensional image of the internals of an object from a large... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... In medicine, bronchoscopy is the visualization of the lower airways using a flexible or rigid endoscope. ... In anatomy, the pleural cavity is the potential space between the lungs and the chest wall. ... White blood cells (a. ... The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... Immunoglobulin E (IgE) is an antibody subclass (known as isotypes), found only in mammals. ... Spirometry (meaning the measuring of breath) is the most common of the Pulmonary Function Tests (PFTs), measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. ... In biology, diffusion capacity is a measurement of the lungs ability to absorb and excrete gases, notably, oxygen and carbon dioxide. ... Iron deficiency anemia is the most common type of anemia, and the most common cause of microcytic anemia. ... A 250 ml bag of newly collected platelets. ...

Treatment

When eosinophilic pneumonia is related to an illness such as cancer or parasitic infection, treatment of the underlying cause is effective in resolving the lung disease. When due to AEP or CEP, however, treatment with corticosteroids results in a rapid, dramatic resolution of symptoms over the course of one or two days. Either intravenous methylprednisolone or oral prednisone are most commonly used. In AEP, treatment is usually continued for a month after symptoms disappear and the x-ray returns to normal (usually four weeks total). In CEP, treatment is usually continued for three months after symptoms disappear and the x-ray returns to normal (usually four months total). Inhaled steroids such as fluticasone have been used effectively when discontinuation of oral prednisone has resulted in relapse.^[4] In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Methylprednisolone (molecular weight 374. ... Prednisone is a synthetic corticosteroid drug which is usually taken orally and can be used for a large number of different conditions. ... Fluticasone proprionate is a glucocorticoid often prescribed as treatment for asthma and allergic rhinitis. ... A relapse occurs when a person is affected again by a condition that affected them in the past. ...

Because EP affects the lungs, individuals with EP have difficulty breathing. If enough of the lung is involved, it may not be possible for a person to breathe enough to live without support. Non-invasive machines such as a bilevel positive airway pressure machine may be used. Otherwise, placement of a breathing tube into the mouth may be necessary and a ventilator may be used to help the person breathe. Bilevel Positive Airway Pressure (or BiPAP) is a method of respiratory ventilation used primarily in the treatment of sleep apnea and various lung diseases. ... An endotracheal tube (ETT) is used in anaesthesia, intensive care and emergency medicine for airway management and mechanical ventilation. ... A medical ventilator is a device designed to provide mechanical ventilation to a patient. ...

Prognosis

Eosinophilic pneumonia due to cancer or parasitic infection carries a prognosis related to the underlying illness. AEP and CEP, however, have very little associated mortality as long as intensive care is available and treatment with corticosteroids is given. CEP often relapses when prednisone is discontinued; therefore, some people with CEP require lifelong therapy. Chronic prednisone is associated with many side effects, including increased infections, weakened bones, stomach ulcers, and changes in appearance.^[5] Intensive care medicine or critical care medicine is concerned with providing greater than ordinary medical care and observation to people in a critical or unstable condition. ... Prednisone is a synthetic corticosteroid drug which is usually taken orally and can be used for a large number of different conditions. ... Immunosuppression is the medical suppression of the immune system. ... Peptic ulcer is usually a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). ...

Epidemiology

Eosinophilic pneumonia is a rare disease. Parasitic causes are most common in geographic areas where each parasite is endemic. AEP can occur at any age, even in previously healthy children, though most patients are between 20 and 40 years of age. Men are affected approximately twice as frequently as women. AEP has been associated with smoking. CEP occurs more frequently in women than men does not appear to be related to smoking. An association with radiation for breast cancer has been described.^[6] In biology and ecology endemic means exclusively native to a place or biota, in contrast to cosmopolitan or introduced. ... Various smoking equipment including different pipes, mothe lungs. ... Breast cancer is cancer of breast tissue. ...

History

Chronic eosinophilic pneumonia was first described by Carrington in 1969, and it is also known as Carrington syndrome. Prior to that, eosinophilic pneumonia was a well described pathologic entity usually associated with medication or parasite exposures. Acute eosinophilic pneumonia was first described in 1989^[7][8]. 1969 (MCMLXIX) was a common year starting on Wednesday (the link is to a full 1969 calendar). ... 1989 (MCMLXXXIX) was a common year starting on Sunday of the Gregorian calendar. ...

References

1. ↑  Bain, GA, Flower, CD. Pulmonary eosinophilia. Eur J Radiol 1996; 23:3. PMID 8872069
2. ↑  Rom, WN, Weiden, M, Garcia, R, et al. Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust. Am J Respir Crit Care Med 2002; 166:797. PMID 12231487
3. ↑  Weller, PF. Parasitic pneumonias. In: Respiratory infections: Diagnosis and management, 3rd ed, Pennington, JE (Ed), Raven Press, New York, 1994, p. 695.
4. ↑  Jantz, MA, Sahn, SA. Corticosteroids in acute respiratory failure. Am J Respir Crit Care Med 1999; 160:1079. PMID 10508792
5. ↑  Naughton, M, Fahy, J, FitzGerald, MX. Chronic eosinophilic pneumonia. A longterm followup of 12 patients. Chest 1993; 103:162. PMID 8031327
6. ↑  Cottin, V, Frognier, R, Monnot, H, et al. Chronic eosinophilic pneumonia after radiation therapy for breast cancer. Eur Respir J 2004; 23:9
7. ↑  Carrington CB, Addington WW, Goff AM, et al. Chronic eosinophilic pneumonia. N Engl J Med 1969;280:788 -798 PMID 5773637
8. ↑  Badesch, DB, King, TE Jr, Schwarz, MI. Acute eosinophilic pneumonia: a hypersensitivity phenomenon?. Am Rev Respir Dis 1989; 139:249.
9. ↑  Allen, JN, Pacht, ER, Gadek, JE, et al. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med 1989; 321:569.

See also

• Pneumonia
• Asthma
• Parasitic pneumonia