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| {{pneumonia}} | | __NOTOC__ |
| {{Infobox_Disease |
| | {{Eosinophilic pneumonia}} |
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| ICD9 = {{ICD9|518.3}} |
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| MedlinePlus = 000105 |
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| MeshID = D011657 |
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| '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; ; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org]
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| ==Overview==
| | '''For the main page on pneumonia, click [[Pneumonia|here]] |
| '''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 [[Earth's atmosphere|atmosphere]]. Several different kinds of eosinophilic pneumonia exist and can occur in any age group. The most common [[symptom]]s include [[cough]], [[fever]], [[dyspnea|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 [[medical laboratory|blood tests]] and [[radiology|x-rays]]. [[Prognosis]] is excellent once most EP is recognized and treatment with [[corticosteroid]]s is begun. | |
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| == Types of eosinophilic pneumonia ==
| | '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com] |
| Eosinophilic pneumonia is divided into different categories depending upon whether a cause can be determined or not. Known causes include certain [[medication]]s or environmental triggers, [[parasitic pneumonia|parasitic]] [[infection]]s, 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.{{ref|Bain}}
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| == Symptoms == | | ==[[Eosinophilic pneumonia overview|Overview]]== |
| Most causes of eosinophilic pneumonia have similar symptoms. [[Cough]], [[fever]], [[dyspnea|increasing breathlessness]], and [[Sleep hyperhidrosis|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 [[Medical ventilator|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.
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| 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.
| | ==[[Eosinophilic pneumonia historical perspective|Historical Perspective]]== |
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| == Pathophysiology == | | ==[[Eosinophilic pneumonia classification|Classification]]== |
| [[image:Eosinophil.jpg|thumb|200px|left|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 ([[cytokine]]s) such as [[histamine]]. The common characteristic among different causes of EP is eosinophil overreaction or dysfunction in the lung. | |
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| === Medications and environmental exposures === | | ==[[Eosinophilic pneumonia pathophysiology|Pathophysiology]]== |
| Medications, [[drug of abuse|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 [[allergy|allergic]] response which results in EP. Chemicals such as [[sulfite]]s, 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]].{{ref|Rom}}
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| === Parasitic infections === | | ==[[Eosinophilic pneumonia causes|Causes]]== |
| Parasites cause EP in three different ways. Parasites can either invade the lung, live in the lung as part of their [[Biological life cycle|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 fluke]]s and the tapeworms ''[[Echinococcus]]'' and ''[[cysticercosis|Taenia solium]]''. Important parasites which inhabit the lung as part of their normal life cycle include the worms ([[helminth]]s) ''[[Ascaris lumbricoides]]'', ''[[Strongyloides stercoralis]]'' and the [[hookworm]]s ''[[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 [[Schistosoma|schistosomes]].{{ref|Weller}}
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| === AEP and CEP === | | ==[[Eosinophilic pneumonia differential diagnosis|Differentiating Eosinophilic pneumonia from Other Diseases]]== |
| 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.
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| == Diagnosis == | | ==[[Eosinophilic pneumonia epidemiology and demographics|Epidemiology and Demographics]]== |
| 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 [[pleural cavity|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. [[spirometry|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. | |
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| == Treatment == | | ==[[Eosinophilic pneumonia risk factors|Risk factors]]== |
| 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 [[corticosteroid]]s 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]].{{ref|Jantz}}
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| 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 [[endotracheal tube|breathing tube]] into the mouth may be necessary and a [[ventilator]] may be used to help the person breathe.
| | ==[[Eosinophilic pneumonia screening|Screening]]== |
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| == Prognosis == | | ==[[Eosinophilic pneumonia natural history, complications, and prognosis|Natural History, Complications and 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 [[Immunosuppression|increased infections]], weakened bones, [[Peptic ulcer|stomach ulcers]], and changes in appearance.{{ref|Naughton}} | |
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| == Epidemiology == | | ==Diagnosis== |
| Eosinophilic pneumonia is a rare disease. Parasitic causes are most common in geographic areas where each parasite is [[Endemic (ecology)|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 [[Tobacco smoking|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.{{ref|Cottin}}
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| === History === | | [[Eosinophilic pneumonia diagnostic criteria | Diagnostic Criteria]] | [[Eosinophilic pneumonia history and symptoms| History and Symptoms]] | [[Eosinophilic pneumonia physical examination | Physical Examination]] | [[Eosinophilic pneumonia laboratory tests |Laboratory Findings]] | [[Eosinophilic pneumonia chest x ray|Chest X Ray]] | [[Eosinophilic pneumonia CT|CT]] | [[Eosinophilic pneumonia other imaging findings|Other Imaging Findings]] | [[Eosinophilic pneumonia other diagnostic studies|Other Diagnostic Studies]] |
| 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]]{{ref|Badesch}}{{ref|Allen}}.
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| | ==Treatment== |
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| | [[Eosinophilic pneumonia medical therapy|Medical Therapy]] | [[Eosinophilic pneumonia surgery|Surgery]] | [[Eosinophilic pneumonia prevention|Prevention]] | [[Eosinophilic pneumonia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Eosinophilic pneumonia future or investigational therapies|Future or Investigational Therapies]] |
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| | ==Case Studies== |
| | [[Eosinophilic pneumonia case study one|Case #1]] |
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| | ==Related Chapters== |
| | *[[Asthma]] |
| | *[[Parasitic pneumonia]] |
| | *[[Pneumonia]] |
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| == References == | | == References == |
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| #{{note|Allen}} 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. | | #{{note|Allen}} 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. |
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| == See also ==
| | [[Category:Pulmonology]] |
| *[[Pneumonia]]
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| *[[Asthma]]
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| *[[Parasitic pneumonia]]
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| == References ==
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| {{reflist|2}}
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| [[Category:Diseaase]]
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| [[Category:Pulmonology]]
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| [[Category:Infectious disease]]
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| [[Category:Pneumonia|Pneumonia]]
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |