Pulmonary alveolar proteinosis: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Mahda (talk | contribs)
nocaptcha
2,695 edits
No edit summary
Mmir (talk | contribs)
CMEAdmin, CMEUser, Bureaucrats, bureaucrats, nocaptcha, smwadministrator, Administrators, Widget editors
14,850 edits
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{SI}}                                                                 
{{SI}}                                                                 
{{CMG}} {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu]  
{{CMG}} {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu]  
   
   
{{SK}}Pulmonary alveolar phospholipoproteinosis ; Synonym 2; Synonym 3
{{SK}}Pulmonary alveolar phospholipoproteinosis ; Synonym 2; Synonym 3
Line 7: Line 7:
==Overview==
==Overview==


Pulmonary alveolar proteinosis ( PAP) was first discovered by Samuel Rosen, Benjamin Castleman, and Averill Liebow, in 1958. Pulmonary alveolar proteinosis ( PAP) may be classified into 2 subtypes, primary and secondary pulmonary alveolar proteinosis. The pathogenesis of pulmonary alveolar proteinosis is characterized by the intraalveolar accumulation of [[surfactant]] [[phospholipid]] and [[apoproteins]]. Pulmonary alveolar proteinosis develop because of reduced [[granulocyte-macrophage colony-stimulating factor]] ([[GM-CSF]]) levels or function and/or impaired alveolar macrophage function. On [[gross pathology]] after lung washings, fluid with the milky composition are the characteristic finding of pulmonary alveolar proteinosis. On microscopic histopathological analysis, [[terminal bronchioles]] and [[alveoli]] are filled with a lipoproteinaceous material that will be pink after [[Periodic acid-Schiff stain|periodic acid-Schiff (PAS) stain]]. The exact etiology of pulmonary alveolar proteinosis (PAP) is unknown, but it may be associated with exposure to [[insecticides]], hematologic [[malignancies]], [[HIV]] infection. Pulmonary alveolar proteinosis must be differentiated from other diseases that cause [[Ground glass opacification on CT|ground glass]] opacities in [[radiography]]. Pulmonary alveolar proteinosis is more commonly observed among patients aged 40- 50 years old. Men are more commonly affected with pulmonary alveolar proteinosis than women. Common risk factors in the development of pulmonary alveolar proteinosis are current or former cigarette smokers and [[Human Immunodeficiency Virus (HIV)|HIV]] infection. If left untreated, patients with pulmonary alveolar proteinosis may progress to develop [[pulmonary fibrosis]], [[cor pulmonale]]. Symptoms of pulmonary alveolar proteinosis may include [[dyspnea]] on exertion, [[cough]]. The physical examination is often normal. Laboratory Findings are serum anti-granulocyte-macrophage colony-stimulating factor ([[GM-CSF]]) antibodies in [[autoimmune]] pulmonary alveolar proteinosis and elevated serum level of [[GM-CSF]] in [[hereditary]] pulmonary alveolar proteinosis. Imaging studies include chest x-ray and high resolution computed tomography (HRCT). Treatment include whole-lung lavage (WLL), recombinant [[Granulocyte macrophage colony stimulating factor|GM-CSF]] and lung transplantation.  
Pulmonary alveolar proteinosis ( PAP) was first discovered by Samuel Rosen, Benjamin Castleman, and Averill Liebow, in 1958. Pulmonary alveolar proteinosis ( PAP) may be classified into 2 subtypes, primary and secondary pulmonary alveolar proteinosis. The pathogenesis of pulmonary alveolar proteinosis is characterized by the intraalveolar accumulation of [[surfactant]] [[phospholipid]] and [[apoproteins]]. Pulmonary alveolar proteinosis develop because of reduced [[granulocyte-macrophage colony-stimulating factor]] ([[GM-CSF]]) levels or function and/or impaired alveolar macrophage function. On [[gross pathology]] after lung washings, fluid with the milky composition are the characteristic finding of pulmonary alveolar proteinosis. On microscopic histopathological analysis, [[terminal bronchioles]] and [[alveoli]] are filled with a lipoproteinaceous material that will be pink after [[Periodic acid-Schiff stain|periodic acid-Schiff (PAS) stain]]. The exact etiology of pulmonary alveolar proteinosis (PAP) is unknown, but it may be associated with exposure to [[insecticides]], hematologic [[malignancies]], or [[HIV]] infection. Pulmonary alveolar proteinosis must be differentiated from other diseases that cause [[Ground glass opacification on CT|ground glass]] opacities in [[radiography]]. Pulmonary alveolar proteinosis is more commonly observed among patients aged 40- 50 years old. Men are more commonly affected with pulmonary alveolar proteinosis than women. Common risk factors in the development of pulmonary alveolar proteinosis are current or former cigarette smokers and [[Human Immunodeficiency Virus (HIV)|HIV]] infection. If left untreated, patients with pulmonary alveolar proteinosis may progress to develop [[pulmonary fibrosis]], [[cor pulmonale]]. Symptoms of pulmonary alveolar proteinosis may include [[dyspnea]] on exertion, [[cough]]. The physical examination is often normal. Laboratory findings are serum anti-granulocyte-macrophage colony-stimulating factor ([[GM-CSF]]) antibodies in [[autoimmune]] pulmonary alveolar proteinosis and elevated serum level of [[GM-CSF]] in [[hereditary]] pulmonary alveolar proteinosis. Imaging studies include chest x-ray and high resolution computed tomography (HRCT). Treatment include whole-lung lavage (WLL), recombinant [[Granulocyte macrophage colony stimulating factor|GM-CSF]] and lung transplantation.  
==Historical Perspective==
==Historical Perspective==
*Pulmonary alveolar proteinosis ( PAP) was first discovered by Samuel Rosen, Benjamin Castleman, and Averill Liebow, in 1958, during pathologic investigations of material filling the alveoli. <ref name="RosenCastleman1958">{{cite journal|last1=Rosen|first1=Samuel H.|last2=Castleman|first2=Benjamin|last3=Liebow|first3=Averill A.|last4=Enzinger|first4=Frank M.|last5=Hunt|first5=Richard T. N.|title=Pulmonary Alveolar Proteinosis|journal=New England Journal of Medicine|volume=258|issue=23|year=1958|pages=1123–1142|issn=0028-4793|doi=10.1056/NEJM195806052582301}}</ref>
*Pulmonary alveolar proteinosis ( PAP) was first discovered by Samuel Rosen, Benjamin Castleman, and Averill Liebow, in 1958, during pathologic investigations of material filling the alveoli. <ref name="RosenCastleman1958">{{cite journal|last1=Rosen|first1=Samuel H.|last2=Castleman|first2=Benjamin|last3=Liebow|first3=Averill A.|last4=Enzinger|first4=Frank M.|last5=Hunt|first5=Richard T. N.|title=Pulmonary Alveolar Proteinosis|journal=New England Journal of Medicine|volume=258|issue=23|year=1958|pages=1123–1142|issn=0028-4793|doi=10.1056/NEJM195806052582301}}</ref>
Line 21: Line 21:
:**[[Autoimmune]] PAP: The most common type of PAP in adults
:**[[Autoimmune]] PAP: The most common type of PAP in adults
:***Effect of [[GM-CSF]] on alveolar [[Macrophage|macrophages]] is neutralized by [[antibodies]] to [[GM-CSF]]
:***Effect of [[GM-CSF]] on alveolar [[Macrophage|macrophages]] is neutralized by [[antibodies]] to [[GM-CSF]]
:**[[Hereditary]] PAP :GM-CSF is intact but [[recessive]] variants of the GM-CSF receptor alpha and beta genes (CSF2RA and [[CSF2RB]]) impair signaling by GM-CSF
:**[[Hereditary]] PAP: GM-CSF is intact but [[recessive]] variants of the GM-CSF receptor alpha and beta genes (CSF2RA and [[CSF2RB]]) impair signaling by GM-CSF
:* [[Congenital]] PAP: Disorders of [[surfactant]] production
:* [[Congenital]] PAP: Disorders of [[surfactant]] production
:** Variants of [[surfactant]] proteins B and C (SFTPB, SFTPC)<ref name="pmid15358702">{{cite journal |vauthors=Brasch F, Birzele J, Ochs M, Guttentag SH, Schoch OD, Boehler A, Beers MF, Müller KM, Hawgood S, Johnen G |title=Surfactant proteins in pulmonary alveolar proteinosis in adults |journal=Eur. Respir. J. |volume=24 |issue=3 |pages=426–35 |date=September 2004 |pmid=15358702 |doi=10.1183/09031936.04.00076403 |url=}}</ref>
:** Variants of [[surfactant]] proteins B and C (SFTPB, SFTPC)<ref name="pmid15358702">{{cite journal |vauthors=Brasch F, Birzele J, Ochs M, Guttentag SH, Schoch OD, Boehler A, Beers MF, Müller KM, Hawgood S, Johnen G |title=Surfactant proteins in pulmonary alveolar proteinosis in adults |journal=Eur. Respir. J. |volume=24 |issue=3 |pages=426–35 |date=September 2004 |pmid=15358702 |doi=10.1183/09031936.04.00076403 |url=}}</ref>
Line 27: Line 27:
:** Variant of NK2 homeobox-1 (NKX2.1) <ref name="pmid23997037">{{cite journal |vauthors=Salerno T, Peca D, Menchini L, Schiavino A, Petreschi F, Occasi F, Cogo P, Danhaive O, Cutrera R |title=Respiratory insufficiency in a newborn with congenital hypothyroidism due to a new mutation of TTF-1/NKX2.1 gene |journal=Pediatr. Pulmonol. |volume=49 |issue=3 |pages=E42–4 |date=March 2014 |pmid=23997037 |doi=10.1002/ppul.22788 |url=}}</ref>
:** Variant of NK2 homeobox-1 (NKX2.1) <ref name="pmid23997037">{{cite journal |vauthors=Salerno T, Peca D, Menchini L, Schiavino A, Petreschi F, Occasi F, Cogo P, Danhaive O, Cutrera R |title=Respiratory insufficiency in a newborn with congenital hypothyroidism due to a new mutation of TTF-1/NKX2.1 gene |journal=Pediatr. Pulmonol. |volume=49 |issue=3 |pages=E42–4 |date=March 2014 |pmid=23997037 |doi=10.1002/ppul.22788 |url=}}</ref>
:** Variants in the gene [[SLC7A7]]<ref name="urlGeneReviews® - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1116/ |title=GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref><nowiki/>
:** Variants in the gene [[SLC7A7]]<ref name="urlGeneReviews® - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1116/ |title=GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref><nowiki/>
:** Variants of the [[MARS (gene)|MARS]] (Methionyl-tRNA synthetasegene ): Prevalent on Réunion Island<ref name="pmid25913036">{{cite journal |vauthors=Hadchouel A, Wieland T, Griese M, Baruffini E, Lorenz-Depiereux B, Enaud L, Graf E, Dubus JC, Halioui-Louhaichi S, Coulomb A, Delacourt C, Eckstein G, Zarbock R, Schwarzmayr T, Cartault F, Meitinger T, Lodi T, de Blic J, Strom TM |title=Biallelic Mutations of Methionyl-tRNA Synthetase Cause a Specific Type of Pulmonary Alveolar Proteinosis Prevalent on Réunion Island |journal=Am. J. Hum. Genet. |volume=96 |issue=5 |pages=826–31 |date=May 2015 |pmid=25913036 |pmc=4570277 |doi=10.1016/j.ajhg.2015.03.010 |url=}}</ref>
:** Variants of the [[MARS (gene)|MARS]] (methionyl-tRNA synthetasegene ): Prevalent on Réunion Island<ref name="pmid25913036">{{cite journal |vauthors=Hadchouel A, Wieland T, Griese M, Baruffini E, Lorenz-Depiereux B, Enaud L, Graf E, Dubus JC, Halioui-Louhaichi S, Coulomb A, Delacourt C, Eckstein G, Zarbock R, Schwarzmayr T, Cartault F, Meitinger T, Lodi T, de Blic J, Strom TM |title=Biallelic Mutations of Methionyl-tRNA Synthetase Cause a Specific Type of Pulmonary Alveolar Proteinosis Prevalent on Réunion Island |journal=Am. J. Hum. Genet. |volume=96 |issue=5 |pages=826–31 |date=May 2015 |pmid=25913036 |pmc=4570277 |doi=10.1016/j.ajhg.2015.03.010 |url=}}</ref>


====== Secondary pulmonary alveolar proteinosis: ======
====== Secondary pulmonary alveolar proteinosis: ======
:* High level dust exposures( [[titanium]], [[silica]], indium-tin oxide, [[aluminum]])<ref name="pmid5775743">{{cite journal |vauthors=Buechner HA, Ansari A |title=Acute silico-proteinosis. A new pathologic variant of acute silicosis in sandblasters, characterized by histologic features resembling alveolar proteinosis |journal=Dis Chest |volume=55 |issue=4 |pages=274–8 |date=April 1969 |pmid=5775743 |doi= |url=}}</ref>
:* High level dust exposures ([[titanium]], [[silica]], indium-tin oxide, [[aluminum]])<ref name="pmid5775743">{{cite journal |vauthors=Buechner HA, Ansari A |title=Acute silico-proteinosis. A new pathologic variant of acute silicosis in sandblasters, characterized by histologic features resembling alveolar proteinosis |journal=Dis Chest |volume=55 |issue=4 |pages=274–8 |date=April 1969 |pmid=5775743 |doi= |url=}}</ref>
:* Hematologic [[dyscrasias]] such as [[GATA2]] gene deficiency, [[myelodysplastic syndrome]] and [[hematologic malignancy]] <ref name="pmid8118651">{{cite journal |vauthors=Cordonnier C, Fleury-Feith J, Escudier E, Atassi K, Bernaudin JF |title=Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients |journal=Am. J. Respir. Crit. Care Med. |volume=149 |issue=3 Pt 1 |pages=788–94 |date=March 1994 |pmid=8118651 |doi=10.1164/ajrccm.149.3.8118651 |url=}}</ref>
:* Hematologic [[dyscrasias]] such as [[GATA2]] gene deficiency, [[myelodysplastic syndrome]] and [[hematologic malignancy]] <ref name="pmid8118651">{{cite journal |vauthors=Cordonnier C, Fleury-Feith J, Escudier E, Atassi K, Bernaudin JF |title=Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients |journal=Am. J. Respir. Crit. Care Med. |volume=149 |issue=3 Pt 1 |pages=788–94 |date=March 1994 |pmid=8118651 |doi=10.1164/ajrccm.149.3.8118651 |url=}}</ref>
:* After [[allogeneic]] hematopoietic cell [[transplantation]] for myeloid malignancies <ref name="pmid16162733">{{cite journal |vauthors=Sharma S, Nadrous HF, Peters SG, Tefferi A, Litzow MR, Aubry MC, Afessa B |title=Pulmonary complications in adult blood and marrow transplant recipients: autopsy findings |journal=Chest |volume=128 |issue=3 |pages=1385–92 |date=September 2005 |pmid=16162733 |doi=10.1378/chest.128.3.1385 |url=}}</ref>
:* After [[allogeneic]] hematopoietic cell [[transplantation]] for myeloid malignancies <ref name="pmid16162733">{{cite journal |vauthors=Sharma S, Nadrous HF, Peters SG, Tefferi A, Litzow MR, Aubry MC, Afessa B |title=Pulmonary complications in adult blood and marrow transplant recipients: autopsy findings |journal=Chest |volume=128 |issue=3 |pages=1385–92 |date=September 2005 |pmid=16162733 |doi=10.1378/chest.128.3.1385 |url=}}</ref>
Line 37: Line 37:
*The pathogenesis of pulmonary alveolar proteinosis is characterized by the intraalveolar accumulation of [[surfactant]] [[phospholipid]] and [[apoproteins]]. Pulmonary alveolar proteinosis develop because of reduced [[granulocyte-macrophage colony-stimulating factor]] ([[GM-CSF]]) levels or function and/or impaired alveolar macrophage function.<ref name="pmid20338813">{{cite journal |vauthors=Carey B, Trapnell BC |title=The molecular basis of pulmonary alveolar proteinosis |journal=Clin. Immunol. |volume=135 |issue=2 |pages=223–35 |date=May 2010 |pmid=20338813 |pmc=2866141 |doi=10.1016/j.clim.2010.02.017 |url=}}</ref>   
*The pathogenesis of pulmonary alveolar proteinosis is characterized by the intraalveolar accumulation of [[surfactant]] [[phospholipid]] and [[apoproteins]]. Pulmonary alveolar proteinosis develop because of reduced [[granulocyte-macrophage colony-stimulating factor]] ([[GM-CSF]]) levels or function and/or impaired alveolar macrophage function.<ref name="pmid20338813">{{cite journal |vauthors=Carey B, Trapnell BC |title=The molecular basis of pulmonary alveolar proteinosis |journal=Clin. Immunol. |volume=135 |issue=2 |pages=223–35 |date=May 2010 |pmid=20338813 |pmc=2866141 |doi=10.1016/j.clim.2010.02.017 |url=}}</ref>   
*Genes involved in the pathogenesis of pulmonary alveolar proteinosis include:  
*Genes involved in the pathogenesis of pulmonary alveolar proteinosis include:  
**[[Surfactant]] proteins B and C (SFTPB, SFTPC) , [[ATP-binding cassette family|ATP-binding cassette]], subfamily A ([[ABCA3]]) , [[SLC7A7]], [[MARS (gene)|MARS]] (Methionyl-tRNA synthetasegene ) and GM-CSF receptor alpha and beta genes (CSF2RA and CSF2RB) genes mutation in production of surfactant     
**[[Surfactant]] proteins B and C (SFTPB, SFTPC), [[ATP-binding cassette family|ATP-binding cassette]], subfamily A ([[ABCA3]]), [[SLC7A7]], [[MARS (gene)|MARS]] (methionyl-tRNA synthetasegene ) and GM-CSF receptor alpha and beta genes (CSF2RA and CSF2RB) genes mutation in production of [[surfactant]].      


*On [[gross pathology]] after lung washings, fluid with milky composition are characteristic finding of pulmonary alveolar proteinosis. <ref name="pmid9516877">{{cite journal |vauthors=Mikami T, Yamamoto Y, Yokoyama M, Okayasu I |title=Pulmonary alveolar proteinosis: diagnosis using routinely processed smears of bronchoalveolar lavage fluid |journal=J. Clin. Pathol. |volume=50 |issue=12 |pages=981–4 |date=December 1997 |pmid=9516877 |pmc=500376 |doi= |url=}}</ref>
*On [[gross pathology]] after lung washings, fluid with milky composition are characteristic finding of pulmonary alveolar proteinosis. <ref name="pmid9516877">{{cite journal |vauthors=Mikami T, Yamamoto Y, Yokoyama M, Okayasu I |title=Pulmonary alveolar proteinosis: diagnosis using routinely processed smears of bronchoalveolar lavage fluid |journal=J. Clin. Pathol. |volume=50 |issue=12 |pages=981–4 |date=December 1997 |pmid=9516877 |pmc=500376 |doi= |url=}}</ref>
Line 77: Line 77:
   
   
== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*If left untreated, patients with pulmonary alveolar proteinosis may progress to develop [[pulmonary fibrosis]], [[cor pulmonale]]. The natural history of secondary pulmonary alveolar proteinosis is related to underlying etiologies
*If left untreated, patients with pulmonary alveolar proteinosis may progress to develop [[pulmonary fibrosis]], [[cor pulmonale]]. The natural history of secondary pulmonary alveolar proteinosis is related to underlying etiologies.
*Common complications of pulmonary alveolar proteinosis include lung infections with [[Pneumocystis carinii]], [[Mycobacterium avium-intracellulare]] , Nocardia asteroides. <ref name="pmid15497254">{{cite journal |vauthors=Abdul Rahman JA, Moodley YP, Phillips MJ |title=Pulmonary alveolar proteinosis associated with psoriasis and complicated by mycobacterial infection: successful treatment with granulocyte-macrophage colony stimulating factor after a partial response to whole lung lavage |journal=Respirology |volume=9 |issue=3 |pages=419–22 |date=August 2004 |pmid=15497254 |doi= |url=}}</ref>
*Common complications of pulmonary alveolar proteinosis include lung infections with [[Pneumocystis carinii]], [[Mycobacterium avium-intracellulare]], Nocardia asteroides. <ref name="pmid15497254">{{cite journal |vauthors=Abdul Rahman JA, Moodley YP, Phillips MJ |title=Pulmonary alveolar proteinosis associated with psoriasis and complicated by mycobacterial infection: successful treatment with granulocyte-macrophage colony stimulating factor after a partial response to whole lung lavage |journal=Respirology |volume=9 |issue=3 |pages=419–22 |date=August 2004 |pmid=15497254 |doi= |url=}}</ref>


*Prognosis is generally good for primary pulmonary alveolar proteinosis with whole lung lavage. [[Congenital]] pulmonary alveolar proteinosis respond well to [[lung transplantation]]. Prognosis for secondary pulmonary alveolar proteinosis is related to underlying etiologies.  
*Prognosis is generally good for primary pulmonary alveolar proteinosis with whole lung lavage. [[Congenital]] pulmonary alveolar proteinosis respond well to [[lung transplantation]]. Prognosis for secondary pulmonary alveolar proteinosis is related to underlying etiologies.  
Line 87: Line 87:
*Symptoms of pulmonary alveolar proteinosis may include the following:<ref name="pmid275145903">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>
*Symptoms of pulmonary alveolar proteinosis may include the following:<ref name="pmid275145903">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>
:*[[Dyspnea]] on exertion
:*[[Dyspnea]] on exertion
:*[[Cough]] ( [[Productive cough|productive]] or nonproduvtive)
:*[[Cough]] ([[Productive cough|productive]] or nonproduvtive)


:*[[Fatigue]]
:*[[Fatigue]]
Line 96: Line 96:
* The physical examination is often normal. <ref name="pmid275145904">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>
* The physical examination is often normal. <ref name="pmid275145904">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>


*Physical examination may be remarkable for:
*Physical examination may be remarkable for:<ref name="pmid9824014">{{cite journal |vauthors=Goldstein LS, Kavuru MS, Curtis-McCarthy P, Christie HA, Farver C, Stoller JK |title=Pulmonary alveolar proteinosis: clinical features and outcomes |journal=Chest |volume=114 |issue=5 |pages=1357–62 |date=November 1998 |pmid=9824014 |doi= |url=}}</ref><ref name="pmid182023483">{{cite journal |vauthors=Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K |title=Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan |journal=Am. J. Respir. Crit. Care Med. |volume=177 |issue=7 |pages=752–62 |date=April 2008 |pmid=18202348 |pmc=2720118 |doi=10.1164/rccm.200708-1271OC |url=}}</ref>
:*[[Crackles]], but may be absent in pulmonary alveolar proteinosis with completely fluid-filled distal [[alveoli]].<ref name="pmid9824014">{{cite journal |vauthors=Goldstein LS, Kavuru MS, Curtis-McCarthy P, Christie HA, Farver C, Stoller JK |title=Pulmonary alveolar proteinosis: clinical features and outcomes |journal=Chest |volume=114 |issue=5 |pages=1357–62 |date=November 1998 |pmid=9824014 |doi= |url=}}</ref>
:*[[Crackles]], but may be absent in pulmonary alveolar proteinosis with completely fluid-filled distal [[alveoli]]
:*[[Clubbing]]<ref name="pmid182023483">{{cite journal |vauthors=Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K |title=Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan |journal=Am. J. Respir. Crit. Care Med. |volume=177 |issue=7 |pages=752–62 |date=April 2008 |pmid=18202348 |pmc=2720118 |doi=10.1164/rccm.200708-1271OC |url=}}</ref>
:*[[Clubbing]]
:*[[Cyanosis]]
:*[[Cyanosis]]
   
   
=== Laboratory Findings ===
=== Laboratory Findings ===
* Serum anti-granulocyte-macrophage colony-stimulating factor ([[GM-CSF]]) antibodies in [[autoimmune]] pulmonary alveolar proteinosis<ref name="pmid275145905">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>
* Serum anti-granulocyte-macrophage colony-stimulating factor ([[GM-CSF]]) antibodies in [[autoimmune]] pulmonary alveolar proteinosis.<ref name="pmid275145905">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>
* [[Complete blood count]] and differential in secondary pulmonary alveolar proteinosis due to [[hematologic malignancy]].
* [[Complete blood count]] and differential in secondary pulmonary alveolar proteinosis due to [[hematologic malignancy]].
* Elevated serum level of [[GM-CSF]] in [[hereditary]] pulmonary alveolar proteinosis<ref name="pmid275145906">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>  
* Elevated serum level of [[GM-CSF]] in [[hereditary]] pulmonary alveolar proteinosis.<ref name="pmid275145906">{{cite journal |vauthors=Suzuki T, Trapnell BC |title=Pulmonary Alveolar Proteinosis Syndrome |journal=Clin. Chest Med. |volume=37 |issue=3 |pages=431–40 |date=September 2016 |pmid=27514590 |doi=10.1016/j.ccm.2016.04.006 |url=}}</ref>  
* Nonspecific laboratory findings:<ref name="pmid666104">{{cite journal |vauthors=Martin RJ, Rogers RM, Myers NM |title=PUlmonary alveolar proteinosis: shunt fraction and lactic acid dehydrogenase concentration as aids to diagnosis |journal=Am. Rev. Respir. Dis. |volume=117 |issue=6 |pages=1059–62 |date=June 1978 |pmid=666104 |doi=10.1164/arrd.1978.117.6.1059 |url=}}</ref>
* Nonspecific laboratory findings:<ref name="pmid666104">{{cite journal |vauthors=Martin RJ, Rogers RM, Myers NM |title=PUlmonary alveolar proteinosis: shunt fraction and lactic acid dehydrogenase concentration as aids to diagnosis |journal=Am. Rev. Respir. Dis. |volume=117 |issue=6 |pages=1059–62 |date=June 1978 |pmid=666104 |doi=10.1164/arrd.1978.117.6.1059 |url=}}</ref>
** [[Hypergammaglobulinemia]]  
** [[Hypergammaglobulinemia]]  
Line 114: Line 114:


===== Chest X-ray: =====
===== Chest X-ray: =====
* Bat wing distribution of [[bilateral]] symmetric alveolar opacities in mid and lower lung zones <ref name="pmid22891182">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref>
* Bat wing distribution of [[bilateral]] symmetric alveolar opacities in mid and lower lung zones.<ref name="pmid22891182">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref>
* Segmental [[atelectasis]] due to bronchiolar [[obstruction]] <ref name="pmid3553760">{{cite journal |vauthors=Prakash UB, Barham SS, Carpenter HA, Dines DE, Marsh HM |title=Pulmonary alveolar phospholipoproteinosis: experience with 34 cases and a review |journal=Mayo Clin. Proc. |volume=62 |issue=6 |pages=499–518 |date=June 1987 |pmid=3553760 |doi= |url=}}</ref>
* Segmental [[atelectasis]] due to bronchiolar [[obstruction]].<ref name="pmid3553760">{{cite journal |vauthors=Prakash UB, Barham SS, Carpenter HA, Dines DE, Marsh HM |title=Pulmonary alveolar phospholipoproteinosis: experience with 34 cases and a review |journal=Mayo Clin. Proc. |volume=62 |issue=6 |pages=499–518 |date=June 1987 |pmid=3553760 |doi= |url=}}</ref>
* In chronic cases, focal [[fibrosis]] may be seen<ref name="pmid4832278">{{cite journal |vauthors=Hudson AR, Halprin GM, Miller JA, Kilburn KH |title=Pulmonary interstitial fibrosis following alveolar proteinosis |journal=Chest |volume=65 |issue=6 |pages=700–2 |date=June 1974 |pmid=4832278 |doi= |url=}}</ref>
* In chronic cases, focal [[fibrosis]] may be seen.<ref name="pmid4832278">{{cite journal |vauthors=Hudson AR, Halprin GM, Miller JA, Kilburn KH |title=Pulmonary interstitial fibrosis following alveolar proteinosis |journal=Chest |volume=65 |issue=6 |pages=700–2 |date=June 1974 |pmid=4832278 |doi= |url=}}</ref>


===== High resolution computed tomography (HRCT): =====
===== High resolution computed tomography (HRCT): =====
* Ground-glass opacification with crazy-paving pattern ( interlobular septal thickening )<ref name="pmid228911822">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref><ref name="pmid3186983">{{cite journal |vauthors=Godwin JD, Müller NL, Takasugi JE |title=Pulmonary alveolar proteinosis: CT findings |journal=Radiology |volume=169 |issue=3 |pages=609–13 |date=December 1988 |pmid=3186983 |doi=10.1148/radiology.169.3.3186983 |url=}}</ref>   
* Ground-glass opacification with crazy-paving pattern (interlobular septal thickening).<ref name="pmid228911822">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref><ref name="pmid3186983">{{cite journal |vauthors=Godwin JD, Müller NL, Takasugi JE |title=Pulmonary alveolar proteinosis: CT findings |journal=Radiology |volume=169 |issue=3 |pages=609–13 |date=December 1988 |pmid=3186983 |doi=10.1148/radiology.169.3.3186983 |url=}}</ref>   
=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===


====== Pulmonary function test: ======
====== Pulmonary function test: ======
* Reduction in the diffusing capacity for carbon monoxide ([[DLCO]]) <ref name="pmid182023484">{{cite journal |vauthors=Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K |title=Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan |journal=Am. J. Respir. Crit. Care Med. |volume=177 |issue=7 |pages=752–62 |date=April 2008 |pmid=18202348 |pmc=2720118 |doi=10.1164/rccm.200708-1271OC |url=}}</ref>
* Reduction in the diffusing capacity for carbon monoxide ([[DLCO]]).<ref name="pmid182023484">{{cite journal |vauthors=Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K |title=Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan |journal=Am. J. Respir. Crit. Care Med. |volume=177 |issue=7 |pages=752–62 |date=April 2008 |pmid=18202348 |pmc=2720118 |doi=10.1164/rccm.200708-1271OC |url=}}</ref>
* Maybe decrease in [[forced vital capacity]]<ref name="pmid12119235">{{cite journal |vauthors=Seymour JF, Presneill JJ |title=Pulmonary alveolar proteinosis: progress in the first 44 years |journal=Am. J. Respir. Crit. Care Med. |volume=166 |issue=2 |pages=215–35 |date=July 2002 |pmid=12119235 |doi=10.1164/rccm.2109105 |url=}}</ref>
* Maybe decrease in [[forced vital capacity]].<ref name="pmid12119235">{{cite journal |vauthors=Seymour JF, Presneill JJ |title=Pulmonary alveolar proteinosis: progress in the first 44 years |journal=Am. J. Respir. Crit. Care Med. |volume=166 |issue=2 |pages=215–35 |date=July 2002 |pmid=12119235 |doi=10.1164/rccm.2109105 |url=}}</ref>


====== Bronchoalveolar lavage (BAL): ======
====== Bronchoalveolar lavage (BAL): ======
* It is done via flexible [[bronchoscopy]]  
* It is done via flexible [[bronchoscopy]].
* Milky or opaque appearance because of abundant lipoproteinaceous material<ref name="pmid21900000">{{cite journal |vauthors=Bonella F, Bauer PC, Griese M, Ohshimo S, Guzman J, Costabel U |title=Pulmonary alveolar proteinosis: new insights from a single-center cohort of 70 patients |journal=Respir Med |volume=105 |issue=12 |pages=1908–16 |date=December 2011 |pmid=21900000 |doi=10.1016/j.rmed.2011.08.018 |url=}}</ref>  
* Milky or opaque appearance because of abundant lipoproteinaceous material.<ref name="pmid21900000">{{cite journal |vauthors=Bonella F, Bauer PC, Griese M, Ohshimo S, Guzman J, Costabel U |title=Pulmonary alveolar proteinosis: new insights from a single-center cohort of 70 patients |journal=Respir Med |volume=105 |issue=12 |pages=1908–16 |date=December 2011 |pmid=21900000 |doi=10.1016/j.rmed.2011.08.018 |url=}}</ref>  


====== Surgical lung biopsy: ======
====== Surgical lung biopsy: ======
*It is done via video-assisted thoracoscopic [[biopsy]]<ref name="pmid182023485">{{cite journal |vauthors=Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K |title=Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan |journal=Am. J. Respir. Crit. Care Med. |volume=177 |issue=7 |pages=752–62 |date=April 2008 |pmid=18202348 |pmc=2720118 |doi=10.1164/rccm.200708-1271OC |url=}}</ref>
*It is done via video-assisted thoracoscopic [[biopsy]].<ref name="pmid182023485">{{cite journal |vauthors=Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K |title=Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan |journal=Am. J. Respir. Crit. Care Med. |volume=177 |issue=7 |pages=752–62 |date=April 2008 |pmid=18202348 |pmc=2720118 |doi=10.1164/rccm.200708-1271OC |url=}}</ref>
   
   
== Treatment ==
== Treatment ==
Line 151: Line 151:
** For patients with failed whole-lung lavage (WLL)
** For patients with failed whole-lung lavage (WLL)


* [[Rituximab]] ( anti-CD20 monoclonal antibody): for refractory [[autoimmune]] pulmonary alveolar proteinosis <ref name="pmid19483052">{{cite journal |vauthors=Borie R, Debray MP, Laine C, Aubier M, Crestani B |title=Rituximab therapy in autoimmune pulmonary alveolar proteinosis |journal=Eur. Respir. J. |volume=33 |issue=6 |pages=1503–6 |date=June 2009 |pmid=19483052 |doi=10.1183/09031936.00160908 |url=}}</ref>
* [[Rituximab]] ( anti-CD20 monoclonal antibody): for refractory [[autoimmune]] pulmonary alveolar proteinosis.<ref name="pmid19483052">{{cite journal |vauthors=Borie R, Debray MP, Laine C, Aubier M, Crestani B |title=Rituximab therapy in autoimmune pulmonary alveolar proteinosis |journal=Eur. Respir. J. |volume=33 |issue=6 |pages=1503–6 |date=June 2009 |pmid=19483052 |doi=10.1183/09031936.00160908 |url=}}</ref>
* Therapeutic plasma exchange: for patients with failed whole lung lavage<ref name="pmid19407056">{{cite journal |vauthors=Luisetti M, Rodi G, Perotti C, Campo I, Mariani F, Pozzi E, Trapnell BC |title=Plasmapheresis for treatment of pulmonary alveolar proteinosis |journal=Eur. Respir. J. |volume=33 |issue=5 |pages=1220–2 |date=May 2009 |pmid=19407056 |doi=10.1183/09031936.00097508 |url=}}</ref>
* Therapeutic plasma exchange: for patients with failed whole lung lavage.<ref name="pmid19407056">{{cite journal |vauthors=Luisetti M, Rodi G, Perotti C, Campo I, Mariani F, Pozzi E, Trapnell BC |title=Plasmapheresis for treatment of pulmonary alveolar proteinosis |journal=Eur. Respir. J. |volume=33 |issue=5 |pages=1220–2 |date=May 2009 |pmid=19407056 |doi=10.1183/09031936.00097508 |url=}}</ref>


=== Surgery ===
=== Surgery ===
* Lung [[transplantation]] in refractory cases especially for [[congenital]] pulmonary alveolar proteinosis<ref name="pmid228911823">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref>  
* Lung [[transplantation]] in refractory cases especially for [[congenital]] pulmonary alveolar proteinosis.<ref name="pmid228911823">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref>  


=== Prevention ===
=== Prevention ===
*Avoiding further exposure is the effective measure for the secondary prevention of pulmonary alveolar proteinosis due to inorganic dust or [[insecticides]].<ref name="pmid228911824">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref>   
*Avoiding further exposure is the effective measure for the secondary prevention of pulmonary alveolar proteinosis due to inorganic dust or [[insecticides]].<ref name="pmid228911824">{{cite journal |vauthors=Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ |title=Pulmonary alveolar proteinosis |journal=Can. Respir. J. |volume=19 |issue=4 |pages=243–5 |date=2012 |pmid=22891182 |pmc=3411387 |doi= |url=}}</ref>   
   
   
*Annual [[influenza vaccination]] and age approriate [[pneumococcal pneumonia]] vaccination  
*Annual [[influenza vaccination]] and age approriate [[pneumococcal pneumonia]] vaccination.


==References==
==References==

Revision as of 17:13, 28 March 2018

WikiDoc Resources for Pulmonary alveolar proteinosis

Articles

Most recent articles on Pulmonary alveolar proteinosis

Most cited articles on Pulmonary alveolar proteinosis

Review articles on Pulmonary alveolar proteinosis

Articles on Pulmonary alveolar proteinosis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Pulmonary alveolar proteinosis

Images of Pulmonary alveolar proteinosis

Photos of Pulmonary alveolar proteinosis

Podcasts & MP3s on Pulmonary alveolar proteinosis

Videos on Pulmonary alveolar proteinosis

Evidence Based Medicine

Cochrane Collaboration on Pulmonary alveolar proteinosis

Bandolier on Pulmonary alveolar proteinosis

TRIP on Pulmonary alveolar proteinosis

Clinical Trials

Ongoing Trials on Pulmonary alveolar proteinosis at Clinical Trials.gov

Trial results on Pulmonary alveolar proteinosis

Clinical Trials on Pulmonary alveolar proteinosis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Pulmonary alveolar proteinosis

NICE Guidance on Pulmonary alveolar proteinosis

NHS PRODIGY Guidance

FDA on Pulmonary alveolar proteinosis

CDC on Pulmonary alveolar proteinosis

Books

Books on Pulmonary alveolar proteinosis

News

Pulmonary alveolar proteinosis in the news

Be alerted to news on Pulmonary alveolar proteinosis

News trends on Pulmonary alveolar proteinosis

Commentary

Blogs on Pulmonary alveolar proteinosis

Definitions

Definitions of Pulmonary alveolar proteinosis

Patient Resources / Community

Patient resources on Pulmonary alveolar proteinosis

Discussion groups on Pulmonary alveolar proteinosis

Patient Handouts on Pulmonary alveolar proteinosis

Directions to Hospitals Treating Pulmonary alveolar proteinosis

Risk calculators and risk factors for Pulmonary alveolar proteinosis

Healthcare Provider Resources

Symptoms of Pulmonary alveolar proteinosis

Causes & Risk Factors for Pulmonary alveolar proteinosis

Diagnostic studies for Pulmonary alveolar proteinosis

Treatment of Pulmonary alveolar proteinosis

Continuing Medical Education (CME)

CME Programs on Pulmonary alveolar proteinosis

International

Pulmonary alveolar proteinosis en Espanol

Pulmonary alveolar proteinosis en Francais

Business

Pulmonary alveolar proteinosis in the Marketplace

Patents on Pulmonary alveolar proteinosis

Experimental / Informatics

List of terms related to Pulmonary alveolar proteinosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2] [3] [4]

Synonyms and keywords:Pulmonary alveolar phospholipoproteinosis ; Synonym 2; Synonym 3

Overview

Pulmonary alveolar proteinosis ( PAP) was first discovered by Samuel Rosen, Benjamin Castleman, and Averill Liebow, in 1958. Pulmonary alveolar proteinosis ( PAP) may be classified into 2 subtypes, primary and secondary pulmonary alveolar proteinosis. The pathogenesis of pulmonary alveolar proteinosis is characterized by the intraalveolar accumulation of surfactant phospholipid and apoproteins. Pulmonary alveolar proteinosis develop because of reduced granulocyte-macrophage colony-stimulating factor (GM-CSF) levels or function and/or impaired alveolar macrophage function. On gross pathology after lung washings, fluid with the milky composition are the characteristic finding of pulmonary alveolar proteinosis. On microscopic histopathological analysis, terminal bronchioles and alveoli are filled with a lipoproteinaceous material that will be pink after periodic acid-Schiff (PAS) stain. The exact etiology of pulmonary alveolar proteinosis (PAP) is unknown, but it may be associated with exposure to insecticides, hematologic malignancies, or HIV infection. Pulmonary alveolar proteinosis must be differentiated from other diseases that cause ground glass opacities in radiography. Pulmonary alveolar proteinosis is more commonly observed among patients aged 40- 50 years old. Men are more commonly affected with pulmonary alveolar proteinosis than women. Common risk factors in the development of pulmonary alveolar proteinosis are current or former cigarette smokers and HIV infection. If left untreated, patients with pulmonary alveolar proteinosis may progress to develop pulmonary fibrosis, cor pulmonale. Symptoms of pulmonary alveolar proteinosis may include dyspnea on exertion, cough. The physical examination is often normal. Laboratory findings are serum anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies in autoimmune pulmonary alveolar proteinosis and elevated serum level of GM-CSF in hereditary pulmonary alveolar proteinosis. Imaging studies include chest x-ray and high resolution computed tomography (HRCT). Treatment include whole-lung lavage (WLL), recombinant GM-CSF and lung transplantation.

Historical Perspective

  • Pulmonary alveolar proteinosis ( PAP) was first discovered by Samuel Rosen, Benjamin Castleman, and Averill Liebow, in 1958, during pathologic investigations of material filling the alveoli. [1]
  • In 1960, the first therapeutic bronchoalveolar lavage by repeated segmental flooding was developed by Dr. Jose Ramirez-Rivera to treat pulmonary alveolar proteinosis. [2]

Classification

Pulmonary alveolar proteinosis ( PAP) may be classified into 2 subtypes:

Primary Pulmonary alveolar proteinosis:
Secondary pulmonary alveolar proteinosis:

Pathophysiology

Causes

The exact etiology of pulmonary alveolar proteinosis (PAP) is unknown, but it may be associated with:

Differentiating pulmonary alveolar proteinosis from other Diseases

  • Pulmonary alveolar proteinosis must be differentiated from other diseases that cause ground glass opacities in radiography such as:[17]

Epidemiology and Demographics

  • The prevalence of pulmonary alveolar proteinosis is approximately 1 per 100,000 individuals worldwide.
  • The incidence of pulmonary alveolar proteinosis is estimated to be 0.33 cases per 100,000 individuals in united states. [18]

Age

  • Pulmonary alveolar proteinosis is more commonly observed among patients aged 40- 50 years old.[19]

Gender

  • Men are more commonly affected with pulmonary alveolar proteinosis than women. The men to women ratio is approximately 2 to 1.

Race

  • There is no racial predilection for pulmonary alveolar protoeinosis.

Risk Factors

  • Common risk factors in the development of pulmonary alveolar proteinosis are:
    • Current or former cigarette smokers[20]
    • HIV infection[15]

Natural History, Complications and Prognosis

  • Prognosis is generally good for primary pulmonary alveolar proteinosis with whole lung lavage. Congenital pulmonary alveolar proteinosis respond well to lung transplantation. Prognosis for secondary pulmonary alveolar proteinosis is related to underlying etiologies.

Diagnosis

Symptoms

  • One third of patients are usually asymptomatic.[22]
  • Symptoms of pulmonary alveolar proteinosis may include the following:[23]

Physical Examination

  • The physical examination is often normal. [24]
  • Physical examination may be remarkable for:[25][26]

Laboratory Findings

Imaging Findings

Chest X-ray:
High resolution computed tomography (HRCT):
  • Ground-glass opacification with crazy-paving pattern (interlobular septal thickening).[34][35]

Other Diagnostic Studies

Pulmonary function test:
 Bronchoalveolar lavage (BAL):
  • It is done via flexible bronchoscopy.
  • Milky or opaque appearance because of abundant lipoproteinaceous material.[38]
Surgical lung biopsy:
  • It is done via video-assisted thoracoscopic biopsy.[39]

Treatment

Interventional therapy

  • Whole-lung lavage (WLL) with normal saline under general anesthesia: [40]
    • Indication:[41]
      • Resting PaO2 <65 mmHg
      • Alveolar-arterial O2 gradient ≥40 mmHg at rest
      • Severe dyspnea
      • Hypoxemia 
    • Contraindication:[42]
      • Clotting disorders
      • Anesthetic risks
      • Cardiopulmonary instability

Medical therapy

  • Recombinant GM-CSF ( sargramostim) by inhaled or subcutenous injections:[43]
    • For patients with failed whole-lung lavage (WLL)
  • Rituximab ( anti-CD20 monoclonal antibody): for refractory autoimmune pulmonary alveolar proteinosis.[44]
  • Therapeutic plasma exchange: for patients with failed whole lung lavage.[45]

Surgery

Prevention

  • Avoiding further exposure is the effective measure for the secondary prevention of pulmonary alveolar proteinosis due to inorganic dust or insecticides.[47]

References

  1. ↑ Rosen, Samuel H.; Castleman, Benjamin; Liebow, Averill A.; Enzinger, Frank M.; Hunt, Richard T. N. (1958). "Pulmonary Alveolar Proteinosis". New England Journal of Medicine. 258 (23): 1123–1142. doi:10.1056/NEJM195806052582301. ISSN 0028-4793.
  2. ↑ Ramirez-R., Jose; Nyka, Walenty; McLaughlin, Joseph (1963). "Pulmonary Alveolar Proteinosis". New England Journal of Medicine. 268 (4): 165–171. doi:10.1056/NEJM196301242680401. ISSN 0028-4793.
  3. ↑ Suzuki T, Trapnell BC (September 2016). "Pulmonary Alveolar Proteinosis Syndrome". Clin. Chest Med. 37 (3): 431–40. doi:10.1016/j.ccm.2016.04.006. PMID 27514590.
  4. ↑ Brasch F, Birzele J, Ochs M, Guttentag SH, Schoch OD, Boehler A, Beers MF, Müller KM, Hawgood S, Johnen G (September 2004). "Surfactant proteins in pulmonary alveolar proteinosis in adults". Eur. Respir. J. 24 (3): 426–35. doi:10.1183/09031936.04.00076403. PMID 15358702.
  5. ↑ Mulugeta S, Gray JM, Notarfrancesco KL, Gonzales LW, Koval M, Feinstein SI, Ballard PL, Fisher AB, Shuman H (June 2002). "Identification of LBM180, a lamellar body limiting membrane protein of alveolar type II cells, as the ABC transporter protein ABCA3". J. Biol. Chem. 277 (25): 22147–55. doi:10.1074/jbc.M201812200. PMID 11940594.
  6. ↑ Salerno T, Peca D, Menchini L, Schiavino A, Petreschi F, Occasi F, Cogo P, Danhaive O, Cutrera R (March 2014). "Respiratory insufficiency in a newborn with congenital hypothyroidism due to a new mutation of TTF-1/NKX2.1 gene". Pediatr. Pulmonol. 49 (3): E42–4. doi:10.1002/ppul.22788. PMID 23997037.
  7. ↑ "GeneReviews® - NCBI Bookshelf".
  8. ↑ Hadchouel A, Wieland T, Griese M, Baruffini E, Lorenz-Depiereux B, Enaud L, Graf E, Dubus JC, Halioui-Louhaichi S, Coulomb A, Delacourt C, Eckstein G, Zarbock R, Schwarzmayr T, Cartault F, Meitinger T, Lodi T, de Blic J, Strom TM (May 2015). "Biallelic Mutations of Methionyl-tRNA Synthetase Cause a Specific Type of Pulmonary Alveolar Proteinosis Prevalent on Réunion Island". Am. J. Hum. Genet. 96 (5): 826–31. doi:10.1016/j.ajhg.2015.03.010. PMC 4570277. PMID 25913036.
  9. ↑ 9.0 9.1 Buechner HA, Ansari A (April 1969). "Acute silico-proteinosis. A new pathologic variant of acute silicosis in sandblasters, characterized by histologic features resembling alveolar proteinosis". Dis Chest. 55 (4): 274–8. PMID 5775743.
  10. ↑ 10.0 10.1 Cordonnier C, Fleury-Feith J, Escudier E, Atassi K, Bernaudin JF (March 1994). "Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients". Am. J. Respir. Crit. Care Med. 149 (3 Pt 1): 788–94. doi:10.1164/ajrccm.149.3.8118651. PMID 8118651.
  11. ↑ Sharma S, Nadrous HF, Peters SG, Tefferi A, Litzow MR, Aubry MC, Afessa B (September 2005). "Pulmonary complications in adult blood and marrow transplant recipients: autopsy findings". Chest. 128 (3): 1385–92. doi:10.1378/chest.128.3.1385. PMID 16162733.
  12. ↑ Carey B, Trapnell BC (May 2010). "The molecular basis of pulmonary alveolar proteinosis". Clin. Immunol. 135 (2): 223–35. doi:10.1016/j.clim.2010.02.017. PMC 2866141. PMID 20338813.
  13. ↑ Mikami T, Yamamoto Y, Yokoyama M, Okayasu I (December 1997). "Pulmonary alveolar proteinosis: diagnosis using routinely processed smears of bronchoalveolar lavage fluid". J. Clin. Pathol. 50 (12): 981–4. PMC 500376. PMID 9516877.
  14. ↑ Maygarden SJ, Iacocca MV, Funkhouser WK, Novotny DB (June 2001). "Pulmonary alveolar proteinosis: a spectrum of cytologic, histochemical, and ultrastructural findings in bronchoalveolar lavage fluid". Diagn. Cytopathol. 24 (6): 389–95. PMID 11391819.
  15. ↑ 15.0 15.1 Juvet SC, Hwang D, Waddell TK, Downey GP (2008). "Rare lung disease II: pulmonary alveolar proteinosis". Can. Respir. J. 15 (4): 203–10. PMC 2677953. PMID 18551202.
  16. ↑ Wardwell NR, Miller R, Ware LB (September 2006). "Pulmonary alveolar proteinosis associated with a disease-modifying antirheumatoid arthritis drug". Respirology. 11 (5): 663–5. doi:10.1111/j.1440-1843.2006.00905.x. PMID 16916345.
  17. ↑ Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ (2012). "Pulmonary alveolar proteinosis". Can. Respir. J. 19 (4): 243–5. PMC 3411387. PMID 22891182.
  18. ↑ Hunt S, Miller AL, Schissel S, Ross JJ (December 2010). "A crazy cause of dyspnea". N. Engl. J. Med. 363 (25): e38. doi:10.1056/NEJMimc1008281. PMID 21158654.
  19. ↑ Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K (April 2008). "Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan". Am. J. Respir. Crit. Care Med. 177 (7): 752–62. doi:10.1164/rccm.200708-1271OC. PMC 2720118. PMID 18202348.
  20. ↑ Suzuki T, Trapnell BC (September 2016). "Pulmonary Alveolar Proteinosis Syndrome". Clin. Chest Med. 37 (3): 431–40. doi:10.1016/j.ccm.2016.04.006. PMID 27514590.
  21. ↑ Abdul Rahman JA, Moodley YP, Phillips MJ (August 2004). "Pulmonary alveolar proteinosis associated with psoriasis and complicated by mycobacterial infection: successful treatment with granulocyte-macrophage colony stimulating factor after a partial response to whole lung lavage". Respirology. 9 (3): 419–22. PMID 15497254.
  22. ↑ Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K (April 2008). "Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan". Am. J. Respir. Crit. Care Med. 177 (7): 752–62. doi:10.1164/rccm.200708-1271OC. PMC 2720118. PMID 18202348.
  23. ↑ Suzuki T, Trapnell BC (September 2016). "Pulmonary Alveolar Proteinosis Syndrome". Clin. Chest Med. 37 (3): 431–40. doi:10.1016/j.ccm.2016.04.006. PMID 27514590.
  24. ↑ Suzuki T, Trapnell BC (September 2016). "Pulmonary Alveolar Proteinosis Syndrome". Clin. Chest Med. 37 (3): 431–40. doi:10.1016/j.ccm.2016.04.006. PMID 27514590.
  25. ↑ Goldstein LS, Kavuru MS, Curtis-McCarthy P, Christie HA, Farver C, Stoller JK (November 1998). "Pulmonary alveolar proteinosis: clinical features and outcomes". Chest. 114 (5): 1357–62. PMID 9824014.
  26. ↑ Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K (April 2008). "Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan". Am. J. Respir. Crit. Care Med. 177 (7): 752–62. doi:10.1164/rccm.200708-1271OC. PMC 2720118. PMID 18202348.
  27. ↑ Suzuki T, Trapnell BC (September 2016). "Pulmonary Alveolar Proteinosis Syndrome". Clin. Chest Med. 37 (3): 431–40. doi:10.1016/j.ccm.2016.04.006. PMID 27514590.
  28. ↑ Suzuki T, Trapnell BC (September 2016). "Pulmonary Alveolar Proteinosis Syndrome". Clin. Chest Med. 37 (3): 431–40. doi:10.1016/j.ccm.2016.04.006. PMID 27514590.
  29. ↑ Martin RJ, Rogers RM, Myers NM (June 1978). "PUlmonary alveolar proteinosis: shunt fraction and lactic acid dehydrogenase concentration as aids to diagnosis". Am. Rev. Respir. Dis. 117 (6): 1059–62. doi:10.1164/arrd.1978.117.6.1059. PMID 666104.
  30. ↑ Suzuki T, Trapnell BC (September 2016). "Pulmonary Alveolar Proteinosis Syndrome". Clin. Chest Med. 37 (3): 431–40. doi:10.1016/j.ccm.2016.04.006. PMID 27514590.
  31. ↑ Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ (2012). "Pulmonary alveolar proteinosis". Can. Respir. J. 19 (4): 243–5. PMC 3411387. PMID 22891182.
  32. ↑ Prakash UB, Barham SS, Carpenter HA, Dines DE, Marsh HM (June 1987). "Pulmonary alveolar phospholipoproteinosis: experience with 34 cases and a review". Mayo Clin. Proc. 62 (6): 499–518. PMID 3553760.
  33. ↑ Hudson AR, Halprin GM, Miller JA, Kilburn KH (June 1974). "Pulmonary interstitial fibrosis following alveolar proteinosis". Chest. 65 (6): 700–2. PMID 4832278.
  34. ↑ Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ (2012). "Pulmonary alveolar proteinosis". Can. Respir. J. 19 (4): 243–5. PMC 3411387. PMID 22891182.
  35. ↑ Godwin JD, Müller NL, Takasugi JE (December 1988). "Pulmonary alveolar proteinosis: CT findings". Radiology. 169 (3): 609–13. doi:10.1148/radiology.169.3.3186983. PMID 3186983.
  36. ↑ Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K (April 2008). "Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan". Am. J. Respir. Crit. Care Med. 177 (7): 752–62. doi:10.1164/rccm.200708-1271OC. PMC 2720118. PMID 18202348.
  37. ↑ Seymour JF, Presneill JJ (July 2002). "Pulmonary alveolar proteinosis: progress in the first 44 years". Am. J. Respir. Crit. Care Med. 166 (2): 215–35. doi:10.1164/rccm.2109105. PMID 12119235.
  38. ↑ Bonella F, Bauer PC, Griese M, Ohshimo S, Guzman J, Costabel U (December 2011). "Pulmonary alveolar proteinosis: new insights from a single-center cohort of 70 patients". Respir Med. 105 (12): 1908–16. doi:10.1016/j.rmed.2011.08.018. PMID 21900000.
  39. ↑ Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K, Hojo M, Ichiwata T, Tanaka N, Yamaguchi E, Eda R, Oishi K, Tsuchihashi Y, Kaneko C, Nukiwa T, Sakatani M, Krischer JP, Nakata K (April 2008). "Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan". Am. J. Respir. Crit. Care Med. 177 (7): 752–62. doi:10.1164/rccm.200708-1271OC. PMC 2720118. PMID 18202348.
  40. ↑ Zhao YY, Huang H, Liu YZ, Song XY, Li S, Xu ZJ (October 2015). "Whole Lung Lavage Treatment of Chinese Patients with Autoimmune Pulmonary Alveolar Proteinosis: A Retrospective Long-term Follow-up Study". Chin. Med. J. 128 (20): 2714–9. doi:10.4103/0366-6999.167295. PMC 4736873. PMID 26481735.
  41. ↑ Campo, Ilaria; Luisetti, Maurizio; Griese, Matthias; Trapnell, Bruce C.; Bonella, Francesco; Grutters, Jan; Nakata, Koh; Van Moorsel, Coline H. M.; Costabel, Ulrich; Cottin, Vincent; Ichiwata, Toshio; Inoue, Yoshikazu; Braschi, Antonio; Bonizzoni, Giacomo; Iotti, Giorgio A.; Tinelli, Carmine; Rodi, Giuseppe (2016). "Whole lung lavage therapy for pulmonary alveolar proteinosis: a global survey of current practices and procedures". Orphanet Journal of Rare Diseases. 11 (1). doi:10.1186/s13023-016-0497-9. ISSN 1750-1172.
  42. ↑ Michaud, Gaëtane; Reddy, Chakravarthy; Ernst, Armin (2009). "Whole-Lung Lavage for Pulmonary Alveolar Proteinosis". Chest. 136 (6): 1678–1681. doi:10.1378/chest.09-2295. ISSN 0012-3692.
  43. ↑ Kavuru MS, Sullivan EJ, Piccin R, Thomassen MJ, Stoller JK (April 2000). "Exogenous granulocyte-macrophage colony-stimulating factor administration for pulmonary alveolar proteinosis". Am. J. Respir. Crit. Care Med. 161 (4 Pt 1): 1143–8. doi:10.1164/ajrccm.161.4.9906044. PMID 10764303.
  44. ↑ Borie R, Debray MP, Laine C, Aubier M, Crestani B (June 2009). "Rituximab therapy in autoimmune pulmonary alveolar proteinosis". Eur. Respir. J. 33 (6): 1503–6. doi:10.1183/09031936.00160908. PMID 19483052.
  45. ↑ Luisetti M, Rodi G, Perotti C, Campo I, Mariani F, Pozzi E, Trapnell BC (May 2009). "Plasmapheresis for treatment of pulmonary alveolar proteinosis". Eur. Respir. J. 33 (5): 1220–2. doi:10.1183/09031936.00097508. PMID 19407056.
  46. ↑ Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ (2012). "Pulmonary alveolar proteinosis". Can. Respir. J. 19 (4): 243–5. PMC 3411387. PMID 22891182.
  47. ↑ Patel SM, Sekiguchi H, Reynolds JP, Krowka MJ (2012). "Pulmonary alveolar proteinosis". Can. Respir. J. 19 (4): 243–5. PMC 3411387. PMID 22891182.


Template:WS Template:WH

Retrieved from "https://www.wikidoc.org/index.php?title=Pulmonary_alveolar_proteinosis&oldid=1457274"