Loefflers syndrome overview: Difference between revisions
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==Overview== | ==Overview== | ||
Loeffler syndrome is rare a form of eosinophilic pulmonary disease, which is characterized by mild respiratory symptoms such as dry cough, wheezing, dyspnea, fever, and blood-tinged sputum containing eosinophil-derived Charcot-Leyden crystals, fleeting migratory pulmonary opacities in chest x-ray, and peripheral blood eosinophilia. Parasitic infections, especially Ascaris lumbricoides, may be the cause, but an identifiable etiologic agent is not found in up to one-third of patients. Transpulmonary passage of helminth larvae is the most precise definition of Loeffler syndrome in the literature, nevertheless, there are plenty of controversial definitions under the cluster of eosinophilic pulmonary disorders. The diagnosis of Löffler syndrome is based on characteristic and often transient respiratory symptoms, chest x-ray findings, and peripheral blood eosinophilia. It requires the exclusion of other types of eosinophilic lung disease. such as acute eosinophilic pneumonia which is a distinct entity with acute onset, severe hypoxemia, and a lack of increased blood eosinophils at the onset of disease. Löffler syndrome is a self-limiting condition which is usually resolved within 3-4 weeks. | Loeffler syndrome is rare a form of eosinophilic pulmonary disease, which is characterized by mild respiratory symptoms such as dry cough, wheezing, dyspnea, fever, and blood-tinged sputum containing eosinophil-derived Charcot-Leyden crystals, fleeting migratory pulmonary opacities in chest x-ray, and peripheral blood eosinophilia. Parasitic infections, especially Ascaris lumbricoides, may be the cause, but an identifiable etiologic agent is not found in up to one-third of patients. Transpulmonary passage of helminth larvae is the most precise definition of Loeffler syndrome in the literature, nevertheless, there are plenty of controversial definitions under the cluster of eosinophilic pulmonary disorders. The diagnosis of Löffler syndrome is based on characteristic and often transient respiratory symptoms, chest x-ray findings, and peripheral blood eosinophilia. It requires the exclusion of other types of eosinophilic lung disease. such as acute eosinophilic pneumonia which is a distinct entity with acute onset, severe hypoxemia, and a lack of increased blood eosinophils at the onset of disease. Löffler syndrome is a self-limiting condition which is usually resolved within 3-4 weeks. | ||
== | ==Historical perspective== | ||
In '''1932, Wilhelm Löffler''' drew attention to the disease in cases of [[eosinophilic pneumonia]] caused by the parasites ''[[Ascaris lumbricoides|such as Ascaris lumbricoides]]'', ''[[Strongyloides stercoralis]]'' and the [[hookworm]]s, such as ''[[Ancylostoma duodenale]]'' and ''[[Necator americanus]]''. Although Löffler only described eosinophilic pneumonia in the context of infection, many authors give the term "Löffler's syndrome" to any form of acute onset pulmonary [[eosinophilia]] no matter what the underlying cause. If the cause is unknown, it is specified and called "simple pulmonary [[eosinophilia]]". | In '''1932, Wilhelm Löffler''' drew attention to the disease in cases of [[eosinophilic pneumonia]] caused by the parasites ''[[Ascaris lumbricoides|such as Ascaris lumbricoides]]'', ''[[Strongyloides stercoralis]]'' and the [[hookworm]]s, such as ''[[Ancylostoma duodenale]]'' and ''[[Necator americanus]]''. Although Löffler only described eosinophilic pneumonia in the context of infection, many authors give the term "Löffler's syndrome" to any form of acute onset pulmonary [[eosinophilia]] no matter what the underlying cause. If the cause is unknown, it is specified and called "simple pulmonary [[eosinophilia]]". | ||
==Pathophysiology== | |||
It is understood that '''Löffler syndrome''' is the result of '''transpulmonary passage of helminth larvae'''. Helminths, with a pulmonary life cycle are responsible for this syndrome, among them are ''[[Ascaris lumbricoides]]'', ''[[Large roundworm of pigs|Ascaris suum]]'', ''[[Ancylostoma duodenale]]'', ''[[Necator americanus]]'', and ''[[Strongyloides stercoralis]].'' | |||
==Causes== | |||
Loeffler syndrome may be caused by ''[[Ancylostoma duodenale]], [[Ascaris lumbricoides|Ascaris lumbricoides,]] [[Large roundworm of pigs|Ascaris suum]],'' ''[[Necator americanus]]'', ''[[Strongyloides stercoralis]].'' | |||
==Differential diagnosis== | |||
Loeffler syndrome must be differentiated from other diseases that cause pulmonary eosinophilia, such as Churg-Strauss, drug and toxin-induced eosinophilic lung diseases, other helminthic and fungal infection related eosinophilic lung diseases, and nonhelminthic infections such as Coccidioidomycosis, and Mycobacterium tuberculosis. | |||
==Epidemiology and demographics== | |||
Löffler syndrome is due to intestinal helminth infections with a pulmonary cycle which is distributed worldwide; nonetheless, parasitic infections such as ''[[Ancylostoma duodenale]], [[Ascaris lumbricoides|Ascaris lumbricoides,]] [[Large roundworm of pigs|Ascaris suum]],'' ''[[Necator americanus]]'', ''[[Strongyloides stercoralis]]'' are more prevalent in tropical areas particularly in communities with low socioeconomic status and poor sanitary conditions. In the United States, 20-67% of children in rural southern communities have been reported to suffer from ascariasis; Nevertheless, there are no specific statistics for the occurrence of Löffler syndrome. Globalization increased immigration, and travel warrants alertness of US physicians and the other health care works of developed countries, because an encounter with imported tropical diseases and thus the resulted Löffler syndrome could be more likely nowadays. The case-fatality rate/mortality rate of Löffler syndrome is literally zero. There has been no report of deaths due to Löffler syndrome. Löffler syndrome is a self-limiting, benign condition without significant morbidity. Symptoms usually subside within 3-4 weeks. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:51, 16 May 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
Loeffler syndrome is rare a form of eosinophilic pulmonary disease, which is characterized by mild respiratory symptoms such as dry cough, wheezing, dyspnea, fever, and blood-tinged sputum containing eosinophil-derived Charcot-Leyden crystals, fleeting migratory pulmonary opacities in chest x-ray, and peripheral blood eosinophilia. Parasitic infections, especially Ascaris lumbricoides, may be the cause, but an identifiable etiologic agent is not found in up to one-third of patients. Transpulmonary passage of helminth larvae is the most precise definition of Loeffler syndrome in the literature, nevertheless, there are plenty of controversial definitions under the cluster of eosinophilic pulmonary disorders. The diagnosis of Löffler syndrome is based on characteristic and often transient respiratory symptoms, chest x-ray findings, and peripheral blood eosinophilia. It requires the exclusion of other types of eosinophilic lung disease. such as acute eosinophilic pneumonia which is a distinct entity with acute onset, severe hypoxemia, and a lack of increased blood eosinophils at the onset of disease. Löffler syndrome is a self-limiting condition which is usually resolved within 3-4 weeks.
Historical perspective
In 1932, Wilhelm Löffler drew attention to the disease in cases of eosinophilic pneumonia caused by the parasites such as Ascaris lumbricoides, Strongyloides stercoralis and the hookworms, such as Ancylostoma duodenale and Necator americanus. Although Löffler only described eosinophilic pneumonia in the context of infection, many authors give the term "Löffler's syndrome" to any form of acute onset pulmonary eosinophilia no matter what the underlying cause. If the cause is unknown, it is specified and called "simple pulmonary eosinophilia".
Pathophysiology
It is understood that Löffler syndrome is the result of transpulmonary passage of helminth larvae. Helminths, with a pulmonary life cycle are responsible for this syndrome, among them are Ascaris lumbricoides, Ascaris suum, Ancylostoma duodenale, Necator americanus, and Strongyloides stercoralis.
Causes
Loeffler syndrome may be caused by Ancylostoma duodenale, Ascaris lumbricoides, Ascaris suum, Necator americanus, Strongyloides stercoralis.
Differential diagnosis
Loeffler syndrome must be differentiated from other diseases that cause pulmonary eosinophilia, such as Churg-Strauss, drug and toxin-induced eosinophilic lung diseases, other helminthic and fungal infection related eosinophilic lung diseases, and nonhelminthic infections such as Coccidioidomycosis, and Mycobacterium tuberculosis.
Epidemiology and demographics
Löffler syndrome is due to intestinal helminth infections with a pulmonary cycle which is distributed worldwide; nonetheless, parasitic infections such as Ancylostoma duodenale, Ascaris lumbricoides, Ascaris suum, Necator americanus, Strongyloides stercoralis are more prevalent in tropical areas particularly in communities with low socioeconomic status and poor sanitary conditions. In the United States, 20-67% of children in rural southern communities have been reported to suffer from ascariasis; Nevertheless, there are no specific statistics for the occurrence of Löffler syndrome. Globalization increased immigration, and travel warrants alertness of US physicians and the other health care works of developed countries, because an encounter with imported tropical diseases and thus the resulted Löffler syndrome could be more likely nowadays. The case-fatality rate/mortality rate of Löffler syndrome is literally zero. There has been no report of deaths due to Löffler syndrome. Löffler syndrome is a self-limiting, benign condition without significant morbidity. Symptoms usually subside within 3-4 weeks.