Loeffler's syndrome

Löffler syndrome is an allergic disease characterized by an increase in the number of eosinophils in the peripheral blood and the presence in one or both of the light transient eosinophilic infiltrates. Or - eosinophilic flying lung infiltrate, simple pulmonary eosinophilia, simple eosinophilic pneumonia.

There are two Loeffler syndromes.

1. Löffler's syndrome I is an eosinophilic volatile infiltrate.
2. The Löffler II syndrome is restrictive cardiomyopathy.

ICD-10 code

J82. 41.42. Eosinophilic asthma, Löffler pneumonia.

Eosinophilic pneumonia is ubiquitous, more common in the tropics. It develops in men and women with the same frequency, mainly and the age of 16-40 years.

What causes Löffler's syndrome?

The Löffler syndrome was first described in 1932 by Wilhelm Löffler, a professor at the University of Zurich. He proved that helminths play a role in the development of eosinophilic inflammation of the lung tissue, the larvae of which migrate through the lungs,

Currently, within the framework of the syndrome, a group of different inflammatory processes in one or both lungs is combined.

Almost all parasites can cause Löffler's syndrome (ascarids, hookworms, trichinella, strongyloid, toksokary, pinworms, filarias, hepatic fluke, cat's fluke, schistosomes and other flatworms). So, recently, patients of this group often diagnosed toxocarosis, caused by invasion of the larvae of Toxocara canis and Toxocara cati, intestinal parasites of cats and dogs.

In the development of the syndrome, inhalation allergens can play a role: pollen of plants, fungal spores, certain industrial substances (in particular, nickel dust), drugs (sulfonamides, penicillins, gold compounds). However, in many cases it is not possible to find out the etiology of pulmonary infiltration, and then we are talking about eosinophilic pneumopathy.

Mechanism of development of the Loeffler syndrome

At the heart of the formation of Loeffler I syndrome is an allergic reaction of immediate type, as evidenced by the "volatile" nature of infiltrates and their complete regression without the formation of secondary pathological foci.

In the blood of patients with eosinophilic pneumonia of blood, an increased content of IgE was often found. Hypereosinophilia and hyperimmunoglobulinemim are aimed at eliminating parasites from the body. Intensive eosinophilic pulmonary infiltration and an increased number of eosinophils in the sprinkling show the involvement of the eosinophilic chemotactic factor of anaphylaxis and the formation of foci of allergic inflammation. This substance secretes mast cells (labrocytes) when activated by immune (IgE-mediated) and non-immune mechanisms (histamine, fragments of complement components, especially C5a).

In a number of cases, Leffler's syndrome develops as a type of Arthus phenomenon due to the formation of precipitating antibodies to antigens. Sometimes in eosinophilic

Infiltrates are detected by lymphocytes, which indicates participation in the pathogenesis of cell-mediated allergic reactions

How is Löffler syndrome manifested?

In most cases, patients do not complain. Less often disturb cough (dry or with a small amount of viscous sputum, in some cases with a trace of blood), subfebrile temperature, there are often signs of bronchospasm.

At auscultation dry rales are heard, mainly in the upper parts of the lungs. In the blood, leucocytosis is detected with a large number of eosinophils (up to 50-70%); Eosinophilia reaches its maximum after the appearance of pulmonary infiltrates.

Typical is the "volatile" nature of infiltrates: they can disappear on their own in a few days, leaving no scar changes to the lung tissue.

At a massive hematogenous dissemination of larvae and eggs of parasites (ascarids, schistosomes, trichinella) in tissues and human organs, including the lungs, shortness of breath, cough, fever, skin rash, wheezing in the lungs (pneumonitis).

The prolonged existence of infiltrates can be caused by the invasion of parasites directly into the lung tissue, for example, by infestation with the nematode Paragonimus westermani. Adult individuals migrate to the pulmonary tissue through the diaphragm and the wall of the intestine, involving the pleura in the pathological process. In the outcome of inflammation, fibrous nodes are formed, which can merge with the formation of cystic cavities.

Classification

Etiopathogenetic classification

• Löffler's syndrome caused by parasitic infestation.
• Löffler's syndrome caused by sensitization to aeroallergens.
• The Löffler syndrome developed as a result of drug allergy.

[1], [2], [3], [4], [5], [6], [7]

How to recognize Leffler's syndrome?

Syndrome diagnosis, as a rule, does not present difficulties. Its justification is a typical combination of volatile pulmonary infiltrates with high eosinophilia of blood. More often there are difficulties in establishing the etiology of the Loeffler syndrome.

Of great importance are the data of an allergological anamnesis:

• seasonal exacerbations of rhinoconjunctival syndrome and asthma, a clear connection of symptoms with occupational and household factors;
• references to previously identified allergic diseases;
• family history;
• pharmacological anamnesis.

Laboratory research

Laboratory diagnosis is performed to confirm the history and physical examination.

• In the general analysis of blood at the onset of the disease, high eosinophilia (up to 20%) is usually recorded, however, when the process is being chronicized, the number of eosinophils may not exceed normal numbers. Often, a high IgE (up to 1000 IU / ml) is detected in the blood.
• In the general analysis of sputum, eosinophils and Charcot-Leiden crystals can be detected.
• In the analysis of stool for some types of parasitic infestation eggs of helminths are found. In this case, the development cycle of parasites should be taken into account. So, with the primary infection of ascarids, the larvae are introduced into the lungs only 1-2 weeks later, and their eggs in the feces can be detected only after 2-3 months. With toxocarosis, the larvae of the parasite in the human body do not develop to the adult state, and therefore eggs are not found in the feces.
• Skin tests are suitable for etiological diagnosis with allergens of helminths, pollen, spores of lower fungi. When indicated, provocative nasal and inhalation tests are prescribed.
• Serological tests include a precipitation reaction, a complement fixation reaction.
• Cell tests - Shelley basophilic degranulation reaction, mast cell degranulation reaction with the corresponding allergens, and the detection of specific IgE by radioallergosorbent test and ELISA.

Instrumental research

When X-ray examination in the lungs identify single or multiple fuzzy round-shaped infiltrates, localized subpleural, more often in the upper parts of both lungs. With a long flow of infiltrative inflammation in the outcome of the disease, fibrous nodes can form, which, merging, form cystic cavities.

To assess the bronchial patency, the FVD is performed, if necessary, bronchomotor tests.

Indications for specialist consultation

• To identify allergic diseases, an allergist should be consulted.
• If there is a suspicion of allergic rhinitis, the advice of an ENT doctor is shown.

Example of the formulation of the diagnosis

The main diagnosis: Loeffler's syndrome I.

Etiological diagnosis: toxocarosis.

Form of the disease: visceral form.

[8], [9], [10]

Treatment of Leffler's syndrome

Since spontaneous recovery is possible, pharmacotherapy is often carried out with mg.

The main goal of treatment is elimination of the etiologic factor. Assign deworming, if possible, eliminate contact with allergens (aeroallergens, drugs).

Antiparasitic treatment

In helminthic invasion, antiparasitic drugs are indicated. In recent years, the following effective and well-tolerated drugs are widely used: albendazole (for children over 2 years) 400 mg once;

• Carbendacum inside 0.01 g / kg once;
• Mebendazole (children over 2 years) inside 100 mg once;
• pyrantel orally 10 mg once.

[11], [12], [13]

Treatment with glucocorticoids

It should avoid the early appointment of glucocorticoid drugs, which accelerate the resolution of infiltrates, but make it difficult to establish the correct diagnosis. However, in the absence of spontaneous recovery, prednisolone is sometimes prescribed at an initial dose of 15-20 mg / day; the dose is reduced by 5 mg every other day. The daily dose is divided into three doses. The course of treatment is from 6 to 8 days.

In addition to these drugs, if there are manifestations of bronchial obstruction syndrome, beta-adrenomimetics are prescribed by inhalation, aminophylline orally, and basic therapy of bronchial asthma is administered.

Indications for hospitalization

• Impossibility of complete elimination of domestic, epidermal, pollen allergen from the environment.
• Severe course of parasitic infection, accompanied by dehydration of the body.

How to prevent Löffler's syndrome?

• Hygienic measures aimed at preventing helminthic invasions.
• Consultation of patients with respiratory allergies (should clarify the need to stop contact with specific aeroallergens).
• With professional sensitization, they study the professional route, recommend a change of work.
• Conduct an individual selection of pharmacological drugs for the prevention of drug allergies.

Forecast

As a rule, favorable.

[14], [15], [16]

Information for Patient

It is necessary to strictly observe hygiene measures, including to patients containing pets in the house.

Patients with allergic diseases should follow the recommendations of an allergist for taking medicines and herbal preparations.