Advertisement

Tachypnea, Fever and Eosinophilia

  • Kevin S. Gipson
  • Ryan H. Avery
  • Luke A. WallEmail author
Chapter

Practical Points

  • Löffler syndrome is a helminth-associated eosinophilic pneumonitis which occurs when helminths transmigrate through the lung parenchyma and airways, provoking a marked eosinophil-mediated inflammatory response.

  • The clinical picture is a constellation of transient pulmonary infiltrates on CXR, respiratory symptoms including cough and hypoxemia, and peripheral blood and pulmonary eosinophilia.

  • Supportive care including supplemental oxygen and inhaled bronchodilators is helpful in acute management of Löffler-associated respiratory symptoms.

  • Anthelmintic treatments may be used in particularly severe or refractory cases of Löffler syndrome, though the condition is generally self-limited.

  • Strongyloides co-infection should be ruled out in patients who have risk factors for helminth exposure before the use of systemic steroids, particularly in otherwise immunosuppressed patients to avoid the potential risk of a disseminated hyperinfection syndrome.

  • The same cautionary statement applies to monoclonal antibodies which are designed to inhibit IgE or eosinophils.

  • Helminth infection should be considered in the differential diagnosis for asthma, eosinophilia, or elevated IgE, even in developed countries.

Keywords

Löffler syndrome Helminth Strongyloides Asthma 

References

  1. 1.
    Gipson K, Avery R, Shah H, Pepiak D, Begue RE, Malone J, Wall LA. Loffler syndrome on a Louisiana pig farm. Respir Med Case Rep. 2016;19:128–31.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Fan LL. Hypersensitivity pneumonitis in children. Curr Opin Pediatr. 2002;14(3):323–6.CrossRefGoogle Scholar
  3. 3.
    Vece TJ, Fan LL. Diagnosis and management of diffuse lung disease in children. Paediatr Respir Rev. 2011;12(4):238–42.CrossRefGoogle Scholar
  4. 4.
    Sharma OP, Maheshwari A. Lung disease in the tropics. Ann N Y Acad Sci. 1991.Google Scholar
  5. 5.
    Knutsen APTJ, Wooldridge JL, et al. Environmental exposures in the normal host. In: Bush A, Wilmott RW, Boat TF, Chernick V, editors. Kendig and Chernicks disorders of the respiratory tract in children. 8th ed. Amsterdam: Elsevier; 2012. p. 858–76.CrossRefGoogle Scholar
  6. 6.
    Cheepsattayakorn A, Cheepsattayakorn R. Parasitic pneumonia and lung involvement. Biomed Res Int. 2014;2014:874021.CrossRefGoogle Scholar
  7. 7.
    Diemert DJ. Ascariasis. In: Walker DH, editor. Tropical infectious diseases: principles, pathogens and practice. Amsterdam: Elsevier; 2011. p. 794–8.CrossRefGoogle Scholar
  8. 8.
    Kassalik M, Mönkemüller K. Strongyloides stercoralis hyperinfection syndrome and disseminated disease. Gastroenterol Hepatol. 2011;7(11):766–8.Google Scholar
  9. 9.
    Segarra-Newnham M. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann Pharmacother. 2007;41(12):1992–2001.CrossRefGoogle Scholar
  10. 10.
    Druilhe A, Letuve S, Pretolani M. Glucocorticoid-induced apoptosis in human eosinophils: mechanisms of action. Apoptosis. 2003;8(5):481–95.CrossRefGoogle Scholar
  11. 11.
    Miller LA, Colby K, Manning SE, Hoenig D, McEvoy E, Montgomery S, Mathison B, de Almeida M, Bishop H, Dasilva A, Sears S. Ascariasis in humans and pigs on small-scale farms, Maine, USA, 2010-2013. Emerg Infect Dis. 2015;21(2):332–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kevin S. Gipson
    • 1
  • Ryan H. Avery
    • 2
  • Luke A. Wall
    • 3
    Email author
  1. 1.Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Pathobiological SciencesLouisiana State University School of Veterinary MedicineBaton RougeUSA
  3. 3.Section of Allergy Immunology, Department of Pediatrics, Children’s HospitalLouisiana State University School of MedicineNew OrleansUSA

Personalised recommendations