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PULMONARY EOSINOPHILIA WITH ASTHMATIC SYNDROME
This group of diseases can include bronchial asthma and diseases with a leading broncho-asthmatic syndrome, which are based on other etiological factors.
These diseases include:
1. Allergic bronchopulmonary aspergillosis.
2. Tropical pulmonary eosinophilia.
3. Pulmonary eosinophilia with systemic manifestations.
4. Hyperereosinophilic myeloproliferative syndrome.
5. Nodular periarteritis.
Aspergillus can cause several types of respiratory damage:
• atonic IgE-dependent bronchial asthma, mediated by mediators of labocytes;
• exogenous allergic alveolitis - in non-atopic patients who inhaled a large number of aspergillus spores;
• allergic bronchopulmonary aspergillosis;
• the formation of aspergillomas in pre-existing pulmonary cavities;
• invasive aspergillosis, which develops in patients with immunodeficiency.
Allergic bronchopulmonary aspergillosis can be assumed in every patient with bronchial asthma, combined with pulmonary infiltrates and eosinophilia. Its distinctive features are: pulmonary infiltrates, high peripheral eosinophilia, recurrent asthma attacks, proximal bronchiectasis, determined radiographically or tomographically (bronchography is contraindicated!), High total IgE content, detection of precipitating antibodies to aspergillus antigen.
The key to the diagnosis of allergic bronchopulmonary aspergillosis is the doctor’s notion of the frequent possibility of this disease. Its presence can be assumed in patients with asthma, with a history of pulmonary infiltrates with a steroid-dependent course of bronchial asthma. Treatment with glucocorticoids gives a good effect.
Tropical pulmonary eosinophilia (synonym: Weingarten syndrome), caused by invasion of various microfilariae - transmissible nematodosis. The clinical picture is characterized by the development of acute allergosis in response to the migration of larval forms of microfilariae helminths with a slow progression of the disease: moderate (up to 38 ° C) increase in body temperature, intoxication, cough, abdominal pain, anorexia, weight loss. Attacks of bronchial asthma, up to severe asthmatic status, are combined with focal, infiltrative, often miliary changes in the lungs, which leads to mixed respiratory failure. As the disease progresses, the fibrous process progresses in the lungs. Microfilariae possess tropism not only to the respiratory system, but also to the lymphatic system (vucheriosis, brugiosis), connective tissue (onchocerciasis, loiasis, dipetalonematosis). In this regard, one can observe exanthema, lymphadenopathy, splenomegaly, and damage to the gastrointestinal tract. In peripheral blood, high (60-80%) eosinophilia, a false positive Wasserman reaction, an increase in the total IgE content.
In the diagnosis, great importance is attached to collecting an epidemiological history (staying in the countries of Southeast Asia, India, Pakistan), identifying microfilariae in a thick drop of blood, taking into account the microfilariaemia rhythm (nighttime is characteristic of vuchereriosis, daytime - for loiasis), detection of antifilarial complement in the binding reaction antibodies. Treatment with a specific drug diethylcarbamazine (ditrazine) gives a good clinical effect, but in advanced cases, changes in the lungs persist.
Pulmonary eosinophilia with systemic manifestations.
To this group
independent diseases are included, which along with pulmonary eosinophilia are characterized by the involvement of many organs and systems in the process.
Hyperereosinophilic myeloproliferative syndrome (syn: HES syndrome, Leffler II syndrome, fibroblastic parietal endocarditis) is a rare disease from the group of systemic allergic vasculitis of unknown etiology. In the development of the disease, great importance is attached to tissue damage caused by degranulapia of eosinophils and, primarily, the endothelium of blood vessels and the endocardium. The disease begins, as a rule, with lung damage in the form of infiltrates, accompanied by high blood eosinophilia, fever, arthralgia, myalgia, polymorphic skin rashes. Subsequently, lymphadenopathy, hepatolienal syndrome, damage to the central nervous system (Gordon's phenomenon), and kidneys (proteinuria, hematuria) join. An examination of the bone marrow reveals its hyperplasia with a high content of eosinophils.
The most clinically significant is heart damage in the form of parietal fibroplastic endocarditis with the development of restrictive heart failure. The heart is small, congestive heart failure develops early.
Treatment is carried out with glucocorticosteroids (average daily dose of 30-40 mg in terms of prednisolone) or their combination with cytostatics (azathioprine 100-150 mg per day).
In 20% of cases, periarteritis nodosa begins with one of the most typical syndromes - bronchial asthma, often combined with high blood eosinophilia, or Charge-Strauss syndrome (allergic necrotizing arteritis with extravasular granulomatosis and eosinophilic tissue infiltrates). Clinically, it is manifested by rhinitis, asthma attacks, eosinophilic pneumonia, signs of systemic vasculitis.
The course of the syndrome can be divided into three phases:
1) prodromal - phase of allergic diseases (allergic rhinitis, bronchial asthma);
2) the phase of blood and tissue eosinophilia (the addition of Leffler's syndrome or chronic eosinophilic pneumonia with relapse of lung infiltrates for several years);
3) the phase of systemic vasculitis (weight loss, fever, diarrhea, myalgia, arthralgia, hemorrhagic exanthema, abdominal pain, pericarditis, asymmetric polyneuritis, coronaryitis, kidney damage with the development of hematuria, persistent arterial hypertension and chronic renal failure).
The diagnosis of asthmatic variant of periarteritis nodosa (Charge-Strauss syndrome) becomes reliable if hypereosinophilic bronchial asthma is combined with at least two of the four classic signs of Kussmaul-Meyer disease: kidney damage with persistent hypertension, asymmetric polyneuritis, abdominal syndrome, coronaritis.
As with hypereosinophilic myeloproliferative syndrome, the prognosis for nodular periarteritis depends on extrapulmonary manifestations and in most cases is unfavorable. Treatment is carried out with large doses of glucocorticoeteroids or combined with cytostatics. <
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PULMONARY EOSINOPHILIA WITH ASTHMATIC SYNDROME
- Pulmonary eosinophilia
Pulmonary eosinophilia is a group of diseases characterized by eosinophilia and limited blackouts on chest radiographs. This section is devoted to the clinical picture, diagnosis and treatment of acute and chronic eosinophilic pneumonia, tropical pulmonary eosinophilia, Cherge – Stros syndrome, periarteritis nodosa, and eosinophilia – myalgia syndrome (see Table 8.3). To this group
- Intensive care for asthmatic status, pulmonary edema, acute respiratory distress syndrome
1. Obstructive ventilation disorders are caused by: 1) Swelling of the mucous membranes 2) Laryngospasm 3) Bronchospasm 4) Hematorax 5) Inhibition of the respiratory center Answers: a) correctly 1,2,3; b) correct 1,2,5; c) correctly 2,3,4. 2. Pulmonary ventilation disorders are observed with: 1) Pneumothorax 2) Laryngospasm 3) Effects of muscle relaxants 4) Poisoning with barbiturates 5) Increased pressure in the abdominal
- Pulmonary hemorrhagic syndromes
Pulmonary hemorrhage and hemorrhage into the lung tissue are serious complications of some interstitial lung diseases. Among pulmonary hemorrhagic syndromes, Goodpasture Syndrome (EWGoodpasture), idiopathic pulmonary hemosiderosis, hemorrhage associated with vasculitis (with angiitis hypersensitivity, Wegener's granulomatosis and systemic lupus erythematosus) are distinguished. Syndrome
- General characteristics of eosinophils, their role in pathological processes
The number of eosinophils in accordance with the leukocyte formula is 2-5%. They function mainly in tissues; their ratio in blood and the number in tissues is 1: 100. The process of production of eosinophils and their release into the blood is stimulated by the cytokines IL-5 and IL-3. Human eosinophil granules contain: - myeloperoxidase (has a toxic effect on parasites); - cationic
- Asthmatic status
Asthmatic status is a severe asthma attack caused by a complication of the chronic course of bronchial asthma. Asthmatic status is distinguished from ordinary asthma attacks by a long course, resistance to standard therapy, and distinct signs of ONE. The duration of asthmatic status can be different - from several hours to 4-6 days or more. Asthmatic status potentially
- ASTMATIC STATUS
Asthmatic status is a severe asthma attack caused by a complication of the chronic course of bronchial asthma. Asthmatic status is distinguished from ordinary asthma attacks by a long course, resistance to standard therapy, and distinct signs of ONE. The duration of asthmatic status can be different - from several hours to 4-6 days or more. Asthmatic status
- Specialized functions of neutrophils, monocytes and eosinophils in inflammation
Neutrophilic leukocytes are the first to infiltrate the area of inflammation. They are called “first line of defense” cells or “quick response squads”. These are highly differentiated, mobile cells, which, coming out of the vessels, quickly find their targets, absorb and destroy them using the mechanisms of phagocytosis. Neutrophils effectively protect a person from many bacterial and fungal infections. They
- Asthmatic status
Asthmatic status is a persistent bronchial obstructive syndrome in which previously used bronchodilators become ineffective, sputum separation completely stops and elements of multiple organ failure appear - decompensation of blood circulation, impaired diuresis and others. Among the main risk factors for the development of asthmatic status, massive exposure to allergens is distinguished.
- Pulmonary heart and pulmonary circulation disorders
ICD code: (126-128) 126 Pulmonary embolism 126.0 Pulmonary embolism with a reference to acute pulmonary heart 126.9 Pulmonary embolism without a mention of acute pulmonary heart 127 Other forms of pulmonary heart failure 127.0 Primary pulmonary hypertension 127.1 Kyphoscoliotic heart disease 127.8 Other specified forms of pulmonary heart failure 127.9
- Asthmatic status: criteria, emergency care
Criteria for asthmatic status: prolonged asthma attack with impaired bronchial drainage function, with outcome in total pulmonary obstruction, acute pulmonary heart, hypoxemic coma. Anaphylactic form of status can develop with atopic and aspirin asthma after the appointment of antibiotics, chlorpromazine, analgesics, sleeping pills, drugs, in contact with massive doses of the allergen,
- Asthmatic status and respiratory failure
A. Definition. Asthmatic status is a severe attack of bronchial asthma in which inhaled beta2-adrenostimulants, adrenaline s / c, iv aminophylline and corticosteroids are ineffective. Asthmatic status in 1-3% of cases leads to death, therefore, requires emergency care. B. The provoking factors are the same as in a normal attack of bronchial asthma - contact with allergens,
- Asthmatic status
This is a severe attack of bronchial asthma, which often develops if the disease is not amenable to medical treatment. The patient experiences severe malaise and severe shortness of breath. If urgent measures are not taken and the patient is not provided with oxygen, bronchodilators are not administered to him, and corticosteroid drugs are not used, a person may die from acute respiratory
- Asthmatic condition
An asthmatic condition (AS) differs from an attack of bronchial asthma in a qualitatively different content. In AS, conventional methods of therapy do not have a sufficient effect. AS in both children and adult patients is potentially life-threatening, requires complex treatment, which should be carried out in ICU. Pathogenesis. In the pathogenesis of AS along with severe bronchospasm, swelling of the mucous membrane
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- Asthma Respiratory Support
One of the common causes of the development of obstructive ARF is an asthmatic condition (crisis, status) in patients with bronchial asthma. As you know, the main difference between asthmatic status and a prolonged attack of bronchial asthma is the addition of severe bronchial obstruction refractory to therapy to bronchospasm. Moreover, it is obstruction that is the main link in the pathogenesis of crisis. At
- Dyspnea. Asthmatic attack
Shortness of breath (violation of the frequency and depth of breathing) in those cases when it manifests itself suddenly, increases rapidly, poses a threat of asphyxiation or is in the nature of an asthma attack, is an important symptom of acute respiratory and circulatory diseases requiring emergency care. Subjectively shortness of breath is perceived by the patient as a lack of air, a feeling of tightness in the chest, anxiety.
- Asthmatic status [status asthmaticus]
ICD-10 code J46 Diagnostics Diagnosis Mandatory Level of consciousness, respiratory rate and effectiveness, heart rate, blood pressure, presence of paradoxical pulse, involvement of auxiliary muscles, ability to lie down, body temperature, skin color Laboratory tests: hemoglobin, blood glucose , white blood cells, blood count Additional (according to indications)
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- Acute respiratory distress syndrome. Asthmatic status. Mendelssohn Syndrome
1. Patient S., 65 years old, suffers from bronchial asthma (hormone-dependent) for 15 years. The last attack of suffocation continues the second day. I called an ambulance twice. She was admitted to the intensive care unit in an asthmatic state (stage II). Name the diagnostic criteria of stage II status, determine the sequence of IT. 2. Patient K., 40 years old, was admitted to the surgical clinic