Articles, Blog

Eosinophilic Pneumonia Explained Clearly by MedCram.com

November 8, 2019


welcome to another MedCram lecture at
MedCram we’re going to talk today about eosinophils pneumonias this is a
topic that could be a little confusing because there’s a lot of different
entities that have EEO sinha fills in them but before we do that let’s talk a
little bit about the immunology of eosinophils and for that let’s kind of
review a little bit here we’ve talked about the antigen presenting cell in
some of our cell talks remember the antigen presenting cell is going to have
an antigen on its surface and it’s going to present via the major
histocompatibility complex to to a t-cell and specifically it would be a
th2 cell which has a cd4 receptor for the major histocompatibility complex or
MHC 2 okay now that th2 cell has a choice in terms of the kind of cytokines
and interleukins that are going to be secreted so one of them it could be this
il-4 which is really important with plasma cells because what it does is it
takes B cells and causes them to turn into plasma cells and make AI G E and we
can actually hit that antibody with another antibody called Oh Mel is you
mAb and so we can block the effect of that IgE
well another interleukin that the th two cells can produce from that antigen is
il 5 so il 5 directly recruits eosinophils it’s got a nice blue nucleus
and then it’s got these pretty large granules and usually it’s a by lobed
nucleus and so this is v can also be blocked with new Polizzi map so just be aware APC antigen-presenting
cell in the airway combines with a th2 cell via a cd4 MHC 2 and then the th2
cells which are t4 cells essentially can make either il-4 il-5 the il-4 goes on
to make IgE which we’ll see a lot of and the il5 goes on to make a lot of yo
sinha fills or to attract them so let’s talk about the different entities which
all have one thing in common and that is they are associated with eosinophils
okay so we’ve got the airway here let’s divide that into airway and parenchyma
so what are some of the diseases of the lungs that have eosinophils in it well
the first one that comes to mind is asthma so if you were to go down and
look you would see eosinophils and asthma there’s no question about it it
is the majority of the cell type that is found in the airway remember with COPD
we saw neutrophils and these neutrophils were attracted by il-8 whereas these yo
cinephiles are attracted by il5 another thing that you could see there is asana
philic bronchitis so bronchitis without asthma but you take a biopsy or you take
a sample of the airway and you see a lot of eosinophils bronchus centric
granulomatosis is also have us nfl’s of course you’ll also see granulomas the
final one that we want to talk about is allergic bronchopulmonary aspergillosis
so let’s clear the screen and look a little bit more carefully at this
disease entity because I think we need to talk a little bit more about this one
so let’s talk about a bee PA allergic bronchopulmonary aspergillosis so what
you need to know is that a bee PA can occur in people that have bronchiectasis
which is basically a dilatation of the airway which is a great place for fungus
to hang out and what you see is the fungal
elements caused an allergic reaction and the most typical one of course is
Aspergillus that’s why it’s in a BPA but you can’t have other types of fungus but
the most common one is a BPA and that’s the one that they would show you on a
test so be aware that anything that cause cystic or anything that causes
bronchiectasis like cystic fibrosis is going to be what you’re gonna see now
what are you gonna see on x-ray okay typically it’s good to be in the upper
lobes and it’s gonna have this finger glove type of pattern okay so in other
words the bronchi come out and you get this inflammation and bronchiectasis
around it so finger and glove and it’s upper lobe and so what are the real
diagnostic elements that you’re gonna see let’s go to something a little bit
brighter to write down what the diagnostic elements are so the first
thing you’re going to see is a skin test that’s positive for Aspergillus the rest
of the three are all serum blood tests so the next thing you’re going to see is
a positive serum precipitants to Aspergillus the third thing that you’re
going to see is an IgE level that’s very high usually greater than 1000 and then
finally you’re going to see antibodies if you will to Aspergillus IgE and IgG
so you don’t need all four of these things but typically you’ll see two or
three of these things and when you look on the CT scan or high-resolution CT
you’ll see bronchiectasis okay but typically it’s going to be in the upper
lobes a lot of times we see it in the lower lobes and other types of diseases
but here we see it in the upper lobes okay so what’s the treatment
steroids even though this is Aspergillus and we’re worried about invasion and
bleeding and things of that nature because this is an allergic reaction to
fungal elements the primary treatment is steroids
now plus/minus you could also add être Kaunas ole okay which is actually an
anti-fungal but they may ask you which is the more important medicine to add
steroids or itraconazole and steroids are the most important things to add
okay I want to talk to you about Loffler syndrome before we move on to the most
important USNO philic diseases this can be caused by just a number of different
types of issues it can be caused by drugs it can be caused by parasites
parasites okay so typically you’ll see on the x-ray a
fleeting infiltration fever cough and what I want to show here is a
distinction about where you find the eosinophilia so typically you can find
the eosinophilia in the lungs and you can find the eosinophilia in the blood
on a blood test now that’s not always the case but I want to make it clear
that when that is the case I’m gonna write both so both means that it’s gonna
be both in the lungs for instance on a bronchoscopy or in the blood and you
would see that in Loffler syndrome in both so think about Loffler syndrome the
other one that I want to talk about is strongly IDs here you can get an
infiltrate of course this is a parasite Strongyloides is a parasite and again
you’re gonna see both yo cinah philia in the blood and also in the lungs in fact
just about all of the diseases that we’re going to talk about there’s a
Osuna philia in the blood and also in the lungs there is one exception to that
and that is with a cute eosinophils pneumonia which we haven’t talked about
yet but the key here is both strong Leeroy days and Loffler syndrome can the
result in yo sin Ophelia both in the blood and in the lung okay so join us
for the next video where we get into the the more testable material on yoson
Affiliate specifically yoson affiliate in the lung
parenchyma and and their distinctions because there are some fine distinctions
thanks for joining us

5 Comments

  • Reply TrueCourse October 9, 2016 at 8:04 pm

    Thank you!

  • Reply José Miguel Zúñiga Inestroza October 10, 2016 at 12:40 am

    Keep it up! Great job pal!

  • Reply da man October 11, 2016 at 8:45 pm

    CRAM THAT MED

  • Reply MedCram - Medical Lectures Explained CLEARLY April 16, 2017 at 4:37 pm

    We have over 100 hours of free medical videos by Dr. Seheult at www.MedCram.com
    Cardiology, Critical Care, Pharmacology, Pulmonology, Infectious Disease, Acid/Base, Hematology, Radiology, and more…

  • Reply wit engineer September 6, 2019 at 7:16 pm

    They claim e-cigs can cause this. What do you think?

  • Leave a Reply