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Pulmonary eosinophilic infiltration

Epidemiology

Epidemiological researches were not conducted.

Etiology and pathogeny of a disease

The medicines which are most often causing development of a pulmonary eosinophilic infiltration:
• nitrofurantoin (most often);
• streptocides;
• penicillin;
• Chlorproramidum;
• thiazide diuretics;
• tricyclic antidepressants;
• gidralazin;
• isoniazid;
• p-aminosalicylic acid;
• kromoglitsiyevy acid (seldom), etc.
The pathogeny of formation of eosinophilic infiltrates is a little studied. It is known that nitrofurans promote education autoanitet to albumine with the subsequent immune complex deposition in lungs.

Clinical signs and symptoms of an illness

Clinical manifestations arise on average in 2 hours — 10 days after the beginning of reception of medicines and are characterized by the following symptoms:
• dry cough;
• thorax pain;
• asthma;
• fervescence with a fever;
• arterial hypotonia;
• small tortoiseshell;
• arthralgias.

The diagnosis and the recommended clinical trials

In clinical blood test reveal increase of level of eosinophils.
In a phlegm, bronchoalveolar lavazhny liquid, a pleural exudate (at a puncture) — a large number of eosinophils.
At a X-ray analysis of lungs reveal focal shadows (most often bilateral) or limited blackout of pulmonary fields, sometimes a pleural exudate. "Volatility" is characteristic of eosinophilic infiltrates: for several days the X-ray pattern can significantly change.

Differential diagnosis

It is necessary to carry out differential diagnosis with pneumonia, system vasculites with damage of lungs, a parasitic invasion of lungs, paraneoplastic process. Unlike all these diseases at RODS positive clinicoradiological dynamics (3 — 4 days) after cancellation of medicine and purpose of short course GKS is observed fast.

Principles of treatment of a pulmonary eosinophilic infiltration

Easy current
Prednisolonum in 15 mg/days; in/in 90 — 120 mg/days (before stopping of symptoms)
Medium-weight current
Before stopping of symptoms:
Prednisolonum in 30 mg/days
+
Prednisolonum in/in 90 — 120 mg/days

After achievement of clinical effect:
Prednisolonum
in 15 mg/days of 10 days
Heavy current
Before stopping of symptoms:
Prednisolonum
in 1 mg/kg
+
Prednisolonum
in/in 300 mg/days
After achievement of clinical effect:
Prednisolonum in 1 mg/kg with a dose decline on 5 mg/week before full cancellation

Assessment of efficiency of treatment

Criterion of efficiency of treatment is disappearance of clinical manifestations and radiological changes.

Complications and side effects of treatment

Side effects of system use of GKS are described (see the Bronchospasm and bronchial asthma. Complications and side effects).

Mistakes and unreasonable appointments

At easy forms of a disease prolonged use of GKS is not shown.
At a medium-weight and heavy current use of GKS in very low doses and fast cancellation of these medicines is not proved.

Forecast

The forecast is favorable.

 
"Infectious rhinitis   Pulmonary heart"