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15 Cards in this Set
- Front
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New onset asthma at 28 no fever eosinophilia disseminated micronodules in a random pattern = miliary pattern
TB, histo, asthma, hodgkin's, Churgg-strauss |
TB: enigmatic lung dz, chronic, miliary pattern; but no fever, unusual wheezing or eosinophilia
Histoplasma: only eosinophilia if adrenal involvement
asthma: childhood hx, eosinophila < 1000 tho, not miliary
hodgkin's: uncommon, 15% eosinophilia, not miliary
Churg-Strauss: very rare, vasculitis, asthma, eosinophilia, but pt has no extrapulm dz |
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what's the differential of eosinophilia |
allergy and asthma autoimmunity like vasculitis infxn (fungi, parasites with tissue invasion) malignancy esp lymphoid adrenal insuffiency cholesterol embolism syndrome |
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where does TB usually have primary infection?
reactivation? |
reactivation in upper lobes |
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in KY if you're considering TB, you should consider? |
histoplasmosis |
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which fungal infection most commonly associated with eosinophilia? |
coccidioidomycosis but not expected in KY (AZ one) |
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miliary pattern can belong to |
blastomycosis histoplasmosis tuberculosis
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ascaris lumbricoides |
most common helminth infxn** by ingesting eggs (fecal-oral)
migrating larvae through lungs for transient pulm sx (cough) imaging and eosinophilia = Loeffler's syndrome
worms go to lung and coughed up, then swallowed, back to small bowel. Goes away unless reinfected- fecally putting out eggs
if stop eating they migrate. Limited in adults, harder on kids.
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strongyloides |
initial infxn like ascaris with small bowel, lung, cough, swallow cycle: autoinfection occurs unless eradicated as this lays eggs inside pt too. So lifelong, eosinophilia.
Hyperinfxn if immunosuppressed- if lose eosinophilia (so steroids for something else). Invade all over, bringing bowel bacteria with them. Polymicrobial bacteremia.
dermal penetration by larva- ask about where they grew up if poly bacteremia.
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echinococcus |
sheep-dog life cycle, ingest eggs from dog feces. eosinophilia variable
large cysts esp liver and less so in lung. Most asx but may have cough, chest pain, hemoptysis by mass effect. Cyst rupture -> severe allergic rxn (so don't biopsy) |
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ameba |
lung dz by direct extension of liver abscess (10%). Empyema's with chocolate fluid, bronchohepatic fistula, pericardial involvement |
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paragonimus westermani |
eosinophilic pneumonic syndrome initially. Chronic: productive cough, hemoptysis, pleurisy with effusion. Adults encyst in lungs making infiltrates, cavities, and effusions. Eosinophilic pleural effusion
get from ingesting snails/seafood contaminated with it. Asia. |
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filariasis |
mosquito bites you and get it. If enough, they block lymph and get elephantitis (India, Nigeria, Indonesia)
Microfilariae migrate at night at peak mosquito time, so night fever.
early infxn cough, dyspnea, wheezing- tropical pulm eosinophilia. If untx, progresses to pulm fibrosis |
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tropical pulmonary eosinophilia |
from microfilariae migration- Wuchereria bancrofti and Brugai malayi
microfilariae get opsonized by antifilarial ab and cleared by pulm microvasc- get wheezing, cough, dyspnea esp at night (peak migration). Mimics asthma, worse at night.
fever, malaise, weight loss, profound eosinophilia common (unlike asthma) CXR: reticulonodular or miliary in mid and lower lungs. If untx: pulm htn with granulomatous vasculitis -> fibrosis (can be fatal)
official dx: eosinophilia, long exposure hx, high titer anti-filarial ab, lack of microfilariae in blood (cleared so fast), response to tx of diethylcarbamazine (3 wks) |
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schistosoma |
chronic infxn eggs may lodge in pulm aa producing granulomatous arteritis and pulm htn |
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hookworms are similar to ___ except ....? |
ascaris
infx'd not by ingestion but dermal penetration- so going without shoes... |
