Lffler syndrome

(Transient Pulmonary
Infiltrations with Eosinophilia)

 In

1932, William Loeffler,Professor of

Medicine at the University of Zurich,
described the syndrome that bears his
name.
The syndrome is characterized by a mild
group of symptoms, a scarcity of physical
signs, a blood eosinophilia varying from
less than 10 per cent to more than 60 per
cent, a benign course and spontaneous
healing usually within a period of two to
three weeks.

Lffler

syndrome is a transient respiratory

illness associated with blood eosinophilia and
radiographic shadowing(infiltrat)
Lffler's syndrome or Loeffler's syndrome is a
disease in which eosinofil accumulate in the
lung in response to a parasitic infection.
The original description of Lffler syndrome
listed
parasitic
infection
with
Ascaris
lumbricoides as its most common cause;
however, other parasitic infections and acute
hypersensitivity reactions to drugs are included
as etiologies for simple pulmonary eosinophilia.

Pathophysiology
*Lffler

syndrome has classically been related to

the transit of parasitic organisms through the
lungs during their life cycle in the human host.
After ingestion of Ascaris lumbricoides eggs,
larvae hatch in the intestine and penetrate the
mesenteric lymphatics and venules to enter the
pulmonary circulation. They lodge in the
pulmonary capillaries and continue the cycle by
migrating through the alveolar walls. Finally, they
move up the bronchial tree and are swallowed,
returning to the intestine and maturing into adult
forms.

*This

process takes approximately 10-16

days after ingestion of the eggs. Other
parasites, such as Necator americanus,
Ancylostoma
duodenale,
and
Strongyloides stercoralis, have a similar
cycle to Ascaris, with passage of larval
forms through the alveolar walls. These
parasites are not orally ingested but
enter the human host through the skin.

*Researchers initially thought that transit of parasitic

forms through the lung was cardinal in the

pathogenesis of Lffler syndrome; however,
pulmonary eosinophilia has been described in
association with parasites whose life cycle does not
include passage through the alveoli and also in
association with an increasing number of
medications. Additionally, eosinophilic pulmonary
infiltrates have appeared in mice challenged with a
transnasal Ascaris extract. In these situations,
accumulation of eosinophils in the lungs is likely
secondary to immunologic hyperresponsiveness. The
exact immunopathogenic mechanism for this
reaction remains unknown.

Epidemiologi
*Intestinal

helminthiases associated with Lffler syndrome are

distributed worldwide; however, they are more prevalent in
tropical climates, especially in communities with poor sanitary
conditions.
*Because young children are exposed to contaminated soil and
exhibit hand-to-mouth behavior more often than adults, they
have a higher incidence of intestinal helminthiases and Lffler
syndrome.
*No deaths due to Lffler syndrome have been reported. Lffler
syndrome is considered a benign, self-limiting disease without
significant morbidity. Symptoms usually subside within 3-4
weeks or shortly after the offending medication is withdrawn
in drug-induced pulmonary eosinophilia.

Clinic manifestation
* Symptoms of Lffler syndrome are usually mild or absent and tend to

spontaneously resolve after several days or, at most, after 2-3 weeks.
Cough is the most common symptom among symptomatic patients. It
is usually dry and unproductive but may be associated with
production of small amounts of mucoid sputum with eosinophil
( Charcot Leyden Crystal )

Parasitic infection
Symptoms appear 10-16 days after ingestion of Ascaris eggs. A similar
timeframe has been described for Lffler syndrome associated with N
americanus, A duodenale, or S stercoralis infection.
Fever, malaise, cough, wheezing, and dyspnea are the most common
symptoms. Less commonly, the patient may present with myalgia,
anorexia, and urticaria.
Social and travel history should be carefully elicited to identify risk
factors for exposure to parasites.

Drug-induced pulmonary eosinophilia

* Symptoms may start hours after taking the medications

or, more commonly, after several days of therapy.

* Dry cough, breathlessness, and fever are common.
* Obtain a detailed drug history, including prescription and
over-the-counter medications, nutritional supplements,
and illicit drugs.

Medical Care
* If Loeffler's syndrome occurs because of an allergic

reaction a drug, your doctor will most likely tell you to

discontinue the use of the drug.
* If the condition is caused by an infection from fungus or
parasites, antibiotics and anti-parasitic medication are
the common treatment.

* Neva.FA. Basic clinical parasitology,sixth

edition, 1994.
* http://journal.publications.chestnet.org/ on
09/21/2014