Chronic pulmonary eosinophilic infiltration

　　The etiology of chronic pulmonary eosinophilic infiltration syndrome is roughly similar to that of simple pulmonary eosinophilic infiltration syndrome, and some people believe that it is a type of Loffler's syndrome. Among parasites, hookworms and roundworms are the most common causes. Among drugs, furazolidone is the most common. Other causes include coccidioidomycosis, Brucellosis, etc. Many patients have allergic constitution, but the true trigger is unknown.

　　There are dense infiltration of eosinophils and macrophages in the interstitium and alveoli, accompanied by a small amount of lymphocytes and plasma cells. In addition, there are type II epithelial cell hyperplasia, protein exudation in alveoli, fibroblast hyperplasia, and interstitial collagen deposition. Eosinophils can also produce pyrogens, leading to frequent fever symptoms in such patients.

　　The etiology of chronic pulmonary eosinophilic infiltration syndrome is roughly similar to that of simple pulmonary eosinophilic infiltration syndrome, and some people believe that it is a type of Loffler's syndrome. Among parasites, hookworms and roundworms are the most common causes, and among drugs, furazolidone is the most common. Other causes include coccidioidomycosis, Brucellosis, etc. Many patients have allergic constitution, but the true trigger is unknown.

　　1. The cause of hookworm can be dermatitis and pica, while the cause of roundworm can be urticaria and biliary ascariasis.

　　2. The cause of furazolidone can be dermatitis, granulocytopenia, hepatitis, etc.

　　The male-to-female ratio among patients with chronic pulmonary eosinophilic infiltration syndrome is 1:2, most of whom are between 20 and 50 years old, half of whom have allergic constitution, symptoms vary from mild to severe, some may only have chest X-ray abnormalities, and some may be as severe as respiratory failure, the course of the disease is about 1 to 8 months, common symptoms include cough, fever, dyspnea, weight loss, night sweats, fatigue, etc., a few patients may have hemoptysis, more than half of the patients may have wheezing during physical examination, and fine moist rales can be heard.

　　Among the parasites of this disease, hookworms and roundworms are the most common causes, so in daily life, we should pay attention to our dietary hygiene, take a bath regularly, wash hands after defecation, and pay attention to the management of feces in rural areas, do not defecate at will, do not eat spoiled vegetables and fruits, and do not eat uncooked meat products.

　　The following is a brief description of the examinations that should be done for chronic pulmonary eosinophilic infiltration syndrome:

　　1. Chest radiography.Typical X-ray manifestations often have diagnostic value, including three changes:

　　① The exudative shadows unrelated to pulmonary lobes or segments are mainly distributed on the lateral sides of both lungs and show progressive characteristics;

　　② After using adrenal cortical hormones, the exudative foci absorb quickly;

　　③ The clinical symptoms recurrently exude and appear repeatedly.

　　2. Chest CT examination

　　3. Erythrocyte Sedimentation Rate (ESR)

　　4. Blood routine

　　5. Pulmonary function tests.Pulmonary function tests often show restrictive ventilation dysfunction with diffusion impairment and hypoxemia, peripheral blood eosinophil percentage between 10% and 40%, erythrocyte sedimentation rate significantly increased up to 100mm/h, the percentage of eosinophils in bronchoalveolar lavage fluid can be as high as over 40%, while normally less than 1%, all of the above changes can regress after treatment.

　　The dietary principles of chronic eosinophilic pneumonia are briefly described as follows:

　　Firstly, eat

　　1. Foods should be high in nutrition, light, and easy to digest.

　　2. Fluids, especially fruit juices;

　　3. Fresh fruits and vegetables;

　　4. Fatty fish, eggs, and other foods rich in vitamin A.

　　Secondly, avoid eating

　　1. Avoid spicy and greasy foods. Do not eat large fish, meat, and overly greasy products. Patients with this disease should not add spices such as chili, pepper, mustard, Sichuan pepper, etc. to their diet. Quit smoking and drinking.

　　2. It is not suitable to eat sweet and warm fruits such as peaches, apricots, plums, and oranges.

　　3. Avoid cold and cool foods, including various ice drinks, and fruits and vegetables with cool properties, such as watermelons, pears, bananas, kiwis, etc.

　　4. Avoid eating sour foods such as vinegar, sauerkraut, pickled vegetables, and hawthorn, black plum, sour tangerine, etc.

　　5. Avoid eating astringent foods such as white sesame seeds, lotus root nodes, and unripe persimmons, hawthorns, etc.

　　Less than 10% of patients with chronic eosinophilic pneumonia can recover spontaneously. Adrenal cortical hormones are the first-line treatment, commonly using prednisone 30-40mg/d, which can cause a decrease in body temperature and general improvement in condition a few hours after taking the medicine; symptoms such as dyspnea, wheezing, and coughing begin to improve one to two days later; X-ray abnormalities usually improve within 2 days of taking the medicine, and recover within about 2 weeks, and all clinical manifestations can completely disappear after one month of treatment. Considering that the disease is prone to recurrence after discontinuation of medication, it is generally recommended to maintain adrenal cortical hormone treatment for 6-12 months, and some patients may need to take medication for several years. Maintenance treatment usually uses prednisone 10mg/d. If wheezing is significant, theophylline or β2 receptor agonists can be added.