home Drugs Lung infiltration: what is it, what diseases does it occur in? Loeffler's syndrome - eosinophilic infiltrate of the lungs

Lung infiltration: what is it, what diseases does it occur in? Loeffler's syndrome - eosinophilic infiltrate of the lungs

is an allergic-inflammatory lesion of the lung tissue, accompanied by the formation of unstable migrating infiltrates of an eosinophilic nature and the development of hypereosinophilia. The disease usually occurs with malaise, low-grade fever, a slight dry cough, and sometimes with scanty sputum; at acute form- with chest pain, myalgia, development of acute respiratory failure. Eosinophilic pneumonia can be established using X-ray and CT scan data of the lungs, general analysis blood, bronchoalveolar lavage, allergy tests, serodiagnostics. The basis of treatment is specific hyposensitization and hormone therapy.

ICD-10

J82 Pulmonary eosinophilia, not elsewhere classified

General information

Causes

Eosinophilic pneumonia may result allergic reaction to take medications (penicillin, acetylsalicylic acid, sulfonamides, nitrofurans, isoniazid, hormonal and X-ray contrast agents, gold compounds), to contact with chemical agents in production (nickel salts). Atopic sensitization of the respiratory tract to fungal spores (especially Aspergillus genus), pollen(lily of the valley, lily, linden) also contributes to the development of eosinophilic pulmonary infiltrates. Eosinophilic pneumonia may be a manifestation of serum sickness and may be associated with an allergy to tuberculin.

Pathogenesis

The development of eosinophilic pneumonia is mediated by immediate hypersensitivity reactions. In addition to hypereosinophilia, patients’ blood often reveals increased level IgE (hyperimmunoglobulinemia). Mast cells activated by immune (IgE) and non-immune (histamine, complement system) mechanisms and producing allergy mediators (mainly eosinophilic chemotactic factor of anaphylaxis) are responsible for the formation of allergic-inflammatory foci in the lung tissue. In some cases, eosinophilic pneumonia develops due to the production of precipitating antibodies to antigens (Arthus phenomenon-type reactions).

Symptoms of eosinophilic pneumonia

The clinical picture is very variable. Allergic inflammation lungs may have asymptomatic with the absence or very mild severity of complaints and can be determined only by X-ray and clinical laboratory methods. Loeffler's pneumonia often occurs with minimal manifestations, manifesting symptoms of catarrhal nasopharyngitis. Patients feel slight malaise, weakness, fever to subfebrile, a slight cough, often dry, sometimes with slight viscous or bloody sputum, pain in the trachea. With massive hematogenous spread of eggs and larvae of worms in the body, a skin rash, itching, and shortness of breath with an asthmatic component occur. Eosinophilic infiltration of other organs is accompanied by mild, quickly disappearing signs of their damage - hepatomegaly, symptoms of gastritis, pancreatitis, encephalitis, mono- and polyneuropathy.

Acute eosinophilic pneumonia is severe, with intoxication, febrility, chest pain, myalgia, rapid (within 1-5 days) development of acute respiratory failure, respiratory distress syndrome. Typical for the chronic form subacute course with sweating, loss of body weight, increasing shortness of breath, development of pleural effusion.

Eosinophilic pneumonia usually lasts from a few days to 2-4 weeks. Recovery may occur spontaneously. At chronic form the prolonged existence of infiltrates and relapses contribute to the gradual progression of the disease, the development of pulmonary fibrosis and respiratory failure.

Diagnostics

Diagnosis of eosinophilic pneumonia includes X-ray and CT scans of the lungs, a general blood test, stool analysis for worm eggs, bronchoalveolar lavage, allergy tests, serological tests (RP, RSK, ELISA) and cellular tests (basophil and mast cell degranulation reactions). Patients with eosinophilic pneumonia usually have a previous allergy history. Auscultation does not determine a large number of moist fine bubbling rales or crepitus. With extensive infiltrates, there is a noticeable shortening of the pulmonary sound during percussion.

In the acute form of eosinophilic pneumonia, glucocorticoids are used, against the background of which a rapid (within 48 hours) regression of inflammation occurs. The dose of GC is selected individually and reduced gradually to avoid exacerbation. IN severe cases mechanical ventilation and long-term hormonal therapy are required. For bronchial obstruction, inhaled GCs and beta-agonists are indicated. For better expectoration, expectorants are used. breathing exercises. Treatment of concomitant bronchial asthma.

Prognosis and prevention

The prognosis of eosinophilic pneumonia is generally favorable, spontaneous resolution of infiltrates is possible. Correct treatment and observation by a pulmonologist allows you to avoid chronicity of the process and relapses. Prevention of eosinophilic pneumonia comes down to hygiene measures to prevent infection of the body with helminths, monitoring medication intake, limiting contact with aeroallergens, and carrying out specific hyposensitization. If necessary, it is recommended to change jobs.

With certain ailments of the respiratory system, an infiltrate appears in the lungs. In this case, the organ tissues are saturated with cell elements, liquid, and various substances. Lung infiltration does not resemble edema. With swelling, only fluid accumulates in the intercellular space.

The pathology is confirmed after studying the symptoms and diagnostic examination. The disease is detected using radiography and due to the manifested morphological signs, which are identified based on the results of a biopsy.

Infiltrate in the lungs forms in inflamed eyes. The following forms of pathology are distinguished:

leukocyte;
lymphocytic;
eosinophilic;
hemorrhagic.

If an infiltrate forms during germination cancerous tumors, its formation is provoked by malignant, and not inflammatory, processes occurring in the body. Inflammation is not observed in 2 other pathologies - pulmonary infarction and leukemia.

On x-ray it is clear that the lung tissue is increased in volume and its density is increased. The doctor determines infiltration by rounded shadows, localized foci with different outlines, and an enhanced pattern on the lungs.

Causes

Factors causing infiltration include:

Pulmonary infarction rarely leads to infiltration. It occurs against the background of: thromboembolism, hemosiderosis, hemosiderosis, echinococcosis, sarcoidosis. In this case, patients exhibit the following symptoms:

shortness of breath;
cough (wet or dry);
pain that appears when breathing (the symptom occurs if the pleura is damaged).

The doctor conducting the examination notices that one half of the chest lags behind during breathing. The patient hears moist rales and characteristic crunching sounds.

The strength of symptoms depends on the size of the infiltrate, the reasons for its development and the location of the lesions. In case of tumor formations or impaired drainage system bronchi, the respiratory process is slightly weakened, other signs are not detected.

Symptoms and therapy for various pathologies

When an infiltrate is detected lung doctor makes differentiation. He takes into account the patient’s medical history, the course of the disease, and the results of diagnostic tests.

Pneumonia

Pneumonia is caused by various pathogens. Infection occurs under the influence of the following pathogens:

At viral infection a person’s temperature suddenly rises, shortness of breath develops, and a cough with sputum develops. The patient is prescribed:

Antibiotics, antiviral or antifungal medications - depending on the pathogen detected.
Mucolytics are medications with an expectorant effect. They thin mucus and restore lung drainage.
Detoxification drugs.
The temperature is brought down with non-steroidal anti-inflammatory drugs.

The main goal of treatment is to stop inflammation: reduce fever, eliminate shortness of breath, improve the patient’s condition.

Tuberculosis

With tuberculosis, an exudative infiltrate occurs in the lungs. The tissues are not subject to destructive deformations. This secondary pathology. It occurs in 60-70% of people with tuberculosis. This disease is contagious and is classified as a dangerous disease.

The infiltrative form of tuberculosis must be treated immediately. Refusal of therapy ends with the onset of severe consequences which can be fatal.

The symptoms are similar to those that appear with pneumonia:

cough;
elevated temperature;
painful breathing.

Distinctive signs of infiltrative tuberculosis: pulmonary hemorrhage and hemoptysis. Pathology is diagnosed by examining sputum for mycobacterium tuberculosis. If the infiltrative form of the disease develops, the pathogen is detected en masse.

Infiltrative tuberculosis is classified into several types:

Cloud-shaped. Images show blurry shading with blurred outlines. Later, cavities (cavity formations) form on the spot.
Round infiltrate. A spherical spot with distinct edges is visible. Clearing that appears in the center of the lesion indicates tissue necrosis. This change is usually localized in the subclavian region.
Lobular form. Several small spots merge into large shading. Traces of disintegrating tissues are visible in the central part.
Regional infiltration. The image shows extensive damage in the form of a triangle. It indicates a violation of the pleura and the occurrence of tuberculous pleurisy.
Lobit. A huge lesion that has captured a decent part of the lung. The image shows an inhomogeneous spot, often with areas of necrosis.

Treatment of infiltrative pulmonary tuberculosis is carried out only in inpatient conditions . Open tuberculosis dangerous to others, it is transmitted by airborne droplets. The patient is hospitalized in the tuberculosis department. The patient is prescribed:

anti-tuberculosis drugs;
glucocorticoids;
immunomodulators;
antioxidants.

At adequate therapy symptoms disappear after 30 days. Pathogenic bacteria stop secreting after 1-4 months. The phthisiatrician registers the patient, prescribes anti-relapse treatment, and monitors the condition. At closed form patients are treated on an outpatient basis.

Cancer

Early signs of malignant neoplasms poorly expressed. At central shape illness on initial stages the temperature rises, there is pain in the chest, a cough with sputum and blood inclusions opens.

In severe cases, raspberry, jelly-like sputum appears. Disintegrating tissue comes out with it. A growing tumor leads to palpitations, shortness of breath.

TO common features include:

weakness;
blanching of the skin and mucous membranes;
dizziness;
progressive exhaustion.

The diagnosis is made based on the results of a biopsy. You can only get rid of the disease surgically. The lung is excised completely (sometimes with adjacent lymph nodes) or partially. IN postoperative period The patient is irradiated and given a course of chemotherapy. TO similar treatment resorted to if the patient cannot undergo surgery.

Treatment with traditional methods

Folk remedies are prescribed in addition to drug therapy with pulmonary infiltration. They are unable to completely replace medications. Home remedies strengthen the immune system, relieve intoxication, and resolve the infiltrate.

Folk remedies for tuberculosis and pneumonia

Traditional methods help with mild flow diseases. They are used after consultation with your doctor.

Lung infiltration is a severe pathology. It requires accurate diagnosis and immediate treatment. Only under such conditions do patients have a chance of recovery.

Description:

In most patients, pulmonary eosinophilic infiltrate associated with ascariasis and other helminthic infestations is asymptomatic and is detected during preventive fluorographic studies. Body temperature, as a rule, is normal, sometimes it rises to subfebrile levels with normalization within several days. In some patients, the appearance of pulmonary eosinophilic infiltrate is accompanied by malaise, headache, night sweats, cough without sputum or with a small amount of colored sputum. yellow sputum.

Physical examination may reveal a slight shortening of the percussion tone and moist rales over the area of infiltration in the lungs. All of the above symptoms and physical signs disappear quickly, within 1-2 weeks.

Clinical manifestations occur on average 2 hours to 10 days after the start of treatment medicines and are characterized by the following symptoms:
   dry ;
   pain in chest;
   ;
   increased body temperature with chills;
   arterial hypotension;
   ;
   .

Causes:

The pathogenesis of these changes is not well understood. There is an idea about the leading role of sensitization and allergies that arise when helminthic infestation. One of the proofs of this point of view is the increase in the level of IgE in the blood serum of patients.

Pathoanatomical changes consist of the appearance of foci of infiltration in the lungs, which on microscopic examination represent alveolar exudation with a large number of eosinophils. In some cases, perivascular infiltration of leukocytes and minor thrombosis were observed.

Treatment:

The most effective antifilarial drug is diegilcarbamazine. In some patients, spontaneous recovery is possible, but in patients who have not received special treatment, the disease can last for a long time - months and years, with repeated exacerbations, leading to the development of pneumosclerosis.

Pulmonary eosinophilic infiltrates can occur from exposure to drugs and chemical compounds. Pulmonary eosinophilic infiltrates developing under the influence of furadoin, acetylsalicylic acid, azathioprine, chlorpropamide, chromoglycate, isoniazid, metatrexate, penicillin, streptomycin, sulfonamides, beryllium, gold and nickel salts and other compounds have been described. In addition, eosinophilic pulmonary infiltrates may appear after inhalation of pollen from certain plants.

The clinical picture of pulmonary eosinophilic infiltrate that occurs after the use of furadonin is described in particular detail. Lung reactions to furadonin can be acute or chronic. In the acute version of the reaction, 2 hours to 10 days after starting to take furadonin, fever, dry cough, runny nose, and shortness of breath appeared. X-rays usually reveal diffuse changes in the lungs, sometimes focal irregular shape infiltrates in the lungs, the rapid disappearance and migration of infiltrates typical of Loeffler's syndrome were absent, sometimes effusion appears, and the pleural fluid contains many eosinophils. Characterized by an increased content of eosinophils in the blood. In the acute course of the disease, soon after discontinuation of the drug, the eosinophilic infiltrate in the lung disappears. In the chronic course of the disease, the resorption of the pulmonary eosinophilic infiltrate is delayed, and in some cases pneumosclerosis develops in its place.

Treatment. Acute reactions to medications and chemical agents do not require special therapy, and cessation of the action of the factor that caused the pulmonary infiltrate leads to the complete disappearance of signs of the disease. In some cases, with a protracted course of the disease, it is necessary to take glucocorticosteroid drugs.

Pulmonary eosinophilic infiltrates in patients with bronchial asthma are associated in half of the cases with exposure to Aspergillus fumigatus. In some cases, eosinophilic infiltrates are caused by inhalation of plant pollen, house dust, and animals. Dry air contributes to the occurrence of this condition, which causes drying of the mucous membrane of the respiratory organs, the formation of thick mucus in the bronchi and impaired mucus secretion. Changes more often occur in patients with bronchial asthma over 40 years of age and mainly in women.

At morphological study areas of the lungs are found filled with exudate containing a large number of eosinophils, which are also present in the lumen of the bronchi and sometimes infiltrate their walls.

The clinical picture in a significant proportion of patients is characterized by a severe course. An exacerbation of the disease is accompanied by an increase in body temperature, sometimes to high numbers. A characteristic symptom is a cough that can be paroxysmal and is accompanied by thick phlegm in the form of plugs and casts of the bronchi.

Infiltration lung tissue is a thickening in the lungs that is caused by the accumulation of fluid, cells or certain things in the tissues chemical substances. At the same time, the size of the fabric increases and takes on a different shade. Soreness appears in the diseased lung, the density of the lung tissue increases. The tumor infiltrate consists of cancer cells, the main sign of cancer will be infiltration. With chemical infiltration, a compaction is formed due to tissue saturation with drugs or medical alcohol.

Causes of pathology

Infiltrative changes in the lungs are pathological condition which can develop at any age. The main causes of the disease are:

pathogens;
lung injuries;
severe hypothermia;
surgical intervention;
purulent appendicitis;
incorrectly performed injections of medications.

The causative agents of the disease are microorganisms that every person has in oral cavity . The infection can enter the lungs through contact and lymphogenous routes. In the latter case, the cause of the disease can be any infection that is in the body.

Older people and smokers are more prone to the formation of infiltrates.

Symptoms

Infiltration in the lungs is inflammatory process, which occurs with compaction of the lung tissue. This pathological process develops over several days. The disease manifests itself with specific symptoms:

The body temperature is slightly elevated, but this condition continues for a long time.
In some cases, a small tumor is found in the infiltrate area.
Pain appears in the area of the affected lung.
Compared with pneumonia, infiltration of the lungs occurs with less severe symptoms and more smoothly.
The main symptom of the disease is the release of blood when coughing, although coughing occurs very rarely. The presence of blood in the sputum indicates that the infiltrate has begun to decompose.
With this disease the patient skin very pale. This symptom most often indicates infiltrative tuberculosis.

Eosinophilic infiltrates most often occur in the upper lobes of the lungs. It is impossible to immediately determine whether there is liquid in the seal; for this, a series of examinations must be carried out.

Infiltration most often appears with tuberculosis and pneumonia.

Types of infiltration

There are several types of infiltrative changes in the lungs, each of them has its own characteristics of course and treatment:

Inflammatory form. In this case, the seal consists of different cells– leukocytes, erythrocytes, lymphoid cells and others. During treatment, such infiltrates resolve or melt, although they may undergo sclerosis, with further formation connective tissue.
Tumor form. This lump is made up of cancer cells of different nature. This phenomenon happens when malignant tumors, while the infiltrate quickly increases in size.
Chemical form. This condition is typical after lung surgery. Compaction occurs due to the introduction of drugs into the tissue.

During infiltration of lung tissue, part of the lungs is excluded from the respiratory process. If the tissues are compacted over a large area of the lung, then this creates a great threat to human life.

When examining a patient, the doctor may note rapid breathing and a slight lag in the respiratory process of the part of the sternum where the tissue lesion is located.

Diagnostics

The disease is diagnosed based on X-ray data. In the photograph, the seal appears as a darkened area larger than 1 cm in size.. With lobar infiltration, a large area of affected tissue can be seen in the image. The contours of the darkening depend on the form of the disease, as well as the location of the compaction.

With the inflammatory form of infiltration, you can see uneven outlines and a completely irregular shape of the dark part in the picture. A similar infiltrate in the lungs occurs with pneumonia. IN acute phase The disease's outlines are not sharp and gradually transform into the tissues that surround the lungs.

In the chronic form of the disease, the edges of the infiltrate are jagged, but are visible much more clearly. With the pneumonic form of infiltration, two light stripes are often found on the image; these are visible bronchi filled with air.

If the disease is caused pathogenic microorganisms, tissue necrosis is often observed varying degrees gravity. This aggravates the course of the disease.

The main task in diagnosing the disease is to determine the nature of the infiltration in the patient. Lobar inflammation is most often observed with tuberculosis or pneumonia. If the nature of the compaction is tumor, then the entire lobe is not captured by the inflammatory process.

When a patient’s image shows a non-lobar compaction, this condition is differentiated from a malignant tumor. Wherein initial stage The disease is completely asymptomatic, and the person has absolutely no complaints.

On an x-ray, the inflammatory infiltrate differs from a malignant tumor. Seals inflammatory in nature always irregular in shape, while oncological diseases always appear with standard outlines. If the inflammation progresses to outer layer bronchial tissue, then peribronchial infiltration of the lungs is diagnosed.

In addition to X-rays, bronchoscopy is used for diagnosis. This method allows you to detect changes in respiratory organs and exclude some diseases.

What pathologies can cause infiltrates in the lungs?

Infiltrates in the lungs of various types can occur in a number of diseases, both inflammatory and infectious:

Besides, infiltrates can be due to a cyst or gangrene of the lungs. Areas of compaction may continue for some time after treatment for tuberculosis.

Only a correct diagnosis can be made experienced doctor. Therefore, if you have any suspicious symptoms, you should immediately go to the hospital.

Features of treatment

Before starting treatment of infiltration in the lung, it is necessary to properly organize the patient’s daily routine and eliminate excessive physical exercise. Doctors recommend that patients with this pathology follow bed rest until complete recovery. Throughout the illness, the patient should eat healthy and easily digestible food. Products must contain sufficient amounts of vitamins, microelements and carbohydrates.

Antibiotics must be prescribed during treatment different groups. Antibiotic monotherapy is very effective, but caution must be exercised.

You cannot take bacteriostatic and bactericidal drugs at the same time. In this case there may be serious consequences, sometimes already irreversible. When drugs from these two groups interact, the body is exposed to severe toxic effects.

Assign medications taking into account the sensitivity of the pathogen. This is determined by culture of sputum or taking samples of biomaterial during bronchoscopy. Antibiotics are most often prescribed wide range actions, many doctors prefer drugs penicillin group. The patient takes antibiotics until the infiltrate completely resolves.

Antibiotics of the same drug group can be taken for no more than 10 days. After this time, if necessary, the drugs are changed to another drug group. The course of treatment is determined by the attending physician; this indicator can vary significantly depending on the course of the disease.

At long-term use Using the same antibiotics can cause a superinfection that is difficult to treat.

For the treatment of infiltrates in the lungs, the following medications can be prescribed:

antiviral;
diuretics;
expectorants;
mucolytic.

Antiviral drugs can be prescribed together with antibiotics if it is proven that the disease was triggered by viruses, but then complicated by bacteria.

Diuretics are prescribed to eliminate swelling of inflamed tissues. Together with mucolytics, these drugs help restore bronchial function and improve sputum discharge.

Play an important role in the treatment of pulmonary infiltrates physical exercise. The course of exercises is indicated by the attending physician; they must be performed several times a day, while the patient should lie on the side of the infiltrate. The depth of inspiration when performing a set of exercises should be limited. Due to this, they are activated respiratory processes in the intact lung, and peripheral circulation improves.

When treating infiltrates in the lungs, it is very important to follow all the doctor’s recommendations. For malignant tumors, surgery is often indicated.

Traditional methods of treatment

You can supplement the treatment prescribed by the doctor by folk recipes. One of the most preferred methods of treatment is inhalation of garlic vapors.. Garlic contains special components that have a detrimental effect on many pathogens.

To prepare, take several large cloves of garlic, peel them and grate them. The resulting pulp is poured into a small jar and inhaled in pairs for 5-10 minutes. In this case, you need to alternately breathe through your nose and mouth. This procedure must be carried out several times a day.

To strengthen general immunity, the patient can take a mixture of aloe leaves, lemon and honey. To prepare the medicine, take 5 large aloe leaves, keep them in the refrigerator for 3-4 days, then twist them together with one lemon and add 1 glass of honey. Mix everything thoroughly and take 1 teaspoon 3 times a day.

Before using any traditional methods treatment, consultation with a doctor is necessary!

If treatment is started on time, the prognosis is good, especially if there is an inflammatory form of the disease. Oncological diseases lung diseases are asymptomatic at first, so the diagnosis may be made late. To exclude late diagnosis, you need to make it a rule to undergo fluorography once a year.

The pathogenesis of these changes is not well understood. There is an idea about the leading role of sensitization and allergies that arise during helminthic infestation. One of the proofs of this point of view is the increase in the level of IgE in the blood serum of patients.

Pathoanatomical changes consist of the appearance of infiltration foci in the lungs, which upon microscopic examination represent alveolar exudation with a large number of eosinophils. In some cases, perivascular infiltration of leukocytes and minor thrombosis were observed.

Symptoms of pulmonary eosinophilic infiltrate:

Diagnosis of pulmonary eosinophilic infiltrate:

At x-ray examination non-intensive, homogeneous shading of various parts of the lungs without clear boundaries is determined. Shadows can be localized in both or one of the lungs, they can disappear in one place and appear in others. More often the shadows are small in size, but sometimes they spread to almost the entire lung. In most cases, shading disappears after 6-12 days. The formation of cavities in the pulmonary parenchyma and pleural changes are not typical.

Differential diagnosis includes tuberculosis, pneumonia and pulmonary infarction. Distinctive features of pulmonary eosinophilic infiltrate are the ease of the disease, “volatility” and rapid disappearance of pulmonary infiltrates and eosinophilia in the peripheral blood.

The course must include an appointment special means for deworming. Any treatment aimed directly at the pulmonary infiltrate is usually not required, since the infiltrate in most patients disappears after a few days and without special treatment. If the manifestations of the disease are pronounced or persist long time, treatment with corticosteroid hormones may be carried out.

The clinical picture is characterized by a latent onset with the appearance and constant intensification of a cough - dry or with the appearance of a small amount of mucous sputum. The cough is sometimes paroxysmal in nature and is especially pronounced at night. During a cough, some patients develop wheezing and a feeling of shortness of breath. Some patients experience hemoptysis and unspecified pain in the chest. Auscultation of the lungs reveals scattered dry rales.

In half of the patients, diffuse small-focal changes in both lungs are noted on radiographs. Some patients have localized infiltrates in the lungs.

At functional study lungs, predominantly obstructive changes are detected.

Characterized by pronounced eosinophilia in peripheral blood, leukocytosis, the presence of eosinophils in sputum and positive reaction binding of complement to filarial antigen. Filariae can be detected by lymph node biopsy.

Treatment of pulmonary eosinophilic infiltrate:

The most effective antifilarial drug is diegilcarbamazine. In some patients, spontaneous recovery is possible, but in patients who have not received special treatment, the disease can last a long time - months and years, with repeated exacerbations, leading to the development of pneumosclerosis.

The clinical picture of pulmonary eosinophilic infiltrate that occurs after the use of furadonin is described in particular detail. Lung reactions to furadonin can be acute or chronic. In the acute version of the reaction, 2 hours to 10 days after starting to take furadonin, fever, dry cough, runny nose, and shortness of breath appeared. Radiographs usually reveal diffuse changes in the lungs, sometimes focal irregularly shaped infiltrates in the lungs; the rapid disappearance and migration of infiltrates typical of Loeffler syndrome were absent; sometimes effusive pleurisy, and the pleural fluid contains many eosinophils. An increased level of eosinophils in the blood is characteristic. In the acute course of the disease, soon after discontinuation of the drug, the eosinophilic infiltrate in the lung disappears. In the chronic course of the disease, the resorption of the pulmonary eosinophilic infiltrate is delayed, and in some cases pneumosclerosis develops in its place.

Pulmonary eosinophilic infiltrates in patients with bronchial asthma are associated in half of the cases with exposure to Aspergillus fumigatus. In some cases, eosinophilic infiltrates are caused by inhalation of plant pollen, house dust, and animal dander. Dry air contributes to the occurrence of this condition, which causes drying of the mucous membrane of the respiratory organs, the formation of thick mucus in the bronchi and impaired mucus secretion. Changes more often occur in patients with bronchial asthma over 40 years of age and mainly in women.

A morphological examination reveals areas of the lungs filled with exudate containing a large number of eosinophils, which are also present in the lumen of the bronchi and sometimes infiltrate their walls.

The clinical picture in a significant proportion of patients is characterized by severe bronchial asthma. An exacerbation of the disease is accompanied by an increase in body temperature, sometimes to high numbers. A characteristic symptom is a cough, which can be paroxysmal and is accompanied by the discharge of thick sputum in the form of plugs and casts of the bronchi.

Pulmonary eosinophilic infiltrates occur with systemic connective tissue lesions: periarterin nodosa (see p. 379), Wegener's granulomatosis (see p. 357), J. Churg and L. Strauss syndrome (see p. 384).