Löffler syndrome

Löffler syndrome is a transient respiratory

illness associated with blood eosinophilia and
radiographic shadowing(infiltrat)
Löffler'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 Löffler syndrome
listed parasitic infection with Ascaris
lumbricoides as its most common cause.
Pathophysiology
*Löffler 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.
*Thisprocess 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 Löffler 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 Löffler 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 Löffler
syndrome.
*No deaths due to Löffler syndrome have been reported. Löffler
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 Löffler 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.

Parasitic infection
 Symptoms appear 10-16 days after ingestion of Ascaris eggs. A similar
timeframe has been described for Löffler 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.
 Socialand 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 fromparasites,
antibiotics and anti-parasitic medication are the common
treatment.