LEFFLERA SYNDROME (W. Loffler, Swiss doctor, sort. in 1887; synonym: flying pulmonary infiltrates, eosinophilic pneumonia, eosinophilic infiltrates of a lung) — a combination of tranzitorny infiltrates of the lungs defined at X-ray inspection to a high eosinophilia of blood. Similar infiltrates are found also in other bodies.
It is described for the first time by Leffler in 1932. Meets in all countries rather seldom, in the tropical countries is more often.
Is caused by various pathogenic factors. The main etiol, a factor — invasions helminths (ascarids, ankylostomas, trikhina, flat worms of Taenia saginata, a hepatic fluke, shistosoma, strongiloida, and also a cat's fluke), larvae to-rykh migrate through lungs. Cases of infection of people, especially children, for larvae of Toxocara — an askaridopodobny parasite of dogs and cats are known. Larvae of Toxocara migrate through lungs, but, unlike larvae of ascarids, form cysts in lungs, a liver and other bodies, without reaching a maturity. Process of migration of these larvae can be followed by Hp. Second group etiol. factors of Hp — chemical agents and drugs. Cases of Hp at the prof. are known contact with nickel and zinc and from many drugs both at the prof. contact, and at to lay down. use (penicillin, acetilsalicylic to - that, streptocides, nitrofurans, PASK, radiopaque substances, etc.). Cases of Hp at the women receiving concerning a breast cancer hormonal drugs (testosterone-propionate and hexestrol) in combination with radiation therapy are described. Third group etiol. factors — various exogenous allergens (pollen of plants, disputes of fungi, tobacco, etc.), defiant atopic diseases of the respiratory device (see. Atopy ). Tranzitorny eosinophilic pulmonary infiltrates are described among other manifestations of a serum disease, and also the nodular periarteritis proceeding with a high eosinophilia; there are instructions on their communication with a tuberkulinovy allergy and an amebiasis. Quite often the etiology of Hp remains not clear.
is the cornerstone of a pathogeny of Hp formation of an allergic eosinophilic alveolitis. The immediate type of allergic reaction is most probable (see. Allergy ), to-ry the wedge, currents is confirmed by positive skin tests, and also nek-ry features: «flying» character of infiltrates, their full involution without formation of the centers of a sclerosis. In some cases it is possible to find the increased maintenance of IgE in blood serum in the children having an ascaridosis that is characteristic of the diseases caused by allergic reactions of immediate type. Intensive infiltration of tissue of lungs eosinophils and the expressed eosinophilia of blood give the grounds to assume that at Hp the special role in formation of the centers of an allergic inflammation belongs to an eosinophilic chemotactic factor of an anaphylaxis (see. Mediators of allergic reactions ). Formation of high credits of precipitant antibodies to antigens in some cases in Hp is explained, apparently, by participation of the allergic reactions developing as Artyus's phenomenon (see. Artyusa phenomenon ). In an experiment the eosinophilic pneumonia similar to Hp at rabbits, sensibilized by horse serum after the allowing intratracheal injection of this serum is got.
A clinical picture
in a wedge, a picture of Hp infiltrates in lungs are the Most characteristic, to-rye come to light at rentgenol, a research, and an eosinophilia of blood (from 7 to 70%) at moderately expressed leukocytosis. Complaints and symptoms (small dry cough, an easy indisposition, weakness, perspiration, subfebrile temperature) can be absent or be very scanty. Perkutorno at extensive infiltrates is defined shortening of a pulmonary sound. Auskultativno occasionally listens in a small amount wet small-bubbling rattles. More often the upper share of the right lung is surprised. The combination of eosinophilic pulmonary infiltrates to dry is described pleurisy (see), at the same time there can be pains at breath in the corresponding half of a thorax and be listened a pleural rub. Symptoms of a prodromal stage can proceed in the form of a catarral nasopharyngitis. Sometimes temperature reaches 38 — 39 °. In a phlegm if it separates, eosinophils are defined preferential.
The easy current is characteristic of a disease. Spontaneous recovery occurs in several days or 2 — 4 weeks. Infiltrates keep more for a long time, possibly when reactions as Artyus's phenomenon participate in a pathogeny, in addition to anaphylactic reactions. Complications, as a rule, do not happen.
At localization of eosinophilic infiltrates in other bodies lungs quickly - passing symptoms of defeat of appropriate authorities and systems — gastritis, pancreatitis, appendicitis, an encephalomeningitis, etc. — in combination with an eosinophilia of blood are usually observed.
the Diagnosis is established on the basis rentgenol, given with their characteristic bystry dynamics and existence of the expressed eosinophilia of blood. Often Hp comes to light accidentally at a preventive rentgenol. inspection.
Etiol, the diagnosis is more difficult; apply skin testing by the allergens prepared from helminths, pollen of plants, a dispute of fungi (see. Skin tests ); serol, tests — reaction precipitations (see) in various modifications and reaction of binding complement (see), and also cellular tests, such as reaction of degranulation of basophiles according to Shelley (see. Basphilic test ) and reaction of degranulation mast cells (see) with the corresponding allergens. Professional «nickel» Hp is usually combined with allergic contact dermatitis, the compresseal (application) test with nickel at the same time positive. In the cases caused by intestinal parasites it is possible, but not always, to find eggs of parasites in Calais, i.e. at primary invasion migration of larvae through lungs happens before achievement by parasites of a maturity and allocation of eggs. However this method can be applied counting on a possibility of the invasion preceding that, led edges to formation of Hp. At an invasion larvae of Toxocara parasites do not reach a maturity in a human body therefore eggs in Calais are not found.
The most typical rentgenol, manifestation of Hp is the shadow of the single infiltrate located in any department of a lung, small or average intensity and, as a rule, its sizes 3 — 4 cm in the diameter. Form of a shadow usually wrong, outlines indistinct (fig. 1). The surrounding pulmonary drawing is strengthened in connection with a local hyperemia. In most cases the shadow of the corresponding root of a lung is slightly expanded, structural. At a multiprojective research it is possible to establish that infiltrate is located more often in a plashchevidny layer of a lung. In this regard it is quite often possible to reveal a thickening of the pleura located in close proximity to infiltrate. At Hp its disappearance in 1 — 3 day after identification is characteristic of dynamics of infiltrate; on site the former infiltrate within several days there is gradually decreasing strengthening of the pulmonary drawing. Such bystry dynamics gave the grounds to call these infiltrates flying. Less often at Hp the infiltrates taking the form of anatomical structures — segments, shares, and multiple infiltrates meet, to-rye can sometimes be bilateral (fig. 2). Bystry disappearance is typical for all types of infiltrates at Hp. In rather exceptional cases infiltrates can recur. In some cases in the presence of large infiltrates it is possible to find small transudate in a pleural cavity, to-ry resolves within several days.
It is necessary to distinguish eosinophilic infiltrates in lungs at Hp from eosinophilic infiltrates as consequences of the embolism of pulmonary vessels caused by a limfografiya. Availability of infiltrates demands in some cases differential diagnosis with bacterial and virus pneumonia (see), tuberculosis, including miliary (see. Tuberculosis of a respiratory organs ).
To differentiate It is necessary for hp with Vayngarten's syndrome (see. Vayngartena syndrome ) and Ler's syndrome — Kindberg, for to-rogo the acute onset of the illness, septic temperature (keeps for weeks), a fever, perspiration, an eosinophilia and a leukocytosis, radiological — pulmonary infiltrates and a pleural exudate is characteristic. Scarcity and not expressiveness a wedge, symptoms, shall suggest existence of an eosinophilia an idea of Hp. Further tranzitorny character of infiltrates in lungs solves the diagnosis in favor of Hp
If does not come spontaneous recovery, carry out treatment by corticosteroid hormones. A course of treatment begin with a dose 15 — 20 mg a day (in terms of Prednisolonum), every other day lower a dose by 5 mg; the course proceeds from 6 to 8 days. This course happens enough for an absolute recovery.
At Leffler's syndrome caused by a helminthic invasion the corresponding treatment is carried out.
Forecast favorable, recovery can occur without any treatment.
Prevention comes down to a gigabyte. to measures of prevention of helminthic invasions. Patients with atopic diseases of the respiratory device shall avoid contact with the corresponding allergens. At professional character of a sensitization it is necessary to exclude contact with «guilty» allergen.
Specific belongs to measures of prevention of Hp desensitization (see) patients with atopic diseases.
It is necessary to remember also various measures of prevention medicinal allergy (see).
Bibliography: Kurashova M. V. and Belov E. V. Sindr Lefflera, Klien, medical, t. 53, JSii 3, page 13, 1975; L and ndenb r and t of e of N of L. And H and at m about in L. B. Radiological syndromes and diagnosis of pulmonary diseases, M., 1972: I with and N about in - with to and y M. A., and N d and I. M. and Lerner P.P. Damages of lungs at rheumatism and some allergic diseases, Kiev, 1969, bibliogr.; Loffler W. Zur Differential-Diagnose der Lungenin-filtrierungen, Uber fliichtige Succedanin-filtrate (mit Eosinophilie), Beitr. Klin. Tuberk., Bd 79, S. 368, 1932; Teschendorf W., A n a with k e r H. u. T h u r n P. Rontgenologische Differentia! diagnostik, Bd 1, T. 1, Stuttgart, 1975; U d w a d i a F. E. Pulmonary eosinophilia, Progr. Respirat. Res., y. 7, p. 275, 1975.
H. B. Adrianova; L. S. Rozenshtraukh (rents.).