Figure 2 - uploaded by Ryan Harry Avery
Content may be subject to copyright.
Source publication
Löffler syndrome, a fulminant eosinophilic pneumonitis associated with the larval migratory phase of human parasites, is rarely reported in the United States. A previously healthy 8-year-old male was hospitalized with tachypnea, cough, hypoxemia, and fever of one week's duration. History revealed exposure to pigs on his family's farm in southernmos...
Citations
... Fourteen cases of ascariasis were identified in persons who had contact with pigs in Maine during 2010-2013 [18]. An 8-year-old child was diagnosed with ascariasis complicated by Löffler syndrome, a pneumonitis resulting from migration of Ascaris larvae through the lungs, after contact with pigs on a southern Louisiana farm [19]. While recently reported cases are zoonotic, Ascaris is predominantly a soil-transmitted helminth (STH) that causes infection when eggs from other infected humans are ingested. ...
This review aims to identify and characterize which neglected infections of poverty (NIPs) represent a public health risk in the United States (US) and describe the health disparities these NIPs represent within the US population. Another aim of this review is to describe public health surveillance for NIPs in the US, including potential gaps in surveillance, and suggest actions to mitigate the disparities represented by these infections.
Data are insufficient to reliably estimate prevalence, burden of disease, and provide optimal diagnostics and treatment for various NIPs in the US. Some of these infections have a long history in the US; others emerged more recently and are expected to increase with climate change. Virtually, all NIPs represent racial and economic disparities.
We provide an updated review of risk factors and suggest actions state, Tribal, local, and territorial public health jurisdictions can take now to respond to this uniquely American crisis.
... As first described in 1932 by Wilhelm Loeffler, Loeffler's syndrome typically presents as a triad of respiratory symptoms, an abnormal chest radiograph (with the constellation of ephemeral and migratory pulmonary infiltrates), and peripheral blood eosinophilia [9]. True Loeffler's syndrome is a disease on the spectrum of eosinophilic lung diseases including acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Churg-Strauss syndrome, and hypereosinophilic syndromes [9,10]. ...
... The cause of Loeffler's syndrome was not known by Loeffler in his early description, but circumstantial evidence suggested it might be caused by parasites, fungi, bacterial infections, and agents in drugs or unknown etiology [11]. Among all the possible causes, Ascaris lumbricoides is the most common cause [3,8,10,12,13]. The life-cycle of Ascaris in the human host is complicated, starting with ingestion of infective, larvated Ascaris eggs. After ingestion of Ascaris eggs, larvae hatch in the intestine, cecum, or upper colon, then they go into the bloodstream via the portal system, and migrate to the liver. ...
... After ingestion of Ascaris eggs, larvae hatch in the intestine, cecum, or upper colon, then they go into the bloodstream via the portal system, and migrate to the liver. After that, they are carried to the capillary-alveolar interface of the lung, subsequently migrating through parenchyma and airways where they both cause mechanical tissue damage and stimulate a marked immune response [3,10,14]. Thus, the accumulation of eosinophil-mediated inflammatory reactions within the airways and lung parenchyma occur. The eosinophilic count may be elevated in sputum, peripheral blood, bronchoalveolar, or lung lesions. ...
Loeffler's syndrome is a rare and benign eosinophilic pneumonia which is commonly transient and self-limiting. Herein we report a 12-year-old boy who presented with dry cough, hemoptysis, chest pain, no fever and diminished breath sounds on the right lung. Chest imaging showed a consolidation lesion with bronchograms in the right upper and middle lobes, accompanied by a right free-flowing pleural effusion. Laboratory studies showed elevated C-reactive protein levels, and an eosinophil count of 13.7%. A lung biopsy was performed to diagnose the Loeffler's syndrome. The patient's condition was improving significantly with antibiotic therapy and is now followed up closely.
... piratory illness associated with blood eosinophilia and radiographic shadowing [1][2][3] . Many lung diseases have migratory pulmonary infiltrates [4] , and the term Loffler names, including "simple pulmonary eosinophilia," "cryptogenic eosinophilic pneumonia," "larval pneumonitis," "pulmonary infiltrates with eosinophilia," and "Loffler's pneumonia." ...
Loffler syndrome is an uncommon, self-limited, benign pulmonary eosinophilia that usually lasts less than a month. Abnormal chest radiography occurs in 95% of patients; however, computed tomography findings are not well described. We present clinical features, radiological, and pathological findings of Loeffler's syndrome with secondary bacterial pneumonia in a child. He presented with dry cough, hemoptysis 2 times, chest pain for 1 week. Blood tests revealed high C-reactive protein levels and eosinophilia. On the initial computed tomography (CT) scan, a lesion was discovered at the upper edge of the right lung hilum. The lesion developed in size, together with right pleural effusion, on the repeated CT scan. A lung biopsy revealed a substantial number of inflammatory cells, including eosinophils and neutrophils. After ruling all other possibilities, Loffler's syndrome was confirmed. As a result of antibiotic treatment, favorable outcomes were confirmed by improving clinical symptoms and follow-up chest CT scans. A close combination of pulmonary symptoms, peripheral blood eosinophilia, abnormal chest imaging, and histopathological findings must be taken to confirm the diagnosis of Loeffler's syndrome.
... This disease is also rare in the United States, and most of the reported cases are associated with rural living. 4 All in all, I felt that Löffler's syndrome would be unlikely. ...
A 40-year-old female presented to the emergency department (ED) after the acute onset of dyspnea. The patient was tachypneic with accessory muscle usage and diffuse wheezing on initial examination. Despite aggressive treatment, the patient deteriorated and was intubated. This case takes the reader through the differential diagnosis and systematic workup of a patient presenting to the ED with dyspnea and arrives at the unexpected cause for this patient’s presentation.
... Eventualmente, algumas dessas parasitoses mencionadas ao longo da evolução de seus processos infecciosos, podem cursar com comprometimento respiratório. As larvas dos parasitos Ascaris lumbricoides, Strongyloides stercoralis e ancilostomídeos, durante o seu ciclo biológico, dispõe da capacidade de migrarem ao pulmão e causar eosinofilia pulmonar, ocasionando na Síndrome de Loeffler [17][18] . Além disso, a respectiva doença esta relacionada a uma resposta de hipersensibilidade mediada por eosinófilos (normalmente, elevados a níveis séricos) no intuito de eliminar o parasito infectante, as quais infiltram no parêquima pulmonar, resultando em uma alteração radiológica que ajuda no diagnóstico da mesma. ...
Objetivos: Descrever as características clínicas e imunopatológicas das infecções pulmonares associadas aos parasitos humanos. Métodos: Realização de uma revisão bibliográfica do tipo narrativa, através da busca de artigos publicados em periódicos especializados escritos na língua inglesa e portuguesa, encontrados em bases de dados: Centro América Latina e Caribe em Ciências da Saúde (Lilacs), Scientific Eletronic Library Online (SciELO), Medline, Pubmed, Science Direct. Resultados: Foi possível identificar que os parasitos frequentemente associados às doenças pulmonares são Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, Ancylostoma duodenale, Wuchereria bancrofti, Brugia malayi, o gênero Paragonimus spp., Plasmodium falciparum, Toxoplasma gondii, Schistosoma mansoni, Echinococcus granulosus, Echinococcus multilocularis, Taenia solium e Entamoeba histolytica. As principais características clínicas e imunopatológicas são: febre, dor torácica, eosinofilia pulmonar, nódulos pulmonares, necrose com danos nas paredes alveolares. Escarro com sanguinolento, escarro purulento e fétido pode ser produzido. Medidas de saneamento devem ser adotadas, como lavar as mãos antes das refeições, infraestrutura adequada evitando esgotos à céu aberto, higienizar vegetais e frutas antes de comer, para assim minimizar o contato com esses parasitas. Conclusões: Tais parasitoses são doenças negligenciadas, a ocorrência é devido a falta de saneamento básico e comumente notificadas em países subdesenvolvidos. Palavras-Chave: Doenças parasitárias. Pulmões. Insuficiência respiratória ABSTRACT Objective: Describe the clinical and immunopathological characteristics of lung infections associated with human parasites.
... Treatment with systemic corticosteroids resulted in rapid clinical improvement. Upon further evaluation, the child was diagnosed with Loeffler syndrome based on peripheral eosinophilia (39%), pulmonary eosinophilia by bronchoalveolar lavage (86%), diffuse reticulonodular lung opacities, mixed obstructive and restrictive pulmonary function pattern, profoundly elevated serum Ascaris-specific IgE detected through the ImmunoCAP assay, performed by the ARUP National Reference Laboratory, and a fourfold increase in total serum IgE (3480-11,500 IU/mL) over a 4-day period (Gipson et al. 2016). Strongyloides was excluded using a Strongyloides-specific IgG ELISA also performed by the ARUP National Reference Laboratory and Toxocara infection was excluded through a Toxocariasis Enzyme Immunoassay performed by the Centers for Disease Control and Prevention (CDC). ...
An 8-year-old male from south Louisiana was diagnosed with Loeffler syndrome of suspected Ascaris origin. Further investigation of the farm recovered larvated, infective Ascaris eggs from the soil in drains surrounding pens on the family's small hog farm. Molecular analysis of the recovered eggs, in conjunction with Ascaris-specific IgE, inadequate farm management and sanitation, and behavioral risk factors indicate the patient had an Ascaris suum soil-transmitted infection.
... [14][15][16] Indeed, a number of relatively recent studies have identified Ascaris suum infection and associated pathology (such as Loffler syndrome) to occur (albeit at low levels) in northern European and North American pig farming areas. [17][18][19][20] A more common cause of zoonotic helminth infections comes from Toxocara canis and T. cati which naturally infect dogs and cats. 21 According to recent studies, levels of human exposure to these parasites can vary from 6% to 87% depending on age and local environmental factors. ...
Background:
Animal and human studies indicate that definitive host helminth infections may confer protection from allergies. However, zoonotic helminths, such as Toxocara species (spp.), have been associated with increased allergies.
Objective:
We describe the prevalence of Toxocara spp. and Ascaris spp. seropositivity and associations with allergic diseases and sensitization, in 2 generations in Bergen, Norway.
Methods:
Serum levels of total IgG4, anti-Toxocara spp. IgG4 and Ascaris spp. IgG4 were established by ELISA in 2 cohorts: parents born 1945-1972 (n = 171) and their offspring born 1969-2003 (n = 264). Allergic outcomes and covariates were recorded through interviews and clinical examinations including serum IgEs and skin prick tests.
Results:
Anti-Ascaris spp. IgG4 was detected in 29.2% of parents and 10.3% of offspring, and anti-Toxocara spp. IgG4 in 17.5% and 8.0% of parents and offspring, respectively. Among offspring, anti-Toxocara spp. IgG4 was associated with pet keeping before age 15 (OR = 6.15; 95% CI = 1.37-27.5) and increasing BMI (1.16[1.06-1.25] per kg/m2 ). Toxocara spp. seropositivity was associated with wheeze (2.97[1.45- 7.76]), hayfever (4.03[1.63-9.95]), eczema (2.89[1.08-7.76]) and cat sensitization (5.65[1.92-16.6]) among offspring, but was not associated with allergic outcomes among parents. Adjustment for childhood or current pet keeping did not alter associations with allergies. Parental Toxocara spp. seropositivity was associated with increased offspring allergies following a sex-specific pattern.
Conclusions & clinical relevance:
Zoonotic helminth exposure in Norway was less frequent in offspring than parents; however, Toxocara spp. seropositivity was associated with increased risk of allergic manifestations in the offspring generation, but not among parents. Changes in response to helminth exposure may provide insights into the increase in allergy incidence in affluent countries.
... [14][15][16] Indeed, a number of relatively recent studies have identified Ascaris suum infection and associated pathology (such as Loffler syndrome) to occur (albeit at low levels) in northern European and North American pig farming areas. [17][18][19][20] A more common cause of zoonotic helminth infections comes from Toxocara canis and T. cati which naturally infect dogs and cats. 21 According to recent studies, levels of human exposure to these parasites can vary from 6% to 87% depending on age and local environmental factors. ...
We describe a case of a 2-year-old child who expelled a single adult female Ascaris lumbricoides worm. The patient is from a rural county in Mississippi, USA, with no reported travel outside of the United States. The caregivers in the home practice good sanitation. Exposure to domestic pigs is the likely source of infection.
