welcome to another MedCram lecture at MedCram we're going to talk today
about eosinophils pneumonias this is a topic that could be a little confusing
because there's a lot of different entities that have EEO sinha fills in
them but before we do that let's talk a little bit about the immunology of
eosinophils and for that let's kind of review a little bit here we've talked
about the antigen presenting cell in some of our cell talks remember the
antigen presenting cell is going to have an antigen on its surface and it's going
to present via the major histocompatibility complex to to a
t-cell and specifically it would be a th2 cell which has a cd4 receptor for
the major histocompatibility complex or MHC 2 okay now that th2 cell has a
choice in terms of the kind of cytokines and interleukins that are going to be
secreted so one of them it could be this il-4 which is really important with
plasma cells because what it does is it takes B cells and causes them to turn
into plasma cells and make AI G E and we can actually hit that antibody with
another antibody called Oh Mel is you mAb and so we can block the effect of
that IgE well another interleukin that the th two
cells can produce from that antigen is il 5 so il 5 directly recruits
eosinophils it's got a nice blue nucleus and then it's got these pretty large
granules and usually it's a by lobed nucleus and so this is v can also be
blocked with new Polizzi map
so just be aware APC antigen-presenting cell in the airway combines with a th2
cell via a cd4 MHC 2 and then the th2 cells which are t4 cells essentially can
make either il-4 il-5 the il-4 goes on to make IgE which we'll see a lot of and
the il5 goes on to make a lot of yo sinha fills or to attract them so let's
talk about the different entities which all have one thing in common and that is
they are associated with eosinophils okay so we've got the airway here let's
divide that into airway and parenchyma so what are some of the diseases of the
lungs that have eosinophils in it well the first one that comes to mind is
asthma so if you were to go down and look you would see eosinophils and
asthma there's no question about it it is the majority of the cell type that is
found in the airway remember with COPD we saw neutrophils and these neutrophils
were attracted by il-8 whereas these yo cinephiles are attracted by il5 another
thing that you could see there is asana philic bronchitis so bronchitis without
asthma but you take a biopsy or you take a sample of the airway and you see a lot
of eosinophils bronchus centric granulomatosis is also have us nfl's of
course you'll also see granulomas the final one that we want to talk about is
allergic bronchopulmonary aspergillosis so let's clear the screen and look a
little bit more carefully at this disease entity because I think we need
to talk a little bit more about this one so let's talk about a bee PA allergic
bronchopulmonary aspergillosis so what you need to know is that a bee PA can
occur in people that have bronchiectasis which is basically a dilatation of the
airway which is a great place for fungus to hang out and what you see is the
fungal elements caused an allergic reaction and
the most typical one of course is Aspergillus that's why it's in a BPA but
you can't have other types of fungus but the most common one is a BPA and that's
the one that they would show you on a test so be aware that anything that
cause cystic or anything that causes bronchiectasis like cystic fibrosis is
going to be what you're gonna see now what are you gonna see on x-ray okay
typically it's good to be in the upper lobes and it's gonna have this finger
glove type of pattern okay so in other words the bronchi come out and you get
this inflammation and bronchiectasis around it so finger and glove and it's
upper lobe and so what are the real diagnostic elements that you're gonna
see let's go to something a little bit brighter to write down what the
diagnostic elements are so the first thing you're going to see is a skin test
that's positive for Aspergillus the rest of the three are all serum blood tests
so the next thing you're going to see is a positive serum precipitants to
Aspergillus the third thing that you're going to see is an IgE level that's very
high usually greater than 1000 and then finally you're going to see antibodies
if you will to Aspergillus IgE and IgG so you don't need all four of these
things but typically you'll see two or three of these things and when you look
on the CT scan or high-resolution CT you'll see bronchiectasis okay but
typically it's going to be in the upper lobes a lot of times we see it in the
lower lobes and other types of diseases but here we see it in the upper lobes
okay so what's the treatment steroids even though this is Aspergillus
and we're worried about invasion and bleeding and things of that nature
because this is an allergic reaction to fungal elements the primary treatment is
steroids now plus/minus you could also add être
Kaunas ole okay which is actually an anti-fungal but they may ask you which
is the more important medicine to add steroids or itraconazole and steroids
are the most important things to add okay I want to talk to you about Loffler
syndrome before we move on to the most important USNO philic diseases this can
be caused by just a number of different types of issues it can be caused by
drugs it can be caused by parasites parasites okay
so typically you'll see on the x-ray a fleeting infiltration fever cough and
what I want to show here is a distinction about where you find the
eosinophilia so typically you can find the eosinophilia in the lungs and you
can find the eosinophilia in the blood on a blood test now that's not always
the case but I want to make it clear that when that is the case I'm gonna
write both so both means that it's gonna be both in the lungs for instance on a
bronchoscopy or in the blood and you would see that in Loffler syndrome in
both so think about Loffler syndrome the other one that I want to talk about is
strongly IDs here you can get an infiltrate of course this is a parasite
Strongyloides is a parasite and again you're gonna see both yo cinah philia in
the blood and also in the lungs in fact just about all of the diseases that
we're going to talk about there's a Osuna philia in the blood and also in
the lungs there is one exception to that and that is with a cute eosinophils
pneumonia which we haven't talked about yet but the key here is both strong
Leeroy days and Loffler syndrome can the result in yo sin Ophelia both in the
blood and in the lung okay so join us for the next video where we get into the
the more testable material on yoson Affiliate
specifically yoson affiliate in the lung parenchyma and and their distinctions
because there are some fine distinctions thanks for joining us