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Löffler Syndrome
Löffler's Syndrome

Presentation

After ivermectin therapy, he re-presented with respiratory symptoms, peripheral eosinophilia and transient pulmonary infiltrates; the classic triad of Löffler's syndrome associated with invasive helminth infection. [ncbi.nlm.nih.gov]

However, he then presented with an exacerbation of his asthma, which raised a suspicion of an additional pulmonary reaction. [escholarship.org]

Cough is the most common symptom, which is generally dry and nonproductive but might be productive or even present with small amounts of blood-tinged mucoid sputum. A less common presentation is accompanied by myalgia, anorexia, and urticaria. [wikidoc.org]

A case of clonorchiasis with clinical presentation of eosinophilic pneumonia. Tuberculosis and Resp dis 46:643–6481998. [kjim.org]

Entire Body System

  • Fever

    Cause(s) : Parasites such as Strongyloides Stercoralis, Dirofilaria immitis Drug-Induced due to drugs like antimicrobials, anticonvulsants, anti-inflammatories, etc Symptoms : Symptoms related to: Parasitic infection Fever and body pain Cough, wheezing [medindia.net]

    Loeffler's syndrome A form of patchy pneumonia featuring fever, cough, difficulty in breathing, associated with a marked rise in the numbers of EOSINOPHIL white cells in the lungs and the circulating blood. [medical-dictionary.thefreedictionary.com]

    The symptoms of Löffler syndrome usually develop 10-16 days after ingestion of Ascaris eggs, or N americanus, A duodenale, S stercoralis infection, and start with common symptoms such as fever, malaise, cough, wheezing, and dyspnea. [wikidoc.org]

    It should be considered a differential diagnosis in case of fever, asthma-like symptoms, BPI and living in endemic areas for parasitic infections, such Brazilian Amazon ( ). [ijidonline.com]

    The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. [ncbi.nlm.nih.gov]

  • Asymptomatic

    It is often asymptomatic, but can also present with mild to moderate pulmonary symptoms. [journals.lww.com]

    Patients usually are only mildly ill or asymptomatic and recovery occurs from few days to some months. [minervamedica.it]

    Red Cross Children’s Hospital and University of Cape Town, South Africa Share this article Abstract Löffler’s syndrome was initiallydescribed as a disorder characterisedby transient pulmonary infiltratesaccompanied by peripheral bloodeosinophilia in asymptomatic [sajr.org.za]

    Most infections are asymptomatic, although non-specific gastrointestinal tract symptoms like abdominal pain, nausea, vomiting, dry cough may occur in some patients. [ncbi.nlm.nih.gov]

Respiratoric

  • Cough

    After discharge, his symptoms decreased but persisted for several weeks and coughed a substance up by sputum expectoration (Fig. 1). [ncbi.nlm.nih.gov]

    The symptoms of Löffler syndrome usually develop 10-16 days after ingestion of Ascaris eggs, or N americanus, A duodenale, S stercoralis infection, and start with common symptoms such as fever, malaise, cough, wheezing, and dyspnea. [wikidoc.org]

    Cause(s) : Parasites such as Strongyloides Stercoralis, Dirofilaria immitis Drug-Induced due to drugs like antimicrobials, anticonvulsants, anti-inflammatories, etc Symptoms : Symptoms related to: Parasitic infection Fever and body pain Cough, wheezing [medindia.net]

    Loeffler's syndrome A form of patchy pneumonia featuring fever, cough, difficulty in breathing, associated with a marked rise in the numbers of EOSINOPHIL white cells in the lungs and the circulating blood. [medical-dictionary.thefreedictionary.com]

  • Dyspnea

    He had not such symptoms as cough or dyspnea. In routine laboratory studies, eosinophilia was noted. Radiographic changes were transient and disappeared by day 25. Eosinophilia was also transient and gradually returned to normal level by 2 months. [ncbi.nlm.nih.gov]

    The symptoms of Löffler syndrome usually develop 10-16 days after ingestion of Ascaris eggs, or N americanus, A duodenale, S stercoralis infection, and start with common symptoms such as fever, malaise, cough, wheezing, and dyspnea. [wikidoc.org]

    Cause(s) : Parasites such as Strongyloides Stercoralis, Dirofilaria immitis Drug-Induced due to drugs like antimicrobials, anticonvulsants, anti-inflammatories, etc Symptoms : Symptoms related to: Parasitic infection Fever and body pain Cough, wheezing, dyspnea [medindia.net]

    There may be cough, wheezing, dyspnea, bronchitis, chest pain, fever, weight loss, fatigue. Duration may be weeks to month and remissions and recrudescences are common. [atulchoube.wordpress.com]

  • Sputum

    Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. [ncbi.nlm.nih.gov]

    Sputum analysis or gastric lavage may occasionally show larvae of Ascaris or the other parasites with pulmonary cycle. Electrocardiogram There are no ECG findings associated with Löffler syndrome. [wikidoc.org]

    Sputum, blood, urine, stool stain, and cultures were all negative for bacterial, mycobacterial, fungal, and parasitic pathogens. Intermediate PPD skin testing was negative with a positive control. Sputum Wright stain revealed numerous eosinophils. [go.gale.com]

    Symptoms related to: Parasitic infection Fever and body pain Cough, wheezing, dyspnea Drug-induced pulmonary eosinophilia Dry cough, breathlessness Fever Diagnosis and Tests : Differential CBC count Stool examination Immunoglobin E level Analysis of sputum [medindia.net]

    Definition / general Acute eosinophilic pneumonia with transient diffuse pulmonary infiltrates composed primarily of eosinophils and serum eosinophilia Characteristic imaging findings, so biopsy is rarely performed Eosinophils may be present in sputum [pathologyoutlines.com]

  • Dry Cough

    Löffler syndrome is a form of eosinophilic pulmonary disease characterized by absent or mild respiratory symptoms (most often dry cough), fleeting migratory pulmonary opacities, and peripheral blood eosinophilia. [msdmanuals.com]

    dyspnea Drug-induced pulmonary eosinophilia Dry cough, breathlessness Fever Diagnosis and Tests : Differential CBC count Stool examination Immunoglobin E level Analysis of sputum or gastric lavages Bronchoalveolar lavage Chest X-ray Chest CT scan Specialist [medindia.net]

    Clinical findings Chest pain, dry cough, fever, malaise, tachypnoea, dyspnoea, rash, wheezing. Imaging Diffuse infiltrates on plain AP film. Bronchoscopy Increased eosinophils. Management APE may respond to corticosteroids. [medical-dictionary.thefreedictionary.com]

    We report a case of a 33-year-old man who presented with a four-day history of fever, dry cough and mild dyspnea in a Brazilian Amazon emergency department. Lung auscultation was normal. [ijidonline.com]

  • Pleural Effusion

    Pleural effusions resolve more slowly than parenchymal opacities. Click here for Patient Education NOTE: This is the Professional Version. [msdmanuals.com]

    Small pleural effusions occur in two thirds of patients and are frequently bilateral. HRCT is always abnormal with bilateral, random, patchy ground-glass or reticular opacities. Pleural fluid examination shows marked eosinophilia with high pH. [merckmanuals.com]

    Pleural effusions and lymphadenopathy are not features. Treatment and prognosis The condition is usually self-limiting and treated conservatively. Opacities typically resolve spontaneously within approximately a month 3,5. [radiopaedia.org]

    Pleural effusions is not common in Loeffler syndrome, but there are reports of pleural effusion in patients with drug-induced pulmonary eosinophilia. [wikidoc.org]

    Computed tomography of the chest showed bilateral pleural effusion and a large left ventricular mass (Figure 2). [hindawi.com]

Musculoskeletal

  • Fracture

    HISTORY AND CLINICAL FINDINGS: A 28-year-old man, who had sustained a traumatic displaced fracture of the left lateral clavicle requiring operative realignment, was admitted to hospital because of the incidental finding of pathological electrocardiographic [rwjms1.umdnj.edu]

Skin

  • Eruptions

    We have had the opportunity of observing 9 cases of creeping eruption in the dermatology wards and clinics of the Army Service Forces Regional Hospital, Camp Blanding, Florida, that have developed transient pulmonary infiltration during the course of [jamanetwork.com]

    Left foot, with a ‘creeping eruption’ on the lateral side and with extensive vesicle/bullae formation. [escholarship.org]

    Abstract Summary Three cases of persons who had “creeping eruption” or “cutaneous larva migrans” and developed psychoses manifested as severe mental depressions and findings suggestive of Loeffler's syndrome are presented. [ajtmh.org]

    Wright DO, Gold EM: Loeffler’s syndrome associated with creeping eruption (cutaneous helminthiasis). JAMA 1945;128:1082–1083. Le Coulant P, Texier L, Tamisier JM, Geniaux M: Cutaneous larva migrans and Loeffler’s type of pulmonary infiltrate. [karger.com]

  • Skin Rash

    The clinical picture Develop skin rashes in the form of blisters, sometimes a maculopapular nature and swelling. Patients complain of a general state of disorder, namely, fever, malaise, cough, shortness of breath. [dixion-healthcare.com]

    Some people develop abdominal pain, bloating, heartburn, intermittent episodes of diarrhea and constipation, a dry cough, and skin rashes. Rarely people will develop arthritis, kidney problems, and heart conditions. [cdc.gov]

    There was no lymphadenopathy, skin rash, jugular venous distension, clubbing, or pedal oedema. Swelling of the proximal interphalangeal joints consistent with rheumatoid arthritis was noted. [thorax.bmj.com]

  • Skin Disease

    Most common inchildren suffering from allergic skin diseases (urticaria, eczema) and helminthiasis, amoebiasis or hypersensitivity to drugs (antibiotics, sulfonamides), plant allergens (pollen, etc.). [dixion-healthcare.com]

    Skin diseases, most notably the bullous dermatoses: “Pemphigus, Erythema bullosiim, Erythema iris, Dermatitis herpetiformis, and Herpes gestationis.” 1922 – Koino studied the infections of Ascaris on humans. [litfl.com]

    […] tissue disorders – Scleroderma, polyarteritis nodosa Skin diseases – Dermatitis herpetiformis Inflammatory bowel disease Sarcoidosis Addison disease Clonal eosinophilia Clonal eosinophilia is diagnosed by bone marrow histology, cytogenetics, and molecular [emedicine.medscape.com]

Neurologic

  • Stroke

    He had an embolic stroke 2 months before admission without a defined embolic source. He had history of well-controlled hypertension and allergic asthma treated with theophylline. [ahajournals.org]

    Zhao, “Löffler endocarditis with multiple cerebral embolism,” Journal of Stroke and Cerebrovascular Diseases, vol. 23, no. 6, pp. 1709–1712, 2014. View at: Publisher Site | Google Scholar Q. Zhuang, Z. Y. Zheng, W. [hindawi.com]

    Dyspnea was the most common presenting complaint (64%) followed by fatigue (23%), cough (19%), fever (19%), orthopnea/paroxysmal nocturnal dyspnea (19%), stroke related symptoms (15%), chest pain (15%) and lower extremity edema (15%). [sciepub.com]

    During the thrombotic phase, patients develop cardiac thrombi and present with symptoms and signs based on embolic events such as stroke, or mass effects including secondary mitral regurgitation (MR) and ventricular cavity obliteration, respectively. [frontiersin.org]

Workup

Chest radiography Chest computed tomography (CT) scanning See Workup for more detail. [emedicine.medscape.com]

An extensive workup for conditions associated with hypereosinophilia was negative. The patient had no rash or other evidence of vasculitis. Parasitosis was ruled out with serial negative stool studies and serologies. [ahajournals.org]

Subsequent to two syncopal episodes, a transthoracic echocardiogram was performed as part of the workup, which showed an unusual calcified mass in the left ventricular apical region but separate from the apical myocardium, with normal left ventricular [rwjms1.umdnj.edu]

X-Ray

  • Pulmonary Infiltrate

    A number of conditions are related to pulmonary eosinophilia or pulmonary infiltration with eosinophilia. [kjim.org]

    We report a neonate-boy with pulmonary infiltrates and peripheral blood eosinophilia. He was noted to have abnormal pulmonary infiltrates on a chest X-ray film taken on day 8 after birth when he had vomiting. [ncbi.nlm.nih.gov]

    Full Text: Eosinophilic pulmonary infiltration is an uncommon presentation from cocaine abuse. We present a patient with migratory pulmonary infiltrates and eosinophilia consistent with Loffler's syndrome. [go.gale.com]

  • Chest X-Ray Abnormal

    Description Löffler's disease, or simple pulmonary eosinophilia, was first described in 1932.[1] It is defined as transient respiratory illness associated with eosinophilia and chest X-ray abnormalities. [patient.info]

  • X-Ray Abnormal

    Description Löffler's disease, or simple pulmonary eosinophilia, was first described in 1932.[1] It is defined as transient respiratory illness associated with eosinophilia and chest X-ray abnormalities. [patient.info]

Microbiology

  • Paragonimus Westermani

    westermani Agents in drug-induced eosinophilia Antimicrobials - Dapsone, ethambutol, isoniazid, nitrofurantoin, penicillins, tetracyclines, clarithromycin, pyrimethamine, daptomycin [5] Anticonvulsants - Carbamazepines, phenytoin, valproic acid, ethambutol [emedicine.medscape.com]

    A skin test for Paragonimus westermani was negative, but one for Clonorchis sinensis was strongly positive. Total serum IgE was 1020 IU/mL and Clonorchis-specific IgG antibody by micro-ELISA was 0.27 (<0.25). [kjim.org]

Pleura

  • Pleural Effusion

    Pleural effusions resolve more slowly than parenchymal opacities. Click here for Patient Education NOTE: This is the Professional Version. [msdmanuals.com]

    Small pleural effusions occur in two thirds of patients and are frequently bilateral. HRCT is always abnormal with bilateral, random, patchy ground-glass or reticular opacities. Pleural fluid examination shows marked eosinophilia with high pH. [merckmanuals.com]

    Pleural effusions and lymphadenopathy are not features. Treatment and prognosis The condition is usually self-limiting and treated conservatively. Opacities typically resolve spontaneously within approximately a month 3,5. [radiopaedia.org]

    Pleural effusions is not common in Loeffler syndrome, but there are reports of pleural effusion in patients with drug-induced pulmonary eosinophilia. [wikidoc.org]

    Computed tomography of the chest showed bilateral pleural effusion and a large left ventricular mass (Figure 2). [hindawi.com]

Treatment

Treatment If a cause is found, therapy consists of removing the offending drug or treating the infection with antibiotic or antiparasitic medication. Expectations (prognosis) The disease often resolves without treatment. [medical-dictionary-search-engines.com]

The disease is usually self-limited so it often resolves itself without treatment. Drugs Used to Treat Loeffler's Syndrome The following list of medications are in some way related to, or used in the treatment of this condition. [drugs.com]

Despite treatment, the patient deceased seven days after admission. Autopsy confirmed the diagnosis of Löffler endocarditis. 1. [hindawi.com]

Treatment should aim to eradicate the parasite if it is present, or to stop the triggering drug. [gpnotebook.com]

Treatment should aim to eradicate the parasite if it is present, or to stop the triggering drug. Otherwise, there is no specific treatment as the disease is self-limiting. [gpnotebook.co.uk]

Prognosis

Natural history, complications and prognosis Löffler syndrome generally presents as a mild syndrome which spontaneously resolves after 2-4 weeks. [wikidoc.org]

The importance of this condition, from the point of view of both differential diagnosis and prognosis, induces us to report a case which came under our observation. [jamanetwork.com]

Complications Restrictive cardiomyopathy due to pericardial fibrosis Prognosis Often resolves without therapy; less commonly, it evolves to acute idiopathic eosinophilic pneumonia. [medical-dictionary.thefreedictionary.com]

Treatment and prognosis The condition is usually self-limiting and treated conservatively. Opacities typically resolve spontaneously within approximately a month 3,5. [radiopaedia.org]

Prevention, and Complications Prognosis if untreated, larvae die on own in 2 - 8 weeks if treated, resolution occurs 2 - 3 days after therapy begins Prevention avoid direct skin contact with fecally contaminated soil or sand Complications secondary [medbullets.com]

Etiology

Parasitic infections, especially ascariasis, may be the cause, but an identifiable etiologic agent is not found in up to one third of patients. [msdmanuals.com]

Eosinophilic lung diseases have been given variable names on the basis of etiology, clinical manifestation, and their pathophysiology. [kjim.org]

A1 - BAHK,Y W, PY - 1962/4/1/pubmed PY - 1962/4/1/medline PY - 1962/4/1/entrez KW - LOEFFLER'S SYNDROME/etiology KW - LUNG ABSCESS/parasitology KW - PARAGONIMUS/infection SP - 598 EP - 601 JF - Radiology JO - Radiology VL - 78 SN - 0033-8419 UR - https [wwww.unboundmedicine.com]

AN ETIOLOGIC INQUIRY. N Engl J Med. 1963 Dec 19;269:1357–1364. [PubMed] [Google Scholar] Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group [ncbi.nlm.nih.gov]

Epidemiology

A review of the geographic distribution and epidemiology of leishmaniasis in the New World. ‏ الصفحة 54 - Hendrix TR: Epithelial and other mucosal lesions of the jejunum in giardiasis. Jejunal biopsy studies. [books.google.com]

Löffler's syndrome Microchapters Home Patient Information Overview Historical Perspective Pathophysiology Causes Differentiating Loefflers syndrome from other Diseases Epidemiology and Demographics Risk Factors Natural History, Complications and Prognosis [wikidoc.org]

[citation needed] Epidemiology[edit] This syndrome can be found anywhere. [en.wikipedia.org]

Epidemiology This is an uncommon condition in the UK but is more likely in children and more likely in parts of the world where parasitic infestation abounds. [patient.info]

Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis. 2008;8(5):302-9. [PubMed] 4. Andronikou S, du Toit G, Carrighal M, Argent A. [escholarship.org]

Pathophysiology

Clinical manifestations, pathophysiology, and diagnosis of the hypereosinophilic syndromes. http://www.uptodate.com/home. Accessed July 22, 2016. . [mayoclinic.org]

Pathophysiology It is understood that Löffler syndrome is the result of transpulmonary passage of helminth larvae. [wikidoc.org]

In pathophysiology, Loeffler syndrome is thought to be related to the passage of parasites through the lungs through their life cycle in the human body. [vinmec.com]

Eosinophilic lung diseases have been given variable names on the basis of etiology, clinical manifestation, and their pathophysiology. [kjim.org]

Pathophysiology Löffler syndrome has classically been related to the transit of parasitic organisms through the lungs during their life cycle in the human host. [emedicine.com]

Prevention

Our patient was successfully treated with ivermectin, a corticosteroid cream, and inhalation medication in an early phase, which prevented complications. We present the details of this case and review the literature. [ncbi.nlm.nih.gov]

Retrieved 2018-12-02. ^ Prevention, CDC-Centers for Disease Control and (2017-05-02). "CDC - Strongyloides - General Information - Frequently Asked Questions". www.cdc.gov. Retrieved 2018-12-05. ^ a b c d "Löffler's syndrome". [en.wikipedia.org]

In addition, to prevent as well as to prevent re-infection, each person needs to be built with a sense of good hygiene, wash hands with soap, eat cooked food and drink hot, build a house with a hygienic fecal treatment system birth, combined with educational [vinmec.com]

[…] minus' sign Virchow -triad Use Parentheses water AND (cup OR glass) Add an asterisk (*) at end of a word to include word stems Neuro* will search for Neurology, Neuroscientist, Neurological, and so on Use quotes to search for an exact phrase "primary prevention [read.qxmd.com]

Prevention This is largely the prevention of parasitic infestation in endemic areas. Good hygiene and hand washing before eating are also important. Historical notes Wilhelm Löffler was born in 1887 and died in 1972. [patient.info]

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