• Differential diagnosis of new-onset wheezing in adult
  • Assess by anatomy:
    • Extrathoracic upper airway obstruction: postnasal drip syndrome, paroxysmal vocal cord motion, hypertrophied tonsils, supraglottitis, laryngeal edem
    • Intrathoracic upper airway obstruction: tracheal stenosis, foreign body aspiration, benign airway tumor, malignancie
    • Lower airway obstruction: asthma/COPD, chronic obstructive pulmonary disease, pulmonary edema, aspiration, pulmonary embolism, bronchiolitis
  
  
  
  

  Posted 09/22/16 09:25:32 AM by Matthew Cummings

• Classic PFT patterns
  • Obstruction: decreased/normal FVC, decreased FEV1, decreased FEV1/FVC ratio (<70%), normal/increase RV, TLC
  • Restriction: decreased FVC, decreased/normal FEV1, normal FEV1/FVC, decreased TLC
  
  

  Posted 09/22/16 09:30:14 AM by Matthew Cummings

• Eosinophilic pulmonary diseases
  • Infections (helminthic infections)
  • Drug-induced pneumonitis (antibiotics, phenytoin, or l-tryptophan)
  • Inhaled toxins (cocaine)
  • Systemic disorders (eosinophilic granulomatosis with polyangiitis aka Churg-Strauss)
  • Allergic bronchopulmonary aspergillosis
  
  

  Posted 09/22/16 09:32:08 AM by Matthew Cummings

• Strongyloidiasis (S. stercoralis)
  • Endemic in tropics and subtropics (prevalence ~25%) , also occurs sporadically in temperate areas. 
  • Commonly asymptomatic, eosinophilia insensitive for diagnosis
  • Symptoms often waxing, waning
    • GI: Abd pain, bloating (70%)
    • Pulm: SOB, wheeze (50-60%)
    • Skin: pruritis (35%)
  
  

  Posted 09/22/16 09:33:19 AM by Matthew Cummings

• Pulmonary strongyloides
  • Migratory phase
    • Microfilariae migrate from pulmonary capillaries into the alveoli.
    • Peripheral eosinophilia, elevated serum IgE levels.
    • Pulmonary infiltrates with eosinophilia syndrome, asthma without infiltrates.
  • Hyperinfection syndrome
    • Accelerated autoinfection leading to wide-spread dissemination, typically in setting of immunosuppression.
    • ARDS, cavitary lesions, interstitial infiltrates, and fibrotic disease.
  • Management: PO vs. IV ivermectin depending on severity
  
  

  Posted 09/22/16 09:35:37 AM by Matthew Cummings

• For further reading...

  Strongyloidiasis Clinical Review (BMJ)
  Diagnosis and management of strongyloides hyperinfection syndrome
  Eosinophilic Lung Disease: Clinico-radiologic overview
  Practical approach to eosinophilia
  
  

  Posted 09/22/16 09:40:30 AM by Matthew Cummings

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