Polmoniti eosinofile- Malattie polmonari
Table of Contents
Generalità
Le polmoniti eosinofile comprendono un etereo gruppo di condizioni cliniche caratterizzate dalla presenza di due manifestazioni principali, un infiltrato endoalveolare polmonare, persistente o recidivante, e un’intensa eosinofilia, generalmente riscontrabile sia nel sangue periferico e soprattutto nella sede della malattia (quindi nel liquido del BAL).
Cause delle polmoniti eosinofile
Numerosi fattori possono provocare le polmonite eosinofile. Spesso non è possibile individuare alcun agente eziologico. Si parla in questi casi di polmoniti eosinofile idiopatiche. Tra le cause più frequenti di sindrome eosinofila polmonare vanno ricordati:
- parassiti (ascaridi, toxocara, filaria)
- miceti (Aspergillus fumigatus, Candida albicans)
- farmaci (streptomicina, penicillina, sulfamidici, antidiabetici orali)
Da questi vanno tenuti distinti quadri di eosinofilia che talora si associano a forme di asma allergica, come quello da pollini o da allergeni alimentari, in quanto è rarissima in questi casi la presenza di infiltrati polmonari radiologicamente obiettivabili.
Sintomi
Gli elementi comuni a queste sindromi sono l’eosinofilia periferica (variabile dal 10 al 60%) e la presenza di infiltrati polmonari generalmente multipli. Dal punto di vista clinico sono essenzialmente riconoscibili tre modalità di decorso di una pneumopatia eosinofila.
- infiltrati polmonari fugaci a tipo Löffler: più frequentemente a eziologia parassitaria (specie nei bambini) o nell’ambito di una reazione a farmaci, possono decorrere del tutto asintomatici; generalmente queste forme hanno la tendenza a regredire spontaneamente dopo qualche settimana, ma è possibile lo sviluppo di recidive, talvolta in sedi differenti da quelle primitive.
- infiltrati permanenti: spesso in questi casi non è individuabile una precisa eziologia e non di rado queste forme, pur essendo associate una sintomatologia acuta, tendono a evolvere progressivamente verso la fibrosi diffusa.
- infiltrati associati a sindrome asmatica: questo è il tipico caso dell’ Aspergillus broncopolmonare allergica, malattia causata dalla colonizzazione e proliferazione nelle vie aeree del micete Aspergillus fumigatus, che si manifesta con insorgenza periodica e che insorge in pazienti atopici.
Diagnosi
La diagnosi si basa sul riscontro di anticorpi precipitanti (IgG) nel siero dei pazienti affetti e sulla positività dei testi allergometrici verso l’ Aspergillus quali il prick test o il RAST (che evidenzia anticorpi di classe IgE). Nelle forme acute e sintomatiche si può inoltre osservare un aumento degli indici di fase acuta.
Terapia
Corticosteroidi.
La polmonite eosinofila può essere lieve e migliorare anche senza terapia.
Per la forma acuta, di solito è necessario un corticosteroide come il prednisone.
- (Rif. Bibl. Rugarli Medicina Interna Sistematica Sett. Ediz. , Ottobre 2017)
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