Parasitic pneumonia

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Parasitic pneumonia is a type of pneumonia caused by parasites. Pneumonia is an inflammatory condition of the lungs, most commonly caused by bacteria or viruses. [1] Parasites are an uncommon cause of pneumonia, usually affecting immunocompromised individuals or those in underdeveloped countries. [2] In developed countries, it is most common to see parasitic pneumonia in immigrants or recently returning travelers. [3] In recent years, improved hygiene and global socioeconomic conditions have decreased the prevalence of parasitic pneumonias, but susceptibility is increasing due to increased travel, urbanization, and population of immunocompromised individuals. [2]

Contents

This article specifically refers to parasitic pneumonia, and will not discuss other pulmonary conditions caused by parasites. For example, pulmonary malaria may present as acute respiratory distress syndrome but likely not pneumonia.

Signs and symptoms

Parasitic pneumonia can present very differently depending on the individual and involved parasite. [2] The most common symptoms caused by pneumonia include fever, fatigue, cough, shortness of breath, chest pain, and mental status changes. [4] These symptoms are nonspecific for individual causes of parasitic pneumonia, and may be subtle in immunocompromised patients.

Causes

Causes of parasitic pneumonia include:

Pathophysiology

Parasites often have complex life cycles and can infect humans in a number of ways including through insect vectors, contact with soil, or direct ingestion. [3] Parasites can affect the lungs in a number of mechanisms, including as a direct infection, while migrating to other organs, or through an inflammatory response to a toxin (see loeffler's syndrome). [3]

Diagnosis

Diagnosis of pneumonia is often made based on physical exam and radiographic findings. Parasitic pneumonia should be suspected in patients who are immunocompromised and/or recently travelled/immigrated.

Physical Exam

Common physical exam findings of pneumonia include low blood pressure, elevated heart rate, elevated respiratory rate, and low oxygen saturation. Auscultation of the lungs may reveal decreased breath sounds, dullness to percussion, increased resonance, and crackles at the site of pneumonia. [5]

Laboratory findings

Common laboratory findings for parasitic pneumonia includes peripheral eosinophilia, or elevated eosinophil levels on a [[complete blood count. [6] Although this may be present in any parasitic infection, this is a defining feature of Loeffler's syndrome. [7]

Parasites may be detected by specific tests depending on which organ system they affect. Those directly affecting the lung may be detected using sputum cultures. [2] Parasites that pass through the gastrointestinal tract in addition to the lungs may be detected using stool specimen. [2] Additional serologic tests may be used to confirm diagnosis of a specific parasite, however these may be positive for multiple years following successful treatment depending on the species. [2]

Radiography findings

Pneumonia is commonly diagnosed using a chest X-ray. Some common findings include lobar consolidations, interstitial infiltrates, and/or pleural effusions. While these are frequently encountered findings, they are not specific for any one pathogen. [8] Some parasites, however, have specific findings on chest imaging that may reveal the causative organism.

Parasites that directly infect the lungs and form cysts such as echinococcus and paragonimus westermani can present with small lesions on chest X-ray or computerized tomography that may be confused with tuberculosis or malignant disease. [6]

Entamoeba histolytica , which causes amoebiasis, may initially appear on imaging as consolidation of the right lower lung, but may also progress to abscess formation, which can be seen on imaging. [6]

Prevention

There are currently no approved vaccines to prevent parasitic pneumonia. [9] Prevention of many types of parasitic infection involves hand washing, washing of kitchen utensils that come in contact with meat, and thorough cooking of meats. In addition, prevention of specific types of parasitic pneumonia depend on the individual and parasite. For example, prevention of toxoplasmosis involves avoiding contact with cat feces and treatment with antibiotics in patients with AIDS. [3]

Management

Management of parasitic pneumonia is highly variable and is based on the specific parasite, severity of disease, and immunocompromised status of the patient. In general, patients that develop parasitic pneumonia require anti-parasitic medications with a few exceptions. [2] There are multiple anti-parasitic medications available which may either directly kill the parasite or prevent its growth. [10] Typically, these medications will resolve the disease, however in rare cases surgical resection may be required. [2]

Related Research Articles

<span class="mw-page-title-main">Pneumonia</span> Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

<span class="mw-page-title-main">Cough</span> Sudden expulsion of air from the lungs as a reflex to clear irritants

A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.

<span class="mw-page-title-main">Bronchiectasis</span> Permanent enlargement of the lung airways

Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest pain. Wheezing and nail clubbing may also occur. Those with the disease often get lung infections.

<i>Entamoeba histolytica</i> Anaerobic parasitic protist

Entamoeba histolytica is an anaerobic parasitic amoebozoan, part of the genus Entamoeba. Predominantly infecting humans and other primates causing amoebiasis, E. histolytica is estimated to infect about 35-50 million people worldwide. E. histolytica infection is estimated to kill more than 55,000 people each year. Previously, it was thought that 10% of the world population was infected, but these figures predate the recognition that at least 90% of these ball infections were due to a second species, E. dispar. Mammals such as dogs and cats can become infected transiently, but are not thought to contribute significantly to transmission.

Toxocariasis is an illness of humans caused by the dog roundworm and, less frequently, the cat roundworm. These are the most common intestinal roundworms of dogs, coyotes, wolves and foxes and domestic cats, respectively. Humans are among the many "accidental" or paratenic hosts of these roundworms.

<span class="mw-page-title-main">Lower respiratory tract infection</span> Medical term

Lower respiratory tract infection (LRTI) is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue. A routine chest X-ray is not always necessary for people who have symptoms of a lower respiratory tract infection.

<span class="mw-page-title-main">Aspiration pneumonia</span> Medical condition

Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may include lung abscess, acute respiratory distress syndrome, empyema, parapneumonic effusion, and pneumonia Some include chemical induced inflammation of the lungs as a subtype, which occurs from acidic but non-infectious stomach contents entering the lungs.

<span class="mw-page-title-main">Fungal pneumonia</span> Infection of the lungs by fungi

Fungal pneumonia is an infection of the lungs by fungi. It can be caused by either endemic or opportunistic fungi or a combination of both. Case mortality in fungal pneumonias can be as high as 90% in immunocompromised patients, though immunocompetent patients generally respond well to anti-fungal therapy.

<span class="mw-page-title-main">Lung abscess</span> Accumulation of pus in the lungs

Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection.

Viral pneumonia is a pneumonia caused by a virus. Pneumonia is an infection that causes inflammation in one or both of the lungs. The pulmonary alveoli fill with fluid or pus making it difficult to breathe. Pneumonia can be caused by bacteria, viruses, fungi or parasites. Viruses are the most common cause of pneumonia in children, while in adults bacteria are a more common cause.

<span class="mw-page-title-main">Pneumonitis</span> General inflammation of lung tissue

Pneumonitis describes general inflammation of lung tissue. Possible causative agents include radiation therapy of the chest, exposure to medications used during chemo-therapy, the inhalation of debris, aspiration, herbicides or fluorocarbons and some systemic diseases. If unresolved, continued inflammation can result in irreparable damage such as pulmonary fibrosis.

Community-acquired pneumonia (CAP) refers to pneumonia contracted by a person outside of the healthcare system. In contrast, hospital-acquired pneumonia (HAP) is seen in patients who have recently visited a hospital or who live in long-term care facilities. CAP is common, affecting people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung (alveoli) filling with fluid. This inhibits lung function, causing dyspnea, fever, chest pains and cough.

Eosinophilic pneumonia is a disease in which an eosinophil, a type of white blood cell, accumulates in the lungs. These cells cause disruption of the normal air spaces (alveoli) where oxygen is extracted from the atmosphere. Several different kinds of eosinophilic pneumonia exist and can occur in any age group. The most common symptoms include cough, fever, difficulty breathing, and sweating at night. Eosinophilic pneumonia is diagnosed by a combination of characteristic symptoms, findings on a physical examination by a health provider, and the results of blood tests and X-rays. Prognosis is excellent once most eosinophilic pneumonia is recognized and treatment with corticosteroids is begun.

<span class="mw-page-title-main">Aspergillosis</span> Medical condition

Aspergillosis is a fungal infection of usually the lungs, caused by the genus Aspergillus, a common mould that is breathed in frequently from the air, but does not usually affect most people. It generally occurs in people with lung diseases such as asthma, cystic fibrosis or tuberculosis, or those who are immunocompromised such as those who have had a stem cell or organ transplant or those who take medications such as steroids and some cancer treatments which suppress the immune system. Rarely, it can affect skin.

Antiparasitics are a class of medications which are indicated for the treatment of parasitic diseases, such as those caused by helminths, amoeba, ectoparasites, parasitic fungi, and protozoa, among others. Antiparasitics target the parasitic agents of the infections by destroying them or inhibiting their growth; they are usually effective against a limited number of parasites within a particular class. Antiparasitics are one of the antimicrobial drugs which include antibiotics that target bacteria, and antifungals that target fungi. They may be administered orally, intravenously or topically. Overuse or misuse of antiparasitics can lead to the development of antimicrobial resistance.

<i>Pneumocystis</i> pneumonia Medical condition

Pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia (PJP), is a form of pneumonia that is caused by the yeast-like fungus Pneumocystis jirovecii.

Pulmonary hygiene, also referred to as pulmonary toilet, is a set of methods used to clear mucus and secretions from the airways. The word pulmonary refers to the lungs. The word toilet, related to the French toilette, refers to body care and hygiene; this root is used in words such as toiletry that also relate to cleansing.

<span class="mw-page-title-main">Desquamative interstitial pneumonia</span> Medical condition

Desquamative interstitial pneumonia (DIP) is a type of idiopathic interstitial pneumonia featuring elevated numbers of macrophages within the alveoli of the lung. DIP is a chronic disorder with an insidious onset. Its common symptoms include shortness of breath, coughing, fever, weakness, weight loss, and fatigue. In more severe cases, it may lead to respiratory failure, chest pain, digital clubbing, cyanosis, and hemoptysis. Asymptomatic cases are rare.

<span class="mw-page-title-main">Amoebiasis</span> Human disease caused by amoeba protists

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica. Amoebiasis can be present with no, mild, or severe symptoms. Symptoms may include lethargy, loss of weight, colonic ulcerations, abdominal pain, diarrhea, or bloody diarrhea. Complications can include inflammation and ulceration of the colon with tissue death or perforation, which may result in peritonitis. Anemia may develop due to prolonged gastric bleeding.

<span class="mw-page-title-main">Ground-glass opacity</span> Radiologic sign on radiographs and computed tomography scans

Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs. It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process. When a substance other than air fills an area of the lung it increases that area's density. On both x-ray and CT, this appears more grey or hazy as opposed to the normally dark-appearing lungs. Although it can sometimes be seen in normal lungs, common pathologic causes include infections, interstitial lung disease, and pulmonary edema.

References

  1. ↑ "Pneumonia - Causes and Risk Factors | NHLBI, NIH". www.nhlbi.nih.gov. 2022-03-24. Retrieved 2024-12-01.
  2. 1 2 3 4 5 6 7 8 Cheepsattayakorn, Attapon; Cheepsattayakorn, Ruangrong (2014). "Parasitic Pneumonia and Lung Involvement". BioMed Research International. 2014: 1–18. doi: 10.1155/2014/874021 . ISSN   2314-6133. PMC   4068046 . PMID   24995332.
  3. 1 2 3 4 Mason, Robert J.; Broaddus, V. Courtney; Martin, Thomas R.; King, Talmadge E.; Schraufnagel, Dean; Murray, John F.; Nadel, Jay A. (2010-06-09). "Chapter 37: Parasitic Lung Infections". Murray and Nadel's Textbook of Respiratory Medicine E-Book: 2-Volume Set. Elsevier Health Sciences. ISBN   978-1-4377-3553-6.
  4. ↑ Hoare, Zara; Lim, Wei Shen (2006-05-06). "Pneumonia: update on diagnosis and management". BMJ. 332 (7549): 1077–1079. doi:10.1136/bmj.332.7549.1077. ISSN   0959-8138. PMC   1458569 . PMID   16675815.
  5. ↑ Nair, Girish B.; Niederman, Michael S. (November 2011). "Community-Acquired Pneumonia: An Unfinished Battle". Medical Clinics of North America. 95 (6): 1143–1161. doi:10.1016/j.mcna.2011.08.007. PMC   7127066 . PMID   22032432.
  6. 1 2 3 Kunst, H.; Mack, D.; Kon, O. M.; Banerjee, A. K.; Chiodini, P.; Grant, A. (2011-06-01). "Parasitic infections of the lung: a guide for the respiratory physician". Thorax. 66 (6): 528–536. doi:10.1136/thx.2009.132217. ISSN   0040-6376. PMID   20880867.
  7. ↑ Al-Tawfiq, Jaffar A.; Kim, Hojoong; Memish, Ziad A. (2022-11-29). "Parasitic lung diseases". European Respiratory Review. 31 (166). doi:10.1183/16000617.0093-2022. ISSN   0905-9180. PMC   9724914 . PMID   36450370.
  8. ↑ Katz, Douglas S.; Leung, Ann N. (1999-09-01). "Radiology of Pneumonia". Clinics in Chest Medicine. 20 (3): 549–562. doi: 10.1016/S0272-5231(05)70235-5 . ISSN   0272-5231. PMID   10516903.
  9. ↑ Mutapi, Francisca; Billingsley, Peter F.; Secor, W. Evan (March 2013). "Infection and treatment immunizations for successful parasite vaccines". Trends in Parasitology. 29 (3): 135–141. doi:10.1016/j.pt.2013.01.003. hdl: 20.500.11820/ec360ded-5557-40b5-96e2-96d3a964c5e7 . PMID   23415733.
  10. ↑ "Antiparasitic Drugs". Cleveland Clinic. May 6, 2022.
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