Loefflers syndrome pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

It is understood that Löffler syndrome is the result of transpulmonary passage of helminth larvae. Helminths, with a pulmonary life cycle are responsible for this syndrome, among them are Ascaris.lumbricoides, Ascaris. suum, Ancylostoma duodenale, Necator americanus, and Strongyloides stercoralis.

Pathophysiology

Pathogenesis

• It is understood that Löffler syndrome is the result of transpulmonary passage of helminth larvae. Helminths, with a pulmonary life cycle are responsible for this syndrome, among them are Ascaris lumbricoides, Ascaris suum, Ancylostoma duodenale, Necator americanus, and Strongyloides stercoralis.
• Pathogen is usually transmitted via the oral route (Ascaris) or penetrate skin (Necator) to the human host.
• Following transmission/ingestion, infecting larvae reach the lungs via the bloodstream, penetrate into alveoli, mature, and ascend the airways before descending the alimentary tract into the small bowel
• Ascaris is the most common cause of Löffler syndrome worldwide. On the other hand, migrating larvae of hookworms (Ancylostoma duodenale, Necator americanus) and Strongyloides are less likely to elicit symptoms or pulmonary eosinophilia.

Associated Conditions

Conditions associated with Loeffler syndrome include:

• Ascaris lumbricoides,
• Ascaris suum, Ancylostoma duodenale,
• Necator americanus,
• Strongyloides stercoralis.

Gross Pathology

• Loeffler syndrome has its own characteristic imaging findings.
• Biopsy is rarely performed
• Diagnosis is based on clinical findings, radiographic findings and evidences of parasite presence in pulmonary secretions.
• Blood-tinged sputum might be presented

Microscopic Pathology

• Eosinophils may be present in sputum
• Eosinophil-derived Charcot-Leyden crystals may be present in blood-tinged sputum
• Stool examinations are generally negative at the time of pulmonary symptoms and thus not useful in the diagnosis of Löffler syndrome.
• Ascaris, Strongyloides, or hookworm larvae might be detected in the respiratory secretions