Migratory Pneumonia

 

Migratory Pneumonia

PKGhatak,MD

Migratory pneumonia is a group of pulmonary conditions having one common finding in all. In migratory pneumonia, different parts of the lung are infected repeatedly by the same agent. The diagnosis is based on a radiological finding of pulmonary infiltrations located at different lobes or sub-lobes.

There are many and varied causes of migratory pneumonia.

Loffler's syndrome due to visceral larva migration is one of the three top causes of Migratory pneumonia when all the cases are taken together worldwide. Migratory pneumonia results from the migration of larvae of Ascaris lumbricoides, Strongyloides stercoralis, Wuchereria bancrofti, Dirofilaria immitis and Trichinella spiralis. As the larva migrates through the lung an intense eosinophilic inflammation takes place. The patients complain of wheezing, cough, fever, and shortness of breath. Sometimes streaks of blood are present in the coughed-up sputum. Sputum contains many eosinophils. Blood eosinophil count reaches 400 to 800/ul. Chest x-ray shows patchy localized infiltrate one day, in another spot another day if the x-ray is repeated. Other parasites known to produce a similar picture are Toxocara, Schistosomiasis, Paragonimus, and Fasciola hepatica.

In western countries, old people residing in nursing homes often develop this migratory pneumonia from repeated aspiration. Asthmatic bronchopulmonary aspergillosis may produce a similar picture. Cystic fibrosis patients have frequent pneumonia episodes.

Common medications are known to produce migratory pneumonia. These drugs are Penicillin, sulfonamides, Aspirin, and Nitrofurantoin.

Fumes of metals like Nickel Zinc Chloride, Beryllium may present with migratory pulmonary infiltrates.

Primary lung diseases like Alveolar cell carcinoma, alveolar proteinosis, bronchiectasis, and Cystic fibrosis, have these characteristics.

Bronchiolitis obliterans with organizing pneumonia (BOOP) is a special serious infectious disease in children.

Certain diseases caused by auto-antibodies are well-known for these migratory pulmonary infiltrates. These are Goodpasture syndrome, Churg-Straus syndrome, Pulmonary fibrosis in Rheumatoid arthritis, Systemic Lupus erythematosus and polyarteritis nodosa may have a similar pulmonary presentation.

Lastly, an obscure entity known as Cryptogenic organizing pneumonia and small vessel angiitis also have this migratory presentation.

The clinical picture of one entity of Migratory pneumonia varies considerably from the others because of the various nature of etiology. In parasitic diseases and drug induced migratory pneumonia resolves easily when proper medical attention is given. Aspiration pneumonia is a preventable disease but is difficult to achieve because of a shortage of trained manpower. Exposure to metal fumes can be controlled by local ordinances and EPA's efforts.

Migratory pneumonia due to autoimmune diseases takes course according to the response obtained by specific treatment of autoimmune pathology.

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