Changes

==Introduction==

==Introduction==

Pulmonary Infiltration with Eosinophilia (PIE) is a broad term describing an inflammatory lung disease in which the predominant infiltrating cell is the eosinophil. It is thought to be an immune mediated condition where the airway abnormalities are a consequence of a hypersensitivity reaction to an unidentified allergen such as microfilariae of [[Heartworm|heartworms]], [[Lungworm|lungworms]], chronic bacterial or fungal infections (eg, histoplasmosis, [[Aspergillosis|aspergillosis]]), viruses, external antigens, and unknown precipitating factors.

Pulmonary Infiltration with Eosinophilia (PIE) is a broad term describing an inflammatory lung disease in which the predominant infiltrating cell is the [[Eosinophils|eosinophil]]. It is thought to be an immune mediated condition where the airway abnormalities are a consequence of a [[Category:Hypersensitivity|hypersensitivity]] reaction to an unidentified allergen such as microfilariae of [[Heartworm|heartworms]], [[Lungworm|lungworms]], chronic bacterial or fungal infections (eg, histoplasmosis, [[Aspergillosis|aspergillosis]]), viruses, external antigens, and unknown precipitating factors.<br>  

<br> '''Eosinophillic pulmonary granulomatosis''' is a severe type of PIE seen in dogs and is characterized by the development of nodules and hilar lymphadenopathy. It is most often associated with a hypersensitivity reaction to microfilarie in heartworm infection.  

'''Eosinophillic pulmonary granulomatosis''' is a severe type of PIE seen in dogs and is characterized by the development of nodules and hilar lymphadenopathy. It is most often associated with a hypersensitivity reaction to microfilarie in heartworm infection.  

==History & Clinical Signs==

==History & Clinical Signs==

Eosinophillic lung diseases are seen in young and older dogs. It is rare in the cat.

Eosinophillic lung diseases are seen in young and older dogs. It is rare in the cat.<br>  

<br> Affected dogs usually present because of slowly progressive respiratory signs such as a cough, increased respiratory effort and exercise intolerance, wheezing and occasionally haemoptysis may be seen.The cough may be mild or severe, productive or nonproductive, and progressive or nonprogressive. Systemic signs are rarely present but may include anorexia and weight loss. There may be a history of a recurring cough which is unresponsive to antibiotics but often responsive to corticosteroid therapy. The clinical signs may be seasonal in appearance.

Affected dogs usually present because of slowly progressive respiratory signs such as a cough, increased respiratory effort and exercise intolerance, wheezing and occasionally haemoptysis may be seen. The cough may be mild or severe, productive or nonproductive, and progressive or nonprogressive. Systemic signs are rarely present but may include anorexia and weight loss. There may be a history of a recurring cough which is unresponsive to antibiotics but often responsive to corticosteroid therapy. The clinical signs may be seasonal in appearance.<br>  

<br> Severely affected animals may exhibit moderate to severe dyspnoea and cyanosis at rest.

Severely affected animals may exhibit moderate to severe dyspnoea and cyanosis at rest.

==Physical Examination==

==Physical Examination==

==Radiography==

==Radiography==

The most common radiographic finding is a diffuse ''interstitial lung pattern'', a bronchial and/or alveolar pattern may also be visible. ''Eosinophilic Pulmonary Granulomatosis'' results in the formation of nodules, usually with indistinct borders. Consolidation of lung lobs and a hilar lymphadenopathy may also be seen.  

The most common radiographic finding is a diffuse '''interstitial lung pattern''', a bronchial and/or alveolar pattern may also be visible. ''Eosinophilic Pulmonary Granulomatosis'' results in the formation of nodules, usually with indistinct borders. Consolidation of lung lobs and a hilar lymphadenopathy may also be seen.  

==Bronchoscopy==

==Bronchoscopy==

==Treatment==

==Treatment==

Any underlying disease needs to be treated directly. Eliminating the source of the antigen that may the triggering the excessive immune response may result in a cure. The most effective management consists of ''corticosteroids''. When PIE is secondary to heartworm disease or pulmonary parasites, treatment with prednisolone before or during antihelmintic treatment controls the pulmonary signs. Prolonged therapy is often needed when the underlying allergen is unknown starting at a high dose and gradually tapering down. When severe bronchoconstriction is suspected, ''bronchodilators'' or ''b2-agonists'' may be helpful.

Any underlying disease needs to be treated directly. Eliminating the source of the antigen that may the triggering the excessive immune response may result in a cure. The most effective management consists of '''corticosteroids'''. When PIE is secondary to heartworm disease or pulmonary parasites, treatment with prednisolone before or during antihelmintic treatment controls the pulmonary signs. Prolonged therapy is often needed when the underlying allergen is unknown starting at a high dose and gradually tapering down. When severe bronchoconstriction is suspected, '''bronchodilators''' or '''beta 2-agonists''' may be helpful.<br>  

<br> ''Eosinophilic Pulmonary Granulomatosis'' requires treatment with corticosteroids and a cytotoxic agent such as ''cyclophasphamide''.

''Eosinophilic Pulmonary Granulomatosis'' requires treatment with corticosteroids and a cytotoxic agent such as '''cyclophasphamide'''.

==Prognosis==

==Prognosis==

* Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

* Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

[[Category:Allergic Respiratory Diseases]][[Category:To_Do_-_Review]]

[[Category:Allergic Respiratory Diseases]][[Category:Expert_Review]]