Cystic FibrosisSymptoms, Couses, Treatments

Discount Sarcoidosis

Although sarcoidosis is a disease spread by international experts did not identify the exact causes of their appearance. The disease is associated with the existence of an abnormal immune response, but it raises yet been identified. One of the most important reasons that cases can be studied is the lack of an animal model of this disease and the inability to detect the antigen that causes immune activation. Although studies conducted have been carried out, could not determine who is the agent responsible for the development of granulomas that characterize the disease
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Potential cases were reviewed in all bacterial infections, medications, toxic exposures, genetic factors and autoimmunity. Most experts believe that sarcoidosis is the result of complex interactions between environmental factors and the body more susceptible host. Following of this interaction could activate the immune system, resulting in inflammatory events in various organs, resulting in granulomas.

Because the lesions sarcoidotice (granulomas) in the nodules was found genetic material (DNA and RNA) from Mycobacterium tuberculosis, many scientists have studied the influence of bacteria in the onset of the disease. Other suspected bacteria Propionibacterium acnes, Streptococcus species, Borrelia burgdorferi, mycoplasma, and species Nocardia. According to the analysis are (still) viruses such as Epstein Barr virus, herpes virus, Coxsackie B virus, cytomegalovirus and retroviruses and the factors environmental (chemicals such as beryllium, aluminum, zirconium, titanium).

Important genetic factors, particularly when simtpomele review the severity of the disease and prognosis.Sarcoidosis is a chronic inflammatory disease characterized by an exaggerated immune response to an unknown antigen, but is expected that target the disease in the organs. The main characteristic of the disease, sarcoidosis granuloma probably formed in response to persistent antigenic stimulation (Which produces a permanent incentive to maintain the abnormal immune response), but can not be eliminated (or at least neutralize) effectively.

The inflammatory cascade starts at the local level, being driven by growing cells to release enzymes, cytokines, interleukins, which are only of assault and maintain additional tissue damage. Tissue, lung cancer, in particular, mechanisms that respond to their own aggression, and secrete growth factors, tumor necrosis factor and cytokines.

After this fight standing, chronic inflammation around the local change in capillary permeability (vascular) will alter the mechanisms of cell proliferation, changes that will eventually lead to the appearance of granulomas. Persistent antigenic stimulation appears to be a key factor that maintains this inflammation is responsible for the disease.

Although sarcoidosis can occur in any organ and often affects the lungs, the granulomas can be described in lymph nodes, eyes, ears, skin, liver, joints, nervous system and heart. The interior of the cell granuloma secrete growth factors that promote the development of local fibrosis. This can sometimes be so severe that visceral.Symptoms sufficient cause of sarcoidosis can vary greatly from one patient to another, depending on the organs affected by the disease process. Most patients complain of fatigue, dry cough and shortness of breath, but the disease may include:
– Chest pain, bone pain, pain abdominal
– Fever, malaise, weight loss
– Erythematous nodules, painful, skin;
– Red eyes, visual acuity and reduce hiperlacrimatie;
– Painful joints, swollen;
– Pneumothorax Pulmonary atelectazii;
– Restrictive respiratory syndrome following pleural effusion (pleurisy)
– Painful lymph nodes in the neck, armpits, groin;
– Nasal congestion or hoarseness;
– Pain in the hands, feet, bones or another region. The pain caused by the formation of cysts in the bones;
– Nephrolithiasis;
– Hepatomegaly;
– Heart rhythm disorders (arrhythmias) pericarditis or heart failure;
– Central Nervous System of hearing loss, meningitis, convulsions, headache;
– Psychiatric disorders: psychosis, dementia, depression.

For some patients, symptoms may appear suddenly and are severe from the start, while in others, even when visceral lesions are present, do not cause clinical symptoms (songs appear in routine radiological examinations, or for other reasons). No proof diagnosis of sarcoidosis, the disease is very complex and damage pluriorganica always conduct thorough investigations. For the diagnosis of sarcoidosis is mainly require histological analysis of tissues affected and the presence of X-rays to certify granulomas (nodules).

Although the clinical picture may contain elements of suspicion, the patient should be investigated and ruled out a number of diseases can have similar events. The differential diagnosis based on symptoms clinical and laboratory. The physician should rule out pulmonary infection with granuloma formation evolution (eg, mycobacteria and fungi) and cancer (lymphoma that causes the lymph nodes). Hypercalcemia in sarcoidosis can mimic metabolic diseases, and sometimes joint events can be interpreted as rheumatoid arthritis youth.

General history and physical examination remains important, and to guide the diagnosis and suspicion on the basis of other evidence, might be required. After medical history to determine the patient's symptoms, time of onset and progression of time until presentation, if there were times when symptoms have worsened or improved. patient's underlying disease (over their treatment), risk factors and personal history (previous illness) and disease secondary hereditary (about) should also be clarified. The physical examination may be conducted simultaneously or consecutively in their history.

Following this review You can see the changes happening:
– Respiratory system: It is dullness to percussion, decreased breath sounds due to pleural interpunerii or the presence of calcifications, or pleural thickening;
lymphatic system -: one of the results of physical examinations performed more frequently is the existence peripheral lymphadenopathy. About 70% of children with sarcoidosis have palpable lymph nodes. They are firm, slight pain, (no do not develop much) and no plans in depth, nor the followers of the lymph nodes that covers (top, such as skin, superficial cases);
– The liver and spleen: liver is relatively common, but the liver has only rarely affected;
– Eyes: patients may have (in 90% of cases) iridocyclitis (uveitis or earlier) and interstitial keratitis, band keratopathy, retinal vasculitis. The patient often describes eye pain, photophobia, and look red, irritated, hiperlacrimatie;
– Skin: Over 75% of young children with signs of cutaneous sarcoidosis yellow-brown or purple papules distributed more often in the face. They can become itchy scratching and scratching lesions appear. Other signs include skin lesions such as plaques, found in the trunk, limbs and buttocks. nodular lesions, ulcers, hyper-or hypopigmentation erythema nodosum and subcutaneous tumors and occur frequently. Erythema nodosum is a definition of the signs of skin sarcoidosis, especially in Europe, consisting of nodules painful, red, poorly defined, in front of the leg, accompanied by pain and swelling of the joints adjacent
– Musculoskeletal system: more 50% of patients for signs of arthritis. In a small percentage appears and joint pain (arthralgia), the rupture of intra-articular, and more rarely, bone lesions. Local lesions cysts can occur in the phalanges, metacarpals and metatarsals;
– Endocrine system and kidneys, the renal granulomatosis can cause proteinuria, white blood cell count, hematuria, hypertension and renal failure;
– Cardiovascular system: the patient may experience arrhythmias, changes the driving (due to cardiac granulomas) may occur or pericardial heart valve, papillary muscle dysfunction;
– Nervous system: sarcoidosis may influence the visual axis and 5% of patients, can cause seizures, neurological signs (cranial nerve palsy).

Neurosarcoidoza can manifest as a disorder of the facial nerve (the most common abnormality), optic nerve and the acoustic-vestibular. In children, sarcoidosis can occur in two ways different. A similar form of adults with multisystem frequent lymphadenopathy and lung disease and general signs (fever and altered general condition). Onset early form that occurs in patients younger than 4 years, characterized by the triad of rash, uveitis and arthritis characteristic.

To establish the correct diagnosis to a series of special investigations, including blood tests, imaging tests, biopsies and histopathological analysis. After assessments can be observed in laboratory acute phase reactants, C-reactive protein, an increased ESR (erythrocyte sedimentation rate). Patients can anemia, leukopenia and eosinophilia. 75% of patients may occur hypergammaglobulinemia.

The survey is very useful non-invasive x-ray is observing their bilateral lymphadenopathy is usually fun, but with normal lung parenchyma. High resolution CT chest computed can be very useful in the identification of possible parenchymal lesions hilarious. TB may appear well-defined nodules, which are in contact with the structures of the pleura, interlobular septa and centrilobular distribution with peribronhovasculara (airlines around the parenchyma and vascular structures).

Conventionally, after imaging tests (Radiology), deterioration of pulmonary sarcoidosis organized as follows:
– Stage 0: normal appearance of parenchyma
– Stage 1: adenopathy accompanied hilarious paratraheala bilateral lymphadenopathy;
– Stage 2: adenopathy hilarious bilateral pulmonary infiltrates;
– Step 3: pulmonary infiltrates without adenopathy hilar;
– Phase 4: Fibrosis with advanced hilar retraction, blisters, cysts and emphysema.

Patient II can be done:
– Tests to evaluate lung functionality
– FB: bronchi and inspects the state of the node can remove a piece of tissue for biopsy (to be examined under a microscope), to be determined so if it is a granuloma or infectious lesions. Bronchoscopy involves placing a thin, flexible tube through the main airway to the lungs;
– Biopsy of one of the surveys is essential for diagnosis. Current guidelines recommend the removal of tissue from the body more accessible, which is presented as a nodule granulomatous suspects. Biopsy in children prefer to be harvested from lymph node devices superficial skin lesions, and sometimes the conjunctiva. erythema nodosum biopsy is not recommended, because in this area are not granulomas.

Transbronchial biopsy is recommended for adults and insist on many specimens harvest (4-5) in different regions of the lung accessible. If transbronchial biopsy can not be achieved or not in tissues that can be properly analyzed, can be used to thoracoscopic biopsy or open thoracic cavity. The diagnosis of sarcoidosis is established if the biopsy is established and no caseous granulomatous nature of the nodule. active of the disease may also have areas of fibrinoid necrosis. The diagnosis is based on the exclusion of infectious diseases that could be responsible for symptoms.

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