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Pleurisy

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Pleurisy is an inflammation of the pleura, the lining surrounding the lungs. It is a symptom not a cause, usually a symptom of infection and the presence of a pathogen or pathogens. Pleurisy, is also known as pleuritis.

Pleurisy is covered in more detail within the overall context of lung diseases in general, as such what follows is only a brief indication of the symptoms and causes.

The same causes can result in other lung diseases such as bronchitis and emphysema/COPD which is why we have treated them all together under the heading of lung diseases.

Symptoms

Pleurisy is inflammation of the membranes (pleurae) that surround the lungs and line the chest cavity. This can result in a sharp chest pain with breathing. Occasionally the pain may be a constant dull ache. Other symptoms may include shortness of breath, cough, fever, or weight loss depending on the underlying cause.

Overall breathing may be very difficult, as breathing in results in pain and even laughing or any form of exercise also causes pain. This symptom is confusing, as it can be mistaken for heart problems or even heartburn.

When the space between the two layers of pleura starts to fill with fluid in a case of pleural effusion, it can ease the chest pain, but instead creates a shortness of breath, since the lungs need room to expand during breathing.

Diagnosis

A doctor uses a stethoscope to listen to the breathing. This method detects any unusual sounds in the lungs. A person with pleurisy may have inflamed layers of the pleurae that make a rough, scratchy sound as they rub against each other during breathing.

This is called pleural friction rub.

Depending on the results of the physical examination, diagnostic tests are sometimes performed. These may include:

A chest x-ray takes a picture of the heart and lungs. It may show air or fluid in the pleural space.
Blood tests can ocasionally detect the cause bacterial or viral infections, or fungal infections. Blood test may not detect toxins or parasites.
Computed tomography (CT) scan provides a computer-generated picture of the lungs that can show pockets of fluid.

Other tests are used for parasites and toxins.

Causes

Chest injuries and surgery

Blunt or penetrating chest injuries can result in inflammation of the pleura as can forms of surgery that affect the pleura. Heart surgery, especially coronary-artery bypass grafting can result in pleurisy.

Viral infection

Viral infections spreading from the lungs to pleural cavity are the most common cause of pleurisy. The inflamed pleural layers rub against each other every time the lungs expand to breathe in air. This can cause sharp pain when breathing, also called pleuritic chest pain.

Viral infections - coxsackievirus, RSV, CMV, adenovirus, EBV, parainfluenza, influenza and so on - can include a host of viruses, not just those normally associated with chest infections such as influenza or the virus that causes the common cold.

It is ESSENTIAL that antiobitics are NOT prescribed if the infection is viral, as not only will antibiotics have no effect, they will reduce the 'good bacteria' in both your intestines and lung, thus reducing your ability to fight infection in general.

Investigation of the lung microbiome is a relatively new field. Although the lungs were classically believed to be sterile, recently published investigations have identified microbial communities in the lungs of healthy humans. At the present time, there are significant methodologic and technical hurdles that must be addressed in ongoing investigations, including distinguishing the microbiota of the upper and lower respiratory tracts. However, characterization of the lung microbiome is likely to provide important pathogenic insights into cystic fibrosis, respiratory disease of the newborn, chronic obstructive pulmonary disease, and asthma. In addition to characterization of the lung microbiome, the microbiota of the gastrointestinal tract have profound influence on the development and maintenance of lung immunity and inflammation. Further study of gastrointestinal-respiratory interactions is likely to yield important insights into the pathogenesis of pulmonary diseases, including asthma. As this field advances over the next several years, we anticipate that studies using larger cohorts, multicenter designs, and longitudinal sampling will add to our knowledge and understanding of the lung microbiome. PMID: 22683412

Bacterial infection

Our lungs contain 'good bacteria', but 'bad' bacteria can cause pleurisy. At the moment what is good and what is bad is a subject of intense study in which many previous assumptions have had to be thrown out of the window. The same bacteria that cause pneumonia and tuberculosis may indeed cause pleurisy, but until the lung biome has been more accurately mapped, the difference between a 'good' bacteria and a 'bad' one can no longer be stated with surety

Recent development of high-throughput sequencing methods has shown that the human respiratory tract (including lower airways) is not sterile as formerly thought, but composed of a previously unappreciated complex microbial community referred as the lung microbiome and composed of bacteria, viruses and fungi. However, many questions remain unresolved, especially in terms of lung microbiome role, its interactions with host but also with environmental pathogens. Although data are still limited, links have already been demonstrated between lung microbiome and chronic respiratory diseases (such as asthma, chronic obstructive pulmonary disease or cystic fibrosis). This lung microbiome appears to play an important role both in disease genesis and evolution, and consequently offers an emerging research field. PMID: 26576604

If alternative treatment can be offered and the person is not sinking, medication is thus best avoided. As with viral infections, it is ESSENTIAL that antiobitics are NOT prescribed, as the antibiotics will reduce the 'good bacteria' in both your intestines and lung, thus reducing your ability to fight infection in general.

Fungal infection

Pleurisy can be caused by fungal infection, and fungal inhalation. A range of fungi are implicated - Penicillium glabrum (formerly called Penicillum frequentans) Chrysonilia sitophilia, Aspergillus fumigatus and Mucor macedo, plus many others, for example:

Four cases of fungal pleurisy diagnosed by medical thoracoscopy at Beijing Chaoyang Hospital from April 2005 to December 2012 were retrospectively studied. There were 3 males and 1 female with an age range of 43-73 years. The time from initial onset to definite diagnosis was 17 days to 4 months. Among them, two were previously healthy while another two had underlying diseases. The diagnoses were mucor pleuritis (n = 1) and aspergillus (n = 3). …. The primary clinical manifestations included fever (n = 2), cough and sputum (n = 3), breathlessness (n = 4) and weight loss (n = 2). The major chest computed tomography (CT) scan revealed pleural effusion with thickening. All cases had an elevated plasma level of C-reactive protein (CRP). …Pleural fluid smear and culture tests for bacteria and fungi were negative, so were pleural fluid smear tests for mycobacteria. All cases were confirmed through histopathological examination of pleural biopsies and cured after systemic antifungal therapy and pleural irrigation. PMID: 26463614

Parasites and Mites

Flukes, the parasites that colonise cats and dogs, amoeba and other parasites are all capable of causing pleurisy.

Mites have a very poor record in causing lung disease in general and are implicated in pleurisy as well. Because mites are so small they can actually be inhaled as they rise dust like in the air. But mites also harbour an absolute plethora of pathogens as such pleurisy can also be caused by mites in the same way it causes asthma – by inhalation of the pathogens attracted by the faeces or by the pathogens that simply colonise the mites. But in addition to the pathogens the mites carry and transmit, it appears that mites can also colonise the lung

… human acariasis, [is caused when] mites invade and parasitize the human body in various tissues from the gastrointestinal tract to the lung. Here, we summarize the reported cases of human acariasis of pulmonary, intestinal, oral (anaphylaxis), urinary, otic, and vaginal systems. Because the clinical symptoms of acariasis often overlap with other disease symptoms leading to frequent misdiagnosis, we highlight the need for more attention on these infections. PMID: 25175486

Pharmaceuticals

An alarmingly large number of pharmaceuticals are implicated in causing pleurisy. The eHealthme site collects Adverse Drug Reports from docotrs submitted to the FDA and SEDA in the USA. As of December 2016, around 900 pharmaceuticals were implicated in causing pleurisy.

The chart below shows the rise in drug related cases over the years.

This LINK should take you to the table showing which particular drugs are implicated. If the link has been broken look in the conditions chart for pleurisy and once the entry has been found scroll down to the section 'Drugs that cause'. Pressing this link will take you to the table.

One of the biggest classes of drugs implicated are the immunosuppressants, which suppress the immune system. But anti-histamines, statins, Proton Pump inhibitors, and antibiotics also figure prominently. The following table came from a medical site:

Toxins

All toxins - heavy metal fumes, insecticides, pesticides, smoke, pollution, fumes, asbestos dust, dust in general - are irritants, and as such can cause pleurisy. There is no one culprit, all toxins are implicated. For example:

From 1950 to 1990 pentachlorophenol (PCP) was used widely in the New Zealand sawmill industry, and persistent claims of long-term health effects have been made…. We surveyed surviving members of a cohort enumerated to study mortality in sawmill workers employed from 1970 to 1990. RESULTS:
Of the 293 participants 177 had not been exposed, and of the 116 exposed all but 10% had low or short-term PCP exposure. Nevertheless, a number of significant associations between PCP exposure and the prevalence of various symptoms were observed including associations between:

(i) exposure levels and self-reported tuberculosis, pleurisy or pneumonia (P < 0.01) and a deficit in cranial nerve function (P = 0.04);

(ii) duration of employment and thyroid disorders (P = 0.04), and neuropsychological symptoms including often going back to check things (P = 0.04), low libido (P = 0.02) and heart palpitations (P = 0.02), and a strong dose-response trend for frequent mood changes without cause (P < 0.01); and

(iii) cumulative exposure and frequent mood changes without cause (P = 0.02), low libido (P = 0.04), and in the overall number of neuropsychological symptoms reported (P = 0.03).

PCP exposure was associated with a number of physical and neuropsychological health effects that persisted long after exposure had ceased. PMID: 19152355

Treatment

Find the cause. Unless you know the cause, no pharmaceutical treatment should be offered, as many drugs simply exacerbate the problem, as you will have seen.

Rest and sleeping, warmth, plenty of liquids and nourishing organic food and avoidance of the cause will help to both alleviate the symptoms and help the immune system fight the problem.

References and further reading

Med Sci (Paris). 2015 Nov;31(11):971-8. doi: 10.1051/medsci/20153111011. Epub 2015 Nov 17. [The lung microbiome in 2015: a window on chronic lung diseases]. [Article in French] Andréjak C1, Delhaes L2.

Zhonghua Yi Xue Za Zhi. 2015 May 26;95(20):1612-4. [Clinical analyses of fungal pleurisy: a report of 4 cases]. [Article in Chinese] Mao W1, Cao Z1, Yang T1, Jiao X1, Xue Y1, Li J1, Hang Y1, Ma X1, Zhang L2.

Am J Ind Med. 2009 Apr;52(4):271-81. doi: 10.1002/ajim.20677. Morbidity in former sawmill workers exposed to pentachlorophenol (PCP): a cross-sectional study in New Zealand. McLean D1, Eng A, Dryson E, Walls C, Harding E, Wong KC, Cheng S, Mannetje A, Ellison-Loschmann L, Slater T, Shoemack P, Pearce N.

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