Cases Of Tropical Pulmonary Eosinophilia Research Articles

A case of tropical pulmonary eosinophilia after elimination of lymphatic filariasis in Sri Lanka

A case of tropical pulmonary eosinophilia after elimination of lymphatic filariasis in Sri Lanka

Tropical Pulmonary Eosinophilia with Eosinophilic Leukemoid Reaction

A 7 year-old male presented with recurrent fever, cough and respiratory distress for over last 2 years. Based on extremely high eosinophil count, high Immunoglobulin E, increase in eosinophilic precursors in bone marrow, and positive antigen test for Wuchereria bancrofti, a diagnosis of Tropical Pulmonary Eosinophilia with Eosinophilic Leukemoid Reaction was made. Complete recovery was achieved with Diethylcarbamazine for 3 weeks. We are reporting this case as the first case of Tropical pulmonary eosinophilia with eosinophilic leukemoid reaction in a child.

Pulmonary function test in Tropical Pulmonary Eosinophilia

Introduction: Tropical pulmonary eosinophilia (TPE) is a syndrome of wheezing, fever and eosiniphilia seen predominantly in the Indian subcontinent and other tropical areas. The syndrome results from immunologic hyper- responsiveness to human filarial parasites, Wuchereria bancrofti and Brugia malayi. Absolute eosinophilia counts are usually more than 3,000 cells/mm3. Lung functions are severely compromised. Pulmonary function tests may show a mixed restrictive and obstructive abnormality with a reduction in diffusion capacity. The mean values of expiratory flow rates were significantly decreased. Oral DEC (6 mg/ kg per day) for 3 weeks is treatment of choice. Methods: A total of 61, clinic-radiologically and haematologically susp ected cases of tropical pulmonary eosinophilia were included in study along with 39 healthy controls. Pulmonary functions , which included forced vital capacity (FVC), force d expiratory volume in one second (FEV 1), FEV 1/FVC Ratio, maximum mid expiratory flow rate (MMEFR) and peak expiratory flow rate (PEFR) were observed in study cases and contro l. Results: The mean values ±S.D. of all spirometric parameter s showed low value in cases in comparison to control. Statistically all parameters showed highly signifi cant difference ('p' value were 0.05). After the treatment with DEC the mean values ± S.D. of all parameters in cases showed improvement but the values were remained still below the contro l value. Conclusion: This disease, if left untreated or treated late, m ay lead to long-term sequelae of pulmonary fibrosis or chronic bronchitis with chronic respiratory failure.

A Case of Chronic Cough with Progressive Breathlessness in a 32 Year-old Male Health Worker – Tuberculosis?, Allergic Bronchitis?, Asthma?

Introduction: Although tuberculosis is hyper-endemic in India and is responsible for a huge proportion of respiratory morbidity, adequate workup should be conducted to rule out other differential diagnosis wherever applicable. Case Report: A 32 year old male health worker was suffering from productive cough and gradually increasing breathlessness since three months. The investigations conducted were a sputum analysis and a chest x-ray, both of which were normal and hence he was treated as a case of allergic bronchitis. Subject presented to us after three months with no relief. We further investigated him and found severe eosinophilia in the peripheral blood, a positive anti-filarial antibody and a negative triple stool test for ova and parasites. He was treated with diethylcarbamazine and albendazole+ivermectin combination. The patient responded well and had no complaints at the end of the 4 week treatment. Discussion and Conclusion: The subject should have been evaluated by conducting a basic investigation like a complete blood count. Delay in treatment of cases of tropical pulmonary eosinophilia can lead to permanent respiratory morbidity.

Parasitic diseases of the respiratory tract

The human pulmonary system can be affected by a variety of parasites. This review focuses on the most common parasitic infestations involving the lung, except for protozoon disease. In many parasitic lung conditions, the clinical manifestations and the imaging findings are non-specific and can make diagnosis challenging. Hydatid disease and paragonimiasis involve the lung directly. Chronic schistosomiasis can lead to pulmonary hypertension. Strongyloides stercoralis infestation is capable of transforming into a fulminant fatal disease. In many types of nematode infestations, the pulmonary phase can cause acute eosinophilic pneumonia. Chest radiographs of patients with paragonimiasis and dirofilariasis can cause diagnostic confusion. Cases of tropical pulmonary eosinophilia typically present with refractory bronchial asthma. Most of these diseases are initially diagnosed by detecting eggs or larvae in stool, sputum, pleural fluid or tissue, and are confirmed by serologic testing. Cystic hydatid disease generally requires surgical treatment, whereas almost all other parasitic lung conditions can be treated medically. Although most parasites that affect the lung are endemic to tropical and subtropical regions, immigration and travel practices have resulted in transfer of these diseases to other areas. It is important for physicians to know the epidemiologic characteristics, clinical presentations, and treatments of choice for these conditions.

Re-examination of the diagnostic criteria of tropical pulmonary eosinophilia

There is no agreement on the minimum absolute eosinophil count essential for the diagnosis of tropical pulmonary eosinophilia (TPE) at present. The aim of this study was to determine this figure as well as to evaluate the other diagnostic criteria of TPE. The response to diethylcarbamazine (DEC) was tested in 98 patients [of whom 79 (80·6%) completed the study] by means of clinical scores, lung function tests and the absolute eosinophil counts. The minimum absolute eosinophil count necessary for the diagnosis of TPE was found to be 3300 for two reasons. Firstly there was a marked fluctuation in the mean percentage change of the absolute eosinophil count after treatment with DEC, when it was below 3225 cells mm −3, while the mean percentage reduction showed a remarkable stability when the eosinophil count exceeded 3600. Secondly there was a marked difference in the response to DEC in patients whose eosinophil counts were above and below these values. All patients who had eosinophil counts greater than 3600 responded to DEC and were diagnosed as cases of TPE. All of them were from filarial endemic areas. The total eosinophil count decreased by a mean of 92·5%, 3 months after administration of DEC. The sensitivities of the following tests in TPE were as follows: filarial antibody test (FAT) 30%, radiological changes 45·5%, erythrocyte sedimentation rate (ESR) 80%. The radiological changes and the ESR, but not the FAT, were helpful in differentiating TPE from those patients with TPE-like symptoms but with lower eosinophil counts, e.g. those with asthma. Patients with cough who had eosinophil counts of between 53 and 2000 cells mm −3, showed elevated filarial antibody levels in a significant number of cases when compared to asymptomatic subjects. ( P<0·001). Five of them responded to DEC. Three of these had filarial antibody in their serum and one had bilateral mottling on chest X-ray. These results suggest that atypical cases of TPE may exist. Our study has shown that the diagnosis of TPE rests on the following criteria: cough worse at night; residence in a filarial endemic area; the eosinophil count greater than 3300 cells mm −3, clinical and haematological response to DEC. The diagnosis is supported by radiological changes and elevated ESR. The FAT is of little value. The clinical benefit and the improvement in lung function which follows the administration of DEC was sustained up to a minimum period of 15 months.

Tropical Pulmonary Eosinophilia

Tropical pulmonary eosinophilia (TPE) usually affects people living in the tropics, especially those in Southeast Asia, India, and certain parts of China and Africa. However, owing to the rising frequency of world-wide travel and the migration between continents, this disease is increasingly seen in the West, where the diagnosis can be easily missed since it is rarely encountered and can mimic many other conditions. Cases of TPE have typically been reported to masquerade as acute or refractory bronchial asthma. TPE results from a hypersensitivity reaction to lymphatic filarial parasites found in endemic regions. There is evidence that it is more likely to occur in nonimmune individuals, ie, visitors to endemic regions, than in individuals of endemic populations who have developed immunity to filarial infections. Clinical features include paroxysmal cough, wheezing and dyspnea, and systemic manifestations such as fever and weight loss. A history of residence in a filarial endemic region and a finding of peripheral eosinophilia >3,000/mm3 should initiate a consideration of this disease. Other criteria for the diagnosis of TPE include absence of microfilariae in the blood, high titers of antifilarial antibodies, raised serum total IgE >1,000 U/mL, and a favorable response to the antifilarial, diethylcarbamazine, which is the recommended treatment. This disease, if left untreated or treated late, may lead to long-term sequelae of pulmonary fibrosis or chronic bronchitis with chronic respiratory failure. Herein lies the importance of early diagnosis and treatment of TPE.

Tropical Pulmonary Eosinophilia

Tropical pulmonary eosinophilia is an unusual pulmonary disorder caused by occult filariasis. Presentation can be varied and can mimic asthma, pulmonary tuberculosis, or atypical pneumonia. We have reported a case of tropical pulmonary eosinophilia mimicking lymphangitic carcinomatosis.

Tropical pulmonary eosinophilia in immigrants in Western Australia.

Two cases of tropical pulmonary eosinophilia, in one with hepatic involvement, are described in immigrants to Western Australia. Both the patients and three siblings harboured intestinal parasites unrelated to the pulmonary disease. An adult filaria was found in a supratrochlear lymph node of one patient and the significance of this finding to the pathogenesis Is discussed.

Tropical eosinophilia and bronchiectasis

Two cases of tropical pulmonary eosinophilia have been described. Both patients developed bronchiectasis as a direct complication. The importance of tropical eosinophilia in the ˦tiology of bronchiectasis in the tropics has been discussed.

Occult filariasis: its relatioship with tropical pulmonary eosinophilia.

Summary A review of the literature on occult filariasis and a consideration of the associated characteristic histological changes indicate that occult filariasis is caused by both human and animal filariae. It is assumed that the disease occurs only in persons who are hypersensitive to filarial antigen. There is accumulating evidence to show that many cases of tropical pulmonary eosinophilia are in fact cases of occult filariasis. It is proposed to use the term occult filariasis for those cases of tropical pulmonary eosinophilia in which a filarial infection is suspected or proved.

Aetiology of tropical eosinophilia.

1. The pathological changes in the lung, liver and lymph-nodes of typical cases of tropical pulmonary eosinophilia are described. 2. Microfilariae have been demonstrated in the centre of nodules in each of these tissues, suggesting that direct invasion by these organisms is the cause of the lesion in this disease. 3. Cases have been encountered with lymph-node and hepatic, but without lung involvement. The lesions in these cases are similar to those seen in the lung, and microfilariae are present. A plea is made to enlarge the concept of tropical eosinophilia to include such cases, and the same time to restrict it to those in which a filarial infection is proved or suspected. 4. Microfilariae recovered from lymph-nodes have been provisionally identified as W. bancrofti-type, but on the analogy of findings in Malaya, it is suggested that these may be of animal origin and that zoonotic filariasis remains the most likely explanation of tropical eosinophilia.