Tropical pulmonary Eosinophilia
Tropical Pulmonary Eosinophilia (TPE)
In a distinct syndrome that develops in individuals infected with lymph node filarial species.
Clinical symptoms result from allergic and inflammatory reaction elicited by the cleared parasites.
Features of TPE:
- Male more commonly affected than females (4:1)
- History of residence in filarial endemic region
- Paroxysmal cough and wheezing that are usually nocturnal.
- Weight loss, low grade fever, adenopathy
- Eosinophilia> 3000 eosinophil / ml
- Chest X-Ray: increased bronchovascular markings, diffuse miliary lesions, or mottled opacities.
- Restrictive changes on Pulmonary function test
- Elevated levels of IgE & Antifilarial antibody titers.
- In TPE, Microfilaria are rapidly cleared from the blood stream by the lungs. Thus, micro filariae are sequestrated in the lung and are not found in the blood.
Pulmonary infiltrates with eosinophilia: (PIE, eosinophilic pneumonias).
Constituted by distinct individual syndromes characterized by eosinophilic pulmonary infiltrates and peripheral blood eosinophilia.
These include (Ref. Hari. 18th ed., Table 255.2 Pg- 2120)
i. Allergic Bronchopulmonary aspergillosis
ii. Parasitic infestations
iii. Drug reactions
iv. Eosinophilia myalgia syndrome
i. Loeffler's syndrome
ii. Acute eosinophilic pneumonia
iii. Chronic eosinophilic pneumonia
iv. Allergic granulomatosis of Churg & Strauss Hypereosinophilic syndrome
Pulmonary eosinophilic granuloma is not a cause of peripheral eosinophilia.