Tropical filarial pulmonary eosinophilia
- Amy D Klion, MD
Amy D Klion, MD
- Baltimore, MD
Tropical filarial pulmonary eosinophilia (TFPE) is a clinical manifestation of lymphatic filariasis, a parasitic infection caused by filarial nematodes (roundworms) that inhabit the lymphatics and bloodstream. Three species cause human lymphatic filariasis: Wuchereria bancrofti, Brugia malayi, and Brugia timori. Infection is transmitted by mosquito vectors; humans are definitive hosts.
TFPE is caused by an immune hyperresponsiveness to microfilariae trapped in the lungs [1-4]. The syndrome has been termed tropical eosinophilia, tropical pulmonary eosinophilia (TPE), or tropical filarial pulmonary eosinophilia (TFPE).
Issues related to TFPE will be reviewed here. Issues related to lymphatic filariasis are discussed separately. (See "Epidemiology, pathogenesis, and clinical manifestations of lymphatic filariasis" and "Diagnosis, treatment and prevention of lymphatic filariasis".)
Tropical filarial pulmonary eosinophilia (TFPE) can occur in any tropical area where filariasis occurs and is most common among young adults. It is more common in individuals from the Indian subcontinent and occurs four to seven times more frequently in males than in females [5,6].
The majority of cases of TFPE occur in endemic areas; cases in nonendemic settings have also been described. In a review of 17 cases observed in Toronto, all received an incorrect diagnosis at presentation (most often asthma), and a median of two consultations was required before the diagnosis was established .
- Vijayan VK. Tropical pulmonary eosinophilia: pathogenesis, diagnosis and management. Curr Opin Pulm Med 2007; 13:428.
- Weingarten RJ. Tropical eosinophilia. Lancet 1943; 1:103.
- Pinkston P, Vijayan VK, Nutman TB, et al. Acute tropical pulmonary eosinophilia. Characterization of the lower respiratory tract inflammation and its response to therapy. J Clin Invest 1987; 80:216.
- Ottesen EA, Nutman TB. Tropical pulmonary eosinophilia. Annu Rev Med 1992; 43:417.
- Udwadia FE. Tropical eosinophilia. In: Progress in Respiration Research: Pulmonary Eosinophilia, Udwadia FE (Ed), Karger, New York 1975. p.35.
- Ong RK, Doyle RL. Tropical pulmonary eosinophilia. Chest 1998; 113:1673.
- Boggild AK, Keystone JS, Kain KC. Tropical pulmonary eosinophilia: a case series in a setting of nonendemicity. Clin Infect Dis 2004; 39:1123.
- Lal RB, Paranjape RS, Briles DE, et al. Circulating parasite antigen(s) in lymphatic filariasis: use of monoclonal antibodies to phosphocholine for immunodiagnosis. J Immunol 1987; 138:3454.
- Ray S, Kundu S, Goswami M, Maitra S. Tropical pulmonary eosinophilia misdiagnosed as miliary tuberculosis: a case report and literature review. Parasitol Int 2012; 61:381.
- Rocha A, Dreyer G, Poindexter RW, Ottesen EA. Syndrome resembling tropical pulmonary eosinophilia but of non-filarial aetiology: serological findings with filarial antigens. Trans R Soc Trop Med Hyg 1995; 89:573.
- Drugs for Parasitic Infections, Med Lett Drug Ther, 2010.
- Fernando SD, Rodrigo C, Rajapakse S. Current evidence on the use of antifilarial agents in the management of bancroftian filariasis. J Trop Med 2011; 2011:175941.
- Hoerauf A. Filariasis: new drugs and new opportunities for lymphatic filariasis and onchocerciasis. Curr Opin Infect Dis 2008; 21:673.