Tropical pulmonary eosinophilia
- Amy D Klion, MD
Amy D Klion, MD
- Baltimore, MD
Tropical pulmonary eosinophilia (TPE) 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.
TPE is caused by an immune hyperresponsiveness to microfilariae trapped in the lungs [1-4]. The syndrome has also been termed tropical eosinophilia or tropical filarial pulmonary eosinophilia. Rarely, a similar hyperresponsive pulmonary syndrome can be seen in the setting of intestinal helminth infection .
Issues related to TPE of filarial origin will be reviewed here. Other 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 pulmonary eosinophilia (TPE) 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 [6,7]. Rare cases have been described in children .
The majority of cases of TPE 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 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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.
- 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.
- 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.
- Randev S, Kumar P, Dhillon P, et al. Tropical pulmonary eosinophilia masquerading as asthma in a 5-year-old girl. Paediatr Int Child Health 2017; :1.
- Boggild AK, Keystone JS, Kain KC. Tropical pulmonary eosinophilia: a case series in a setting of nonendemicity. Clin Infect Dis 2004; 39:1123.
- Sharma P, Sharma A, Vishwakarma AL, et al. Host lung immunity is severely compromised during tropical pulmonary eosinophilia: role of lung eosinophils and macrophages. J Leukoc Biol 2016; 99:619.
- 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.
- Drugs for Parasitic Infections, 3rd Ed, The Medical Letter, New Rochelle, NY 2013.
- 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.