Pulmonary function test in Tropical Pulmonary Eosinophilia
Abstract
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 suspected cases of tropical pulmonary eosinophilia were included in study along with 39 healthy controls. Pulmonary functions, which included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC Ratio, maximum mid expiratory flow rate (MMEFR) and peak expiratory flow rate (PEFR) were observed in study cases and control.
Results: The mean values ±S.D. of all spirometric parameters showed low value in cases in comparison to control. Statistically all parameters showed highly significant difference (‘p’ value were <0.001) except in FEV1/FVC ratio (‘p’ value was >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 control value.
Conclusion: This disease, if left untreated or treated late, may lead to long-term sequelae of pulmonary fibrosis or chronic bronchitis with chronic respiratory failure.
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References
2. Udwadia FE. Tropical eosinophilia. In: Herzog H (Ed). Pulmonary Eosinophilia; Progress in Respiration Research. Basel; S Karger; 1975. pp. 35-155.
3. Otteses EA, Nutman TB. Tropical pulmonary eosinophilia. Ann Rev Med. 1992;43:417-24. [PubMed]
4. Vijayan VK. Tropical pulmonary eosinophilia. Curr Opin Pulm Med. 2007;13:428-33. [PubMed]
5. Stuiver PC, Wismans PJ, Schornagel R. Tropical eosinophilia is an important disease in the Netherlands. Ned Tijdschr Geneeskd. 1991;135:283-6. [PubMed]
6.Neva FA, Ottesen EA. Tropical (filarial) eosinophilia. N Engl J Med 1978; 289 : 1129-31. [PubMed]
7.Ottesen EA. Immunological aspects of lymphatic filariasis and onhocerciasis. Trans R Soc Trop Med Hyg 1984; 73 (Suppl): 9-18. [PubMed]
8. Viswanathan R, Prasad M, Prasad S, Saran R, Sinha TR, Sinha SP. Morbidity survey of jail population. Part I: Incidence of certain chronic respiratory diseases with special reference to pulmonary eosinophilosis. Indian J Chest Dis 1965; 7 : 142-5.
9. Ong RK, Doyle RL. Tropical pulmonary eosinophilia. 16. Chest 1998; 113 : 1673-9. [PubMed]
10. Hayashi K, Horiba M, Shindou J, Sumida T, Takekoshi A. Tropical eosinophilia in a man from Sri Lanka. Nihon Kyobu. Shikkan Gakkai Zasshi. 1996;34:1411-5. [PubMed]
11. Jiva TM, Israel RH, Poe RH. Tropical pulmonary eosinophiliamasquerading as acute bronchial asthma. Respiration. 1996;63:55-8. [PubMed]
12.Vijayan VK, Kuppurao KV, Sankaran K, Venkatesan P, Prabhakar R. Tropical eosinophilia: clinical and physiological response to diethylcarbamazine. Respir Med 1991; 85 : 17-20. [PubMed]
13. Udwadia FE. Tropical eosinophilia - a correlation of clinical, histopathologic and lung function studies. Dis Chest 1967; 52 : 531-8. [PubMed]
14. Kuppurao KV, Vijayan VK, Venkatesan P, Sankaran K. Effect of treatment on maximal expiratory flow rates in tropical eosinophilia. Ceylon Med J 1993; 38 : 78-80. [PubMed]
15. Vijayan VK, Kuppurao KV, Venkatesan P, Sankaran K, Prabhakar R. Pulmonary membrane diffusing capacity and capillary blood volume in tropical eosinophilia. Chest 1990; 97 : 1386-9. [PubMed]
16. Danaraj TJ. The treatment of eosinophilic lung (Tropical eosinophilia) with diethylcarbamazine. Quart J Med. 1958;27: 243-63. [PubMed]
17. Vijayan VK, Kuppurao KV, Sankaran K, Venkatesan P, Prabhakar R. Diffusing capacity in acute untreated tropical eosinophilia. Indian J Chest Dis Allied Sci. 1988;30:71-77. [PubMed]
18. Vijayan VK, Kuppurao KV, Sankaran K, Venkatesan P, Prabhakar R. Pulmonary membrane diffusing capacity and capillary blood volume in tropical eosinophilia. Chest. 1990;97:1386-9. [PubMed]
19. Kuppurao KV, Vijayan VK, Venkatesan P, Sankaran K. Effect of treatment on maximal expiratory flow rates in tropical eosinophilia. Ceylon Med J. 1993;38:78-80. [PubMed]
20. Kamat SR, Pimparkar BD, Store SD, Warrier NVU, Fakey 61. YC. Study of clinical radiological and pulmonary function patterns of response to treatment in pulmonary eosinophilia. Indian J Chest Dis 1970; 12 : 91-100. [PubMed]
21. Rom WN, Vijayan VK, Cornelius MJ, Kumaraswami V, Prabhakar R, Ottesen EA, et al. Persistent lower respiratory tract inflammation associated with interstitial lung disease in patients with tropical pulmonary eosinophilia following conventional treatment with diethylcarbamazine. Am Rev Respir Dis. 1990;142:1088–92.
22. Sandhu M, Mukhopadhyay S, Sharma SK. Tropical pulmonary eosinophilia: a comparative evaluation of plain chest radiography and computed tomography. Australas Radiol. 1996;40: 32-37.
23. Sharma SK, Pande JN, Khilnani GC, Verma K, Khanna M. Immunologic & pulmonary function abnormalities in tropical pulmonary eosinophilia. Indian J Med Res 1995; 101 : 98-102. [PubMed]
24. Panda A. et al. Pulmonary function in Tropical Eosinophilia before and after treatment with diethylcarbamazine. J.A.M.A. 1985;83:11:376-8. [PubMed]
25.Singh R.P. et al.Ventilatory functions in Tropical Pulmonary Eosinophilia. J.A.P.I. 1989;37:12775-7. [PubMed]
26. Kamat SR, Warrier NVU, Store SD, Karandikar KN, D’Sa 65. E, Hoskote VR. Clinical studies in pulmonary eosinophila. I - Comparative study of response to diethylcarbamazine and corticosteroid drugs. Indian J Chest Dis 1976; 18 : 221-32.
27. Pinkston P, Vijayan VK, Nutman TB, Rom WN, O’Donnell KM, Cornelius MJ, et al. Acute tropical pulmonary eosinophilia: characterization of the lower respiratory tractinflammation and its response to therapy. J Clin Invest. 1987;80:216-25.
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