DETECTION OF LIVING ADULT WUCHERERIA-BANCROFTI IN A PATIENT WITH TROPICAL PULMONARY EOSINOPHILIA

Tropical pulmonary eosinophilia (TPE) is a relatively unusual and diag nostically challenging manifestation of infection with Wuchereria banc rofti. The pathogenesis of TPE remains unclear, although immune hyperr esponsiveness to the microfilarial stage of the parasite is thought to play an essential role. Microfilariae are almost never detected in th e peripheral blood of persons with TPE and living adult worms have not been reported. Thus, no parasitologic marker has existed with which t o assess the effectiveness of antifilarial treatment. In 1986, a 74-ye ar old man from Olinda, Pernambuco, Brazil, developed classic signs an d symptoms of filarial TPE. Within 48 h after beginning treatment with diethylcarbamazine (DEC), the drug of choice for TPE, his symptoms dr amatically improved. He remained symptom-free until June 1994, when he again developed signs and symptoms of TPE. To visualize the adult wor m and monitor the macrofilaricidal effectiveness of DEC treatment, ult rasound examinations of the scrotal area were performed before, during , and for 6 months after treatment. These examinations revealed diffus e dilatation of the lymphatic vessels of the spermatic cord and moveme nts characteristic of living adult W. bancrofti known as the ''filaria dance sign''. Although the patient responded clinically to treatment, no change was noted in the filaria dance sign throughout the observat ion period. Visualization of adult W. bancrofti by ultrasound can be u sed to monitor the parasitologic effectiveness of treatment for TPE an d to explore the relationship between death of the adult worm and recu rrence of symptoms.