HYPEREOSINOPHILIA IN ASSOCIATION WITH PULMONARY TUBERCULOSIS IN A RURAL-POPULATION IN SOUTH-INDIA

In a prospective study conducted in four villages of North Arcot Ambed kar district of Tamil Nadu in south India over a 5 yr period from 1981 -86, 279 patients were detected to have pulmonary tuberculosis (PTB). Thirty one of them were found to have associated hypereosinophilia (HE ) with total blood eosinophil level of greater than or equal to 2000 p er cumm; besides cough with expectoration they also complained of dysp noea and wheeze. Twelve of the 18 patients with intestinal parasites h ad remission with deworming agents alone. The other 6 non responsive p atients like the 13 who did not have parasitic infestation, needed tre atment with diethylcarbamazine for eosinopenic remission and thus coul d be classified as patients of tropical pulmonary eosinophilia (TPE). The association of hypereosinopilic state as a whole as well as TPE wi th tuberculosis as compared to that prevalent in the general populatio n was; found to be highly significant (P < 0.001). The frequent associ ation of TPE with tuberculosis as observed by us suggests the possibil ity of an early hypersensitivity reaction to mycobacterial antigens tr iggering a florid TPE state in susceptible patients from an area endem ic for filariasis. A similar mechanism may also operate in cases of pu lmonary eosinophilia induced by other helminths in areas where they ar e endemic.