TROPICAL PULMONARY EOSINOPHILIA

Tropical pulmonary eosinophilia (TPE) usually affects people living in the tropics, especially those in Southeast Asia, India, and certain p arts of China and Africa. However, owing to the rising frequency of wo rld-wide travel and the migration between continents, this disease is increasingly seen in the West, where the diagnosis can be easily misse d since it is rarely encountered and can mimic many other conditions. Cases of TPE have typically been reported to masquerade as acute or re fractory bronchial asthma. TPE results from a hypersensitivity reactio n to lymphatic filarial parasites found in endemic regions. There is e vidence that it is more likely to occur in nonimmune individuals, ie, visitors to endemic regions, than in individuals of endemic population s who have developed immunity to filarial infections. Clinical feature s include paroxysmal cough, wheezing and dyspnea, and systemic manifes tations such as fever and weight loss. A history of residence in a fil arial endemic region and a finding of peripheral eosinophilia > 3,000/ mm(3) should initiate a consideration of this disease. Other criteria for the diagnosis of TPE include absence of microfilariae in the blood , high titers of antifilarial antibodies, raised serum total IgE > 1,0 00 U/mL, and a favorable response to the antifilarial, diethylcarbamaz ine, which is the recommended treatment. This disease, if left untreat ed or treated late, may lead to long-term sequelae of pulmonary fibros is or chronic bronchitis with chronic respiratory failure. Herein lies the importance of early diagnosis and treatment of TPE.