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Tropical Pulmonary Eosinophilia - Lessons Learned from 180 Patients at Tertiary Care Teaching Hospital
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A1911 - Tropical Pulmonary Eosinophilia - Lessons Learned from 180 Patients at Tertiary Care Teaching Hospital
Author Block: A. Khan1, A. Nath1, Z. Hashim1, V. Agarwal2, V. Agarwal3; 1Pulmonary Medicine, SGPGIMS, Lucknow, India, 2Pathology, SGPGIMS, Lucknow, India, 3Immunology, SGPGIMS, Lucknow, India.
Rationale: Tropical pulmonary eosinophilia (TPE) is a syndrome of dyspnea, cough, wheezing, and eosinophilia in the tropical setting. It represents a pulmonary hypersensitivity response to circulating filarial antigen. There is an ambiguity regarding its diagnosis as well as treatment dosage and duration. This study describes the lessons learned from the clinical, serological, radiological and treatment aspects of a large cohort of patients presenting with eosinophilia and pulmonary symptoms. Methods: We retrospectively reviewed the preliminary data of 180 consecutive patients undergoing etiological evaluation of pulmonary eosinophilia under fixed protocol at our institution from 2014 through 2016 for diagnosis of TPE. After excluding the secondary causes, patients were labeled as probable TPE and started on treatment with only diethylcarbamazine. Long-term follow up (2 years) were undertaken initially at 3, 6 and 12 weeks then 6 monthly interval to evaluate the treatment effect, persistent disease, and relapses. Additional testing like bone marrow examination, lung biopsies, and platelet-derived growth factor alpha and beta were performed if the eosinophils counts were more than 50% of the total count at presentation or patients showed no response to treatment. Results: A total of 180 patients (male, 145; female, 35) with a mean age of 38.3 ± 16.54 years underwent treatment for TPE. Dyspnea and cough were the major symptoms with a mean duration of 26.32 ± 20.70 and 16.02 ± 14.98 months respectively. Characteristics nocturnal worsening of the symptoms was present in 74% of the patient. The median absolute eosinophil count and IgE levels were 2030 (range, 1006 to74860) and 1604 (range, 10.5 to 31368) respectively that gradually decreased to normal values with treatment. Majority of the patients required more than six weeks of treatment with diethylcarbamazine and only small proportions of patients experienced relapse after the initial treatment. None of the patients needed additional therapy. The median duration of follow-up was 12 months (range, 6 to 36 months). Conclusions: TPE is an underrecognized entity which can lead to chronic and progressive respiratory compromise in vast majority due to its resemblance to asthma. Although a disease of tropics, TPE is increasingly being recognized even in areas of non-endemicity. There is a need to define a diagnostic algorithm and the optimal dose/duration of TPE.
Author Block: A. Khan1, A. Nath1, Z. Hashim1, V. Agarwal2, V. Agarwal3; 1Pulmonary Medicine, SGPGIMS, Lucknow, India, 2Pathology, SGPGIMS, Lucknow, India, 3Immunology, SGPGIMS, Lucknow, India.
Rationale: Tropical pulmonary eosinophilia (TPE) is a syndrome of dyspnea, cough, wheezing, and eosinophilia in the tropical setting. It represents a pulmonary hypersensitivity response to circulating filarial antigen. There is an ambiguity regarding its diagnosis as well as treatment dosage and duration. This study describes the lessons learned from the clinical, serological, radiological and treatment aspects of a large cohort of patients presenting with eosinophilia and pulmonary symptoms. Methods: We retrospectively reviewed the preliminary data of 180 consecutive patients undergoing etiological evaluation of pulmonary eosinophilia under fixed protocol at our institution from 2014 through 2016 for diagnosis of TPE. After excluding the secondary causes, patients were labeled as probable TPE and started on treatment with only diethylcarbamazine. Long-term follow up (2 years) were undertaken initially at 3, 6 and 12 weeks then 6 monthly interval to evaluate the treatment effect, persistent disease, and relapses. Additional testing like bone marrow examination, lung biopsies, and platelet-derived growth factor alpha and beta were performed if the eosinophils counts were more than 50% of the total count at presentation or patients showed no response to treatment. Results: A total of 180 patients (male, 145; female, 35) with a mean age of 38.3 ± 16.54 years underwent treatment for TPE. Dyspnea and cough were the major symptoms with a mean duration of 26.32 ± 20.70 and 16.02 ± 14.98 months respectively. Characteristics nocturnal worsening of the symptoms was present in 74% of the patient. The median absolute eosinophil count and IgE levels were 2030 (range, 1006 to74860) and 1604 (range, 10.5 to 31368) respectively that gradually decreased to normal values with treatment. Majority of the patients required more than six weeks of treatment with diethylcarbamazine and only small proportions of patients experienced relapse after the initial treatment. None of the patients needed additional therapy. The median duration of follow-up was 12 months (range, 6 to 36 months). Conclusions: TPE is an underrecognized entity which can lead to chronic and progressive respiratory compromise in vast majority due to its resemblance to asthma. Although a disease of tropics, TPE is increasingly being recognized even in areas of non-endemicity. There is a need to define a diagnostic algorithm and the optimal dose/duration of TPE.
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