Tropical eosinophilia - The Indian scene.

Vijayan, V.K.

Indian Journal of Clinical Practice; 1993; 3; 39-43.

Tropical eosinophilia, an occult form of filariasis results from immunologic hyper-responsiveness to the human filarial parasites - Wuchereria bancrofti and Brugia malayi . The clinical syndrome is characterised by cough, dyspnoea, nocturnal wheezing and chest discomfort and is occasionally accompanied by constitutional symptoms such as weight loss, anorerxia and fever. Chest radiographs show diffuse reticulo-nodular infiltrates and pulmonary function reveals restrictive ventilatory defect with mild obstruction. Laboratory studies are characaterised by marked peripheral blood eosinophilia and high serum levels of IgE and filaria-specific IgG and IgE antibodies. The hallmark of the syndrome is markedly elevated eosinophils in the lower respiratory tract and interstitial lung fibrosis develops if left untreated. Although patients respond rapidly following a standard 3-week course of diethylcarbamazine, there is incomplete reversal of clinical, hematological, radiological, physiological and pathological changes despite treatment. Therefore other therapeutic modalities such as the addition of corticosteroids to the DEC regimen have to be evaluated in controlled clinical trials.

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