Tropical eosinophilia (TE) occurs in patients who have filariasis, which is an infection caused by certain types of roundworm, exemplified by Wuchereria bancrofti and Brugia malayi [1]. The presence of these parasites in the body leads to an exaggerated immune response in some individuals characterized by markedly high levels of eosinophils in the blood and even higher concentrations in the lungs [2]. This immune response, in turn, provokes transient episodes of acute respiratory symptoms such as wheezing, coughing, shortness of breath and chest pain, often worse at night [3]. Systemic symptoms such as fever, loss of weight and appetite, lymphadenopathy, hepatomegaly, and splenomegaly may also occur, although, in a small percentage of patients, no pulmonary symptoms are present.

TE is most frequently seen in areas where filarial infections are endemic, however, cases in non-endemic areas have been reported, aided by travel and immigration, albeit some cases are misdiagnosed due to failure to recognize the syndrome [4] [5]. Males are four times more affected by the illness than females. More serious clinical manifestations include permanent widening of the airways, pneumothorax, consolidation of the lungs and granulomas. Cardiac activity can also be affected, and this is demonstrated by electrocardiogram (ECG) abnormalities [6]. Changes in the lung tissue that result in chronic disease have also been reported in a minority of cases, where symptoms do not resolve despite adequate treatment with diethylcarbamazine (DEC) [7].

• Malaise

  […] identical to Loeffler’s Chronic Eosinophilic Pneumonia X-ray  Similar to Loeffler’s except infiltrates last for many days or week without steroids Chronic Eosinophilic Pneumonia Clinical  Most are asymptomatic or mild symptoms  Some have  High fever  Malaise [learningradiology.com]

  Symptoms of acute schistosomiasis usually involve fever, malaise, and high-grade eosinophilia (usually over 3,000 eosinophils 10 9 /L) [4], [5]. [journals.plos.org]

  CLINICAL FEATURES The typical history is that of the onset of fever, malaise, cough and shortness of breath several hours after exposure to the causative antigen. [medassignments.com]

  […] mild or absent and tend to resolve spontaneously after several days or, at most, after two or three weeks: Cough - usually dry and unproductive Small amounts of mucoid sputum With infestation-related illness, symptoms may also occur including: Fever Malaise [patient.info]

  Other commonly reported symptoms include malaise, fever, and weight loss [ 10 ]. Rapid amelioration of signs and symptoms with diethylcarbamazine treatment is a hallmark of TPE. [doi.org]

• High Fever

  fever  Malaise  Weight loss  Respond within days to steroid therapy  Idiopathic  Associated With Specific Etiology  Associated with Connective Tissue Disease or Vasculitis Eosinophilic Lung Disease Classification of PIE by Etiology Eosinophilic [learningradiology.com]

  Occasionally, however, the disease becomes more prolonged, with a high fever lasting for over a month. There is usually an eosinophilia in the blood and this condition is called prolonged pulmonary eosinophilia. [medassignments.com]

• Dyspnea

  He had often complained of dyspnea on exertion before coming to Japan. He was admitted to Ogaki Municipal Hospital in June 1993 for further examination of persistent coughing, dyspnea, and fever. [jstage.jst.go.jp]

  Its clinical presentation includes nocturnal cough, dyspnea, wheezing, fever, weight loss, fatigue, interstitial mottling on chest radiograph, predominantly restrictive but also obstructive lung function abnormalities, and peripheral blood eosinophilia [ncbi.nlm.nih.gov]

  (70%): Exertional Dyspnea (45%): Wheeze (28%): Chest pain: Wheezing/Rales, or Diffuse Rhonchi (20% of cases have normal lung exam) (see [[Obstructive Lung Disease]]) Constitutional Weight Loss (52%): Fatigue (75%): Anorexia (42%): Fever (25%): Lymphadenopathy [mdnxs.com]

  […] with eosinophilia A condition characterized by intense, nonspecific Sx accompanied by chronic relapsing fever, cough and SOB, associated with chronic eosinophilic pneumonia PIE syndrome Simple PIE Löffler syndrome Transient pulmonary infiltrates fever, dyspnea [medical-dictionary.thefreedictionary.com]

• Dry Cough

  Even though dry cough is commonly found in cases of acute schistosomiasis, severe respiratory complications might also occur. [journals.plos.org]

  Described tropical eosinophilia, which have long fever, increasing respiratory disorders asthma nature, persistent dry cough, defined radiographically seal roots and infiltration in the lungs, giperlakotsitos and hypereosinophilia (80%). [medicalency.com]

  Dry cough, breathlessness, and fever are common. Obtain a detailed drug history. [patient.info]

  || doi: 10.5694/j.1326-5377.2007.tb01316.x Published online: 1 October 2007 Clinical records Patient 1 A 27-year-old man presented to an infectious diseases outpatient clinic in May 2006 with a 3-month history of nocturnal dry cough, paroxysmal dyspnoea [mja.com.au]

  They present with paroxysmal dry cough, wheezing, dyspnea, anorexia, malaise and weight loss. [ncbi.nlm.nih.gov]

• Pulmonary Disorder

  Eosinophilia in Pulmonary Disorders. Immunol Allergy Clin North Am. 2015 Aug. 35 (3):477-92. [Medline]. [emedicine.medscape.com]

• Productive Cough

  He was a non-smoker and reported a history of non-productive cough over several days. Physical examination was unremarkable including the respiratory system examination. [mja.com.au]

  Typical features are fever, weight loss, recurrent abdominal pain, persistent non-productive cough and congestive cardiac failure. Corticosteroid treatment may be of value in some cases. [medassignments.com]

• Nasal Discharge

  Pre-treatment Diagnostic Criteria PNDS was considered when (1) patient described a sensation of something dripping down into their throats, nasal discharge, and /or the need to frequently clear the throat, or (2) physical examination of the nasopharynges [lungindia.com]

• Choking

  Visit for more related articles at Journal of Thrombosis and Circulation: Open Access Abstract Clinical Image S.K.G., 28 yrs male complained of choking sensation in throat and chest. [omicsonline.org]

• Thrombosis

  Visit for more related articles at Journal of Thrombosis and Circulation: Open Access Abstract Clinical Image S.K.G., 28 yrs male complained of choking sensation in throat and chest. [omicsonline.org]

  World Journal of Emergency Surgery 10 (1), 38, 2015 66 2015 Cardiac involvement in trichinellosis: a case of left ventricular thrombosis D Tint, ME Cocuz, OF Ortan, MD Niculescu, M Radoi The American journal of tropical medicine and hygiene 81 (2), 313 [scholar.google.com]

• Headache

  Reported side effects include headache, fever, pruritus and gastrointestinal upset. The eosinophil count often falls dramatically within 7–10 days of starting treatment. [en.wikipedia.org]

  Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized [nejm.org]

  The most common side effects are dizziness, nausea, fever, headache, or pain in muscles or joints. DEC is contraindicated in patients who may also have onchocerciasis. [cdc.gov]

  Reported side effects include headache, fever, pruritis and gastrointestinal upset. 11 The eosinophil count often falls dramatically within 7–10 days of starting treatment. 3 Diethylcarbamazine is available only through the Special Access Scheme of the [mja.com.au]

  About 14 to 90 days after initial contact with schistosomes, this acute form of schistosomiasis produces clinical symptoms comprising nocturnal fever, cough, myalgia, headache and abdominal pain developing as a reaction to the maturing worms. [aerzteblatt.de]

• Dizziness

  The most common side effects are dizziness, nausea, fever, headache, or pain in muscles or joints. DEC is contraindicated in patients who may also have onchocerciasis. [cdc.gov]

Patient history is important, especially in non-endemic areas, as a recent travel history to tropical regions may give diagnostic clues. Laboratory investigations such as white cell count as well as measurement of antibody titers are performed. In individuals with TE, leukocytes are increased, with a predominance of eosinophils. Furthermore, there are high titers of specific as well as non-specific immunoglobulins (Ig), namely IgE, IgG, and IgM, in response to filarial antigens [8].

Pulmonary function tests are necessary, and reveal a mixed picture of obstructive and restrictive lung disease, with a decrease in parameters such as the forced expiratory volume (FEV) and the diffusing capacity for carbon monoxide (DLCO) [7] [9]. In some cases, a purely restrictive picture is seen.

In addition, the following studies are also done:

• Arterial blood gas analysis: May reveal lower than normal concentrations of oxygen due to a ventilation-perfusion mismatch [3].
• Chest X-ray: This may be normal in up to one fifth of patients. Usually, widespread nodular opacities are visible, similar to those seen in miliary tuberculosis.
• Computerized tomography scan: Useful in showing structural lung damage such as bronchiectasis [10].
• Bronchoscopy and bronchoalveolar lavage: This allows the visualization of inflammation of the parenchyma as a direct consequence of the presence of a large number of eosinophils in the lungs [2]. Furthermore, anti-filarial antibodies, as well as, nonspecific antibodies can also be seen.
• Lung biopsy: Biopsy is usually done in the context of chronic disease which is first confirmed via spirometry, in the years following treatment.

• Wuchereria Bancrofti

  It is caused by immunologic hyperresponsiveness to the filarial parasites Wuchereria bancrofti or Brugia malayi. [ncbi.nlm.nih.gov]

  Definition / general Due to microfilaria of Wuchereria bancrofti or Brugia malayi, which circulate in pulmonary capillaries and cause an immediate type of eosinophilic hypersensitivity reaction Patients have high levels of IgE and high titers of filarial [pathologyoutlines.com]

  bancrofti, occurring in the tropics. [medical-dictionary.thefreedictionary.com]

Rapid amelioration of signs and symptoms with diethylcarbamazine treatment is a hallmark of TPE. [doi.org]

Abstract Spirometric and lung volume measurements were carried out before and after treatment with diethylcarbamazine in 19 patients with tropical eosinophilia. [ncbi.nlm.nih.gov]

The eosinophil count often falls dramatically within 7–10 days of starting treatment. [en.wikipedia.org]

Signs and symptoms, pathology, pathogenesis, etiology, course and prognosis, and treatment are discussed. Evidence is preponderantly in favor of the etiology in all cases being nematode larvae invasions of the liver and other viscera. [pediatrics.aappublications.org]

PROGNOSIS AND TREATMENT The median survival time for patients with CFA is approximately 5 years although mortality is very high with the acute form. [medassignments.com]

Prognosis Löffler's disease tends to follow an uncomplicated course and resolve completely within a month. Recurrence occurs only if infection recurs or the offending drug is reintroduced. [patient.info]

[…] mention TPE as a cause of pulmonary hypertension and isolated heart failure, but literature does suggest that some TPE patients may develop pulmonary hypertension if not timely diagnosed. [8] Development of pulmonary hypertension usually confers to a poor prognosis [atmph.org]

 Associated with Connective Tissue Disease or Vasculitis Eosinophilic Lung Disease Classification of PIE by Etiology Eosinophilic Lung Disease Specific Etiology  Drug-induced  Nitrofurantoin  Penicillin  Sulfonamides  Parasite-induced  Ascariasis [learningradiology.com]

The historical development of evidence supporting the filarial etiology of TE was reviewed. [ncbi.nlm.nih.gov]

In our modified diagnostic protocol we were able to determine the etiology in 90% of patients with ≤ RS 1000. However if the etiology is undetermined even at step-3 the cost escalates. [lungindia.com]

In the group of large eozinofilia blood comes with a number of diseases with unclear etiology. This so-called infectious eosinophiles (I. A. [medicalency.com]

Signs and symptoms, pathology, pathogenesis, etiology, course and prognosis, and treatment are discussed. Evidence is preponderantly in favor of the etiology in all cases being nematode larvae invasions of the liver and other viscera. [pediatrics.aappublications.org]

A review of the geographic distribution and epidemiology of leishmaniasis in the New World. ‎ Seite 54 - Hendrix TR: Epithelial and other mucosal lesions of the jejunum in giardiasis. Jejunal biopsy studies. [books.google.de]

[…] with protease inhibitors in patients from Braşov ME Cocuz, R Silaghi, B Nedelcu, G Manea BMC infectious diseases 14 (S4), P32, 2014 2014 Early Lyme disease–current clinical and epidemiological aspects in Braşov ME Cocuz, L Rodina, IG Cocuz BMC infectious [scholar.google.com]

It is important for physicians to know the epidemiologic characteristics, clinical presentations, and treatments of choice for these conditions. [ncbi.nlm.nih.gov]

Epidemiology and Pathology There are some findings in the epidemiology of TPE which have not been explained. These include predominance of disease in males (4:1 male: female predominance) and an age group of 20-40 years. [isradiology.org]

Effective strategies to prevent and treat AD remain elusive despite major efforts to understand its basic biology and clinical pathophysiology. Significant investments in therapeutic ... [doi.org]

Pathophysiology The eosinophils develop from the stem cells in bone marrow. Myeloid series cells get maturation under the influence of granulocytes colony-stimulating factor (G-CSF). [labpedia.net]

Clinical, pathophysiologic, and therapeutic considerations. Ann Intern Med. 1982 Jul. 97(1):78-92. [Medline]. Jederlinic PJ, Sicilian L, Gaensler EA. Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature. [emedicine.medscape.com]

Mutual pathophysiological relationships, but only a low correlation exist between IgE and eosinophilia ( 11 ). No guidelines are yet available for diagnostic evaluation of eosinophilia in the primary care setting. [aerzteblatt.de]

In order to prevent the long term morbidity of cardiorespiratory disability, the early signs of TPE should be recognized and the infection treated. [ncbi.nlm.nih.gov]

Prevent, evaluate, and manage diseases that can be acquired in tropical environments and foreign countries with The Travel and Tropical Medicine Manual. [books.google.de]

Effective strategies to prevent and treat AD remain elusive despite major efforts to understand its basic biology and clinical pathophysiology. Significant investments in therapeutic ... [doi.org]

Prevention This is largely the prevention of parasitic infestation in endemic areas. Good hygiene and hand washing before eating are also important. Historical notes Wilhelm Löffler was born in 1887 and died in 1972. [patient.info]

Early diagnosis and treatment with diethylcarbamazine (DEC) may prevent progressive pulmonary disease. [mja.com.au]

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2. O'Bryan L, Pinkston P, Kumaraswami V, et al. Localized Eosinophil Degranulation Mediates Disease in Tropical Pulmonary Eosinophilia. Infect Immun. 2003;71(3):1337–1342.
3. Ray D, Abel R, Selvaraj KG. Epidemiology of pulmonary eosinophilia in rural South India — a prospective study, 1981–1986. J Epidemiol Community Health. 1993;47(6): 469-474.
4. Jacobson B. Public Health in Inner London. BMJ. 1992;305(6865):1344-1347.
5. Jones DA, Pillai DK, Rathbone BJ, Cookson JB. Persisting ‘asthma’ in tropical pulmonary eosinophilia. Thorax. 1983;38(9):692-693.
6. Vakil RJ. Cardiovascular involvement in tropical eosinophilia. Br Heart J. 1961;23(5):578–586.
7. Poh SC. The course of lung function in treated tropical pulmonary eosinophilia. Thorax. 1974;29(6):710-712.
8. Billa G, Thakkar K. A Case of Chronic Cough with Progressive Breathlessness in a 32 Year-old Male Health Worker -Tuberculosis?, Allergic Bronchitis?, Asthma?. Br J Med Med Res. 2014;4(35):5513-5518.
9. Nesarajah MS. Pulmonary function in tropical eosinophila. Thorax. 1972;27(2):185–187.
10. Sandhu M, Mukhopadhyay S, Sharma SK. Tropical pulmonary eosinophilia: a comparative evaluation of plain chest radiography and computed tomography. Australas Radiol. 1996;40(1):32–37.