Tropical Pulmonary Eosinophilia (TPE)

  • A rare, but well recognised, syndrome characterised by pulmonary interstitial infiltrates and marked peripheral eosinophilia

  • caused by Wuchereria bancrofti, a filarial infection. It occurs most frequently in India and Southeast Asia.

  • also?? Brugia malayi, Burgia timori (filaria worms)

  • Microfilariae (larvae) take up residence in the lung tissue, hindering respiration and causing chest pain as the disease progresses

Clinical

  • Cough

  • Asthma attacks (common differential in nonendemic countries)

  • Splenomegaly

Differential diagnosis

  • Tuberculosis

  • Asthma

  • Coughs related to roundworms (Löffler's syndrome)


  • Chronic symptoms may delay the diagnosis by up to five years.[5] Early recognition and treatment with the antifilarial drug, diethylcarbamazine, is important, as delay before treatment may lead to progressive interstitial fibrosis and irreversible impairment.[7]

  • The condition of marked eosinophilia with pulmonary involvement was first termed tropical pulmonary eosinophilia in 1950.[8]

  • The syndrome is caused by a distinct hypersensitive immunological reaction to microfilariae of W. bancrofti and Brugia malayi.[7][9] However, only a small percentage (< 0.5%)[10] of the 130 million people globally who are infected with filariasis apparently develop this reaction. The clearance of rapidly opsonised microfilariae from the bloodstream results in a hypersensitive immunological process and abnormal recruitment of eosinophils, as reflected by extremely high IgE levels of over 1000 kU/L.[7][11]

  • The typical patient is a young adult man from the Indian subcontinent.[9]

  • https://en.wikipedia.org/wiki/Tropical_eosinophilia