1
|
Wetzler L, Klion AD. Pulmonary Infiltrates With Hypereosinophilia. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:530-532.e18. [PMID: 37984795 PMCID: PMC10922332 DOI: 10.1016/j.jaip.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
Pulmonary infiltrates and hypereosinophilia have a wide range of causes. Here, we discuss the approach, diagnosis, and treatment of two cases with similar clinical presentations. Additional information, images, and discussion may be found in Table I and Supplemental Material (in this article’s Online Repository at www.jaci-inpractice.org ).
Collapse
Affiliation(s)
- Lauren Wetzler
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| |
Collapse
|
2
|
Calin R, Lampros A, Canestri A, Barral M, Schmidt M, Mesnard L, Paris L, Hennequin C, Jauréguiberry S. 'Clinical exacerbation of an overlooked tropical pulmonary eosinophilia after deworming'. J Travel Med 2023; 30:taad122. [PMID: 37792885 DOI: 10.1093/jtm/taad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
Eosinophilia with nonspecific symptoms, which may be overlooked, is a common finding in migrants and may lead to the administration of non-targeted antihelmintic treatment. This practice can have dangerous consequences as illustrated by a patient who developed acute tropical pulmonary eosinophilia and severe secondary myocarditis after administration of ivermectin and albendazole.
Collapse
Affiliation(s)
- Ruxandra Calin
- Infectious Diseases Department, Tenon Hospital, Sorbonne University, AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Alexandre Lampros
- Infectious Diseases Department, Tenon Hospital, Sorbonne University, AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Ana Canestri
- Infectious Diseases Department, Tenon Hospital, Sorbonne University, AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Matthias Barral
- Radiology Department, Tenon Hospital, Sorbonne University, AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Matthieu Schmidt
- Intensive Care Department, Institute of Cardiology, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, 47-83 Bd de l'Hôpital, 75013 Paris, France
| | - Laurent Mesnard
- Nephrology and Acute Kidney Intensive Care Department, Tenon Hospital, Sorbonne University, AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Luc Paris
- Parasitology Department, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, 47-83 Bd de l'Hôpital, 75013 Paris, France
| | - Christophe Hennequin
- Parasitology-Mycology Department, INSERM, Saint-Antoine Research Center - CRSAAP-HP, Saint-Antoine Hospital, Sorbonne University, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Stéphane Jauréguiberry
- Infectious Diseases Department, Bicêtre Hospital, Paris-Saclay University, AP-HP, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
- French Society of Travel Medicine, 79 rue Tocqueville, 75017 Paris, France
| |
Collapse
|
3
|
Panjwani A, Salman MR, Nabar U. An interesting case of pulmonary infiltrates with eosinophilia: out of sight out of mind. Breathe (Sheff) 2023; 19:230097. [PMID: 38020341 PMCID: PMC10644105 DOI: 10.1183/20734735.0097-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Tropical pulmonary eosinophilia should be considered in patients presenting with respiratory symptoms and hypereosinophilia, even in areas not endemic for filariasis. This awareness may prevent morbidity associated with its late or wrong diagnosis. https://bit.ly/3t8hHVc.
Collapse
Affiliation(s)
- Amit Panjwani
- Department of Internal Medicine (Respiratory Unit), Government Hospitals-Salmaniya Medical Complex, Manama, Kingdom of Bahrain
- Department of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Kingdom of Bahrain
| | - Mohamed Redha Salman
- Department of Internal Medicine (Respiratory Unit), Government Hospitals-Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Umesh Nabar
- Department of Radiology, Government Hospitals-Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| |
Collapse
|
4
|
Vinay V, Verma P, Kumar A, Modi S, Munjal SK. Pulmonary Cavitation With Eosinophilia in a Young Man. Chest 2023; 164:e27-e31. [PMID: 37558332 DOI: 10.1016/j.chest.2023.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 08/11/2023] Open
Abstract
CASE PRESENTATION An 18-year-old man with no noted medical history from Northern India presented with history of fever for 15 days and nocturnal cough for 10 days. He denied breathlessness or wheeze. There was no medical history of asthma. He denied any current sinus-related symptoms, pruritis, skin rashes, lesions, or ulcers, abdominal pain, dysphagia, vomiting or diarrhea, numbness or tingling, joint pain, or food allergy. There was no recent exposure to a patient with TB or history of substance misuse. The patient had sought medical care 7 days before presentation for the same symptoms, and after a chest radiograph was obtained, the patient was started on an antitubercular regimen.
Collapse
Affiliation(s)
- Vinay V
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Paras Verma
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Aman Kumar
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Shibani Modi
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Sushil Kumar Munjal
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India.
| |
Collapse
|
5
|
Datta A, Chhotray P, Jena B, Sivasankar R. A Case of Tropical Pulmonary Eosinophilia With Incomplete Response to Diethylcarbamazine Therapy. Cureus 2023; 15:e34359. [PMID: 36874679 PMCID: PMC9977209 DOI: 10.7759/cureus.34359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Tropical pulmonary eosinophilia (TPE) is a specific pulmonary manifestation of lymphatic filariasis. There is overwhelming infiltration of eosinophils in the lung parenchyma in response to microfilaria. The characteristic features include paroxysmal respiratory symptoms, strikingly high blood eosinophil count, elevated level of immunoglobulin (Ig) E along with high titer of anti-filarial antibody. Treatment with diethylcarbamazine (DEC) has an excellent favorable response. However, recovery may often be incomplete. We present a case of a 36-year-old man with TPE who had complete symptomatic improvement after a three-week course of DEC, but only a partial response in radiological and pulmonary function abnormalities.
Collapse
Affiliation(s)
- Ananda Datta
- Pulmonary Medicine, Institute of Medical Sciences and SUM hospital, Bhubaneswar, IND
| | - Pritam Chhotray
- Pulmonary Medicine, Institute of Medical Sciences and SUM hospital, Bhubaneswar, IND
| | - Banani Jena
- Pulmonary Medicine, Institute of Medical Sciences and SUM hospital, Bhubaneswar, IND
| | | |
Collapse
|
6
|
Al-Tawfiq JA, Kim H, Memish ZA. Parasitic lung diseases. Eur Respir Rev 2022; 31:31/166/220093. [DOI: 10.1183/16000617.0093-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/20/2022] [Indexed: 12/02/2022] Open
Abstract
Parasitic lung diseases are caused by a number of parasites as a result of transient passage in the lung or as a result of an immunologic reaction. The clinical presentation may be in the form of focal or cystic lesions, pleural effusion or diffuse pulmonary infiltrates. With increasing globalisation, it is important to consider parasitic infections in the differential diagnosis of lung diseases. This is particularly important since early identification and prompt therapy result in full cure of these conditions. In this review, we summarise the most common parasitic lung diseases.
Collapse
|
7
|
MRI as an Effective Tool for the Diagnosis and Monitoring of Leffler Endocarditis at the Stages of Longitudinal Observation. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypereosinophilic syndrome (HES) is an extremely rare disease that is not always diagnosed, and the lack of statistic data does not let to determine its real incidence.
Among patients men predominate, the ratio of men and women is 9: 1, the most vulnerable age is from 20 to 50 years. The familial hypereosinophilia is inherited disease of autosomal dominant type. Two-year mortality was recorded in half of the cases of Leffler’s endocarditis with progressive fibrosis due to heart failure and thromboembolic complications.
Leffler’s endocarditis and endomyocardial fibrosis as components of restrictive cardiomyopathy are accompanied by eosinophilia. The story of the discovery of eosinophils is closely connected to the name of Paul Ehrlich; the further idea of tracing the connection between eosinophilia and the involvement of the heart and other organs belongs to Leffler.
In the presence of Leffler’s syndrome, the probability of thrombosis in the heart cavities and determination of the stage of the disease were analyzed by longitudinal observation using cardiac MRI.
The described clinical case of Leffler syndrome in a young man in real clinical practice clearly demonstrates the difficulties of diagnosis in the outpatient phase, need in interdisciplinary approach in the work of the team “heart team” during the hospital period, the role and importance of long-term cardiac MRI monitoring of the selected optimal therapy.
Leffler’s syndrome in real clinical practice requires from physicians of various specialties, including family physicians, knowledge of etiology, pathogenesis, clinical masks of disease manifestation and tactics of patient management in the outpatient phase.
MRI of the heart remains the “gold standard” for diagnosis and longitudinal monitoring of patients with Leffler syndrome.
Collapse
|
8
|
Tyagi R, Kapoor A, Kaur G, Srinivas S. Pregnant lady with eosinophilia: common cause, uncommon association. Med J Armed Forces India 2022; 78:103-105. [PMID: 35035052 PMCID: PMC8737090 DOI: 10.1016/j.mjafi.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 09/10/2019] [Indexed: 01/03/2023] Open
Abstract
Peripheral eosinophilia can have a myriad of causes and presents a diagnostic challenge in everyday practice. Tropical pulmonary eosinophilia (TPE), seen commonly in tropics, is an immunological reaction to filarial parasites. This disease can present with clinical features that closely mimic asthma, eosinophilic pneumonia, and Loffler's syndrome. Differentiating between these diseases is essential owing to marked differences in treatment. This can be further challenging in pregnancy as any wrong treatment is likely to affect both the mother and the child. We report a case of a pregnant lady who presented with eosinophilia and of how she was worked up to the correct diagnosis. There are only few reported cases of TPE in pregnancy, and there are no reported cases from India. The case also underlines the approach required in these patients to reach the correct diagnosis.
Collapse
Affiliation(s)
- Rahul Tyagi
- Classified Specialist (Pulmonary Medicine), INHS Asvini, Colaba, Mumbai, India
| | - Anupam Kapoor
- Consultant and Head (Obstetrics and Gynaecology), INHS Asvini, Colaba, Mumbai, India
| | - Gurpreet Kaur
- Graded Specialist (Pathology), INHS Asvini, Mumbai, India
| | - S. Srinivas
- Senior Advisor (Obstetrics and Gynaecology), INHS Asvini, Mumbai, India
| |
Collapse
|
9
|
Delcros Q, Groh M, Nasser M, Kahn JE, Cottin V. Steroid alternatives for managing eosinophilic lung diseases. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.2003777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Quentin Delcros
- National Reference Center for Hypereosinophilic Syndrome (Cereo)
- Department of Internal Medicine Hôpital Foch, Suresnes, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndrome (Cereo)
- Department of Internal Medicine Hôpital Foch, Suresnes, France
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases (Orphalung), Louis Pradel Hospital, Hospices Civils De Lyon, and Claude Bernard University Lyon 1, IVPC, Member of OrphaLung, RespiFIL and ERN-lung, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndrome (Cereo)
- Department of Internal Medicine, Hôpital Ambroise Paré, Université Paris Saclay, Assistance Publique Hôpitaux De Paris, Boulogne-Billancourt, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases (Orphalung), Louis Pradel Hospital, Hospices Civils De Lyon, and Claude Bernard University Lyon 1, IVPC, Member of OrphaLung, RespiFIL and ERN-lung, France
| |
Collapse
|
10
|
Bottieau E, Huits R, Van Den Broucke S, Maniewski U, Declercq S, Brosius I, Theunissen C, Feyens AM, Van Esbroeck M, van Griensven J, Clerinx J, Soentjens P. Human filariasis in travelers and migrants: a retrospective 25-year analysis at the Institute of Tropical Medicine, Antwerp, Belgium. Clin Infect Dis 2021; 74:1972-1978. [PMID: 34463732 DOI: 10.1093/cid/ciab751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Information on human filariasis in international travelers is scarce. We describe the epidemiology, clinical presentation and outcome of these infections in a reference travel clinic over the past decades. METHODS We reviewed all cases of filariasis diagnosed at the Institute of Tropical Medicine, Antwerp, Belgium, from 1994 to 2018. Diagnosis was obtained by either parasitological methods (confirmed) or strict clinical case definitions (probable). We assessed the characteristics of cases at diagnosis and response to therapy within three to 12 months. RESULTS A total of 320 patients (median age: 41 years; 71% males) were diagnosed with 327 filarial infections (Wuchereria bancrofti = 6; Onchocerca volvulus = 33, Loa loa = 150, Mansonella perstans = 130; unspecified species = 8). Diagnosis was confirmed in 213/320 (67%) patients. European long-term travelers accounted for 166 patients (52%) and visitors/migrants from tropical countries for another 110 (34%). Central Africa was the likely region of acquisition for 294 (92%) patients. The number of filariasis cases decreased from 21.5/year in average in the nineties to 6.3/year in the last decade, when loiasis became predominant. Cases reported symptoms in > 80% of all filarial infections but mansonellosis (45/123 single infections; 37%). Lymphatic filariasis and onchocerciasis cases responded well to conventional therapy. However, 30% of patients with loiasis and mansonellosis experienced treatment failure (with diethylcarbamazine and levamisole-mebendazole, respectively). CONCLUSIONS The burden and species distribution of filariasis in travelers evolved in the past decades. Most presentations were symptomatic. Case management would benefit from more effective therapies for loiasis and mansonellosis.
Collapse
Affiliation(s)
- Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Ula Maniewski
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Steven Declercq
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Caroline Theunissen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anne-Marie Feyens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Soentjens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
11
|
Angirish B, Jankharia B, Sanghavi P. The role of HRCT in Tropical Pulmonary Eosinophilia. Eur J Radiol 2020; 131:109207. [PMID: 32823149 DOI: 10.1016/j.ejrad.2020.109207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/30/2020] [Accepted: 08/02/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To determine the pattern of pulmonary involvement in clinically confirmed patients of tropical pulmonary eosinophilia (TPE). METHOD An observational study on 13 patients with clinically confirmed TPE was performed to determine the CT scan appearances. RESULTS The predominant CT scan finding is the presence widespread ill-defined bronchocentric nodules, which need to be differentiated from other conditions. CONCLUSION The pattern of lung involvement on a CT scan can give a clue to the diagnosis of TPE in the correct clinical context. Radiologists in tropical countries should have a high index of suspicion for this diagnosis when reading scans showing widespread ill-defined bronchocentric nodules.
Collapse
|
12
|
Simmons RP, Dudzinski DM, Shepard JAO, Hurtado RM, Coffey KC. Case 16-2019: A 53-Year-Old Man with Cough and Eosinophilia. N Engl J Med 2019; 380:2052-2059. [PMID: 31116923 DOI: 10.1056/nejmcpc1900595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rachel P Simmons
- From the Department of Medicine, Boston Medical Center (R.P.S.), the Department of Medicine, Boston University School of Medicine (R.P.S.), the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Harvard Medical School - all in Boston
| | - David M Dudzinski
- From the Department of Medicine, Boston Medical Center (R.P.S.), the Department of Medicine, Boston University School of Medicine (R.P.S.), the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Harvard Medical School - all in Boston
| | - Jo-Anne O Shepard
- From the Department of Medicine, Boston Medical Center (R.P.S.), the Department of Medicine, Boston University School of Medicine (R.P.S.), the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Harvard Medical School - all in Boston
| | - Rocio M Hurtado
- From the Department of Medicine, Boston Medical Center (R.P.S.), the Department of Medicine, Boston University School of Medicine (R.P.S.), the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Harvard Medical School - all in Boston
| | - K C Coffey
- From the Department of Medicine, Boston Medical Center (R.P.S.), the Department of Medicine, Boston University School of Medicine (R.P.S.), the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Massachusetts General Hospital, and the Departments of Medicine (D.M.D., R.M.H.), Radiology (J.-A.O.S.), and Pathology (K.C.C.), Harvard Medical School - all in Boston
| |
Collapse
|
13
|
Utpat KV, Sanghavi P, Desai UD, Jankharia BG, Joshi JM. TROPICAL PULMONARY EOSINOPHILIA- AN ELABORATE CASE SERIES. ACTA ACUST UNITED AC 2019. [DOI: 10.18410/jebmh/2019/100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Thapa B, Sapkota R, Kim M, Barnett SA, Sayami P. Surgery for parasitic lung infestations: roles in diagnosis and treatment. J Thorac Dis 2018; 10:S3446-S3457. [PMID: 30505532 DOI: 10.21037/jtd.2018.08.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Pulmonary parasitic infestations are a worldwide problem associated with significant morbidity and socioeconomic impact. They are known to have varied clinical presentations and radiological appearances. Prevention of parasite transmission and medical treatment of cases form the two pillars of control of these diseases. The role of surgery is limited to the diagnosis and definitive treatment of the minority of pulmonary parasitic afflictions, most notably hydatidosis. Despite surgery being established as the treatment of choice in pulmonary hydatid cysts (PHCs) for over half a century, variations and unresolved controversies persist regarding the best surgical technique. Complications brought on by cyst rupture, multiplicity and multi-organ involvement add complexity to treatment decisions. The development of video-assisted thoracoscopic surgery (VATS) brings the promise of reduced peri-operative morbidity but is yet to be universally accepted as a safe technique. In this review, we endeavor to discuss the common pulmonary infestations focusing on the current trends and controversies surrounding surgery for PHC.
Collapse
Affiliation(s)
- Bibhusal Thapa
- Olivia Newton-John Cancer Research Institute, Victoria, Australia.,Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal
| | - Ranjan Sapkota
- Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal
| | - Michelle Kim
- Department of Cardiothoracic Surgery, Barwon Health, Geelong, Australia
| | | | - Prakash Sayami
- Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal
| |
Collapse
|
15
|
Tsanglao WR, Nandan D, Chandelia S, Arya NK, Sharma A. Filarial tropical pulmonary eosinophilia: a condition masquerading asthma, a series of 12 cases. J Asthma 2018; 56:791-798. [PMID: 29969926 DOI: 10.1080/02770903.2018.1490748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Tropical pulmonary eosinophilia (TPE) is a form of occult filariasis, clinically characterized by paroxysmal cough, wheezing and dyspnea which is often misdiagnosed and treated as asthma. These manifestations result from a host immune response to trapped antigens of the microfilarial parasites Wuchereria bancrofti or Brugia malayi in the pulmonary microcirculation. CASE STUDY We describe three rare presentations of TPE (cor pumonale, cystic lung disease and respiratory distress mimicking acute severe asthma) in our series of 12 cases. All cases were from filaria endemic areas and presented with cough, wheezing and dyspnea, either alone or in combination. Subsequent work-up revealed peripheral eosinophilia, raised serum IgE levels and positive serum filarial antibody and/or antigen in all the cases. RESULTS All patients were treated with diethylcarbamazine (DEC), while few required inhaled/systemic corticosteroid. Prompt improvement in clinical symptoms with a decrease in eosinophil count was seen in all. Two cases relapsed requiring a second course of DEC. Long-term outcome was good, however, there was a persistence of restrictive lung function and echocardiographic feature of pulmonary hypertension in the patients with cystic lung disease and cor pulmonale, respectively. CONCLUSION TPE should always be considered in patients from filaria endemic areas presenting with cough, dyspnea or wheezing. High eosinophil count (>3 × 109 cells) with raised IgE level (>1000 IU/mL) in such cases should alert the physician to look for TPE. Early diagnosis and treatment can prevent disease progression and complications.
Collapse
Affiliation(s)
- Wonashi R Tsanglao
- a Department of Pediatrics , PGIMER, Dr.RML Hospital , New Delhi , India
| | - Devki Nandan
- a Department of Pediatrics , PGIMER, Dr.RML Hospital , New Delhi , India
| | - Sudha Chandelia
- a Department of Pediatrics , PGIMER, Dr.RML Hospital , New Delhi , India
| | | | - Anu Sharma
- a Department of Pediatrics , PGIMER, Dr.RML Hospital , New Delhi , India
| |
Collapse
|
16
|
Olaru ID, Van Den Broucke S, Rosser AJ, Salzer HJF, Woltmann G, Bottieau E, Lange C. Pulmonary Diseases in Refugees and Migrants in Europe. Respiration 2018; 95:273-286. [PMID: 29414830 DOI: 10.1159/000486451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/18/2022] Open
Abstract
More than 2 million people fleeing conflict, persecution, and poverty applied for asylum between 2015 and 2016 in the European Union. Due to this, medical practitioners in recipient countries may be facing a broader spectrum of conditions and unusual presentations not previously encountered, including a wide range of infections with pulmonary involvement. Tuberculosis is known to be more common in migrants and has been covered broadly in other publications. The scope of this review was to provide an overview of exotic infections with pulmonary involvement that could be encountered in refugees and migrants and to briefly describe their epidemiology, diagnosis, and management. As refugees and migrants travel from numerous countries and continents, it is important to be aware of the various organisms that might cause disease according to the country of origin. Some of these diseases are very rare and geographically restricted to certain regions, while others have a more cosmopolitan distribution. Also, the spectrum of severity of these infections can vary from very benign to severe and even life-threatening. We will also describe infectious and noninfectious complications that can be associated with HIV infection as some migrants might originate from high HIV prevalence countries in sub-Saharan Africa. As the diagnosis and treatment of these diseases can be challenging in certain situations, patients with suspected infection might require referral to specialized centers with experience in their management. Additionally, a brief description of noncommunicable pulmonary diseases will be provided.
Collapse
Affiliation(s)
- Ioana D Olaru
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andrew J Rosser
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Helmut J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Gerrit Woltmann
- Respiratory Biomedical Research Centre, Institute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
17
|
Ribeiro EL, Fragoso IT, Gomes FODS, Oliveira AC, Silva AKSE, Silva PME, Ciambarella BT, Ramos IPR, Peixoto CA. Diethylcarbamazine: A potential treatment drug for pulmonary hypertension? Toxicol Appl Pharmacol 2017; 333:92-99. [PMID: 28851623 DOI: 10.1016/j.taap.2017.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/09/2017] [Accepted: 08/25/2017] [Indexed: 01/16/2023]
Abstract
The present study demonstrated the potential effects of diethylcarbamazine (DEC) on monocrotaline (MCT)-induced pulmonary hypertension. MCT solution (600mg/kg) was administered once per week, and 50mg/kg body weight of DEC for 28days. Three C57Bl/6 male mice groups (n=10) were studied: Control; MCT28, and MCT28/DEC. Echocardiography analysis was performed and lung tissues were collected for light microscopy (hematoxylin-eosin and Masson's trichrome staining), immunohistochemistry (αSMA, FADD, caspase 8, caspase 3, BAX, BCL2, cytochrome C and caspase 9) western blot (FADD, caspase 8, caspase 3, BAX, BCL2, cytochrome C and caspase 9) and qRt-PCR (COL-1α and αSMA). Echocardiography analysis demonstrated an increase in the pulmonary arterial blood flow gradient and velocity in the systole and RV area in the MCT28 group, while treatment with DEC resulted in a significant reduction in these parameters. Deposition of collagen fibers and αSMA staining around the pulmonary arteries was evident in the MCT28 group, while treatment with DEC reduced both. Western blot analysis revealed a decrease in BMPR2 in the MCT28 group, in contrast DEC treatment resulted in a significant increase in the level of BMPR2. DEC also significantly reduced the level of VEGF compared to the MCT28 group. Apoptosis extrinsic and intrinsic pathway markers were reduced in the MCT28 group. After treatment with DEC these levels returned to baseline. The results of this study indicate that DEC attenuates PH in an experimental monocrotaline-induced model by inhibiting a series of markers involved in cell proliferation/death.
Collapse
Affiliation(s)
- Edlene Lima Ribeiro
- Laboratory of Ultrastructure, Aggeu Magalhães Research Center - CPqAM, Pernambuco, Brazil; Federal University of Pernambuco, Brazil
| | - Ingrid Tavares Fragoso
- Laboratory of Ultrastructure, Aggeu Magalhães Research Center - CPqAM, Pernambuco, Brazil; Federal University of Pernambuco, Brazil
| | | | - Amanda Costa Oliveira
- Laboratory of Ultrastructure, Aggeu Magalhães Research Center - CPqAM, Pernambuco, Brazil; Federal University of Pernambuco, Brazil
| | - Amanda Karoline Soares E Silva
- Laboratory of Ultrastructure, Aggeu Magalhães Research Center - CPqAM, Pernambuco, Brazil; Federal University of Pernambuco, Brazil
| | | | | | - Isalira Peroba Rezende Ramos
- National Center Structural Biology and Bio-imaging, Carlos Chagas Filho Biophysics Institute, Department of Radiology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
18
|
Weissler JC. Eosinophilic Lung Disease. Am J Med Sci 2017; 354:339-349. [PMID: 29078837 DOI: 10.1016/j.amjms.2017.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/22/2017] [Accepted: 03/13/2017] [Indexed: 12/28/2022]
Abstract
Eosinophils are involved in the pathogenesis of a number of lung diseases. Recent advances in eosinophil biology have now produced clinically applicable therapies that seek to counter eosinophilia in blood and lungs. This article reviews the basic biology of eosinophils and their role in mediating T-helper 2 cell responses. The current status of anticytokine therapy for eosinophilic lung disease is discussed. A clinical approach to eosinophilic lung disease based on symptoms and radiography is generated. The clinical significance of persistent eosinophilia in lung transplant patients and patients with asthma will receive special emphasis.
Collapse
Affiliation(s)
- Jonathan C Weissler
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
19
|
Fragoso IT, Ribeiro EL, Gomes FODS, Donato MAM, Silva AKS, Oliveira ACOD, Araújo SMDR, Barbosa KPS, Santos LAM, Peixoto CA. Diethylcarbamazine attenuates LPS-induced acute lung injury in mice by apoptosis of inflammatory cells. Pharmacol Rep 2017; 69:81-89. [DOI: 10.1016/j.pharep.2016.09.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/25/2016] [Accepted: 09/23/2016] [Indexed: 12/31/2022]
|
20
|
Mikasa K, Aoki N, Aoki Y, Abe S, Iwata S, Ouchi K, Kasahara K, Kadota J, Kishida N, Kobayashi O, Sakata H, Seki M, Tsukada H, Tokue Y, Nakamura-Uchiyama F, Higa F, Maeda K, Yanagihara K, Yoshida K. JAID/JSC Guidelines for the Treatment of Respiratory Infectious Diseases: The Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy - The JAID/JSC Guide to Clinical Management of Infectious Disease/Guideline-preparing Committee Respiratory Infectious Disease WG. J Infect Chemother 2016; 22:S1-S65. [PMID: 27317161 PMCID: PMC7128733 DOI: 10.1016/j.jiac.2015.12.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/14/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Keiichi Mikasa
- Center for Infectious Diseases, Nara Medical University, Nara, Japan.
| | | | - Yosuke Aoki
- Department of International Medicine, Division of Infectious Diseases, Faculty of Medicine, Saga University, Saga, Japan
| | - Shuichi Abe
- Department of Infectious Diseases, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Kazunobu Ouchi
- Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Junichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan
| | | | | | - Hiroshi Sakata
- Department of Pediatrics, Asahikawa Kosei Hospital, Hokkaido, Japan
| | - Masahumi Seki
- Division of Respiratory Medicine and Infection Control, Tohoku Pharmaceutical University Hospital, Miyagi, Japan
| | - Hiroki Tsukada
- Department of Respiratory Medicine and Infectious Diseases, Niigata City General Hospital, Niigata, Japan
| | - Yutaka Tokue
- Infection Control and Prevention Center, Gunma University Hospital, Gunma, Japan
| | | | - Futoshi Higa
- Department of Respiratory Medicine, National Hospital Organization Okinawa National Hospital, Okinawa, Japan
| | - Koichi Maeda
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | |
Collapse
|
21
|
Abstract
In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes.
Collapse
Affiliation(s)
- Elise M O'Connell
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Building 4, Room B105, Bethesda, MD 20892, USA.
| | - Thomas B Nutman
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Building 4, Room B105, Bethesda, MD 20892, USA
| |
Collapse
|
22
|
Mehta AC, Jain P, Gildea TR. Parasitic Diseases of the Lung. DISEASES OF THE CENTRAL AIRWAYS 2016. [PMCID: PMC7122070 DOI: 10.1007/978-3-319-29830-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parasitic infection is a major healthcare problem that affects millions of the world’s population. Immigration and global warming have changed the natural distribution of parasitic diseases far removed from endemic areas. The respiratory system can be affected by a broad spectrum of helminthic and protozoal parasitic diseases. The diagnosis of parasitic infection of the respiratory system may be delayed due to myriad clinical and radiographic presentations of parasitic diseases which make the diagnosis of these entities challenging. Pulmonologists need to be familiar with the epidemiology, clinical presentation, pathophysiology, and bronchoscopic findings of parasitic lung diseases, in order to provide proper management in a timely fashion. This review provides a comprehensive view of both helminthic and protozoal parasitic diseases that affect the respiratory system, especially the central airways.
Collapse
Affiliation(s)
- Atul C. Mehta
- Family Endowed Chair in Lung Transplanta, Lerner College of Medicine Buoncore, Clevland, Ohio USA
| | - Prasoon Jain
- Louis A Johnson VA Medical Center, Fairmont, West Virginia USA
| | | |
Collapse
|
23
|
Sharma P, Sharma A, Vishwakarma AL, Agnihotri PK, Sharma S, Srivastava M. Host lung immunity is severely compromised during tropical pulmonary eosinophilia: role of lung eosinophils and macrophages. J Leukoc Biol 2015; 99:619-28. [PMID: 26489428 DOI: 10.1189/jlb.4a0715-309rr] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/01/2015] [Indexed: 12/28/2022] Open
Abstract
Eosinophils play a central role in the pathogenesis of tropical pulmonary eosinophilia, a rare, but fatal, manifestation of filariasis. However, no exhaustive study has been done to identify the genes and proteins of eosinophils involved in the pathogenesis of tropical pulmonary eosinophilia. In the present study, we established a mouse model of tropical pulmonary eosinophilia that mimicked filarial manifestations of human tropical pulmonary eosinophilia pathogenesis and used flow cytometry-assisted cell sorting and real-time RT-PCR to study the gene expression profile of flow-sorted, lung eosinophils and lung macrophages during tropical pulmonary eosinophilia pathogenesis. Our results show that tropical pulmonary eosinophilia mice exhibited increased levels of IL-4, IL-5, CCL5, and CCL11 in the bronchoalveolar lavage fluid and lung parenchyma along with elevated titers of IgE and IgG subtypes in the serum. Alveolar macrophages from tropical pulmonary eosinophilia mice displayed decreased phagocytosis, attenuated nitric oxide production, and reduced T-cell proliferation capacity, and FACS-sorted lung eosinophils from tropical pulmonary eosinophilia mice upregulated transcript levels of ficolin A and anti-apoptotic gene Bcl2,but proapoptotic genes Bim and Bax were downregulated. Similarly, flow-sorted lung macrophages upregulated transcript levels of TLR-2, TLR-6, arginase-1, Ym-1, and FIZZ-1 but downregulated nitric oxide synthase-2 levels, signifying their alternative activation. Taken together, we show that the pathogenesis of tropical pulmonary eosinophilia is marked by functional impairment of alveolar macrophages, alternative activation of lung macrophages, and upregulation of anti-apoptotic genes by eosinophils. These events combine together to cause severe lung inflammation and compromised lung immunity. Therapeutic interventions that can boost host immune response in the lungs might thus provide relief to patients with tropical pulmonary eosinophilia.
Collapse
Affiliation(s)
- Pankaj Sharma
- *Parasitology Division, Sophisticated Analytical Instrument Facility, and Toxicology Division, Council of Scientific and Industrial Research-Central Drug Research Institute, Lucknow, India; and Academy of Scientific and Innovative Research, New Delhi, India
| | - Aditi Sharma
- *Parasitology Division, Sophisticated Analytical Instrument Facility, and Toxicology Division, Council of Scientific and Industrial Research-Central Drug Research Institute, Lucknow, India; and Academy of Scientific and Innovative Research, New Delhi, India
| | - Achchhe Lal Vishwakarma
- *Parasitology Division, Sophisticated Analytical Instrument Facility, and Toxicology Division, Council of Scientific and Industrial Research-Central Drug Research Institute, Lucknow, India; and Academy of Scientific and Innovative Research, New Delhi, India
| | - Promod Kumar Agnihotri
- *Parasitology Division, Sophisticated Analytical Instrument Facility, and Toxicology Division, Council of Scientific and Industrial Research-Central Drug Research Institute, Lucknow, India; and Academy of Scientific and Innovative Research, New Delhi, India
| | - Sharad Sharma
- *Parasitology Division, Sophisticated Analytical Instrument Facility, and Toxicology Division, Council of Scientific and Industrial Research-Central Drug Research Institute, Lucknow, India; and Academy of Scientific and Innovative Research, New Delhi, India
| | - Mrigank Srivastava
- *Parasitology Division, Sophisticated Analytical Instrument Facility, and Toxicology Division, Council of Scientific and Industrial Research-Central Drug Research Institute, Lucknow, India; and Academy of Scientific and Innovative Research, New Delhi, India
| |
Collapse
|
24
|
Santos LAM, Ribeiro EL, Barbosa KPS, Fragoso IT, Gomes FODS, Donato MAM, Silva BS, Silva AKS, Rocha SWS, França MER, Rodrigues GB, Silva TG, Peixoto CA. Diethylcarbamazine inhibits NF-κB activation in acute lung injury induced by carrageenan in mice. Int Immunopharmacol 2014; 23:153-62. [PMID: 25175917 DOI: 10.1016/j.intimp.2014.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/12/2014] [Accepted: 08/18/2014] [Indexed: 12/25/2022]
Abstract
Diethylcarbamazine citrate (DEC) is widely used to treat lymphatic filariasis and Tropical Pulmonary Eosinophilia. A number of studies have reported a possible role in the host immune system, but exactly how DEC exerts this effect is still unknown. The present study reports the effects of DEC pretreatment on NF-κB regulation using the pleurisy model induced by carrageenan. Swiss male mice (Mus musculus) were divided into four experimental groups: control (SAL); carrageenan (CAR); diethylcarbamazine (DEC) and curcumin (CUR). The animals were pretreated with DEC (50mg/kg, v.o), CUR (50mg/kg, i.p) or distilled water for three consecutive days before pleurisy. One way analysis of variance (ANOVA) was performed by Tukey post-hoc test, and values were considered statistically significant when p<0.05. DEC pretreatment reduced tissue damage and the production of inflammatory markers, such as NO, iNOS, PGE2, COX-2, and PARP induced by carrageenan. Similarly, a known inhibitor of NF-κB pathway (curcumin) was also able to reduce these parameters. Like curcumin, DEC prevents NF-κB activation by reducing NF-κB p65 phosphorylation and IκBα degradation. DEC prevented NF-κB activation via p38 MAPK, but did not interfere in the ERK pathway in this experimental model. However, further studies should be developed to confirm this hypothesis. These findings suggest that DEC could be a promising drug for inflammatory disorders, especially in pulmonary diseases such as Acute Lung Inflammation, due its high anti-inflammatory potential which prevents NF-κB activation.
Collapse
Affiliation(s)
| | - Edlene Lima Ribeiro
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, CPqAM/FIOCRUZ, Brazil.
| | | | | | | | | | - Bruna Santos Silva
- Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, CPqAM/FIOCRUZ, Brazil.
| | | | | | | | | | - Teresinha Gonçalves Silva
- Departamento de Antibióticos, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Brazil.
| | | |
Collapse
|
25
|
Abstract
OBJECTIVE Several cases of lymphatic filariasis (LF) have been reported in non-endemic countries due to travellers, military personnel and expatriates spending time in and returning from endemic areas, as well as immigrants coming from these regions. These cases are reviewed to assess the scale and context of non-endemic presentations and to consider the biological factors underlying their relative paucity. METHODS Cases reported in the English, French, Spanish and Portuguese literature during the last 30 years were examined through a search of the PubMed, ProMED-mail and TropNet resources. RESULTS The literature research revealed 11 cases of lymphatic filariasis being reported in non-endemic areas. The extent of further infections in recent migrants to non-endemic countries was also revealed through the published literature. CONCLUSIONS The life-cycle requirements of Wuchereria and Brugia species limit the extent of transmission of LF outside of tropical regions. However, until elimination, programmes are successful in managing the disease, there remains a possibility of low rates of infection being reported in non-endemic areas, and increased international travel can only contribute to this phenomenon. Physicians need to be aware of the signs and symptoms of lymphatic filariasis, and infection should be considered in the differential diagnosis of people with a relevant travel history.
Collapse
Affiliation(s)
- Robert T Jones
- Department of Biology and Biochemistry, University of Bath, Bath, UK
| |
Collapse
|
26
|
|
27
|
Abstract
Pneumonia is a common diagnosis with significant morbidity and mortality. However, pneumonia is a commonly overdiagnosed entity, with many similar-appearing conditions. A young, previously healthy woman was misdiagnosed with a variety of respiratory tract infections over the course of five months before establishing the correct diagnosis - chronic eosinophilic pneumonia.
Collapse
|
28
|
Díaz-Menéndez M, Norman F, Monge-Maillo B, Pérez-Molina JA, López-Vélez R. [Filariasis in clinical practice]. Enferm Infecc Microbiol Clin 2012; 29 Suppl 5:27-37. [PMID: 22305667 DOI: 10.1016/s0213-005x(11)70041-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Filariases are infections caused by distinct species of nematodes. These infections are transmitted through insect bites and primarily affect lymph nodes and skin. Filariases are classified as neglected diseases and affect millions, producing severe disability and social stigma. This type of infection is rarely diagnosed in travellers, as prolonged stays in endemic areas are usually required acquire infection. Infections may be asymptomatic, and clinical manifestations depend on the host immune response to the infection and the parasite burden. Diagnosis is based on the demonstration of microfilariae in blood or skin, but there are other methods that support the diagnosis. Individual treatment is effective, but community interventions, mostly mass drug administration, have helped to diminish the incidence of filariases.
Collapse
Affiliation(s)
- Marta Díaz-Menéndez
- Unidad de Medicina Tropical, Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España
| | | | | | | | | |
Collapse
|
29
|
Abstract
Parasitic infections previously seen only in developing tropical settings can be currently diagnosed worldwide due to travel and population migration. Some parasites may directly or indirectly affect various anatomical structures of the heart, with infections manifested as myocarditis, pericarditis, pancarditis, or pulmonary hypertension. Thus, it has become quite relevant for clinicians in developed settings to consider parasitic infections in the differential diagnosis of myocardial and pericardial disease anywhere around the globe. Chagas' disease is by far the most important parasitic infection of the heart and one that it is currently considered a global parasitic infection due to the growing migration of populations from areas where these infections are highly endemic to settings where they are not endemic. Current advances in the treatment of African trypanosomiasis offer hope to prevent not only the neurological complications but also the frequently identified cardiac manifestations of this life-threatening parasitic infection. The lack of effective vaccines, optimal chemoprophylaxis, or evidence-based pharmacological therapies to control many of the parasitic diseases of the heart, in particular Chagas' disease, makes this disease one of the most important public health challenges of our time.
Collapse
|
30
|
Abstract
Filarial infections including loiasis, onchocerciasis, and lymphatic filariasis are important causes of morbidity in endemic populations worldwide, and they present a risk to travelers to endemic areas. Definitive diagnosis is complicated by overlap in the geographic distribution and clinical manifestations of the different filarial parasites, as well as similarities in their antigenic and nucleic acid composition. This has important implications for treatment, because the efficacies and toxicities of available antifilarial agents differ dramatically among filarial species. Recent advances, including the visualization of adult filarial worms in vivo by high-frequency ultrasound and the identification of the bacterial endosymbiont, Wolbachia, have greatly improved our understanding of the pathogenesis of filarial infection and have led to novel approaches to the diagnosis and treatment of travelers and immigrants from filarial-endemic regions.
Collapse
Affiliation(s)
- Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 4, Room 126, 4 Center Drive, Bethesda, MD 20892, USA.
| |
Collapse
|
31
|
Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management. J Infect 2010; 60:1-20. [DOI: 10.1016/j.jinf.2009.11.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 11/11/2009] [Accepted: 11/13/2009] [Indexed: 11/18/2022]
|
32
|
Queto T, Xavier-Elsas P, Gardel MA, de Luca B, Barradas M, Masid D, E Silva PMR, Peixoto CA, Vasconcelos ZMF, Dias EP, Gaspar-Elsas MI. Inducible nitric oxide synthase/CD95L-dependent suppression of pulmonary and bone marrow eosinophilia by diethylcarbamazine. Am J Respir Crit Care Med 2009; 181:429-37. [PMID: 20007928 DOI: 10.1164/rccm.200905-0800oc] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE The mechanism of action of diethylcarbamazine (DEC), an antifilarial drug effective against tropical pulmonary eosinophilia, remains controversial. DEC effects on microfilariae depend on inducible NO synthase (iNOS). In eosinophilic pulmonary inflammation, its therapeutic mechanism has not been established. We previously described the rapid up-regulation of bone marrow eosinophilopoiesis in ovalbumin (OVA)-sensitized mice by airway allergen challenge, and further evidenced the down-regulation of eosinophilopoiesis by iNOS- and CD95L-dependent mechanisms. OBJECTIVES We investigated whether: (1) DEC can prevent the effects of airway challenge of sensitized mice on lungs and bone marrow, and (2) its effectiveness depends on iNOS/CD95L. METHODS OVA-sensitized BALB/c mice were intranasally challenged for 3 consecutive days, with DEC administered over a 12-, 3-, or 2-day period, ending at the day of the last challenge. We evaluated: (1) airway resistance, cytokine (IFN-gamma, IL-4, IL-5, and eotaxin) production, and pulmonary eosinophil accumulation; and (2) bone marrow eosinophil numbers in vivo and eosinophil differentiation ex vivo. MEASUREMENTS AND MAIN RESULTS DEC effectively prevented the effects of subsequent challenges on: (1) airway resistance, Th1/Th2 cytokine production, and pulmonary eosinophil accumulation; and (2) eosinophilopoiesis in vivo and ex vivo. Recovery from unprotected challenges included full responses to DEC during renewed challenges. DEC directly suppressed IL-5-dependent eosinophilopoiesis in naive bone marrow. DEC was ineffective in CD95L-deficient gld mice and in mice lacking iNOS activity because of gene targeting or pharmacological blockade. CONCLUSIONS DEC has a strong impact on pulmonary eosinophilic inflammation in allergic mice, as well as on the underlying hemopoietic response, suppressing the eosinophil lineage by an iNOS/CD95L-dependent mechanism.
Collapse
Affiliation(s)
- Tulio Queto
- Laboratório de Fisiopatologia Humana, IFF, FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Gluckman SJ. Acute respiratory infections in a recently arrived traveler to your part of the world. Chest 2008; 134:163-71. [PMID: 18628219 PMCID: PMC7094426 DOI: 10.1378/chest.07-2954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Accepted: 02/25/2008] [Indexed: 11/20/2022] Open
Abstract
Many acute infectious pulmonary diseases have incubation periods that are long enough for travelers to have symptoms after returning home to a health-care system that is not familiar with "foreign" infections. Respiratory infections have a relatively limited repertoire of clinical manifestations, so that there is often nothing characteristic enough about a specific infection to make the diagnosis obvious. Thus, the pathway to the diagnosis of infections that are not endemic in a region relies heavily on taking a thorough history of both itinerary and of specific exposures. One important caveat is that on occasion, the history of a recent trip creates an element of "tunnel vision" in the evaluating health-care provider. It is tempting to relate a person's problem to that recent trip; however, when evaluating recent returnees, it is always important to remember that the travel may have nothing to do with the patient's presentation. Recent travel may add diagnostic considerations to the list of possibilities, but an astute clinician must not disregard the possibility that the patient's illness has nothing to do with the recent trip.
Collapse
Affiliation(s)
- Stephen J Gluckman
- University of Pennsylvania School of Medicine, Medical Arts Building, Ste 102, Thirty-Eighth and Filbert Streets, Philadelphia, PA 19104, USA.
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW Tropical pulmonary eosinophilia is predominantly seen in the tropical and subtropical regions of the world. It is being increasingly reported from other parts of world, however, due to increases in global travel and migration. This review focuses attention on recent developments. RECENT FINDINGS Tropical pulmonary eosinophilia is an occult form of human filariasis. The gamma-glutaryl transpeptidase found in the infective L3 stage larvae of Brugia malayi has been found to have similarities with the gamma-glutaryl transpeptidase present on the surface of human pulmonary epithelium. It has, therefore, been proposed that filarial gamma-glutaryl transpeptidase may play an important role in the pathogenesis of tropical eosinophilia. Airway hyperresponsiveness, manifesting as asthma-like syndrome, has been reported in tropical pulmonary eosinophilia and it has been suggested that interleukin-4 induces and interferon-gamma suppresses filarial-induced airway hyperresponsiveness. The intense eosinophilic alveolitis seen in acute tropical pulmonary eosinophilia is suppressed by 3 weeks of treatment with diethylcarbamazine citrate. A mild eosinophilic alveolitis along with radiological, physiological and hematological abnormalities, though with reduced intensity, persists in some patients however. SUMMARY A chronic mild interstitial lung disease has been found to persist in tropical pulmonary eosinophilia despite treatment.
Collapse
|
35
|
Cordier JF. [Hypereosinophilic asthma]. Presse Med 2007; 37:167-72. [PMID: 17980546 DOI: 10.1016/j.lpm.2007.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 08/29/2007] [Indexed: 10/22/2022] Open
Abstract
Although moderate airway infiltration by eosinophils is present in the eosinophilic inflammatory phenotype of asthma, hypereosinophilic asthma differs in its frankly elevated levels of eosinophils in the blood, induced sputum, and bronchoalveolar lavage. Some etiologic pitfalls may be tricky especially wheezing in eosinophilic pneumonia induced by drugs or parasitic infections. Idiopathic chronic eosinophilic pneumonia is associated with asthma in most cases. Churg-Strauss syndrome has asthma as a basic feature, but true systemic vasculitis with antineutrophil cytoplasmic autoantibodies is not always present. Systemic corticosteroids are the mainstay of treatment of most hypereosinophilic asthma patients.
Collapse
Affiliation(s)
- Jean-François Cordier
- Service de pneumologie, Centre de référence des maladies orphelines pulmonaires, Hôpital Louis Pradel, F-69677 Bron Cedex, France.
| |
Collapse
|
36
|
Yong MK, Marshall CL, Eisen DP. Tropical pulmonary eosinophilia: a rare cause of cough in immigrants to Australia. Med J Aust 2007; 187:416-8. [PMID: 17908009 DOI: 10.5694/j.1326-5377.2007.tb01316.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 06/21/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle K Yong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | | | | |
Collapse
|
37
|
Franco-Paredes C, Rouphael N, Méndez J, Folch E, Rodríguez-Morales AJ, Santos JI, Hurst JW. Cardiac manifestations of parasitic infections part 3: pericardial and miscellaneous cardiopulmonary manifestations. Clin Cardiol 2007; 30:277-80. [PMID: 17551959 PMCID: PMC6653132 DOI: 10.1002/clc.20092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This is part three of a three-part series discussing parasites of the heart. In this section, we present an overview on parasitic diseases involving predominantly the pericardium and other miscellaneous cardiopulmonary manifestations such as some pulmonary hypertension syndromes and endomyocardial fibrosis.
Collapse
Affiliation(s)
- Carlos Franco-Paredes
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30303, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW The human pulmonary system can be affected by a variety of parasites. This review focuses on the most common parasitic infestations involving the lung, except for protozoon disease. RECENT FINDINGS In many parasitic lung conditions, the clinical manifestations and the imaging findings are non-specific and can make diagnosis challenging. Hydatid disease and paragonimiasis involve the lung directly. Chronic schistosomiasis can lead to pulmonary hypertension. Strongyloides stercoralis infestation is capable of transforming into a fulminant fatal disease. In many types of nematode infestations, the pulmonary phase can cause acute eosinophilic pneumonia. Chest radiographs of patients with paragonimiasis and dirofilariasis can cause diagnostic confusion. Cases of tropical pulmonary eosinophilia typically present with refractory bronchial asthma. Most of these diseases are initially diagnosed by detecting eggs or larvae in stool, sputum, pleural fluid or tissue, and are confirmed by serologic testing. Cystic hydatid disease generally requires surgical treatment, whereas almost all other parasitic lung conditions can be treated medically. SUMMARY Although most parasites that affect the lung are endemic to tropical and subtropical regions, immigration and travel practices have resulted in transfer of these diseases to other areas. It is important for physicians to know the epidemiologic characteristics, clinical presentations, and treatments of choice for these conditions.
Collapse
Affiliation(s)
- Akin Kuzucu
- Department of Thoracic Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.
| |
Collapse
|
39
|
Kim YJ, Nutman TB. Eosinophilia: Causes and pathobiology in persons with prior exposures in tropical areas with an emphasis on parasitic infections. Curr Infect Dis Rep 2006; 8:43-50. [PMID: 16448600 DOI: 10.1007/s11908-006-0034-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Eosinophilia in patients exposed to tropical or subtropical environments is caused most commonly by helminth (worm) infections. Besides a detailed exposure history, the diagnostic approach must consider other infections and noninfectious causes of eosinophilia, as treatments for many of these disorders differ.
Collapse
Affiliation(s)
- Yae-Jean Kim
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Room B1-03, Bethesda, MD 20892, USA.
| | | |
Collapse
|
40
|
Abstract
Treatment of parasitic infections in children presents many challenges for the clinician. Although parasitic infections are ubiquitous on a worldwide basis, with an estimated 1 billion persons infected with intestinal helminthes alone, physicians in the United States and other developed countries are often unfamiliar with the management of these diseases. Children are traveling internationally in larger numbers than ever before, however, and emigration from developing countries to the United States and other Western countries is increasing, so clinicians in these countries are confronted more frequently with parasitic diseases from the tropics. This article describes current approaches to antiparasitic therapy. Drugs used in the treatment of more than one type of parasite are presented once in detail, with reference to the detailed description in subsequent sections.
Collapse
Affiliation(s)
- Troy D Moon
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA.
| | | |
Collapse
|
41
|
|