Epidemiology of pulmonary eosinophilia in rural south India--a prospective study, 1981-86.

Abstract

Study objective-The study aimed to determine the prevalence and incidence of pulmonary eosinophilia, with special reference to tropical pulmonary eosinophilia, in a rural community. Design-This was a five year prospective study from 1981-86. Setting-The study was conducted in four villages of Tamil Nadu in south India. Subjects-The study population consisted of 24 950 subjects. Measurements and main results-After being questioned about pulmonary symptoms, the selected subjects had peripheral blood examined for total leukocyte and eosinophil counts; stools for ova, cysts, and parasites; sputum for acid-fast bacilli, and chest radiography. Subjects with blood eosinophilia of ¢2000/mm3 were classified as having pulmonary eosinophilia. One of the 200 asymptomatic control subjects had blood eosinophilia >2000/mm3. Twenty two (7 7%) of a further 286 subjects selected at random were found to have microfilaraemia. Between 1981 and 1984 the annual incidences of pulmonary eosinophilia were estimated at 4 1, 3i1, and 2i7/1000 while the prevalence rates were 6i4, 9 3, and 119/1000 respectively. This rising prevalence over time occurring simultaneously with a falling incidence suggests that the final incidence rate (2-7/1000) was likely to be the most accurate of the three estimated. At resurvey in 1986, 314 cases were classified as pulmonary eosinophilia giving a prevalence rate of 12-6/1000. Altogether 214 of them also had intestinal worm infestations, including 58 in whom eosinopenic remission was recorded after deworming alone. Eosinopenic remission was documented in 135 of 182 cooperative patients who were considered to have tropical pulmonary eosinophilia and agreed to be treated with diethylcarbamazine. Conclusions-This study found that tropical pulmonary eosinophilia, either alone or with worm infestation, was a major cause or morbidity in this rural population.

Respiratory morbidity due to ammonia exposure among the employees of a urea manufacturing industry located in western part of India

“…Ray et al .,[7] reported in their community-based study an incidence of pulmonary eosinophilia in the range of 2.7–4.1 per 1,000. This study calculated an incidence rate of 0.87 for pulmonary eosinophilia with statistically significant RR of 1.55 (1.01–2.38) when exposure to ammonia is considered; although, AR for ammonia for pulmonary eosinophilia here was 40%.…”

Parasitic Pulmonary Eosinophilia

“…Rarely, Dirofilaria immitis may also cause TPE. 26 Originally described by Lowe in 1916, 27 the term tropical eosinophilia was coined by Weingarten in 1943. 28 General recognition that human filarial infections are the cause of tropical eosinophilia came in the 1960s.…”

“…These infected larvae enter human skin during a subsequent mosquito bite and migrate to another location, where they develop into adult worms. 21,23,26,30 Tropical eosinophilia has the highest prevalence in the third and fourth decade of life and chiefly involves the lungs. Less than 7% of patients have only the nonpulmonary manifestations involving the liver, spleen, or lymphatics.…”

Tropical pulmonary eosinophilia presenting as severe pulmonary arterial hypertension

“…In India, majority of cases are reported from Uttar Pradesh, Orissa, Bihar, and some areas of south India. [3,4] It is notable that TPE is seen in only less than 1% of filarial infections. [2] The following diagnostic criteria has been proposed for the diagnosis of TPE: (a) Appropriate exposure history (mosquito bite) in an endemic area of filariasis, (b) a history of paroxysmal nocturnal cough and breathlessness, (c) chest radiographic evidence of pulmonary infiltrations, (d) leucocytosis in blood, (e) peripheral blood eosinophils more than 3000 cells per cumm, (f) elevated serum IgE levels, (g) elevated serum antifilarial antibodies (IgG and/or IgE), and (h) a clinical response to DEC. [5] Our patient fulfilled the above criteria and diagnosed as a case of TPE.…”