Persistent lower respiratory tract inflammation associated with interstitial lung disease in patients with tropical pulmonary eosinophilia following conventional treatment with diethylcarbamazine

W. N. Rom, V. K. Vijayan, M. J. Cornelius, V. Kumaraswami, R. Prabhakar, E. A. Ottesen, Ronald Crystal

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Tropical pulmonary eosinophilia (TPE) presents as an acute syndrome with dyspnea, fluffy infiltrates, and rounded opacities on the chest radiograph, reduced lung function, marked eosinophilia in the blood and lower respiratory tract, and high titers of specific IgE and IgG antifilarial antibodies. The standard therapy for TPE is a 3-wk course of diethylcarbamazine (DEC) following which there is almost always a marked improvement in all parameters. However, clinical observations suggest that the disease can persist despite DEC therapy and lead to chronic dyspnea with restrictive lung impairment. To evaluate the concept that DEC therapy is not completely 'curative' for TPE, but rather leaves most individuals with a mild, chronic form of TPE defined by persistent inflammation of the lower respiratory tract, we evaluated 23 individuals an average of 12 ± 2 months following a standard 3-wk course of diethylcarbamazine for acute TPE. In the majority there were mild, persistent symptoms referrable to the lung, chest x-ray abnormalities, blood eosinophilia, and elevated serum IgE and filarial specific IgG. On the average, lung function was consistent with the presence of chronic, mild interstitial lung disease. When the inflammatory cells from the lower respiratory tract were examined, there was a persistent eosinophilic alveolitis (TPE/post-DEC 1769 ± 376 eosinophils/μl epithelial lining fluid; normal subjects 256 ± 38, p < 0.02). Evaluation of the lower respiratory tract inflammatory cells recovered from the TPE/post-DEC-treated individuals demonstrated spontaneous release of exaggerated amounts of O-/2̇ and H2O2 compared to normal subjects (p < 0.05, both comparisons). Thus, following a standard 3-wk course of DEC therapy, most patients show improvement but not complete resolution of TPE, and many are left with chronic respiratory tract inflammation and a mild form of interstitial lung disease. Alternative antifilarial drugs or regimens of corticosteroids may be useful in treating this chronic form of TPE.

Original languageEnglish
Pages (from-to)1088-1092
Number of pages5
JournalAmerican Review of Respiratory Disease
Volume142
Issue number5
DOIs
Publication statusPublished - 1 Jan 1990
Externally publishedYes

Fingerprint

Diethylcarbamazine
Pulmonary Eosinophilia
Interstitial Lung Diseases
Eosinophilia
Respiratory System
Inflammation
Therapeutics
Lung
Dyspnea
Immunoglobulin E
Thorax
Immunoglobulin G
Eosinophils
Adrenal Cortex Hormones

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Persistent lower respiratory tract inflammation associated with interstitial lung disease in patients with tropical pulmonary eosinophilia following conventional treatment with diethylcarbamazine. / Rom, W. N.; Vijayan, V. K.; Cornelius, M. J.; Kumaraswami, V.; Prabhakar, R.; Ottesen, E. A.; Crystal, Ronald.

In: American Review of Respiratory Disease, Vol. 142, No. 5, 01.01.1990, p. 1088-1092.

Research output: Contribution to journalArticle

@article{e97972d01b234b4a8ce865860690d40c,
title = "Persistent lower respiratory tract inflammation associated with interstitial lung disease in patients with tropical pulmonary eosinophilia following conventional treatment with diethylcarbamazine",
abstract = "Tropical pulmonary eosinophilia (TPE) presents as an acute syndrome with dyspnea, fluffy infiltrates, and rounded opacities on the chest radiograph, reduced lung function, marked eosinophilia in the blood and lower respiratory tract, and high titers of specific IgE and IgG antifilarial antibodies. The standard therapy for TPE is a 3-wk course of diethylcarbamazine (DEC) following which there is almost always a marked improvement in all parameters. However, clinical observations suggest that the disease can persist despite DEC therapy and lead to chronic dyspnea with restrictive lung impairment. To evaluate the concept that DEC therapy is not completely 'curative' for TPE, but rather leaves most individuals with a mild, chronic form of TPE defined by persistent inflammation of the lower respiratory tract, we evaluated 23 individuals an average of 12 ± 2 months following a standard 3-wk course of diethylcarbamazine for acute TPE. In the majority there were mild, persistent symptoms referrable to the lung, chest x-ray abnormalities, blood eosinophilia, and elevated serum IgE and filarial specific IgG. On the average, lung function was consistent with the presence of chronic, mild interstitial lung disease. When the inflammatory cells from the lower respiratory tract were examined, there was a persistent eosinophilic alveolitis (TPE/post-DEC 1769 ± 376 eosinophils/μl epithelial lining fluid; normal subjects 256 ± 38, p < 0.02). Evaluation of the lower respiratory tract inflammatory cells recovered from the TPE/post-DEC-treated individuals demonstrated spontaneous release of exaggerated amounts of O-/2̇ and H2O2 compared to normal subjects (p < 0.05, both comparisons). Thus, following a standard 3-wk course of DEC therapy, most patients show improvement but not complete resolution of TPE, and many are left with chronic respiratory tract inflammation and a mild form of interstitial lung disease. Alternative antifilarial drugs or regimens of corticosteroids may be useful in treating this chronic form of TPE.",
author = "Rom, {W. N.} and Vijayan, {V. K.} and Cornelius, {M. J.} and V. Kumaraswami and R. Prabhakar and Ottesen, {E. A.} and Ronald Crystal",
year = "1990",
month = "1",
day = "1",
doi = "10.1164/ajrccm/142.5.1088",
language = "English",
volume = "142",
pages = "1088--1092",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "5",

}

TY - JOUR

T1 - Persistent lower respiratory tract inflammation associated with interstitial lung disease in patients with tropical pulmonary eosinophilia following conventional treatment with diethylcarbamazine

AU - Rom, W. N.

AU - Vijayan, V. K.

AU - Cornelius, M. J.

AU - Kumaraswami, V.

AU - Prabhakar, R.

AU - Ottesen, E. A.

AU - Crystal, Ronald

PY - 1990/1/1

Y1 - 1990/1/1

N2 - Tropical pulmonary eosinophilia (TPE) presents as an acute syndrome with dyspnea, fluffy infiltrates, and rounded opacities on the chest radiograph, reduced lung function, marked eosinophilia in the blood and lower respiratory tract, and high titers of specific IgE and IgG antifilarial antibodies. The standard therapy for TPE is a 3-wk course of diethylcarbamazine (DEC) following which there is almost always a marked improvement in all parameters. However, clinical observations suggest that the disease can persist despite DEC therapy and lead to chronic dyspnea with restrictive lung impairment. To evaluate the concept that DEC therapy is not completely 'curative' for TPE, but rather leaves most individuals with a mild, chronic form of TPE defined by persistent inflammation of the lower respiratory tract, we evaluated 23 individuals an average of 12 ± 2 months following a standard 3-wk course of diethylcarbamazine for acute TPE. In the majority there were mild, persistent symptoms referrable to the lung, chest x-ray abnormalities, blood eosinophilia, and elevated serum IgE and filarial specific IgG. On the average, lung function was consistent with the presence of chronic, mild interstitial lung disease. When the inflammatory cells from the lower respiratory tract were examined, there was a persistent eosinophilic alveolitis (TPE/post-DEC 1769 ± 376 eosinophils/μl epithelial lining fluid; normal subjects 256 ± 38, p < 0.02). Evaluation of the lower respiratory tract inflammatory cells recovered from the TPE/post-DEC-treated individuals demonstrated spontaneous release of exaggerated amounts of O-/2̇ and H2O2 compared to normal subjects (p < 0.05, both comparisons). Thus, following a standard 3-wk course of DEC therapy, most patients show improvement but not complete resolution of TPE, and many are left with chronic respiratory tract inflammation and a mild form of interstitial lung disease. Alternative antifilarial drugs or regimens of corticosteroids may be useful in treating this chronic form of TPE.

AB - Tropical pulmonary eosinophilia (TPE) presents as an acute syndrome with dyspnea, fluffy infiltrates, and rounded opacities on the chest radiograph, reduced lung function, marked eosinophilia in the blood and lower respiratory tract, and high titers of specific IgE and IgG antifilarial antibodies. The standard therapy for TPE is a 3-wk course of diethylcarbamazine (DEC) following which there is almost always a marked improvement in all parameters. However, clinical observations suggest that the disease can persist despite DEC therapy and lead to chronic dyspnea with restrictive lung impairment. To evaluate the concept that DEC therapy is not completely 'curative' for TPE, but rather leaves most individuals with a mild, chronic form of TPE defined by persistent inflammation of the lower respiratory tract, we evaluated 23 individuals an average of 12 ± 2 months following a standard 3-wk course of diethylcarbamazine for acute TPE. In the majority there were mild, persistent symptoms referrable to the lung, chest x-ray abnormalities, blood eosinophilia, and elevated serum IgE and filarial specific IgG. On the average, lung function was consistent with the presence of chronic, mild interstitial lung disease. When the inflammatory cells from the lower respiratory tract were examined, there was a persistent eosinophilic alveolitis (TPE/post-DEC 1769 ± 376 eosinophils/μl epithelial lining fluid; normal subjects 256 ± 38, p < 0.02). Evaluation of the lower respiratory tract inflammatory cells recovered from the TPE/post-DEC-treated individuals demonstrated spontaneous release of exaggerated amounts of O-/2̇ and H2O2 compared to normal subjects (p < 0.05, both comparisons). Thus, following a standard 3-wk course of DEC therapy, most patients show improvement but not complete resolution of TPE, and many are left with chronic respiratory tract inflammation and a mild form of interstitial lung disease. Alternative antifilarial drugs or regimens of corticosteroids may be useful in treating this chronic form of TPE.

UR - http://www.scopus.com/inward/record.url?scp=0025144567&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025144567&partnerID=8YFLogxK

U2 - 10.1164/ajrccm/142.5.1088

DO - 10.1164/ajrccm/142.5.1088

M3 - Article

C2 - 2173455

AN - SCOPUS:0025144567

VL - 142

SP - 1088

EP - 1092

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 5

ER -