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Medical Analysis of Tropical Eosinophilia (Weingartein Syndrome, Pulmonary Eosinophillosis)

This condition, common in tropical regions, is characterized by absolute eosinophil counts and is accompanied by respiratory symptoms. The disease is endemic in India, Sri Lanka, Malaysia, Pakistan, Bangladesh and West Central Africa.

Etiology

The microscopic lesion was essentially an inflammatory cell infiltration of several tissues. Lymphocytes and histiocytes are the initial invaders. It was later changed to eosinophilic bronchopneumonia, interstitial histiocyte infiltration, and interstitial fibrosis. In some cases, the lesions resembled granulomas with foreign giant cells surrounded by monocytes. The extent of the lesion may be related to the duration of the disease. Histologic changes are not characteristic of tropical hypereosinophilia, as similar lesions may result from hypersensitivity to several other allergens.

clinical manifestations

Most of the onset is insidious, and patients come to see a doctor several months after the onset. Men are more affected than women. Symptom severity did not correlate with eosinophil counts. Many patients with high eosinophil counts may be asymptomatic. In some cases, the onset may be acute, such as with influenza, bronchial asthma, or gastrointestinal disease. The chronic form may present as dyspnea on exertion, vague poor health, or asthma symptoms. Mild hemoptysis may occur. Chest auscultation may show evidence of bronchospasm with crackles. Some cases manifested as mild fever, weight loss, generalized lymphadenopathy, mild splenomegaly, and rarely bleeding tendency. Absolute eosinophil counts ranged from 2000-10,000/cmm. In some cases, the total number of white blood cells may be as high as 30-40,000/cmm, and eosinophils may comprise 70-90% of the total. They are all mature eosinophils. The bone marrow showed an infiltration of eosinophils and their precursors.

In approximately 50% of cases, the chest Skiagram shows diffuse fine spots bilaterally. Radiological features are rarely unilateral or even limited to one lung. Pulmonary function tests showed restrictive and obstructive features.

diagnosis

Tropical eosinophilia should be suspected in all cases of respiratory disease presenting with short-term asthmatic symptoms. An absolute eosinophil count above 2000/cmm is essential for making the diagnosis. Tropical hypereosinophilia must be distinguished from other parasitic infections that cause hypereosinophilia. Loeffler syndrome, aspergillosis, allergic alveolitis, bronchial asthma, and tuberculosis. Eosinophils may also increase in bronchial asthma, but counts rarely reach the levels seen in tropical hypereosinophilia. In the latter, treatment is curative, while in the former, treatment is only palliative. Helminth infections can also lead to lower levels of eosinophilia. These may be associated with respiratory symptoms. Eosinophilia can be cleared by deworming.

The course of tropical hypereosinophilia is benign, with remissions and exacerbations lasting months or years. Deaths are rare, although some cases have been reported.

treat

The drug of choice is diethylcarbamazine at a dose of 4-12 mg/kg/day for 10-14 days. In most cases, eosinophil counts and symptoms resolve quickly. Side effects are mild. These include headaches, joint pains, anorexia, nausea and vomiting. In rare cases, respiratory symptoms may slightly worsen at the beginning of treatment. These cases responded to bronchodilators or corticosteroids. Long-term follow-up is necessary because the condition is likely to recur.

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