Serum C3d levels in tropical pulmonary eosinophilia.

Background & objectives: Results of earlier studies to evaluate the possible role of complement system in tropical pulmonary eosinophilia (TPE) using classical methods like serum haemolyte component CH50, C3 and C4 levels were inconclusive. In this study we determined levels of serum C3d which is a catabolic fragment of C3, to find out any direct evidence of activation of the complement system in TPE. Methods: The study population consisted of 3 groups. Group A consisted of 37 patients with well characterized TPE. In group B, 26 patients with pulmonary eosinophilia had similar respiratory and haemotological features as in Group A but had associated worm infestation in stool. The control group consisted of 39 healthy volunteers. Serum C3d levels were determined by sandwich ELISA technique. Results: The serum C3d levels in TPE patients were not significantly different from those of the patients of group B or the normal controls. Interpretation & conclusions: Absence of significant change in serum C3d goes against the possibility of complement activation in TPE. Results of our study suggest that complement system is unlikely to play a pivotal role in pathogenesis of TPE.

Chronic eosinophilic pneumonia: a case report.

Chronic eosinophilic pneumonia (CEP) is a disorder, characterized by a history of pneumonia (> 2 months) and eosinophilic pulmonary infiltration without any organic causes. We describe a 28-year-old woman who presented with cough, dyspnea and fever for 2 months. She was diagnosed with mild asthma and allergic rhinitis 2 years before being diagnosed with CEP. For a period of 9 months she took no medication. Her chest roentgenogram at this admission revealed patchy infiltration in both upper lung fields. Laboratory data revealed blood eosinophilia (4,284/mm3), and her serum IgE was mildly elevated (245.8 IU/ml). A computerized tomography of the chest did not show bronchiectasis. CEP was diagnosed from significant eosinophilia in bronchoalveolar larvage fluid and transbronchial biopsy revealed eosinophilic infiltration without any demonstrable infectious agent. The patient was treated with prednisolone 45 mg/day. Her symptoms disappeared and her chest roentgenogram showed nearly complete resolution in 2 and 4 days, consecutively.

A clinico-radiological review of 62 cases of tropical eosinophilia in Punjab.

A clinico-radiological account of 62 cases of tropical pulmonary eosinophilia (TPE) seen during past seven years among permanent residents of Punjab, a non-filarial endemic state, has been presented. In comparison to reports from filarial states, rhonchi (32.2%), systemic involvement (1.6%) and mottled radiological appearance (8%) was seen less commonly. Possible means of transmission have been discussed. This report should dispel the commonly held view that TPE is prevalent in filarial endemic regions only.

Adrenal function & the pattern of glucocorticoid induced eosinopenia in tropical pulmonary eosinophilia.

Plasma cortisol levels were estimated in 16 patients with tropical pulmonary eosinophilia (TPE; group A) by radioimmunoassay using 125I labelled cortisol. The cortisol levels showed diurnal variation, the mean levels were 10.22 +/- 4.5 micrograms/dl for the morning samples and 4.91 +/- 2 micrograms/dl for the night samples respectively and were within normal limits. Another six patients with TPE included in the study (group B) had an initial mean plasma cortisol level of 5.83 +/- 1.33 micrograms/dl. Half an hour after intramuscular administration of 250 micrograms of Synacthen (a synthetic glucocorticoid with corticotrophic activity), the mean cortisol level showed a significant rise up to 14.7 +/- 3.54 micrograms/dl (P < 0.01) thus indicating normal adrenocorticohypophysial functions in TPE. There was no significant alteration of total blood eosinophil counts before and after intramuscular Synacthen. An additional 6 patients with TPE (group C) who were given oral prednisolone 30 mg a day for 5 days which was subsequently tapered off in the next 5 days showed a spectacular mid-treatment fall in blood eosinophil levels with a post-treatment rise. In another 3 patients with TPE (group D) total blood eosinophil counts were estimated 4 h after intramuscular hydrocortisone and a prompt eosinopenic response was observed. This indicated that a dose related response to steroids in TPE is unlikely. The absence of eosinopenic response after Synacthen could have been due to the short (half an hour) interval when the eosinophil counts were repeated.