Tropical eosinophilia: Relationships between lower respiratory tract inflammation and changes in lung function following treatment at one year

Our previous studies in 50 Tropiccal Eosinophilia (TE) \npatients (45 males, 5 females; age 14-48 years) had shown that \nradiological and pulmonary function abnormalities especially a \nreduction in single breath Transfer factor and a mild \nalveolitis were persisting at one month, immediately following \ntreatment with a standard 3 weeks course of diethylcarbamazine \n(DEC) (6 mg/kg/day) (1,2). In order to study the long term \nsequele in such patients, physiological sudies were reevaluated \nat 3, 6 and 12 months, and bronchoalveolar lavage (BAL) studies at \n6 and 12 months. Twelve normal non-smoking healthy subjects were \nevaluated as controls for BAL, and predicted values for pulmonary \nfunction were obtained from our study (3). Of the 43 patients \navailable for follow up at one year, reduced TLCO \n(<85% predicted) and KCO (<85% predicted) were found in 22 \n(51%) and 21 (49%) patients respectively. Seven patients (16%) \nhad persisting airflow limitation and another 7 (16%) had \nrestriction. BAL could be repeated in 26 patients at one year \nand nine of them (35%) had chrinic eosiniphilic alveolitis, i.e. \nand increase in percent eosinophils in BAL greater than 3 standard \ndeviations above normal. the patients with chronic eosinophilic \nalveolitis (n: 9) at one year had a significantly lower TLCO \n(75.3 +2.9% VS 87.4+3.5%, P < 0,05) and KCO (78.8+2.8% VS \n90.8+3.1%, P <0.05) compared to the patients without alveolitis \n(n: 17). these data suggest that 3 weeks treatment with DEC is \nnot sufficient for complete recovery.