A Rare Case of Lymphatic Filariasis

Lymphatic filariasis is a parasitic infection caused by Wuchereria bancrofti, Brugia malayi and Brugia timori.Asymptomatic microfilaria, acute lymphatic filariasis, chronic lymphatic filariasis, tropical pulmonary eosinophilia are the different presentations of lymphatic filariasis. Systemic manifestation can involve joint, kidney, heart and nerve. This article is a case report of lymphatic filariasis with a rare presentation of anasarca and nephritic syndrome.

Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis

Background Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows. Methods This retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed. Results Baseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7–18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2–9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse. Conclusions The ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.

A Comparative Clinical Study in the Management of Vataja Kasa w.s.r. to Tropical Pulmonary Eosinophilia by Shringarabhra Rasa and Shwasakasa Chintamani along with Mridu Virechana

Vataja kasa vis-à-vis T.P.E is a disease of Swasanavaha samsthana, is one of the commonest problem in tropical countries like India. India being a tropical country the prevalence of TPE is remarkable. Vatajakasa presents with symptoms like Shuska kasa, Prasakta vega, Uraha shoola, Ksheena bala, Ksheena oja, Kshamana etc. In Ayurveda, researches have been done and Vataja kasa can be compared with TPE. TPE symptoms such as repeated bouts of dry cough, chest pain, weight loss, and Malaise etc may continue for weeks or months with remission and reoccurrence. Methods: Classical signs and symptoms of Vataja kasa and raised esinophil count >500cells/cumm and 30 patients were selected and randomly allocated in two groups. Firstly, Shunti churna with hot water was given for Amapachana, later patients were given Kantakari ghrita for Snehapana prior to Virechana with Eranda taila in both the groups followed by Shringarabhra rasa in Group A and Shwasa kasa chintamani in Group B for 21 days with follow up of 1 month. Results: Both Group A and Group B provided highly significant results in all parameters of assessment but group B showed better improvement in the symptoms of the disease Vataja kasa in the present study. Interpretation and Conclusion: 15 subjects (50%) got marked relief, 5 subjects (16.66%) got moderate relief in subjective parameters; 20 subjects (66.66%) got mild relief and 5 (16.66%) subjects got moderate relief in objective parameter. Hence, the modalities of our treatment can be recommended to all the patients of Vataja kasa without any hesitation.

A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF KASANTAKA CHOORNA AND SITOPALADI CHOORNA IN THE MANAGEMENT OF VATAJA KASA (TROPICAL PULMONARY EOSINOPHILIA)

In this study, VatajaKasa is compared to Tropical Pulmonary Eosinophilia, which is having symptoms ShuskaKasa, PrasktaVega, ParshwaShula, ShiraShoola, Urashula, SwaraBheda and Kanthakandu similar to that in T.P.E. hence taken for the study. The present study was undertaken to evaluate the efficacy of Kasantakachoorna and Sitopaladichoorna in in the management of VatajaKasa w.s.r.t. T.P.E. The symptoms which are expressed in Tropical Pulmonary Eosinophilia, are very nearer to the symptoms of vatajakasa. Evaluate the effect of KasantakaChoorna in Vatajakasa (T.P.E). Evaluate the effect of Sitopaldi Choorna in Vatajakasa (T.P. E). To compare the efficacy of Kasantaka Choorna and Sitopaladi Choorna in the management of Vatajakasa (T.P.E). Sample size – 40 patients of Vatajakasa were selected and divided into 2 groups, comprising 20 patients in each group. Kasantaka Choorna: This is more effective on ShushkaKasa, HrutShoola, Prasakta Vega Kantha Kandu because Kasantaka Choorna ingredients contains Snigdha, Rasayana and Kaphavatahara properties. Sitopaladi Choorna: ingredients include Ela, Twaka, Pippali, Vamsalochana etc. These herbs promote various medical properties that help in improving the immune system and its having Kaphashamaka, Vatanulomaka,Pittashamaka and Antitussive properties. Sitopaladi Choorna acts more effective on Shira Shool, Parshwashool and SwaraBheda. Keywords: Kasantaka Choorna, Sitopaladichoorna, Vatajakasa Tropical pulmonary Eosinophilia,

Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis

Background Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia and pulmonary infiltration, a condition described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows. Methods This retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019 using criteria proposed by the International Society of Human and Animal Mycology (ISHAM). Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed. Results Baseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7–18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2–9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse. Conclusions The ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.

ILC2s Are Responsible for RSV-induced Pulmonary Eosinophilic Infiltration by Response to IL-4/IL-13 via STAT6 Signaling

Group 2 innate lymphoid cells (ILC2s) play an important role in respiratory syncytial virus (RSV)-induced lung inflammation, including eosinophilic infiltration. However, the underlying signals are still not fully understood. Therefore, we aimed to explore the potential mechanism(s) of ILC2s contributes to the RSV-induced eosinophilic infiltration. RSV-induced mouse airway inflammation model was established. The mice were treated with or without recombinant human IL-4 to block signal transducer and activator of transcription 6 (STAT6). The proportions of different leukocyte subtypes, numbers of eosinophils and ILC2s, and mRNAs levels of IL-4Rα and IL-13Rα1 in ILC2s were assessed. Moreover, ILC2s or recombinant human IL-4 pre-treated-ILC2s were administrated to the mice, and then histologic analysis of lung tissues and the number of eosinophils were analyzed. Furthermore, after treatment with IL-4 + IL-13, the migration of ILC2s was investigated. Block of STAT6 significantly decreased RSV-induced eosinophilic infiltration and the number of ILC2s, and also statistically reduced the mRNAs levels of IL-4Rα and IL-13Rα1 in ILC2s. Adoptive transfer of recombinant human IL-4 pre-treated ILC2 did not augment RSV-induced eosinophilic infifiltration, including less mucous and infiltrated cells in the airways. Furthermore, the lung ILC2s were responded to IL-4/IL-13-induced production of STAT6 and STAT6-mediated signals regulated ILC2s proliferation and migration during the RSV-induced pulmonary eosinophilia recruitment. However, STAT6 did not regulate the transcriptional levels of IL-4 and IL-13 in ILC2s. In conclusion, ILC2s are responsible for RSV-induced pulmonary eosinophilic infiltration by response to IL-4/IL-13 via STAT6 signaling.

Eosinophilic pneumonia in the allergist's practice

Pulmonary eosinophilia is defined as infiltration of eosinophils into the lungs airways, interstitium, and alveoli. Various infections, drugs, parasites, autoimmune processes, malignancies and obstructive lung diseases have been associated with increased eosinophils in the lungs The eosinophilic pneumonias are a heterogeneous group of diseases characterized by an increase in eosinophils in lung tissue or bronchoalveolar lavage fluid. Many, but not all, of the eosinophilic pneumonias are also associated with a peripheral blood eosinophilia. The two main variants of the disease are acute and chronic eosinophilic pneumonia

Management of Vataja Kasa w.s.r. to Tropical Pulmonary Eosinophilia by Shringarabhra Rasa with Mridu Virechana

The clinical features of vataja kasa are oftenly compared to TPE are, Shushka kasa, Alpa kapha nishtivana, Swarabedha, shushka ura kantha vaktrata, Dourbalya etc. TPE is an occult form of filariasis and is characterized by dry cough, dyspnoea, nocturnal wheezing etc, and marked peripheral blood eosinophilia. This affects males and females at a ratio of 4:1 often during the 3rd decade of life. Keeping in view about the adverse effects of the modern sciences, an attempt was made to find an effective Ayurvedic treatment modality. Methods: 15 subjects with classical signs and symptoms of Vataja kasa and raised esinophil count >500cells/cumm were selected. After Amapachana by Shunti churna with hot water, subjects were given Kantakari ghrita for Snehapana prior to Virechana with Eranda taila followed by Shringarabhra rasa for 21 days with follow up of 1 month. Results: Shringarabhra Rasa with Mridu Virechana provided highly significant results in all parameters of assessment. Conclusion: It is found that the relief was highly significant after Mridu Virechana. It is found that the effect of therapy was highly significant on Shushka kasa and Shushka urah kantha vaktra.

Unusual presentation of chronic eosinophilic pneumonia with mild peripheral eosinophilia

Chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown aetiology which comes under the class of diffuse parenchymal lung diseases with eosinophilia. It is classically characterised by blood and pulmonary eosinophilia, peripheral consolidation on chest radiograph and prompt response to corticosteroid therapy. We report a case of CEP in a 66-year-old man, smoker showing bilateral pulmonary infiltrates with mild peripheral eosinophilia. Our study shows that CEP can be kept as a possibility if radiological pictures are consistent, even if peripheral blood eosinophilia is mild.