542
TUNSACTIONS OF THE ROYALSOCIETY OFTROPICAI.M~nrcr~r AND HYGIBPI’E (1992)86, 542
-Report/ An eosinophilic granuloma containing an adult female Wuchefefia bancrofti in a patient with tropical pulmonary eosinophilia C. Selvie Perera’, L. M. Perera’, Chitrika de Silva’, W. Abeywickreme*, A. S. Dissanaikes and M. M. Ismail** IGeneral Hospital, Colombo, Sri Lanka; 2Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka, 328 Welikadewatte, Nawala Road, Rajagiriya, Sri Lanka Tropical pulmonary eosinophilia (TPE) is a syndrome believed to be triggered by hyper-responsiveness to tilarial parasites. This is a report of a 24 years old Sri Lankan male with this syndrome who was admitted to the General Hospital, Colombo on 24 September 1991 with nocturnal paroxysmal cough, wheezing and dyspnoea of one month’s duration. He had been febrile, anorexic and had lost weight. There was no history of bronchial asthma. The only clinical signs detected were bilateral
showed an eosinophilic granuloma with segments of a degenerating adult female filarial worm with the uteri full of microfilariae (Fig. 1). The nuclei of the microfilariae ,were of uniform size, discrete and resembled those of Wuchereria bancrofti, the only human filarial species found in Sri Lanka at the present time (Fig. 2). Dirofilaria repens adults have been found in skin nodules (DISSANAIKE, 1991) but microfilariae were not seen in any of them. Furthermore, the diameter of the uteri (about 65 urn) seen in the histological sections was compatible with that of W. bancrofti. The diameter of the uterus of worms of the genus Dirofilaria (Nochtiella) is over 133 urn (DISSANAIKEet al., 1972). WEBB et al. (1960) were the first to demonstrate microfilariae in the lungs, liver and lymph nodes in Tl’E. More recently, CHANDKASUMA et al. (1977) reported an eosinophilic granuloma containing microfilariae, identified as those of W. bancrofti, which developed in the breast of a Sri Lankan patient with TPE a few days after commencement of diethylcarbamazine therapy. Adult filarial worms, however, have never been reported in TPE (PARTONO, 1987). Ours is perhaps the first case of TPE with an adult K. bancrofti worm recorded in south where this syndrome is not unand south-east Asia common, and confirms the present view that TPE is caused by occult W. bancrofti infection.
Fig. 2. Section showing morphological details of microfilariae. Bar=10 nrn.
Fig. 1. Section of granuloma showing degenerating worm tissue containing uterine tubes with microfilariae. Note also eosinophils and CharcotIxyden Crystals. Bar=50 tmrm.
rhonchi. The patieni had a white blood cell (WBC) count of 54 600 cells/mm with 96% eosinophils, an erythrocyte sedimentation rate of 66 mm (first hour), and radiological evidence of extensive bilateral coarse mottling in the lungs; lung function tests showed obstructive and restrictive elements. A diagnosis of TPE was made and the patient was treated with diethylcarbamazine 250 mg, prednisolone 10 mg, and salbutamol 4 mg, al! thrice daily for 5 d. His clmical condition iFproved, his WBC count decreased to 15 000 cells/mm with 13% eosinophils on 28 September 1991, and he was discharged from hospital. The patient was readmitted to hospital on 4 December 1991 with a recurrence of his symptoms. His WBC count was 49 700 cells/mm3 with 77% eosinophils. He was given the same treatment regimen as before, but 2 d after commencement of therapy he developed a lump on the right snermatic cord. A biopsy of the lump *Author for correspondence.
References Chandrasoma, I’. T., Mendis, K. N. & Kumararatne, D. S. (1977). Microlilarial granuloma of the breast in a patient with tropical pulmonary eosinophilia. American Journal of Tropical Medicine and Hygiene, 26, 570-571. Dissanaike, A. S. (1991). Filariasis in Ceylon then (1961) and in Sri Lanka now (1990-30 years on). Annals of Tropical Medicine and Parasitology, 85, 123-129. Dissanaike, A. S., Lykov, V. I’., Sri Skanda Rajah Sivayoham, I., Wijesekerea, S. V. J. & Perera, M. C. S. (1972). Four more cases of human infection with Dirojilaria (Norhtiella). Ceylon MedicalJournal, 17, 105-l 12. Partono, F. (1987). The SpeCTrUm of disease in lymphatic filariasis. In: Filariasis, Ciba Foundation Symposium no. 127, Evered, D. & Clark, S. (editors). Chichester: John Wiley & Sons, pp. 15-31. Webb, J. K. G., Job, C. K. & Gault, E. W. (1960). Tropical eosinophilia: demonstration of microfilariae in lung, liver and lymph nodes. Lancet, i, 835-842.
Received 31 March 1992; accepted for publication 15 April 1992 **While this paper was in preparation, Dr Gerusa Dreyer, in a personal communication To M. M. Ismail, indicated that nodules containing degenerating adult W. bancrofti had been observed in Recife, Brazil in TI’E patients after DEC therapy.
TUNSACTIONS OF THE ROYALSOCIETY OFTROPICAI.M~nrcr~r AND HYGIBPI’E (1992)86, 542
-Report/ An eosinophilic granuloma containing an adult female Wuchefefia bancrofti in a patient with tropical pulmonary eosinophilia C. Selvie Perera’, L. M. Perera’, Chitrika de Silva’, W. Abeywickreme*, A. S. Dissanaikes and M. M. Ismail** IGeneral Hospital, Colombo, Sri Lanka; 2Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka, 328 Welikadewatte, Nawala Road, Rajagiriya, Sri Lanka Tropical pulmonary eosinophilia (TPE) is a syndrome believed to be triggered by hyper-responsiveness to tilarial parasites. This is a report of a 24 years old Sri Lankan male with this syndrome who was admitted to the General Hospital, Colombo on 24 September 1991 with nocturnal paroxysmal cough, wheezing and dyspnoea of one month’s duration. He had been febrile, anorexic and had lost weight. There was no history of bronchial asthma. The only clinical signs detected were bilateral
showed an eosinophilic granuloma with segments of a degenerating adult female filarial worm with the uteri full of microfilariae (Fig. 1). The nuclei of the microfilariae ,were of uniform size, discrete and resembled those of Wuchereria bancrofti, the only human filarial species found in Sri Lanka at the present time (Fig. 2). Dirofilaria repens adults have been found in skin nodules (DISSANAIKE, 1991) but microfilariae were not seen in any of them. Furthermore, the diameter of the uteri (about 65 urn) seen in the histological sections was compatible with that of W. bancrofti. The diameter of the uterus of worms of the genus Dirofilaria (Nochtiella) is over 133 urn (DISSANAIKEet al., 1972). WEBB et al. (1960) were the first to demonstrate microfilariae in the lungs, liver and lymph nodes in Tl’E. More recently, CHANDKASUMA et al. (1977) reported an eosinophilic granuloma containing microfilariae, identified as those of W. bancrofti, which developed in the breast of a Sri Lankan patient with TPE a few days after commencement of diethylcarbamazine therapy. Adult filarial worms, however, have never been reported in TPE (PARTONO, 1987). Ours is perhaps the first case of TPE with an adult K. bancrofti worm recorded in south where this syndrome is not unand south-east Asia common, and confirms the present view that TPE is caused by occult W. bancrofti infection.
Fig. 2. Section showing morphological details of microfilariae. Bar=10 nrn.
Fig. 1. Section of granuloma showing degenerating worm tissue containing uterine tubes with microfilariae. Note also eosinophils and CharcotIxyden Crystals. Bar=50 tmrm.
rhonchi. The patieni had a white blood cell (WBC) count of 54 600 cells/mm with 96% eosinophils, an erythrocyte sedimentation rate of 66 mm (first hour), and radiological evidence of extensive bilateral coarse mottling in the lungs; lung function tests showed obstructive and restrictive elements. A diagnosis of TPE was made and the patient was treated with diethylcarbamazine 250 mg, prednisolone 10 mg, and salbutamol 4 mg, al! thrice daily for 5 d. His clmical condition iFproved, his WBC count decreased to 15 000 cells/mm with 13% eosinophils on 28 September 1991, and he was discharged from hospital. The patient was readmitted to hospital on 4 December 1991 with a recurrence of his symptoms. His WBC count was 49 700 cells/mm3 with 77% eosinophils. He was given the same treatment regimen as before, but 2 d after commencement of therapy he developed a lump on the right snermatic cord. A biopsy of the lump *Author for correspondence.
References Chandrasoma, I’. T., Mendis, K. N. & Kumararatne, D. S. (1977). Microlilarial granuloma of the breast in a patient with tropical pulmonary eosinophilia. American Journal of Tropical Medicine and Hygiene, 26, 570-571. Dissanaike, A. S. (1991). Filariasis in Ceylon then (1961) and in Sri Lanka now (1990-30 years on). Annals of Tropical Medicine and Parasitology, 85, 123-129. Dissanaike, A. S., Lykov, V. I’., Sri Skanda Rajah Sivayoham, I., Wijesekerea, S. V. J. & Perera, M. C. S. (1972). Four more cases of human infection with Dirojilaria (Norhtiella). Ceylon MedicalJournal, 17, 105-l 12. Partono, F. (1987). The SpeCTrUm of disease in lymphatic filariasis. In: Filariasis, Ciba Foundation Symposium no. 127, Evered, D. & Clark, S. (editors). Chichester: John Wiley & Sons, pp. 15-31. Webb, J. K. G., Job, C. K. & Gault, E. W. (1960). Tropical eosinophilia: demonstration of microfilariae in lung, liver and lymph nodes. Lancet, i, 835-842.
Received 31 March 1992; accepted for publication 15 April 1992 **While this paper was in preparation, Dr Gerusa Dreyer, in a personal communication To M. M. Ismail, indicated that nodules containing degenerating adult W. bancrofti had been observed in Recife, Brazil in TI’E patients after DEC therapy.
