International Journal of Open Medicine and surgery Review | Vol 1 Iss 1 Parasitic Lung Diseases Death and Dilemma Raghavendra Rao M.V*1, Abrar A khan2, Vijaya Kumar C3, Badam Aruna Kumari4, Mohammed Khaleel5, Mohammed Ismail Nizami6, Jithendra K.Naik7,Mahendra Kumar Verma8 *1Scientist-Emeritus, and Director of Central research laboratory, Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, TS, India. 2Dean, American University School of Medicine Aruba, Central America. 3Professor, Department of Pulmonology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India. 4Associate Professor, Department of Respiratory Medicine, Apollo Institute of Medical sciences and Research, Hyderabad, TS, India. 5Professor of Microbiology, Clinical & Diagnostic Microbiologist, Department of Microbiology, Deccan college of Medical Science, Hyderabad, TS, India. 6Department of Emergency Medicine NIMS, Punjagutta, Hyderabad, TS, India. 7Department of Zoology, University college of Science,Osmania University. 8Department of Biotechnology, Acharya Nagarjuna University, Guntur, AP, India *Corresponding author: Dr. M. V.Raghavendra Rao, Scientist-Emeritus and Director of Central research laboratory, Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana State, India, E-Mail: [email protected] Received: 14 July 2020 Accepted: 19 July 2020 Published: 25 July 2020 Abstract Warm countries are the worm countries. We are living in the"Wormy world" "Delays have dangerous ends" We take our breathing and our respiratory health for granted, but the lung is a vital organ that is vulnerable to airborne infection and injury. The parasites produce toxic metabolites and increase eosinophilic eosinophils induce tissue damage. protozoans, Nematodes and Trematodes affect the lungs. Echinococcus produces hydatid cysts. Lesions are discovered on the Chest X- ray during asymptomatic primary infection. Dirofilaria immitis produce chest pain, cough, haemoptysis, wheezing symptoms. In Amoebic liver abscess, primary complication that encounters is Amoebic pleuropulmonary disease. Ascaris larvae invade lung tissue and produce Loffler's syndrome. Similarly, hookworm larvae, Strongyloid, Schistosome larvae produce the similar pulmonary symptoms. Wucheraria bancrufti, Brugia malayi produce tropical eosinophilia. Keywords: Loeffler's syndrome, Eosinophilic pneumonia, Wucheraria bancrufti, Human pulmonary dirofilariasis (HPD), Paragonimus westermani, Microfilaria Citation: Raghavendra RMV. Parasitic Lung Diseases Death and Dilemma. International Journal of Open Medicine and Surgery. 2020;1(1):2. © 2020 IJOMASR. 5 www.ijomasr.com | JULY-2020 INTRODUCTION Parasitic infections are seen all over the globe in general and in immunocompromised patients in particular. Echinococcus granulosus produce hydatid cysts. It takes years for full formation of cysts, during this time, patients are asymptomatic [1]. The cysts are seen in X-Rays accidentally. The cyst contains hydatid fluid and salts. The cysts cavity producing “Water Lilly sign” [2]. The adult heart worm lives in heart and nearby blood vessels of dog and cause the dog to have cough, shortness of breath and weakness [3]. The trophozoites into the bronchial airways after the rupture of abscess. Swelling and redness appears on the pleura of lung [4] Practitioners should misdiagnose this as Tuberculosis, as the clinical symptoms like fever, cough, weight loss are almost match to TB. However, in endemic areas it is present to consider Paragonimus westermani as well [5]. Paragonimus westermani, is a trematode parasite. It is the parasite of lung primarily but infects other parts of the body. Ova can be observed in microscopic examination of sputum, faeces and pleural fluid [6]. A -year-old male with history of Down syndrome who presented with severe right side pneumonia and empyema. He is resistant to regular medical therapy. Patient was diagnosed as Pleuropulmonary amoebiasis, observing trophozoites in pleural fluid. Patient recovered from the disease on metronidazole therapy [7]. Tropical (pulmonary) eosinophilia, or TPE, is characterized by coughing, asthmatic attacks, and an enlarged spleen, and is caused by Wuchereria bancrofti, a filarial infection. Tropical pulmonary eosinophilia is very common in India and Southeast Asian countries. This disease also mimic with tuberculosis, asthma, or coughs related to roundworms [8]. Tropical pulmonary eosinophilia or Weingarten’s’ lung resembles T B. with low grade fever, cough, loss of weight symptoms [9]. In tropical pulmonary eosinophilia or Weingarten’s’ lung or Eosinophilic lung, chest X-ray shows “mottling’s” like TB X- ray. The link has been established with Wuchereria bancrofti and Brugia malayi [10]. Research on the Infections of the Lower Airway Protozoan and Helminth parasites, and their larvae cause infection in lower air way. 15 www.ijomasr.com | JULY-2020 The mucus membrane of this part the air way is probably sterile in health, but direct examination involves bronchoscopy or lung biopsy, neither of which is indicated in the normal course of the diagnosis of infection. Sputum from subjects with acute excerbarations of chronic bronchitis and pneumonia, should be examined. The more purulent material is likely to contain specific pathogens and therefore examination should be directed to this part by spreading the sputum in a dish so that the purulent material may be picked directly for observing larvae if any. (Mackie and McCartney) Pulmonary defenses Most microbes are small and can penetrate to the distal gas exchanging surfaces of the lung, although the majority are excluded by the defenses of the upper airways are to be cleared by the mu co ciliary as escalator. Humeral factors, including secretory immunoglobulin A(SIgA) and defensins released y air cells, limits microbial penetration in to tissues. Air way mucosal cells trap microbial antigens and transport them to regional lymph nodes, where they both T and B lymphocytes, evoking adaptive immunity ulceration or thickening of the gas exchange surface limits diffusion of o2 and co2. For this reason, the alveolus, under normal conditions, is maintain sterile by resident macrophages that scavenge inhaled particulates and secrete mono-kines, including interlukin 10 and transforming growth factor Beta, that locally supress inflammation and promote non-tolerance. If the alveolar lining is injured or if the number of invading organisms exceeds the phagocytic capacities of resident macrophages, nutrophils and exudation of monocytes are recruited to sites of lung infection [11]. Parasites induced eosinophilic lung diseases Pulmonary Ascarisis. The larva of Ascaris, Rhabditiform produce peribronchial inflammation, increased mucus production and bronchospasm. The larvae produce Loffler's syndrome. The patients may present with general symptoms of malaise, loss of appetite, headache, myalgia and fever lasting 2 or 3 days. The respiratory system include chest pain cough with mucoid sputum, haemoptysis, shortness of breath and wheezing. Pulmonary Amoebiasis Pulmonary amoebiasis is not a common clinical presentation. In India and many other tropical contries, one does come across pulmonary amoebiasis. So long as the disease is not recognized, it is a clinical problem, which is quite baffling to the uninitiated, whereas once recognized and the treatment instituted, the clinical result will be very gratifying to all concerned. In most cases the condition is missed not because the clinician is not aware of the possibility. In the tropics whenever one gets a problem chest case, where the presentation is like pneumonia or lung abscess or pleural effusion or any other lung manifestation, or one must think of the possibility of pleuro pulmonary amoebiasis. The disease is rare at either extremes of life and the reason for this is,all the extra intestinal amoebiasis are common in alcoholics. The incidence of complications started declining [12]. 15 www.ijomasr.com | JULY-2020 Pulmonary ancylostomiasis and Pulmonary strogyloidiasis. Ancylostoma duodenale larva, the (Filariform) penetrate the intact skin and reach lungs. It produces fever, cough. Wheezing and transient pulmonary infiltrates in chest radiographs. It is associated with Pulmonary eosinophilia Pulmonary strogyloidiasis, the females live in the wall of intestine of man; The rhabdity form metamorphose into filariform. This larva reaches the lungs through circulation. In lungs, the larvae produce bronchopneumonia, and hemorrhages in the alveoli. This is associated with elevated eosinophilia and IgE. Gram negative bacteria are carried by large on their cuticle. As a result of invasion of bacteria along with larvae diffuse and patchy bronchopneumonia and pulmonary abscess can occur. Tropical Pulmonary Eosinophilia or Weingarten’s’ Lung or Eosinophilic Lung, It is by Brugia malayi and Wucheraria TPE is pervasive in endemic regions of the world. Patients suffer from fever, cough and massive eosinophilia. This is described as pseudo-Tuberculosis condition. It is called wingarten syndrome [13]. Pulmonary dirofilariasis, Visceral larva migrans, Pulmonary richinellosis, schistosomiasis, Paragonimiasis, Hydatid, Eosinophilia and pulmonary tuberculosis, and Brucellosis. Fungus induced eosinophilic lung disease are Coccidiomycosis, Aspergillosis, Cryptococcosis and Histoplasmosis. Clinical features of TPE- Paroxysmal cough and wheezing, Weight loss, low grade fever, lymphedenopathy and pronounced