Loeffler’s syndrome, pulmonary
ascariasis, in Thailand, rare or
under-reported?
Letter to the Editor
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Sir, ascariasis is an important tropical round worm infestation.
This parasitic infestation is still prevalent in many countries.
Extraintestinal manifestation of ascariasis is not common and can
be misdiagnosed. An important extranintestinal manifestation is
pulmonary ascariasis. The disorder namely “Loeffler’s syndrome”,
which manifests as eosinophils accumulation in the lung as a
response to a parasitic infection, is an important concern in tropical
medicine (1). This syndrome can be a response to several parasitic
infestations. Ascariasis is a common etiology of this syndrome.
Acar et al. suggested that “Loeffler’s syndrome must be considered
early in the differential diagnosis for community acquired
pneumonia when peripheric eosinophilia is seen in patients if they
live in an endemic area for parasitic disease (2).” Here, the authors
review previous publications on this syndrome in Thailand, a
tropical country with high prevalence of ascariasis. From standard
database search, Pubmed, Scopus, ISI and ThaiIndexMedicus
(from 1,918 till present), there are only 2 previous reported cases
on Loeffler’s syndrome due to ascariasis in Thailand (3). The
two reported cases are children with confirmed parasitosis from
stool examination, one with overt pulmonary symptoms and the
other without (with incidental finding, migratory pulmonary
infiltrates, from chest X-ray) (3). Eosinophilia could be detected
by complete blood count and increase serum IgE could be seen (3).
Of interest, there are extremely few reports on Loeffler’s syndrome
in Thailand and this is an interesting issue for further discussion.
The question is why there are very few reports despite the fact
that ascariasis is common in Thailand. The first possibility is that
this syndrome is extremely rare in Thailand. Indeed, Loeffler’s
syndrome is a rare disease. However, in many settings with lower
prevalence of parasitosis, there are many case reports on Loeffler’s
syndrome. Second, whether the syndrome is under-investigated
and under-reported is a query. One might urge that the present
sanitation in Thailand is much improved and the incidence of
parasitosis decreases. However, there is a recent report of Loeffler’s
syndrome (with approval by antiparasitic trial treatment) in the
returning traveler from Thailand (4) indicating that the syndrome
should not be extremely rare in Thailand. Indeed, the local
pulmonarologist might overlook this syndrome or there might be
some unknown immunotolerance mechanism that suppresses the
clinical presentation among the patients due to the high parasitosis
in Thailand.
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Acknowledgements
Disclosure: The authors declare no conflict of interest.
Beuy Joob, Viroj Wiwanitkit
Email: beuyjoob@hotmail.com
DOI: 10.3978/j.issn.2072-1439.2012.05.03
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References
Cite this article as: Joob B, Wiwanitkit V. Loeffler’s syndrome, pulmonary
ascariasis, in Thailand, rare or under-reported? J Thorac Dis 2012;4(3):339.
doi: 10.3978/j.issn.2072-1439.2012.05.03
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