Pulmonary Manifestations of Parasitic Diseases in Children

Key points

Clinical approach

Parasites can cause fever and nonspecific respiratory symptoms such as cough, dyspnea, wheezing, chest pain, and hemoptysis. The degree of lung involvement will depend on the characteristics and location of the parasite, as well as the host's immune response. Many clinical features are due to the host immune response to parasite antigens, which may be protective or deleterious.¹

Parasites can produce respiratory symptoms through 3 main mechanisms: (1) hypersensitivity stimulus during their life

Most relevant parasites

Clinical manifestations and management of the most relevant parasites associated with pulmonary manifestation are discussed in this section. Epidemiology, transmission, and incubation period of each parasite are presented in Table 1. Pulmonary symptoms, chest imaging, and diagnostics tools are summarized in Table 2.

Tropical pulmonary eosinophilia

Tropical pulmonary eosinophilia (TPE) is a clinical syndrome associated with lymphatic filariasis (Brugia malayi, Wuchereria bancrofti, Brugia timori). It is caused by a robust host immune response to microfilariae trapped in the lungs.⁴⁵ TPE is rare in children. Clinical manifestations include fever, cough, nocturnal asthma, weight loss, lymphadenopathy, and diffuse migratory pulmonary nodules. Diagnosis is supported by elevated antifilarial antibodies in the setting of hypereosinophilia

Summary and future directions

Parasitic infections account for significant childhood morbidity and disproportionately affect children in low- and middle-income countries. Pulmonary manifestations occur on a spectrum of disease, ranging from transient and self-limited syndromes to chronic and serious lung pathology. Early diagnosis and treatment can prevent long-term pulmonary sequelae. Although major advancements have been made in human parasitology in recent years, several high-priority areas for research and intervention

Clinical care points

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  Parasitic infections may mimic common lung diseases such as tuberculosis (eg, Paragonimus), asthma (eg, Ascaris) and malignancy (e.g. Dirofilaria), as they share similar clinical and radiological features.

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  Loeffler syndrome, which is associated with several helminths (Ascaris, hookworms, strongyloides, etc), manifests with fever, wheezing, cough, dyspnea, chest pain, hemoptysis, rash, and peripheral hypereosinophilia.

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  Corticosteroid use and human T-cell lymphotropic virus type (HTLV-I) infection

Disclosure

The authors have nothing to disclose.