Clinical Reports (Septilin)

(Ind. med. J., (1985): 12, 161.)

SEPTILIN in the Treatment of Tropical Eosinophilia

P.K. Prusty, M.D., D.T.C.D.,
Asst. Professor,
M.K. Mahapatra, M.B.,B.S.,
P.G. Student,
G.C. Mishra, M.D.,
Registrar,

and

R.K. Das, M.D.,
Associate Professor, Department of Medicine, S.C.B. Medical College, Cuttack.

INTRODUCTION

Tropical eosinophilia is a clinical syndrome characterised by paroxysmal respiratory symptoms along with significant rise of eosinophils in the peripheral blood and when other known causes of eosinophilia are excluded. These patients are usually in the second and third decades, presenting with symptoms of chronic, hacking cough and exertional dyspnoea. Fever may be present in some cases (about 4%). Less commonly, patients of tropical eosinophilia may have acute prostration. About 8% of the patients may present with the features of influenza and about 20% as acute bronchial asthma. Filariasis is attributed as the cause of this syndrome. Till date, diethylcarbamazine citrate (D.E.C) with or without antibiotics, has been the mainstay of treatment.

Septilin (of The Himalaya Drug Co.) contains antibacterial and anti-inflammatory plant extracts which are very effective in chronic stubborn infections of the upper respiratory tract, various inflammatory diseases of the joints and septic conditions of diverse aetiology. Septilin is also known to help in building up body resistance to infection. In view of various reports about its efficacy in the treatment of infections of the upper respiratory tract and of dermatological and dental origin. Septilin was taken up for trial in the treatment of Tropical Eosinophilia.

MATERIAL AND METHODS

Seventy-five patients of both sexes, in different age groups, admitted to the S.C.B. Medical College and Hospital, Cuttack, were included in the present study. The diagnosis of tropical eosinophilia was established by:

(1)	Pulmonary symptoms:— Insidious, dry paraxysmal cough especially nocturnal with features of asthmatic dyspnoea.
(2)	Eosinophil count—200/cubic mm.
(3)	Diffuse miliary mottling, increased hilar mottling and stranding into bases.

For establishing the diagnosis, investigations like E.S.R., haemoglobin estimation, total and differential leucocyte counts, absolute eosinophil count, X-ray chest P.A. view, Mantoux test, sputum for AFB, culture and sensitivity etc., were done to exclude tuberculosis and other chest diseases.

After the diagnosis was confirmed all the patients were subjected to pulmonary function tests (P.F.T.) at an interval of one month to assess the improvement after therapy. Patients having restrictive type of pulmonary function tests were included in the study.

The sputum of all the patients was sent for bacteriological culture and sensitivity to the bacteriology laboratory of our institute. Thus the patients were randomised and grouped.

Sixty patients of tropical eosinophilia without any bacterial growth in sputum were divided into three groups. Groups A, B and C and treatment commenced as shown in Table 1. The response was assessed by clinical improvement, absolute eosinophilic counts and pulmonary function tests.

Table 1 : Treatment schedule in patients without bacterial growth in their sputum
Groups	Dosage of drugs	No. of cases
Group A	D.E.C. 12 mg/kg/day in divided doses for 21 days	20
Group B	D.E.C. 12 mg/kg/day in divided doses for 21 days + Septilin 2 tabs. 8 hourly for 21 days	20
Group C	Septilin 2 tabs. 8 hourly for 21 days	20

Next, fifteen patients of tropical eosinophilia with bacterial growth on culture were divided into two groups. Group A was given D.E.C. with the proper antibiotic according to the sensitivity report, whereas Group B was given D.E.C. with Septilin (See Table 2).

Table 2 : Treatment schedule of the patients with bacterial growth in their sputum
Groups	Dosage of drugs	No. of cases
Group A	D.E.C. 12 mg/kg/day + appropriate antibiotic, as per the sensitivity test, in proper doses	7
Group B	D.E.C. 12 mg/kg/day in divided doses + Septilin 2 tabs. 8 hourly for 21 days	8

OBSERVATIONS AND RESULTS

The results of treatment were assessed by three criteria:

1.	Clinical improvement, which included both symptomatology of the patients and improvement in chest signs.
2.	Decrease in absolute eosinophilic count.
3.	Improvement in pulmonary function tests.

Depending upon these three critieria the response was divided into:

(a) Good response (b) Fair response (c) No response (See Table 3).

Table 3 : Criteria of response
Response	Clinical symptoms	Total eosinophil count	Pulmonary function tests
Good Response	No signs and symptoms	Reduction by 30 to 40%	Improvement by 20 to 30%
Fair Response	Symptomatically better with persistence of chest signs but less than before	Reduction by 10 to 30%	Improvement by 10 to 20%
No Response	Persistence of symptoms and signs	No reduction	No improvement

The response to treatment is depicted in Table 4 and 5.

Table 4 : Showing response to treatment in patients having no growth in sputum
Groups	No. of	Response
	Patients	Good	Fair	No response
Group A (D.E.C. only)	20	14 (70%)	3	3
Group B (D.E.C. + Septilin)	20	15 (75%)	4	1
Group C (Septilin only	20	4	9	7

Table 5 : Showing response in patients having bacterial growth in sputum
Groups	No. of	Response
	Patients	Good	Fair	No response
Group A (D.E.C. + antibiotic)	7	5 (71%)	2	—
Group B (D.E.C. + Septilin)	8	7 (88%)	1	—

DISCUSSION

The response was determined by monthly clinical assessments, absolute eosinophil counts, pulmonary function tests and X-rays of the chest. We cannot correlate well the clinical progression with X-rays of the chest. Hence we have considered the other three criteria as our guide.

The patients having restrictive type of pulmonary function tests did improve with therapy. The patients on D.E.C. and D.E.C. + Septilin showed good response of 70% and 75% respectively. Almost all patients of Group B (i.e. D.E.C. + Septilin) did respond to the therapy. Patients with Septilin alone did not respond as remarkably (See Table 4).

The 15 patients, whose sputum showed bacterial growth, were divided into two groups—Group A and Group B. In Group A, we had 7 patients of which 5 showed good response and 2 responded fairly. In contrast in Group B (who were on D.E.C. + Septilin) out of 8 patients, 7 showed good response (88%) and only one patient showed fair response (See Table 5).

The good response in the second group, where D.E.C. + Septilin was given, is due to the broad spectrum antibacterial property of Septilin.

SUMMARY AND CONCLUSION

1.	D.E.C. when combined with Septilin gives better results than D.E.C. alone or Septilin alone, in tropical eosinophilia.
2.	D.E.C. when combined with Septilin gives better results than D.E.C. with antibiotics.

This study shows that Septilin has therapeutic properties which definitely produce positive results in tropical eosinophilia.

Further, since Septilin has no side-effects and on the presumption that Septilin therapy for a longer period, e.g. 6 weeks, may be more beneficial in this condition and in filariasis, we are continuing the trial and study.

REFERENCES

1.	Udwadia, F.E., "Pulmonary Eosinophilic Syndrome with special reference to the tropics and asthma", (Progress in Clinical Medicine) (1978) : 2nd series, 453-475.
2.	Viswanathan, R. and Jaggi, O.P., "Tropical Eosinophilia—Progress in Clinical Medicine", Editor Arnold Heinemann, (1976): pp75-91.
3.	Udwadia, F.E., "Tropical Eosinophilia, co-relation of clinical, histological and lung function studies", Diseases of Chest (1967) : pp. 52 and 53.
4.	Udwadia, F.E. and Joshi, V.V., "A study on Tropical Eosinophilia", Thorax (1964): pp.19 and 548.
5.	Viswanathan, R., "Pulmonary Eosinophilia—natural history, aetiology and pathogenesis", Indian Journal of Chest Diseases (1963): pp. 5 and 213.
6.	Davidson’s Principles and Practice of Medicine, Edited by John Macleod (14th Ed.).
7.	Harrison’s Principles of Internal Medicine, 11th Ed., Editors Peterdif, R.G., Adams, R.D. and Bradnwald et al.
8.	Bhat, M.R., "The phagocytic activity of Septilin in chronic recurrent infections", Probe (1983): 2, 100.
9.	Ahmed, S.A., "Septilin as an adjuvant to antibiotics in the treatment of acute bacterial pneumonias", Probe (1983): 1, 17.
10.	Rastogi, P.K., Bhatia, B.P.R. and Kumar, A., "Septilin in Chronic Infections of Ear, Nose and Throat", Probe (1982): 3, 205.