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2.1
Paragonimiasis
Paragonimiases

Images

WIKIDATA, CC BY-SA 2.0

Presentation

The physical exam presented diffuse rales in both hemithoraces. [scielo.br]

Patients generally present with chronic productive cough, hemoptysis, and chest pain. 3 During the migration process, other parts of the body can be involved, such as the brain, skin, abdomen, heart, breast, intraspinal, and subcutaneous tissues. [radiopaedia.org]

In our case, the worms reached to masseteric muscle which lead to rupture the cyst and inflammatory reaction present like allergic reaction. [ijcasereportsandimages.com]

The present study emphasizes the requirement for the consideration of paragonimiasis when a patient presents with lung nodules and pleural effusion, even without an elevated eosinophil count. [spandidos-publications.com]

Here we present a child with cerebral paragonimiasis. She presented with new onset seizures in the setting of a febrile illness. [ncbi.nlm.nih.gov]

Entire Body System

  • Fever

    Symptoms Initial signs and symptoms may be diarrhea and abdominal pain followed several days later by fever, chest pain, and fatigue. [dshs.texas.gov]

    These nine patients, aged 10-32 years, had fever, cough, pleural effusion, and eosinophilia. All had eaten raw or undercooked crayfish from rivers in Missouri while on canoeing or camping trips within 4 months of illness onset. [ncbi.nlm.nih.gov]

    Hacking cough that persists for 5 days or more with clear, yellow, white, or green phlegm, absence of fever/ low grade fever may indicate bronchitis, another complication of the disease. [2,3,4] Difficulty in breathing This is due to primary infestation [explainmedicine.com]

  • Fatigue

    A 94-year-old female with end-stage renal disease presents with fever, fatigue, and hematochezia. She had previously resided in Hunan Province, China, and Myanmar, and she immigrated to Taiwan 30 years ago. Colonoscopy revealed a colonic ulcer. [ncbi.nlm.nih.gov]

    Symptoms Initial signs and symptoms may be diarrhea and abdominal pain followed several days later by fever, chest pain, and fatigue. [dshs.texas.gov]

    This may be followed several days later by fever, chest pain, and fatigue. The symptoms may also include a dry cough initially, which later often becomes productive with rusty-colored or blood-tinged sputum on exertion. [cdc.gov]

    After several days, these initial symptoms may be followed by symptoms such as fatigue, fever, and chest pain. Symptoms of paragonimiasis may appear similar to the symptoms of tuberculosis. [newsmax.com]

Respiratoric

  • Cough

    There can be chronic cough and difficulty breathing. Infection with a large number of the parasites can lead to coughing fits with blood-tinged sputum; the sputum may be brown because of the Paragonimus eggs being coughed up. [southernnevadahealthdistrict.org]

    There they can cause respiratory symptoms, such as: Cough Shortness of breath Chest pain (made worse by deep breathing or coughing) Without treatment, paragonimiasis becomes chronic. It can continue for decades. [webmd.com]

    During the chronic phase, pulmonary manifestations include cough, expectoration of discolored sputum, hemoptysis (spitting up blood), and chest radiographic abnormalities. [medicinenet.com]

    Most infections are asymptomatic, but pulmonary symptoms may occur, including chronic cough, chest pain, dyspnea, and hemoptysis. [msdmanuals.com]

  • Pleural Effusion

    Patients with pleural effusion also had parenchymal lesions. No pneumothorax or hydropneumothorax was found. Unilateral pleural effusion was more common than bilateral pleural effusion (seven versus four patients). [ncbi.nlm.nih.gov]

    Analyses of pleural effusion and bronchoalveolar lavage fluid (BALF) showed marked eosinophilia and high levels of eosinophil cationic protein and interleukin (IL)-5. [semanticscholar.org]

    Typical human paragonimiasis demonstrates an elevated eosinophil count, positive immunoblot, nodular shadows of the lung and pleural thickening with pleural effusion, and these symptoms may be confused with chest cancer. [spandidos-publications.com]

  • Hemoptysis

    Paragonimiasis is a cause of parasitic hemoptysis worldwide. Paragonimiasis is infrequently encountered in North America and is usually not considered in the differential diagnosis of hemoptysis unless specific risk factors are known. [ncbi.nlm.nih.gov]

    Major presenting symptoms comprised pain or tightness in the chest, difficult breathing, and coughing up rusty brown or blood-stained sputum (hemoptysis). [parasito.fkkmk.ugm.ac.id]

    This patient was treated with a course of praziquantel, and the hemoptysis resolved within 2 months. An 18-year-old man presented with a 1-year history of episodic hemoptysis. [nejm.org]

  • Chronic Cough

    We found that the village leaders report on “blood in sputum” had a higher and in combination of with the presence of “chronic cough” a maximal sensitivity. [journals.plos.org]

    Both share similar clinical manifestations, which include chronic productive cough, hemoptysis, dyspnea, fever, weight loss, and night sweats. [ncbi.nlm.nih.gov]

  • Dry Cough

    When the worms finally reach the lungs, symptoms may include: • Dry cough (cough with little to no phlegm) • Phlegm that is stained with blood, or is rust-colored and smells fishy • Chest or back pain • Difficulty breathing • Fever Symptoms and signs [healthypilipinas.ph]

    The symptoms may also include a dry cough, which later becomes productive with rusty-colored or blood-tinged sputum on exertion, and pleuritic chest pain. [dshs.texas.gov]

    The symptoms may also include a dry cough initially, which later often becomes productive with rusty-colored or blood-tinged sputum on exertion. The symptoms of paragonimiasis can be similar to those of tuberculosis. [cdc.gov]

    Initial symptoms may also include dry cough, which then becomes productive with rust-colored or blood-tinged sputum on exertion. [newsmax.com]

Gastrointestinal

  • Abdominal Pain

    In conclusion, herein, we report a case of pulmonary and abdominal paragonimiasis in a girl who presented with abdominal pain and tenderness in the inguinal area. [ncbi.nlm.nih.gov]

    The acute phase (invasion and migration) may be marked by diarrhea, abdominal pain, fever, cough, urticaria (hives), hepatosplenomegaly (enlargement of the liver and spleen), pulmonary abnormalities, and eosinophilia (an elevated level of eosinophils, [medicinenet.com]

    Symptoms Initial signs and symptoms may be diarrhea and abdominal pain followed several days later by fever, chest pain, and fatigue. [dshs.texas.gov]

  • Nausea

    METHODS: The authors have encountered 14 cases of cerebral paragonimiasis in patients between the ages of 6 and 16 years (mean age 11.5 years) who presented with sudden headache, nausea, and vomiting. [ncbi.nlm.nih.gov]

    Other chronic paragonimiasis symptoms may include: Belly pain Nausea Vomiting Bloody diarrhea Lumps or bumps on the skin of the belly or legs that come and go over time Some people with chronic paragonimiasis have no noticeable symptoms. [webmd.com]

    Methods The authors have encountered 14 cases of cerebral paragonimiasis in patients between the ages of 6 and 16 years (mean age 11.5 years) who presented with sudden headache, nausea, and vomiting. [thejns.org]

    Incidence Worldwide distribution Age More common in younger patients Gender Males appear to be more commonly infected Ethnicity No ethnic predilection Site Infection can involve Lung Brain Skin/subcutis Presentation Symptoms Abdominal pain Diarrhea Nausea [basicmedicalkey.com]

    Diarrhea, abdominal pain, nausea, vomiting and urticarial eruption of dermatitis were observed as transient side-effects, less frequently in children than in adults. [ajtmh.org]

Workup

Ultrasound of the swelling was done for further workup, which showed "a well-defined cystic area with tubular echogenic structure within masseteric muscle suggestive of the remote possibility of the parasitic infestation, Parotid and submandibular glands [ijcasereportsandimages.com]

X-Ray

  • Pulmonary Infiltrate

    infiltration and nine cases showed massive pleural effusion without pulmonary infiltration. [semanticscholar.org]

    Physicians should be alerted to the possibility of this disease in Asian patients with hemoptysis and pulmonary infiltrates. [ncbi.nlm.nih.gov]

    Roentgenograms reveal transient diffuse pulmonary infiltrates. Although the adult worms cause pulmonary disease, the larvae occasionally produce lesions at ectopic sites, such as the brain, liver, gut, skeletal muscle, testes, and lymph nodes. [histopathology-india.net]

    Later, once the worms are reproducing in the lung tissue, pulmonary infiltrates and hemoptysis occur, the sputum containing dark brown eggs. [web.stanford.edu]

  • Cavitary Lesion

    CONCLUSIONS: The presence of internal low attenuation and perilesional centrilobular nodules associated with pulmonary consolidative lesions, along with cavitary lesions and worm-migration tracts, is more frequent in patients with paragonimiasis than [ncbi.nlm.nih.gov]

    (b) Photograph of the gross specimen demonstrates an irregular cavitary lesion (arrows). Anchovy sauce content and trophozoites of E histolytica (not shown) were found on the lesion wall. Figure 3b. [pubs.rsna.org]

    Chest radiography demonstrated right lower lobe nodules and cavitary lesions [Figure 1]a and [Figure 1]b. [ijam-web.org]

  • Multiple Cavitary Lung Lesions

    Multiple cavitary lung lesions on CT: imaging findings to differentiate between malignant and benign etiologies. J Bras Pneumol. 2020;46(2):e20190024. https://doi.org/10.36416/1806-3756/e20190024. [cardiothoracicsurgery.biomedcentral.com]

  • Ground Glass Appearance

    Chest computed tomography showed a nodular shadow with a cavity and a surrounding ground-glass appearance in the left upper lung lobe (Figure 1). [ajtmh.org]

Microbiology

  • Paragonimus Westermani

    […] by Paragonimus Paragonimus westermani infection edit English paragonimiasis food-borne parasitic infection caused by the lung fluke, most commonly Paragonimus westermani Infection by Paragonimus (disorder) lung fluke disease lung fluke infection pulmonary [wikidata.org]

    A positive result of the intradermal Paragonimus westermani test 2. Detection of Paragonimus westermani ova in the sputum or stool or a positive complement fixation test in the serum 3. [pubs.rsna.org]

    It is caused by Paragonimus westermani and transmitted via ingestion of raw or undercooked crab or crayfish. Fifty species and subspecies of Paragonimus have been described. Infection in humans has been repoted by 16 species. [ijcasereportsandimages.com]

    However, here we describe an exceedingly rare case of Paragonimus westermani with a mass in the pleural cavity. [ncbi.nlm.nih.gov]

Pleura

  • Pleural Effusion

    Patients with pleural effusion also had parenchymal lesions. No pneumothorax or hydropneumothorax was found. Unilateral pleural effusion was more common than bilateral pleural effusion (seven versus four patients). [ncbi.nlm.nih.gov]

    Analyses of pleural effusion and bronchoalveolar lavage fluid (BALF) showed marked eosinophilia and high levels of eosinophil cationic protein and interleukin (IL)-5. [semanticscholar.org]

    Typical human paragonimiasis demonstrates an elevated eosinophil count, positive immunoblot, nodular shadows of the lung and pleural thickening with pleural effusion, and these symptoms may be confused with chest cancer. [spandidos-publications.com]

Treatment

After completing a course of treatment, the symptoms returned or even worsened, and patients then sought treatment again. [cardiothoracicsurgery.biomedcentral.com]

The treatment for M. tuberculosis and MAC complex was initiated, and the treatment with praziquantel was repeated. The PCR exam and sputum culture were positive for M. tuberculosis, and the treatment for MAC-complex was then interrupted. [scielo.br]

DNA probes, PCR, and PCR-based restriction fragment length polymorphism (PCR-RFLP) analysis have been developed. 1-4 Treatment and prognosis Praziquantel is the treatment for human paragonimiasis, 25 mg/kg three times daily for 2–3 days is the recommended [radiopaedia.org]

Is there treatment? Yes, there is treatment. Once the diagnosis is made, effective treatment for paragonimiasis is available from a physician. How can I prevent Paragonimus infection? Never eat raw freshwater crabs or crayfish. [cdc.gov]

Paragonimiasis Treatment In most people, paragonimiasis can be cured with oral anti-parasite medications. Both praziquantel (Biltricide) and triclabendazole (Egaten) are approved for treatment. [webmd.com]

Prognosis

DNA probes, PCR, and PCR-based restriction fragment length polymorphism (PCR-RFLP) analysis have been developed. 1-4 Treatment and prognosis Praziquantel is the treatment for human paragonimiasis, 25 mg/kg three times daily for 2–3 days is the recommended [radiopaedia.org]

Prognosis This is good with the correct treatment. [patient.info]

BACKGROUND AND PURPOSE: The early diagnosis of cerebral paragonimiasis (CP) is essential for a good prognosis. We seek to provide references for early diagnosis by analyzing the imaging characteristics of cerebral paragonimiasis. [ncbi.nlm.nih.gov]

The prognosis in pulmonary paragonimiasis is good, but ectopic lesions of brain are often fatal, even with aggressive treatment. The worms provoke leukocytic infiltrates and later, fibrous encapsulation. [histopathology-india.net]

If the patient had possessed cancer with advanced metastasis, the opportunity for surgery would have been lost and the patient would receive a poor prognosis (11). [spandidos-publications.com]

Etiology

Anatomical dissection confirmed the presence of a mass of unknown etiology. [ncbi.nlm.nih.gov]

TERMINOLOGY Synonyms Pulmonary distomiasis, lung fluke disease, parasitic hemoptysis, tojil (earth-borne disease), and gregarinosis Definitions Infectious condition caused by trematode ETIOLOGY/PATHOGENESIS Environmental Exposure Raw or partially cooked [basicmedicalkey.com]

Etiology Factors that facilitate the life cycle of the flukes and subsequent transmission of infection to humans include the following: Large numbers of reservoir and intermediate hosts Behaviors such as spitting Culinary habits In Asia, raw and undercooked [emedicine.medscape.com]

Multiple cavitary lung lesions on CT: imaging findings to differentiate between malignant and benign etiologies. J Bras Pneumol. 2020;46(2):e20190024. https://doi.org/10.36416/1806-3756/e20190024. [cardiothoracicsurgery.biomedcentral.com]

The etiology is a flat worm called “lung fluke” which usually infects the lower respiratory tract [ 1, 2, 3 ]. Cerebral infection is uncommon and in Thailand there has been no reported case of cerebral paragonimiasis. [ispub.com]

Epidemiology

Intradermal test, ELISA and Dot-immunogold filtration assay (DIGFA) were used for diagnosis and epidemiological survey of paragonimiasis. [ncbi.nlm.nih.gov]

In this article Life cycle Epidemiology Presentation Differential diagnosis Investigations Management Complications Prognosis Prevention Paragonimiasis In this article Life cycle Epidemiology Presentation Differential diagnosis Investigations Management [patient.info]

Public health and Education institutes should study the amount of the parasite in the metacercaria stage in fresh-water crayfish and fresh-water crabs to collect data for statistics and epidemiology. [smj.medicine.psu.ac.th]

Autor : Palabras clave : PARAGONIMUS;PARAGONIMIASIS;EPIDEMIOLOGY;ECUADOR Fecha de publicación : 2014 Citación : Calvopiña M. et al. (2014). Current status of Paragonimus and paragonimiasis in Ecuador. [repositorio.educacionsuperior.gob.ec]

Pathophysiology

Pathophysiology The life cycle of these flukes involves 2 intermediate hosts plus humans. Its complex life cycle involves 7 distinct phases: egg, miracidium, sporocyst, redia, cercaria, metacercaria, and adult. [emedicine.medscape.com]

Prevention

The following strategies can help prevent paragonimiasis infections in a community: • proper sanitation of surroundings and adequate hand hygiene • cooking food, especially crustaceans like crabs, very well • preventive medications like triclabendazole [healthypilipinas.ph]

Photo courtesy of The Centers for Disease Control and Prevention. [emedicine.medscape.com]

Complications Prognosis Prevention Paragonimiasis is a foodborne trematode infection that primarily affects the lungs. [patient.info]

Preventive antiepileptic drugs should be used along with the administration of parasiticide. [ncbi.nlm.nih.gov]

We also work to prevent further spread of the illness in the community. Visit the Disease Report Investigation Process webpage to learn more. References: Suguyama, H et.al. [southernnevadahealthdistrict.org]

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