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Paragonimiasis
Lung Fluke Disease
Presentation
- 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]
- Humans with paragonimiasis usually present with fever and cough, which, together with the presentation of hemoptysis, can be misdiagnosed as tuberculosis. Only 7 autochthonous cases of paragonimiasis have been previously reported from North America.[ncbi.nlm.nih.gov]
- After the praziquantel use, the patient presented a thick ferruginous expectoration and the result for BAAR examination was positive.[ncbi.nlm.nih.gov]
- We describe the case of a 5-year-old boy with paragonimiasis who presented with a swelling of the parotid and no pulmonary signs or symptoms.[ncbi.nlm.nih.gov]
- […] as not having typical clinical symptoms, but repeatedly presenting with migrated lesions between the lung and pleura.[ncbi.nlm.nih.gov]
Entire Body System
Fever
- A 15-month-old girl presented with persistent mild fever with a duration of 1 month, hepatomegaly, and low-density lesions in the right hepatic lobe on abdominal ultrasound and computer tomography.[ncbi.nlm.nih.gov]
- Physicians should consider the possibility that patients who present with cough, fever, hemoptysis, and eosinophilia may have paragonimiasis.[ncbi.nlm.nih.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]
- The male:female case ratio was 9.3:1.0 and more than 80% of cases presented with fever, cough, pleural effusions and peripheral eosinophilia. One patient developed cerebral paragonimiasis, and one patient died of pneumonic sepsis.[ncbi.nlm.nih.gov]
- One case is a 32-year-old male patient who was admitted to the hospital due to upper abdominal discomfort without fever for 1 month.[ncbi.nlm.nih.gov]
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]
- 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 Vomiting Fatigue[basicmedicalkey.com]
- 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]
- Symptoms Initial signs and symptoms may be diarrhea and abdominal pain followed several days later by fever, chest pain, and fatigue.[dshs.state.tx.us]
Camping
- 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]
- Clinicians should inquire about consumption of raw or undercooked crayfish in all patients with unexplained fever, cough, eosinophilia and pleural effusions returning from camping or canoeing adventures in P. kellicotti-endemic areas of the Mississippi[ncbi.nlm.nih.gov]
- On further questioning the parents acknowledged that partially cooked crayfish had been part of the family's diet while they stayed in a refugee camp in Thailand en route to the United States.[pidj.com]
Movement Disorder
- Most symptoms were markedly improved after treatment, but mild movement disorders combined with impaired memory and personality changes remained in a small number of patients.[ncbi.nlm.nih.gov]
Respiratoric
Cough
- Physicians should consider the possibility that patients who present with cough, fever, hemoptysis, and eosinophilia may have paragonimiasis.[ncbi.nlm.nih.gov]
- Both share similar clinical manifestations, which include chronic productive cough, hemoptysis, dyspnea, fever, weight loss, and night sweats.[ncbi.nlm.nih.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]
- The male:female case ratio was 9.3:1.0 and more than 80% of cases presented with fever, cough, pleural effusions and peripheral eosinophilia. One patient developed cerebral paragonimiasis, and one patient died of pneumonic sepsis.[ncbi.nlm.nih.gov]
- A clinical infection by paragonimiasis usually begins with cough, haemoptysis, and dyspnoea, some of which overlap with symptoms of tuberculosis and other pulmonary disorders.[ncbi.nlm.nih.gov]
Pleural Effusion
- In this patient, high IL-5 levels in both BALF and pleural effusion could explain the remarkable eosinophilia.[ncbi.nlm.nih.gov]
- This case suggests that paragonimiasis should be strongly suspected if blood eosinophilia, pseudochylothorax, and a high level of immunoglobulin E in pleural effusion are detected.[ncbi.nlm.nih.gov]
- A 72-year-old man patient was referred to our institution for evaluation and treatment of right pleural effusion. Eosinophilic pleural effusion and peripheral eosinophilia were identified during the course of hospitalization.[ncbi.nlm.nih.gov]
- The disease should be considered in any case of elusive pleural effusion occurring in endemic areas.[ncbi.nlm.nih.gov]
- A 47-year-old man, who had presented with chest pain nine months earlier, was found to have right pleural effusion on detection survey computed tomography.[ncbi.nlm.nih.gov]
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]
- The patient presented with a one-week history of nonmassive hemoptysis about 1 month after completion of treatment for smear-negative pulmonary tuberculosis (sputum polymerase chain reaction positive for Mycobacterium tuberculosis).[ncbi.nlm.nih.gov]
- Physicians should consider the possibility that patients who present with cough, fever, hemoptysis, and eosinophilia may have paragonimiasis.[ncbi.nlm.nih.gov]
- Physicians should be alerted to the possibility of this disease in Asian patients with hemoptysis and pulmonary infiltrates.[ncbi.nlm.nih.gov]
- Lung fluke, Paragonimus westermani of Paragonimus species usually are accompanied by a persistent cough, hemoptysis, and chest pain.[ncbi.nlm.nih.gov]
Chronic Cough
- Patients with chronic cough were interviewed, examined, and requested to submit two sputum samples which were processed using Ziehl-Neelsen method to detect acid-fast bacilli (AFB), and NaOH concentration technique for the detection of Paragonimus ova[ncbi.nlm.nih.gov]
- 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]
- cough; and (4) compared different ZNS procedures.[ncbi.nlm.nih.gov]
Dry Cough
- Initial symptoms may also include dry cough, which then becomes productive with rust-colored or blood-tinged sputum on exertion.[newsmax.com]
- 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.state.tx.us]
- It causes chronic inflammatory reactions and the first effects are usually dry cough which may transform in to a productive cough with purulent sputum or hemoptysis before long.[explainmedicine.com]
- The other patient (patient 29), who complained of dry cough and who had a history of paragonimiasis, was classified in the parenchymatous lesion group because his symptoms improved and the parasite-specific antibody titer in his serum dramatically decreased[cid.oxfordjournals.org]
Gastrointestinal
Abdominal Pain
- Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain.[ncbi.nlm.nih.gov]
- 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]
- Abdominal pain or discomfort, fever and high eosinophil percentage were the predominant clinical features.[ncbi.nlm.nih.gov]
- Patients with paragonimiasis most frequently showed respiratory symptoms, including cough (26.0%, 32/123) and tachypnea (16.3%, 20/123), and gastrointestinal symptoms, including abdominal pain (26.8%, 33/123), abdominal distention (22.8%, 28/123), and[ncbi.nlm.nih.gov]
- The other one is a 62-year-old female patient who was referred to the hospital for 1 month of right upper abdominal pain and fever.[ncbi.nlm.nih.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]
- 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]
- 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]
- 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]
- 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]
Pelvic Mass
- This is an unusual case of ovarian paragonimiasis mimicking ovarian cancer, which is instructive and informative for differential diagnoses of pelvic masses.[ncbi.nlm.nih.gov]
Upper Abdominal Pain
- The other one is a 62-year-old female patient who was referred to the hospital for 1 month of right upper abdominal pain and fever.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
- Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain.[ncbi.nlm.nih.gov]
Musculoskeletal
Joint Swelling
- Clinical presentation accounted for extensive recurrent pruritic urticarian subcutaneous induration, permanent assymetrical pauciarthritis associated with joint swelling, and marked eosinophilia.[ncbi.nlm.nih.gov]
Eyes
Hemianopsia
- Five cases of cerebral paragonimiasis presenting with hemianopsia, convulsion, and gait disturbance are discussed. The cases were all in the chronic stage.[ncbi.nlm.nih.gov]
Urogenital
Scrotal Mass
- Two young males sought medical advice because of scrotal masses.[ncbi.nlm.nih.gov]
Neurologic
Dysarthria
- He was hospitalized because of a sudden onset of headache, right hemiparesis, and dysarthria. A computed tomography scan revealed an intracerebral hemorrhage in the left parietal lobe.[ncbi.nlm.nih.gov]
- A 10-yr-old girl presented with sudden-onset dysarthria, right facial palsy and clumsiness of the right hand. Brain imaging showed acute intracerebral hemorrhage in the left frontal area.[ncbi.nlm.nih.gov]
Akinesia
- Echocardiography and angiography demonstrated akinesia of the apex and mid-wall of the left ventricle with preserved contraction of the basal segments, which suggested Takotsubo cardiomyopathy.[ncbi.nlm.nih.gov]
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
- 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
- Internal low attenuation, perilesional centrilobular nodules, cavitary lesions, and worm-migration tracts were more frequently found in the paragonimiasis group (P 0.05).[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]
Ultrasound
Ovarian Mass
- However, a frozen section revealed Paragonimus eggs in the enlarged ovarian mass. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed instead of complete staging.[ncbi.nlm.nih.gov]
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]
- However, here we describe an exceedingly rare case of Paragonimus westermani with a mass in the pleural cavity.[ncbi.nlm.nih.gov]
- This is an illustration of the life cycle of Paragonimus westermani, one of the causal agents of paragonimiasis. Photo courtesy of The Centers for Disease Control and Prevention.[emedicine.com]
Colonoscopy
Colonic Ulcer
- Colonoscopy revealed a colonic ulcer. Biopsy of the colonic ulcer showed ulceration of the colonic mucosa, and many Paragonimus westermani-like eggs were noted.[ncbi.nlm.nih.gov]
Other Pathologies
Lymphocytic Infiltrate
- Transbronchial lung biopsy revealed the presence of pneumonia with mild eosinophilic infiltration but remarkable lymphocytic infiltration. In this patient, high IL-5 levels in both BALF and pleural effusion could explain the remarkable eosinophilia.[ncbi.nlm.nih.gov]
Other ECG Findings
Ischemic Changes
- Cardiac involvement accompanied with old and recent-onset myocardial ischemic changes resulted in death of this patient. Here, we report a very rare case of malignant mesothelioma with a concomitant infection of parasitic lung fluke.[ncbi.nlm.nih.gov]
Pleura
Pleural Effusion
- In this patient, high IL-5 levels in both BALF and pleural effusion could explain the remarkable eosinophilia.[ncbi.nlm.nih.gov]
- This case suggests that paragonimiasis should be strongly suspected if blood eosinophilia, pseudochylothorax, and a high level of immunoglobulin E in pleural effusion are detected.[ncbi.nlm.nih.gov]
- A 72-year-old man patient was referred to our institution for evaluation and treatment of right pleural effusion. Eosinophilic pleural effusion and peripheral eosinophilia were identified during the course of hospitalization.[ncbi.nlm.nih.gov]
- The disease should be considered in any case of elusive pleural effusion occurring in endemic areas.[ncbi.nlm.nih.gov]
- A 47-year-old man, who had presented with chest pain nine months earlier, was found to have right pleural effusion on detection survey computed tomography.[ncbi.nlm.nih.gov]
Treatment
- Close follow-up after the initial treatment is necessary especially for such patients.[ncbi.nlm.nih.gov]
- […] diagnosis and treatment.[ncbi.nlm.nih.gov]
- The diagnostic, treatment and follow-up data were statistically analyzed.[ncbi.nlm.nih.gov]
- Most patients with paragonimiasis are cured by standard praziquantel treatment. However, several cases have been reported to have unsatisfactory responses to the standard praziquantel treatment.[ncbi.nlm.nih.gov]
- Three of these patients were given carbamazepine from the beginning of parasiticidal treatment to prevent seizures; 4 of the remaining 7 patients experienced epileptic seizures during the treatment process.[ncbi.nlm.nih.gov]
Prognosis
- 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]
- Early diagnosis and timely treatment of this disease are vital for a positive prognosis.[thejns.org]
- Age (y)/Sex History Lung Lesion Onset of Symptoms Invaded Site Peripheral Eosinophilia, 10 9 /L Eosinophils in CSF Tx Prognosis 1/6/M Yes Yes Seizure Frontotemporal insula 0.04 / Praziquantel Cured 2/9/M Yes No HA, blurred vision Trigonum, thalamus 0.42[stroke.ahajournals.org]
Etiology
- Anatomical dissection confirmed the presence of a mass of unknown etiology.[ncbi.nlm.nih.gov]
- Our work suggests that P. heterotremus may be the main etiological agent of human paragonimiasis in this locality.[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]
- Paragonimiasis was suspected in 21 of the patients who were referred to our laboratory, including 3 who tested positive for parasite eggs, and 9 patients were referred for screening for parasitic diseases of unknown etiology.[academic.oup.com]
Epidemiology
- Worldwide, an estimated 20.7 million people are infected with paragonimiasis, but relatively little epidemiological data exists for Africa.[ncbi.nlm.nih.gov]
- Intradermal test, ELISA and Dot-immunogold filtration assay (DIGFA) were used for diagnosis and epidemiological survey of paragonimiasis.[ncbi.nlm.nih.gov]
- Abstract As a part of a broader effort to determine the status of Paragonimus species infection in Lao PDR, an epidemiological survey was conducted on villagers and schoolchildren in Namback District between 2003 and 2005.[ncbi.nlm.nih.gov]
- Abstract A review of national and international publications on paragonimiasis in Ecuador, epidemiological records from the Ministry of Public Health and unpublished research data was conducted to summarise the current status of the parasite/disease.[ncbi.nlm.nih.gov]
- The preliminary survey for epidemiological data in Nam-Piang-Din, Mae Hong Son revealed that most of Thai-Karen villagers had the habit of eating raw crabs and fresh water prawns.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution
Pathophysiology
- ISBN 978-0340663202. a b c d "Paragonimiasis: Background, Pathophysiology, Epidemiology". 2016-06-20. a b c d e "Paragonimiasis". Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC). 2010-10-13. Retrieved 2012-09-06.[en.wikipedia.org]
Prevention
- Preventive antiepileptic drugs should be used along with the administration of parasiticide.[ncbi.nlm.nih.gov]
- Human infections can be easily prevented and treated, but proper diagnosis of paragonimiasis is a problem.[ncbi.nlm.nih.gov]
- Photo courtesy of The Centers for Disease Control and Prevention.[emedicine.medscape.com]