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PubMed1983

[An Epidemiological Study Of Human Paragonimiasis By Means Of Micro-ELISA]

As epidemiological parameters of human paragonimiasis, the positive rates of intradermal test and the sputum/stool examination have long been employed in population surveys. However, both the specificity of the intradermal test and the sensitivity of sputum/stool examination have been gradually declined as the endemicity was lowered; thus the gap between above two parameters widened. In such context, the development of a new epidemiological parameter or tool which makes it possible to accurately discriminate the active paragonimiasis cases was necessary. In the present study, the detection rate of Paragonimus-specific IgG antibody by micro-ELISA was evaluated as an indicator of epidemiologic status of human paragonimiasis in a population. A total of 4,285 students and inhabitants living in Bukpyeong Myeon and Bukil Myeon, Haenam Gun, Jeonlanam Do was surveyed in October 1983 by intradermal test first. Out of them, 244 case (5.7 %) were found positively reacted to VBS antigen of P. wetermani. Out of 168 positive reactors, 7 cases (4.2 %) were egg positive either by two times of sputum examination or by one stool examination. That indicated that only 0.16 % of total surveyed were confirmed as active paragonimiasis by egg detection. When sera collected from 239 positive reactors of intradermal test were tested by micro-ELISA for their specific IgG antibody, 40 cases (16.7 %) were found to be positive. All of 7 eggs positive cases were again positive for specific IgG antibody. Among remaining 232 intradermal test positive cases, 33 cases were positive for IgG antibody. In contrast to those, none of 42 positive reactors to intradermal test for Clonorchis and of 128 intradermal test negative cases showed positive for Paragonimus- specific IgG antibody. The rate of specific IgG antibody as detected by micro-ELISA appeared to be increased with the wheal size of the intradermal test. When the wheal size was over 13 mm in diameter, about 50 % of them were positive for specific IgG antibody. Thirty-one specific antibody positive cases were clinically evaluated by laboratory examinations (repeated sputum examination, peripheral eosinophil count and chest roentgenogram) and by history taking. Out of them 24 cases were associated with one or more positive laboratory findings; thus considered as active paragonimiasis cases. Out of 7 lab. finding-free cases 3 revealed past history of typical paragonimiasis symptoms, suggesting that they were in chronic or in convalescent stages. The remaining 4 cases were considered as either mild or ectopic infection cases; the possibility of cross-reaction with other helminthiases could not be ruled out. From the above results, it was inferred that the detection of Paragonimus-specific IgG antibogy by micro-ELISA was very much helpful in detecting the active cases as well as in proper evaluation of the endemicity of human paragonimiasis in a population. The convenience of mass handling of sera in micro-ELISA was considered another superiority as an epidemiologic tool.

Journal Article↗
PubMed2001

Elevated IL-5 levels in pleural fluid of patients with paragonimiasis westermani.

To investigate the pathogenic mechanisms of eosinophilic pleural effusion in patients with paragonimiasis, we measured the levels of IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF) and interferon-gamma (IFN-gamma) in pleural effusions. Samples were obtained from 11 patients with Paragonimus westermani infection. In addition, samples from 12 patients with pleural transudates, 16 with tuberculous pleurisy, seven with empyema and 20 with lung cancer were also examined. Eosinophilia was remarkable in peripheral blood (range 4-34%, median 23.4%) and pleural fluid (range 0-95%, median 71%) of paragonimiasis patients. IL-5 concentrations in pleural effusions of paragonimiasis were markedly higher than those in other groups. Although marked elevation of GM-CSF and IFN-gamma levels was observed in pleural effusion of empyema and tuberculosis patients, it was marginal in the pleural effusion of paragonimiasis patients. In paragonimiasis patients, IL-5 levels in the pleural effusion correlated well with the percentage of eosinophils in peripheral blood and pleural fluid. Such a correlation was not observed between GM-CSF levels in pleural effusion and percentages of eosinophils in pleural fluid or peripheral blood. Our findings suggest that in paragonimiasis IL-5 in the local inflammatory site is particularly important in mediating eosinophilia in peripheral blood and pleural effusion.

Adult↗
PubMed1981

Pleural paragonimiasis in a Southeast Asia refugee.

We report a Laotian patient with pleural paragonimiasis who did not have the usual diagnostic triad for this parasitic disease. He did not have chronic hemoptysis (considered by many to be an "invariable" finding), there were no pulmonary infiltrations, and stool and sputum examinations did not yield Paragonimus ova. The diagnosis was made on the basis of ova found in the pleural fluid. Paragonimiasis pleural effusion did not resolve with bithionol, the drug of choice for pulmonary paragonimiasis, and, as a result, chest tube drainage was required. The difference between pleural paragonimiasis and pulmonary paragonimiasis is that the classic clinical presentation of the latter (hemoptysis, ova in sputum and stools, lung infiltration, etc.) requires an intrapulmonary location on the parasite. A search for ova in the pleural fluid may be the only diagnostic tool for patients suspected of pleural paragonimiasis. With the influx of Southeast Asia refugees, this case report may be of relevance to U.S. physicians involved in the care of patients in whom not all chronic pleuropulmonary diseases are tuberculous.

Adult↗
PubMed1994

Cerebral paragonimiasis in early active stage: CT and MR features.

OBJECTIVE: Diagnosis of cerebral paragonimiasis in its early active stage is important because curative chemotherapy is possible. Accordingly, this study was undertaken to evaluate the CT and MR features of early active cerebral paragonimiasis. MATERIALS AND METHODS: We retrospectively reviewed the CT scans (n = 29) and MR images (n = 7) of the brain in 20 patients between 7 and 59 years old who had cerebral paragonimiasis in the early active stage. The diagnosis was based on a positive antibody test by enzyme-linked immunosorbent assay (ELISA) for paragonimiasis in serum and CSF. The diagnosis was confirmed surgically in seven patients. RESULTS: The most common and characteristic imaging finding was a conglomerate of ringlike enhancing lesions (grape-cluster appearance) with surrounding edema in one cerebral hemisphere in 11 patients (55%). Other nonspecific findings included a solitary ringlike lesion (n = 4) or irregular enhancing lesions (n = 2), localized hemorrhage with (n = 3) or without (n = 2) enhancing lesions, and a poorly defined non-hemorrhagic, nonenhancing lesion (n = 1). CONCLUSION: CT and MR findings of clustered ring-enhancing lesions, seen in approximately half of the cases of early cerebral paragonimiasis, are suggestive of cerebral paragonimiasis.

Adolescent↗
PubMed1991

Studies on clinical manifestations, diagnosis and control of paragonimiasis in China.

Paragonimiasis is a common parasitic zoonosis in China. Its clinical manifestations may be classified into two clinical entities, eg, paragonimiasis westermani type and paragonimiasis szechuanensis type. The latter mainly manifests as trematode larva migrans. The immunodiagnostic methods frequently used in the diagnosis of paragonimiasis are intradermal test, CFT and ELISA. The detection of circulating antigens in patients has been used in China for diagnosis and bithionol and praziquantel are drugs of choice in the treatment of paragonimiasis. Combined measures including mass survey, mass treatment and health education have been found to be effective in the control of paragonimiasis in China.

Animals↗
PubMed1976

Immunoglobulin E: raised levels in sera and pleural exudates of patients with paragonimiasis.

Serum IgE concentrations of patients with paragonimiasis were determined by a radioimmunosorbent test. The mean concentration was 3,462.3 IU/ml in a group of 13 cases of paragonimiasis miyazakii in which patients showed clinical symptoms and/or positive immunological diagnostic tests, and 1,026.6 IU/ml in a control group of 13 individuals who had eaten uncooked freshwater crabs, Potamon dehaani, but had been found to be free from the infection. Moreover, the IgE level of the pleural exudates obtained from four patients with paragonimiasis miyazakii on the day of bleeding or within several days after was significantly higher than that of their sera, ranging between 4,200 IU/ml and 10,000 IU/ml. This was true also in a case of paragonimiasis westermani. Sera and pleural exudates of patients with both forms of paragonimiasis were applied to immunosorbent columns of Sepharose 4B beads coupled with saline extracts of Paragonimus miyazakii, P. weetermani, or P. ohirai. IgE eluted from the corresponding column was considered to be specific, being around 5% to 10% of the total IgE.

Adult↗
PubMed1975

Cerebral Paragonimiasis.

The first case of cerebral paragonimiasis was reported by Otani in Japan in 1887. This was nine years after Kerbert's discovery of the fluke in the lungs of Bengal tigers and seven years after a human pulmonary infection by the fluke was demonstrated by Baelz and Manson. The first case was a 26-year-old man who had been suffering from cough and hemosputum for one year. The patient developed convulsive seizures with subsequent coma and died. The postmortem examination showed cystic lesions in the right frontal and occipital lobes. An adult fluke was found in the occipital lesion and another was seen in a gross specimen of normal brain tissue around the affected occipital lobe. Two years after Otani's discovery, at autopsy a 29-year-old man with a history of Jacksonian seizure was reported as having cerebral paragonimiasis. Some time later, however, it was confirmed that the case was actually cerebral schistosomiasis japonica. Subsequently, cases of cerebral paragonimiasis were reported. However, the majority of these cases were not confirmed histologically. It was pointed out that some of these early cases were probably not Paragonimus infection. After World War II, reviews as well as case reports were published. Recently, investigations have been reported from Korea, with a clinicla study on 62 cases of cerebral paragonimiasis seen at the Neurology Department of the National Medical Center, Seoul, between 1958 and 1964. In 1971 Higashi described a statistical study on 105 cases of cerebral paragonimiasis that had been treated surgically in Japan.

Adolescent↗
PubMed1996

Enzyme-linked immunosorbent assay using cysteine proteinase antigens for immunodiagnosis of human paragonimiasis.

An enzyme-linked immunsorbent assay (ELISA) using worm extract antigens from lung flukes of Paragonimus westermani provided good sensitivity to sera from patients with paragonimiasis westermani but high cross-reactivity with sera from most fascioliasis patients and some patients with onchocerciasis or clonorchiasis. To improve the specificity, we tested an ELISA using fluke cysteine proteinases as antigens. Cysteine proteinases were partially purified from the excretory/secretory products of P. westermani by 40-75% ammonium sulfate fractionation, hydrophobic chromatography, and arginine affinity chromatography. An ELISA using the enzyme preparation not only had increased sensitivity to paragonimiasis westermani sera but also reduced cross-reactivity with the fascioliasis, onchocerciasis, and clonorchiasis sera to negligible levels. The reactivity of the ELISA to paragonimiasis miyazakii sera was similar to that of paragonimiasis westermani sera. A proteinase preparation from P. ohirai, which can be obtained easily from infected rats, provided similar results. Therefore, the ELISA using cysteine proteinases of Paragonimus could not distinguish the parasite species with which patients were infected, but it is a valuable assay with which to immunodiagnose paragonimiasis even when the proteinases are prepared from nonhuman species.

Animals↗
PubMed1997

Epidemiology of paragonimiasis in Korea.

In Korea, soybean-sauce soaked freshwater crabs (kejang) have been a favorite delicacy when eating a bowl of rice. This traditional food has been a main source of human paragonimiasis. Until the late 1960s, human paragonimiasis had been prevalent; at least two million people had contracted the infection as determined by intradermal tests. About 40% of these were egg positive. In the turmoil of the green revolution and industrialization in the 1970s/1980s, ecological damage occurred widely. In many streams, populations of snail and crustacean hosts were reduced to levels almost of extinction. Population reduction of the intermediate hosts was followed by lowered endemicity. Attitudes of people, changed during the period, also reduced chances of paragonimiasis. Survey data in the 1990s indicated that prevalence of human paragonimiasis has lowered to about one 100th of that in the early 1970s. In a referral system, however, about one hundred clinical cases have been diagnosed annually by antibody test (ELISA), undertaken for clinical differentiation from tuberculosis. At least 10% of freshwater crabs sold in local markets are infected with the metacercariae. Paragonimiasis control has benefited in Korea mainly by the untoward effects of water pollution. To place P. westermani infections as enzootic, health education and surveillance systems should have a priority.

Animals↗
PubMed1987

Evaluation of ELISA for the diagnosis of paragonimiasis westermani.

Possible applicability of an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of paragonimiasis westermani was examined using crude extract of adult Paragonimus westermani (Pw) as the test antigen. The mean ELISA values of the sera from Pw egg-positive cases and from clinically suspected cases were more than 22 times higher than that of the healthy control. No, or only marginal, cross-reactivity was observed against Pw antigen using sera from patients with various parasitic diseases other than paragonimiasis, except that from schistosomiasis and clonorchiasis cases. When serum samples from the endemic area were tested by ELISA and double diffusion (DD), sera from skin test (ST)-positive and DD-positive cases were all positive with ELISA, whereas approximately 19% of ST-positive but DD-negative cases were positive for ELISA. Diagnosis by ELISA values correlated well with, and seemed to be more sensitive than, that by DD test. In some definite paragonimiasis cases, the ELISA value was markedly reduced after drug-treatment with bithionol. These results suggest that ELISA is useful not only in mass screening but also in the evaluation of the efficacy of drug treatment in paragonimiasis.

Animals↗
PubMed1993

Pulmonary paragonimiasis: clinical and experimental studies.

Pulmonary paragonimiasis is a disease caused by a lung fluke. It is endemic to East Asia, but there have been several case reports in North America. Human infestation occurs by ingestion of raw or incompletely cooked freshwater crab or crayfish infected with metacercaria. A retrospective study was performed with 78 patients who lived in South Korea and had chest radiographic findings of pleuropulmonary disease; it was subsequently shown that they had paragonimiasis. The diagnosis was based on positive results of serologic tests for Paragonimus-specific antibody or on the detection of eggs in sputum samples. Radiologic findings from these 78 patients were correlated with the pathologic and radiologic findings from a study of experimentally induced pulmonary paragonimiasis in 21 cats. Findings from the correlative study document that the typical radiologic manifestations of pulmonary paragonimiasis vary with the stage of the disease. Early findings include pneumothorax or hydropneumothorax, focal airspace consolidation, and linear opacities and are caused by the migration of juvenile worms. Later findings include thin-walled cysts, dense masslike consolidation, nodules, or bronchiectasis and are due to worm cysts.

Adult↗
PubMedDate not supplied

North American paragonimiasis. A case report.

BACKGROUND: Paragonimiasis is a parasitic infection with a predilection for pulmonary involvement. Paragonimus species occur throughout the world and exist in nature in a snail-crustacean-mammalian life cycle. Human disease is most frequently encountered in cultures that ingest raw or undercooked crustaceans. North American paragonimiasis, caused by an endemic Paragonimus species, Paragonimus kellicotti, predominantly causes disease in carnivorous and omnivorous animals but may cause human disease if the intermediate host, the crayfish, is ingested raw or undercooked. CASE: A previously healthy, 21-year-old male was infected with P kellicotti and developed parasitic hemoptysis. The disease was contracted through the ingestion of local, undercooked crayfish. Diagnosis was established through the morphologic examination of eggs in the cytologic preparation of bronchioalveolar lavage fluid. The patient was successfully treated with praziquantel and recovered without incident. CONCLUSION: 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. The cytologist or cytopathologist, therefore, may be the first to encounter the diagnostic eggs and should be familiar with this disease.

Adult↗
PubMedDate not supplied

Paragonimiasis of the breast. Report of a case diagnosed by fine needle aspiration.

BACKGROUND: Paragonimiasis infestation is endemic mostly to Asia, Africa and South and Central America and commonly found in the lung. It is extremely rare in soft tissue. CASE: A case of paragonimiasis occurred in a 66-year-old woman who presented with a left, painful, 2-cm-diameter breast mass and had a history of eating uncooked freshwater crabs. On mammography, an ill-defined, round, isodense mass was detected without calcification. Hemorrhagic material was aspirated by fine needle aspiration (FNA) of the breast mass, which contained many parasitic eggs. They were about 90 microns long, ovoid, yellowish brown, transparent and thick shelled, with a flattened operculum at 1 end. The breast mass was completely excised. Many collapsed eggs of Paragonimus infiltrated the lobules and fibroadipose tissue, with accompanying abscess formation. To confirm the diagnosis, serologic testing for paragonimiasis was performed; it was positive for Paragonimus antibody. CONCLUSION: Paragonimiasis very rarely presents as a breast mass and can be diagnosed by FNA.

Aged↗
PubMed2005

Clinical features of recently diagnosed pulmonary paragonimiasis in Korea.

STUDY OBJECTIVE: Paragonimiasis is a typical food-borne parasitic disease that is common in Southeast Asia, the Far East, Latin American, and Africa. Recently, however, this disease has been seen in many parts of the world, largely due to increases in the numbers of immigrants and overseas travelers. The purpose of this study was to evaluate the clinical and radiologic features of recently diagnosed pulmonary paragonimiasis. PATIENTS: We retrospectively analyzed the clinical and radiologic characteristics of 36 patients (21 men and 15 women; median age 48 years; range, 19 to 75) with pulmonary paragonimiasis whose conditions were diagnosed between October 1994 and September 2004. RESULTS: Thirty-four patients (94%) presented with respiratory symptoms, including hemoptysis (n = 20, 56%) and cough (n = 17, 47%). However, chest pain (n = 5, 14%) and fever (n = 5, 14%) were less frequently reported. Chest radiography revealed intrapulmonary parenchymal lesions (n = 26, 72%), such as nodules (n = 14, 39%), linear opacity (n = 6, 17%), and airspace consolidations (n = 4, 11%), which occurred more commonly than did pleural lesions (n = 10, 28%). Most cases were initially suspected to be lung cancer or tuberculosis. In 13 patients with intrapulmonary parenchymal lesions who underwent bronchoscopy, bronchial luminal narrowing, coupled with congested or edematous mucosal changes, was seen in 7 patients (54%). Bronchial mucosal biopsy specimens exhibited chronic inflammation with eosinophilic infiltrations in three of these seven patients (43%). CONCLUSIONS: Our findings indicate that patients with pulmonary paragonimiasis presented with a variety of clinical and radiologic findings that were different from the classic presentations reported earlier, frequently mimicking those of lung cancer or tuberculosis.

Adult↗
PubMed2004

Paragonimiasis cases recently found among immigrants in Japan.

OBJECTIVE: Paragonimiasis is a typical food-borne parasitic disease mainly endemic in Southeast Asia. In Japan, the disease has been re-emerging since the 1980s. In addition, recently we encountered an increasing number of immigrants with paragonimiasis in Japan. In this study we summarized the clinical features of immigrants. PATIENTS AND METHODS: Among a total of 152 paragonimiasis cases referred to and diagnosed in our laboratory during 1998 to 2002, 18 were immigrants. Their clinical features including laboratory data such as eosinophilia and total IgE level were gathered from the consultation sheets from attending physicians. RESULTS: Among a total of 18 immigrant cases, 16 were from China and 2 from Thailand. A majority of immigrants had eaten freshwater crabs. Most of the Chinese patients were infected as small groups of family and/or compatriots. Chest radiographic findings were variable and multiple lung lesions were seen in about one-half of the patients. About 80% of patients had peripheral blood eosinophilia and 65% had elevated serum IgE level. CONCLUSION: The clinical features of paragonimiasis in immigrants in Japan were much more severe compared to those of Japanese patients.

Adolescent↗
PubMed1992

Pleuropulmonary paragonimiasis: radiologic findings in 71 patients.

Pleuropulmonary paragonimiasis is a disease caused by lung flukes characterized by migration of a juvenile worm in the early stage and by formation of cysts around the worm later on. The purpose of this study was to describe the radiologic manifestations of pleuropulmonary paragonimiasis, with special emphasis on the worm cyst and worm migration track. We retrospectively studied 71 patients who had evidence of pleuropulmonary paragonimiasis on chest radiographs (n = 71) and CT scans (n = 17). The diagnosis was based on the detection of eggs or on positive antibody tests. On chest radiographs, 59 patients (83%) had pulmonary lesions and 43 patients (61%) had pleural lesions. Pulmonary findings included patchy air-space consolidation (n = 37) with or without cystic changes; ring shadows (n = 16); and peripheral linear opacities (n = 29), which were more prominent in patients with pleural effusion. Twelve patients (17%) had bilateral pleural effusions or pneumothoraces. On CT scans, round low-attenuation cystic lesions (5-15 mm), filled either with fluid (n = 5) or gas (n = 5), were characteristically seen within the consolidation. Peripheral linear opacities seen on radiographs were suggestive of worm migration tracks on CT scans. CT may reveal an intracystic worm. Although the findings vary depending on the stage of the disease, findings on chest radiographs are usually typical of paragonimiasis. CT provides more specific information about the worm cyst and the worm migration track.

Adult↗
PubMed2005

Pleuropulmonary paragonimiasis: CT findings in 31 patients.

OBJECTIVE: The purpose of our study was to identify any specific CT features that may help in the diagnosis of pleuropulmonary paragonimiasis. CONCLUSION: Pleuropulmonary paragonimiasis usually manifests as a subpleural or subfissural nodule of about 2 cm in diameter that frequently contains a necrotic low-attenuation area. The constellation of focal pleural thickening and subpleural linear opacities leading to a necrotic peripheral pulmonary nodule is another frequent CT finding of paragonimiasis. Although minimal and easily overlooked, focal fibrotic pleural thickening adjacent to a pulmonary nodule can be an important clue in the diagnosis of pleuropulmonary paragonimiasis on CT.

Adult↗
PubMed2004

Imaging findings of hepatic paragonimiasis : a case report.

Hepatic paragonimiasis is a rare form of ectopic infestation caused by Paragonimus. We experienced a case of hepatic paragonimiasis that showed characteristic imaging findings. CT and MR images showed a cluster of small cysts with rim enhancement in the subcapsular area of the liver. This finding seems to be characteristic for hepatic paragonimiasis, considering imaging findings in paragonimiasis involving other organs.

Adult↗