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PubMed1993

Serodiagnosis of human paragonimiasis by ELISA-inhibition test using monoclonal antibodies.

ELISA-inhibition test using Paragonimus westermani specific monoclonal antibody (Mab) was investigated to improve the diagnostic specificity of paragonimiasis. By cell fusion, one hybridoma clone secreting anti-P. westermani specific Mab was selected (Pwa-14), which reacted on bands of 28 kDa, 42.5 kDa, 89 kDa and 120.5 kDa. IFA showed Pwa-14 was located at the vitelline follicles. By micro-ELISA, 100% of 22 paragonimiasis cases were found positive, but 5 of 40 clonorchiasis cases (12.5%), 3 of 26 cysticercosis cases (7.7%) showed false positive. None of 10 sparganosis patients or 28 normal controls reacted positively. On the other hand, by ELISA-inhibition test using a P. westermani specific Mab, 100% of paragonimiasis cases were found positive, and there were no positive in cysticercosis, sparganosis cases or normal controls, except 2 (5.0%) false-positive sera of 40 clonorchiasis cases. The ELISA-inhibition test using a Mab showed higher specificity in comparison with micro-ELISA for serodiagnosis of human paragonimiasis.

Animals↗
PubMed1998

Cystatin capture enzyme-linked immunosorbent assay for immunodiagnosis of human paragonimiasis and fascioliasis.

An ELISA was developed using chicken cystatin as a capture agent for the immunodiagnosis of paragonimiasis and fascioliasis. The assay detected specific antibodies to fluke cysteine proteinases without the need for purified proteinases. An ELISA plate was sensitized with chicken egg white cystatin, incubated with excretory-secretory (ES) products of adult flukes, and standard ELISA procedures were then followed. The ELISA plates incubated with the ES products of Paragonimus westermani and Fasciola sp. showed high reactivity to sera from patients with paragonimiasis westermani and fascioliasis, respectively. The capture ELISA showed little cross-reactivity with sera from patients with paragonimiasis and fascioliasis, which showed immunodiagnostic cross-reactivity in a conventional ELISA using crude fluke antigens. Moreover, the capture ELISA showed little reactivity with sera from patients with five other helminth diseases and from healthy volunteers. Omitting either sensitization with cystatin or incubation with fluke ES products abolished high ELISA reactivity, as did a prior exposure of the ES products to cystatin. The addition of papain to an incubation solution of the ES products greatly reduced ELISA reactivity. Incubating the cystatin-sensitized plates with partially purified cysteine proteinases from flukes instead of the ES products also maintained a similar high ELISA reactivity. These results indicate that the cystatin capture ELISA elicits a cystatin and fluke cysteine proteinase antigen-mediated reaction and measures fluke cysteine proteinase-specific antibodies. Prior exposure to low molecular weight inhibitors of cysteine proteinases and other proteinases, such as E-64, leupeptin, aprotinin, and pepstatin, had no effect, suggesting that these inhibitors can be added to cysteine proteinase preparations to prevent autoproteolysis. This assay has good sensitivity and high specificity and is useful for the immunodiagnosis of paragonimiasis and fascioliasis.

Animals↗
PubMed2001

Paragonimiasis in Yongjia County, Zhejiang Province, China: clinical, parasitological and karyotypic studies on Paragonimus westermani.

Paragonimiasis in Yongjia County, Zhejiang Province, China, has been of such public health concern that a specialized Institute for Paragonimiasis Control has been established there. The study reported here involved both parasitological research on Paragonimus westermani in the endemic areas and a clinical analysis of 94 cases of paragonimiasis. Eggs were found in sputum, feces and brain tissue in 45 cases. Twenty patients, 19 of whom where children under 10 years of age, showed hepatic injury. Treatment with praziquantel or bithionol had satisfactory results in all cases. Dimensions of the parasite eggs, metacercariae from freshwater crabs and adult flukes suggested that the form of P. westermani in Yongjia is the 'small type': a suggestion supported by karyotypic studies on gonad cells from adult flukes collected from experimentally infected animals as all were found to be diploid. In conclusion, the 'small type' or diploid form of P. westermani is the cause of paragonimiasis pulmonary symptoms in Yongjia.

Adolescent↗
PubMed2003

[Paragonimiasis in Cameroon: clinicoradiologic features and treatment outcome].

A prospective study of paragonimiasis was undertaken from September 1992 to July 1997 in the Mount Kupe zone of the Southwest Province of Cameroon. In a group of 2700 subjects, 312 presenting one or more signs of paragonimiasis underwent testing to detect Paragonimus africanus eggs in sputum and stools. Eggs were found in 30 subjects (9.61%). These patients underwent chest x-rays to assess radiological lesions due to paragonimiasis before and after treatment with Praziquantel. Symptoms included cough in all patients, hemoptysis in 13 (43.33%) and chest pain in 18 (60%). Only one patients presented altered general status. No patients presented fever. Before treatment chest x-rays demonstrated perinodular shadow in 22 patients (73.33%), pulmonary infiltrative opacity in 12 (40.00%), pulmonary nodules and cavitation in 3 (10.00%), pleuropulmonary calcification in 3 (10.00%), and cicatricial lesions in 2 (6.66%). Radiological findings were normal in 8 patients (26.66%). Following treatment parasitological and clinical cure was achieved at 1 and 2 months in all cases but X-ray abnormalities persisted for six months in 56.6% of cases. The most notable changes included disappearance of perihilar shadow in 8 out of 22 patients (36.36%) and worsening of radiological findings in 3 (13.66%). In 19 patients, treatment had no effect on X-ray findings in comparison with baseline. Absence of pleural effusion and high incidence of perihilar shadow may be specific features of paragonimiasis in Central Africa where the incidence of concomitant parasitic, fungal and microbial diseases is high.

Adolescent↗
PubMed2004

[Clinicopathologic analysis of paragonimiasis].

OBJECTIVE: To study the clinical manifestations and pathologic findings of paragonimiasis. METHODS: Nine cases of paragonimiasis diagnosed in the Peking Union Medical College Hospital during the past 20 years were studied, with literature review and analysis of the epidemiological, clinical and pathologic characteristics. RESULTS: Of the 9 cases studied, 4 came from the northeast China and 5 from Beijing. Eight cases had a history of eating raw crabs. Most had symptoms including fever, chest discomfort or pain, and hemoptysis or rusty sputum. All had the following common pathologic features: formation of irregular lacunae or sinus tracts, Charcot-Leyden crystals, sometimes paragonimus body parts and/or eggs, and eosinophil infiltration in the adjacent tissues. CONCLUSIONS: Paragonimiasis is not as uncommon as previously thought. The incidence is increasing in some cities due to movement of populations. The pathological diagnosis can be confirmed by finding paragonimus body parts and/or eggs. Diagnosis can also be made by correlation with other typical pathologic features, clinical history, immunologic findings and radiography. Paragonimiasis needs to be differentiated from pulmonary tuberculosis and cancer.

Adult↗
PubMed1983

Immunodiagnosis of human paragonimiasis by an enzyme immunoassay.

An enzyme immunoassay was applied to stepless antibody determination in sera from patients with paragonimiasis africanus, paragonimiasis uterobilateralis, paragonimiasis ecuadoriensis, other helminthic infestation, non parasitic diseases and healthy individuals. Crude extracts from adult P. africanus, P. uterobilateralis, P. ecuadoriensis and P. westermani worms served as antigen. The most distinct cross reactivity occurred with sera containing F. hepatica antibodies. Cross reaction was observed to least extent when P. westermani antigen was utilized. By comparison of results obtained by homologous and heterologous Paragonimus antigen it was demonstrated that even species-specific diagnosis of paragonimiasis may be possible when using this system.

Diagnosis, Differential↗
PubMed1975

[Cerebral paragonimiasis-a report of three cases (author's transl)].

Paragonimiasis is a benign parasitic disease caused by Paragonimus westermani and endemic in Japan, mostly in south-western area. Although the lung is the primary site of infection, ectopic involvement of the brain is not uncommon. Over 300 cases of cerebral paragonimiasis have been reported since the first case of this disease described by Ohtani in Japan in 1887. The patient with paragonimiasis in the lung and the brain were though to be decreasing because of the introduction of Bithionol treatment (Yokogawa in 1961) and public health instruction. However, about 20 cases of cerebral paragonimiasis have been reported for 10 years past in Kyushu.

Adolescent↗
PubMed1969

Mass Chemotherapy In The Control Of Paragonimiasis.

Among 11,005 inhabitants(61% of total population) surveyed in 13 villages of Che Ju Island in 1964, were identified as paragonimiasis patients, of these 1,355 were treated with 40 mg/kg body weight of bithionol for 10~15 doses. The purpose of the study was to test whether mass chemotherapy of the human host may provie an answer for the control of paragonimiasis in an area where the human host is main source of infection to the intermediate hosts. The efficacy of the mass chemotherapy as control program was measured by the acceptance of the survey and treatment by the inhabitants, the efficacy and the toxicity of the drug applied, and the influence of the infection rates of the intermediate hosts. The acceptance of the survey and the treatment was not entirely satisfactory: an estimate based on data suggests that only fifty to sixty percent of all cases infected were detected, and 93% of detected cases were treated in the primary program. All cases detected during the follow up survey, which could not cover whole population, were treated. The efficacy of bithionol was excellent when the treatment was completed. 40 mg/kg body weight for 10~15 doses was sufficient to turn the sputum egg-negative except in a few cases infected heavily that needed 20 doses. Side reactions were generally mild; the most frequent reaction was gastrointestinal; which spontaneously subsided within a few to several days. The infection rate of intermediate hosts started to decrease from the third year of the mass treatment with a pattern of gradual drop. Follow up studies on general population in three and four years of the mass treatment also showed markedly decreased prevalence of paragonimiasis by intradermal test and sputum examination. It is concluded that a complete mass chemotherapy with bithionol in an area where human is the main source of infection to the intermediate hosts can be the answer for control of paragonimiasis.

Journal Article↗
PubMed1976

[Immunoelectrophoresis For Anthelmintics Evaluation Against Experimental Paragonimiasis]

Paragonimiasis is one of the most important endemic diseases in Korea. However, recognition of the limitation of microscopic examination of sputum and feces for Paragonimus eggs has led to the investigation of immunoserological techniques for paragonimiasis. The other hand, bithionol preparation has been used as a drug of choice in paragonimiasis but recently niclofolan preparation has introduced as a new agent. By the time, the authors attempted the evaluation of above both agents against experimental rat paragonimiasis by immunoelectrophoresis and Ouchterlony test. The immunoeletrophoresis and Ouchterlony tests were performed according to the method Tsuji and Grabar et Williams respectively, with antigen extracted from lyophilized worm of P. westermani with 0.1 per cemt saline solution. Meanwhile, rats were infected with per os 20 metacercariae of P. westermani above two kinds of serologic tests and were undertaken at biweekly intervals. Then, bithionol was administered every other day for 5 successively for 2 weeks or 6 weeks after infection. Another groups, niclofolan was administered per os single dose same as above. 1. The sera from the rats infected with P. westermani, after treatment with bithionol or niclofolan preparations began to show the precipitin bands against P. westermani antigen 8 weeks after the infection in immunoelectrophoresis and Ouchterlony test, but from 10 or 12 weeks after infection, the number of bands were decreased or disappeared gradually. 2. In genera1, the sera from the rats treated with bithionol or niclofolan showed the precipitin bands delaying 2 weeks than control rat groups. 3. The sera from the rats administered with hydrocortisone showed precipitin bands neither in immunoelectrophoresis nor in Ouchterlony test.

Journal Article↗
PubMed2006

MRI features of pediatric cerebral paragonimiasis in the active stage.

We retrospectively reviewed the MR images of the brains of six children (age = 5-13 years) who had cerebral paragonimiasis in the early active stage. Diagnosis was based on a positive antibody test enzyme-linked immunosorbent assay (ELISA) for paragonimiasis in serum. The most common finding (in five patients) was irregular hemorrhage of various degrees. Moreover, in three cases some multiple irregular lesions with surrounding edema appeared to be conglomerated and aggregated. The rare appearance (in one patient) was a "tunnel sign," which showed the migrating track of the adult worm. In one patient with abscess and minimal hemorrhage, diffusion-weighted imaging (DWI) showed a heterogeneous high signal of lesions. Other findings included slight (one patient) or marked (one patient) irregular contrast enhancement, and large edematous areas surrounding small centers of hemorrhage (two patients). MR findings of conglomerated lesions with hemorrhage or tunnel sign may help to establish the diagnosis of active-stage cerebral paragonimiasis.

Adolescent↗
PubMed1988

Application of the latex agglutination test for human paragonimiasis in South America.

The latex agglutination test (LAT) was compared with the complement fixation test (CFT), double diffusion test (DDT) and enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of South American paragonimiasis. Sera from 17 Peruvian and Ecuadorian patients with paragonimiasis, from 15 Japanese patients with other helminthiases, and from 100 healthy students were analyzed. The tests were also compared using serum samples from patients treated with bithionol. There was remarkable agreement among the methods and it was concluded that the LAT could be a useful serodiagnostic technique for paragonimiasis, especially in field surveys.

Complement Fixation Tests↗
PubMed2002

Paragonimiasis: a Japanese perspective.

Paragonimiasis has been considered to be a foodborne zoonosis endemic only in limited areas in the world. Recently, however, patients have been seen almost all over the world because of the increase in number of overseas travelers and the popularization of ethnic dishes in developed countries. If paragonimiasis is misdiagnosed as tuberculosis or lung cancer patients suffer from a considerable burden of long-term hospitalization and unnecessary examinations and treatments. Clinicians should always be aware of the possibility of paragonimiasis when patients have pulmonary lesions with eosinophilia and an elevated serum IgE. For the diagnosis, rapid and reliable immunodiagnostic methods are now available. Highly effective drugs are also available for treatment.

Animals↗
PubMed2002

Paragonimiasis: a view from Columbia.

Paragonimiasis is a zoonosis caused by adult trematodes of the Paragonimus genus. The infection in humans is a result of a complex transmission cycle that includes two obligate intermediate hosts, a snail and a crustacean or a crayfish, and a definitive mammalian host. It has been shown that 9 of the more than 40 species of Paragonimus described affect humans in over 39 countries in Asia, Africa and America. It is estimated that 20.7 million people have paragonimiasis and it is calculated that 195 million people are at risk of being infected. The illness usually is caused once the parasite has settled in the lung at the site of the main clinical symptoms: cough, thoracic pain and hemoptysis. The diagnosis of paragonimiasis is based on the patient's history, the parasitological findings (ova in sputum and in feces), and the result of radiological and immunological tests. In severe cases, the patient may suffer from life-threatening hemoptysis or pneumothorax. Currently, praziquantel is the drug of choice.

Animals↗
PubMed2003

A case of cutaneous paragonimiasis with pleural effusion.

BACKGROUND: Paragonimiasis is an infectious disease caused by Paragonimus, which persists in the lung of mammals. Infection in the skin is very rare. RESULTS: A subcutaneous tumor with itching developed on the right lateroabdominal region of a 55-year-old man 10 days after eating fresh-water crab. It was surgically excised 2 months later. Examination of a specimen of the surgically excised tumor revealed an abscess containing many eosinophils. Parasites or other infectious organisms were not found in sections. The blood eosinophil count of the patient was elevated, and P. westermani-specific immunoglobulin G (IgG) antibody titer was strongly detected in the serum. The tumor was diagnosed as cutaneous paragonimiasis caused by P. westermani. Three months after eating the crab, a chest X-ray film showed a pleural effusion. P. westermani-specific IgG antibody was also detected in the pleural fluid. The patient was given 75 mg/kg/day of praziquantel for 3 days. The pleural effusion gradually disappeared after the medication. CONCLUSIONS: This patient had cutaneous paragonimiasis with a skin tumor that was diagnosed prior to the expression of a pleural effusion.

Animals↗
PubMed2005

Triclabendazole for the treatment of fascioliasis and paragonimiasis.

Fascioliasis and paragonimiasis, which are caused by liver flukes (Fasciola) and lung flukes (Paragonimus), are emerging public health problems. Several hundred millions of people are at risk of the two diseases that cause considerable morbidity and delay socio-economic development. Triclabendazole, a benzimidazole derivative, has been routinely used since 1983 in veterinary medicine to control infections with Fasciola spp. in domestic herbivorous animals. In 1986, a veterinary formulation of triclabendazole was first administered to two human patients with fascioliasis. Clinical data obtained thus far suggest that triclabendazole is the most efficacious and best tolerated drug for the treatment of fascioliasis. Moreover, the drug holds promise as a useful therapeutic alternative to praziquantel in the treatment of paragonimiasis. This review of triclabendazole includes an overview of the pharmacodynamics and pharmacokinetics, toxicology and efficacy against the major food-borne trematodes in laboratory animals. Data from case reports and clinical trials in humans infected with Fasciola spp. and Paragonimus spp. are summarised and the current state of triclabendazole regarding treatment of human fascioliasis and paragonimiasis is described. Efforts to facilitate broader registration of this drug should go hand-in-hand with research and development on novel drugs against food-borne trematodiasis, better access to improved sanitation, sound health education and the development of new technologies for assuring food safety.

Animals↗
PubMed1990

Paragonimus and paragonimiasis in Korea.

The lung fluke, Paragonimus, and lung fluke disease, were reviewed, especially on the works performed in Korea. Among 43 species of Paragonimus recorded in the world literature, P. westermani, P. pulmonalis, and P. iloktsuenensis are known to distribute in Korea. Biological studies on P. westermani have revealed that its snail intermediate host is Semisulcospira spp. and major second intermediate hosts are crabs such as Eriocheir japonicus and E. sinensis or crayfish such as Cambaroides similis and C. dauricus. The final hosts other than man are dogs, cats, pigs, and wild animals. Paragonimiasis has been known to distribute widely over the south Korea, however, the prevalence among people and intermediate hosts is gradually decreasing in recent years. In Korean people, the lung fluke have caused pulmonary infections in a great many of cases but as well extrapulmonary ones including cerebral, spinal, subcutaneous, hepatic, splenic, abdominal, urinary, gynecologic, and other types. The definite diagnosis of paragonimiasis can be executed by the recovery of eggs from sputum or feces of patients, however, immunological methods such as intradermal test, complement-fixation test, precipitin reactions, immunofluorescent techniques, enzyme-linked immunosorbent assay (ELISA) are greatly helpful for egg-negative or extrapulmonary cases. Various drugs have been introduced for the treatment of paragonimiasis, and among them, bithionol, niclofolan and praziquantel have shown high therapeutic efficacy. The most recommendable one is considered praziquantel. For control of this disease, mass chemotherapy of patients seems to be the most efficient and feasible measure.

Animals↗
PubMed2000

Persisting antibody reaction in paragonimiasis after praziquantel treatment is elicited mainly by egg antigens.

Antibody responses in serum and cerebrospinal fluid (CSF) samples from patients with active and chronic paragonimiasis and in sera from patients on whom follow-up studies were done after praziquantel treatment were analyzed using antigens of Paragonimus westermani prepared from eggs, metacercariae, juveniles of 4- and 7-week old, adult worms and recombinant protein of 28 kDa cruzipain-like cysteine protease (rPw28CCP). The patient sera/CSFs of active and chronic paragonimiasis revealed strong antibody reactions against the crude extracts of 4- and 7-week old juveniles as well as against those from egg and adult. rPw28CCP also showed specific reaction to the sera with active paragonimiasis. After the treatment, levels of specific antibodies in the sera gradually decreased to negative range in most patients. In some cases with persisting high antibody levels, however, the reactions at 27 kDa egg protein were sustained throughout the observation period of 34 months. The reactions at 35 and 32 kDa in adult extract and rPw28CCP disappeared rapidly after the treatment. Persistent antibody reactions even after successful treatment are provoked by continuous antigenic challenge from eggs which were not resolved by treatment.

Animals↗
PubMed2000

A case of chronic cerebral paragonimiasis westermani.

We report a chronic cerebral paragonimiasis from a 41-year-old Korean man who complains a headache and weakness of left motor neuron components. Magnetic resonance images of the brain revealed conglomerates of multiple ring-like enhancements in temporo-occipital and frontal lobes of the right hemisphere. An intradermal test for paragonimiasis westermani was positive. The patient was born near an endemic area of paragonimiasis and used to eat boiled or grilled freshwater crayfish in his childhood. Nodules in the brain were resected through craniotomies. The eggs of P. westermani were identified pathologically and parasitologically in the calcified necrotic lesions. Examinations on sputum and fecal specimens for the eggs of P. westermani were shown to be negative and a chest radiograph was normal. It is presumed that the brain lesions were formed by P. westermani approximately 30 years ago.

Adult↗