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PubMed1988

Diagnosis of paragonimiasis by immunoblot.

A sensitive and specific immunoblot assay was used to rapidly and accurately diagnose paragonimiasis. The immunoreactivity of a complex Paragonimus westermani Chaffee antigen was evaluated by SDS-PAGE and Western blot analysis. Initial probing with pooled human serum from proven Paragonimus infections revealed many bands, including a significant antibody response to an approximately 8,000 molecular weight (8 kDa) protein. Forty-three of 45 proven paragonimiasis serum specimens had antibodies to this diagnostic band. Of 29 normal serum specimens and 210 serum specimens from patients with other parasitic and nonparasitic infections, only 1 serum, from a schistosomiasis haematobium patient, reacted positively. These results indicate that our immunoblot for paragonimiasis, which uses a comparatively crude antigen, is highly sensitive (96%) and specific (99%).

Animals↗
PubMed2000

Pulmonary paragonimiasis referred to the department of surgery.

We encountered seven cases of pulmonary paragonimiasis. All patients were adult males and 6 of 7 cases were over 50-year-old. Except for one case of chronic pleural empyema, 6 patients were referred to the department of surgery because of having a mass lesion on chest roentgenography which was indistinguishable from malignancy. Although 3 patients had mild hemoptysis, none of them showed classical rusty sputum. Only one patient had high level of eosinophilia, whereas others showed normal or marginal level of eosinophilia. Paragonimus eggs were detected in transbronchial lung biopsy specimens from 4 patients. All patients' sera were positive for Paragonimus-specific IgG antibody by immunodiagnosis. Surgical option was undergone only for one patient with chronic pleural empyema which was not cured by repeated chemotherapy. In the present series, we could avoid surgical options due to an erroneous diagnosis. When a pulmonary mass lesion or empyema is detected in patients who live in paragonimiasis endemic areas, paragonimiasis should always be included in the different diagnosis of lung diseases.

Adult↗
PubMed2001

[Clinical features in twenty-three patients with paragonimiasis westermani].

We assessed the clinical features in twenty-three cases diagnosed as paragonimiasis westermani from April 1988 to May 2000 in our clinic at Miyazaki Medical College Hospital. Twenty-one patients had eaten wild boar or crab meat. Their symptoms included productive cough, chest pain and hemosputum. The findings of radiography and computed tomography (CT) were nodules, masses, infiltrative shadows and pleural effusion. The percentages of eosinophils in the peripheral blood were elevated in 16 of 23 patients, and the serum IgE values were elevated in 12 of 18 patients. Serologic tests, which are very helpful for diagnostic purposes were performed on the blood sera of all patients, and on the pleural effusions of five patients. It is often difficult to diagnose paragonimiasis westermani in patients in whom eosinophilia or increased serum IgE is not present. However, paragonimiasis westermani should also be considered as a possible diagnosis when abnormal shadows are found in chest radiographs and chest CT.

Adolescent↗
PubMed2001

Clinical features and parasite-specific IgM/IgG antibodies of paragonimiasis patients recently found in Japan.

Clinical features of a total of 30 paragonimiasis westermani patients referred to and diagnosed in our laboratory in 1999 were analyzed retrospectively. Most patients were middle-aged (average: 48 years, range: 13-72 years) with the male/female ratio of 19/11. Over 70% of the patients had respiratory symptom and over 80% had peripheral blood eosinophilia and high serum IgE level. All but two cases had radiologic abnormalities on the chest X-ray. Only in 3 cases were Paragonimus eggs detected in the sputum smear. We classified the patients into two groups depending on the chest X-ray findings: patients having pleurisy alone and those having nodular/cavitating lesions in the lung parenchyma. We measured parasite specific IgM/IgG antibodies in all patients sera by microplate ELISA. The mean parasite-specific IgM/IgG antibody ratio was significantly higher in the parenchymatous lesion group than in the pleurisy group. While IgM antibody titer had a strong positive correlation with the degree of eosinophilia in peripheral blood, IgG antibody titer had an inverse correlation. Although the degree of eosinophilia in peripheral blood was higher in the pleurisy group than in the parenchymatous lesion group, total IgE level in serum was comparable between the two groups. The present results indicate that pleurisy with eosinophilia and dominant IgM antibody are the characteristic features of the early stage of paragonimiasis, whereas parenchymatous lesions in lungs with low grade eosinophilia and dominant IgG antibody are of the late stage. These results suggest that detection of IgM antibody should always be considered for the immunodiagnosis for paragonimiasis-suspected patients with pleurisy.

Adolescent↗
PubMed1976

[Antibodies and immunoglobulin levels in sera from patients with African paragonimiasis (author's transl)].

96% of the P. uterobilateralis patients and 86.5% of the P. africanus patients showed a positive reaction with the homologous antigen in the passive haemagglutination test (PA). Common antigens of the two species were demonstrated by cross reactions. About 75% of the Paragonimus sera reacted also with the heterologous antigen with titres greater than or equal to 1:160. The PA test can be useful in the evaluation of the efficacy of treatment and is well suited for seroepidemiologic purposes. The complement fixation (CF) test was not suitable for serodiagnostic or seroepidemiologic studies nor for the assessment of the cure of African Paragonimiasis since antibodies persisted for at least one year after treatment. Comparative studies on levels of IgA, IgE, IgG and IgM seems to be of no diagnostic value in African paragonimiasis because no significant correlation between immunoglobulin concentration and paragonimiasis could be recognized. Very high IgE levels--up to 100 times higher than in Europeans--were found in nearly all sera. Shipment of filter papers blood specimens collected from P. africanus patient resulted in a significant decrease of antibody reactivity in all sera, the loss being about 30% in the parasitologically proven patients.

Blood Preservation↗
PubMed2003

[Paragonimiasis westermani caused by ingestion of Chinese freshwater crabs].

We encountered three cases of paragonimiasis westermani caused by ingestion of Chinese freshwater crabs. All patients are Chinese living in Japan who had a history of eating raw Shanghai crabs at the Chinese restaurant owned by one of them. A few months later they complained of cough, chest pain and dyspnea. On examination, their peripheral blood showed a remarkable increase in eosinophils. Chest radiographs revealed the presence of pleural effusion in all cases, and of pneumothorax in one. Pleural fluid obtained from two cases showed an increased number of eosinophils, an elevated LDH, and a decreased glucose level. Paragonimus westermani was determined in a positive serum antibody test. The patients were treated with praziquantel for 3 days at a daily dosage of 75 mg/kg and their symptoms were relieved, but one case needed additional treatment with praziquantel for 3 days at a daily dosage of 50 mg/kg because of sustained pleural effusion and a persistently high antibody titer. Most cases of paragonimiasis found in Japan have been sporadic and individual, but three cases occurring close to each other in both distance and time have recently been reported. Such multiple infections are likely to increase because of the gourmet food boom and the internationalization of eating habits. Paragonimiasis must be kept in mind in the differential diagnosis of cases of pleural effusion with eosinophilia. We would therefore like to emphasize the importance of the detection of parasite-specific antibodies and of careful history-taking from patients.

Adult↗
PubMedDate not supplied

Pulmonary paragonimiasis mimicking lung cancer on FDG-PET imaging.

The case of a 48-year-old man with pulmonary paragonimiasis mimicking lung cancer on positron emission tomography with fluorodeoxyglucose (FDG-PET) imaging is reported herein. Plain radiography and computed tomography (CT) of the chest showed a nodular lesion at the left pulmonary hilum. Lung cancer was strongly suggested from standardized uptake values determined on FDG-PET imaging; however, repeat chest CT revealed the lesion to have decreased in size. Pulmonary paragonimiasis was subsequently diagnosed after sputum microscopy demonstrated operculated parasitic eggs. To the best of our knowledge, this is the first reported case of pulmonary paragonimiasis mimicking lung cancer on FDG-PET imaging.

Diagnosis, Differential↗
PubMed2005

Paragonimiasis in Nan Province, northern Thailand.

Two cases of paragonimiasis were identified within the hill-tribe population living on the Thai-Laotian border of Nan Province, northern Thailand, where information on Paragonimus was then still limited. The patients were in the habit of eating improperly cooked crabs and freshwater prawns. A survey for natural intermediate hosts to complete the life cycle was in progress at that time, and the detection of paragonimiasis cases indicated that there was persistence of paragonimiasis in the endemic area of Nan Province.

Adolescent↗
PubMed1990

Serodiagnosis of human paragonimiasis caused by Paragonimus heterotremus.

Enzyme-linked immunosorbent assay (ELISA) and indirect hemagglutination tests (IHA) were evaluated for serodiagnosis of human paragonimiasis caused by Paragonimus heterotremus using homologous adult worm extract as antigen. IgG-ELISA was the most sensitive, being positive in all paragonimiasis sera tested while IHA and IgA-ELISA gave 88% and 59% positive rates respectively. Cross reactivity in IgG-ELISA was detected with fascioliasis sera, producing overall assay specificity of 97%. It is suggested that IgG-ELISA is a reliable serodiagnostic test for human paragonimiasis caused by Paragonimus heterotremus.

Animals↗
PubMed1989

[A diagnostic kit for rapid microenzyme linked immunosorbent assay of paragonimiasis].

With a diagnostic kit for paragonimiasis we recently developed, 112 active paragonimiasis cases were examined and 111 (99.1%) of them showed positive reaction. Sera of 100 healthy persons all showed negative reaction, while 2.3% (3/130) of the patients with other parasitic diseases showed a week cross reaction. Sera of 40 cases with non-parasitic pulmonary diseases also showed negative reaction. The reciprocal titre of cases of paragonimiasis in terms of geometrical mean (GMRT) versus that of normal person was 1396 to 21 (P less than 0.0001). The reproduction and stability of this kit was satisfactory and no significant changes were noted when being kept in room temperature for 12 weeks or being treated with heat (37 degrees C 30', 56 degrees C 30', 64 degrees C 30', 100 degrees C 1', 2', 3', in water bath). When the antigen was treated in 100 degrees C water bath for 30', the OD value obtained with positive control serum showed a slight decrease, but OD value of the positive specimen was still 2.1 times higher than that of negative specimen. There was no significant difference whether the antigen was lyophilized or not. When the antigen was purified by sephadex G 100 gel column, the G100-1 portion showed higher antigenic activity and specificity, but it was not as sensitive as the crude antigen.

Animals↗
PubMed1987

[Paragonimiasis of the lung].

Paragonimiasis results from infection with a trematode worm, P. Westermani or, less commonly, one of the many of the other Paragonimus species (for instance: Paragonimus africanus). It usually affects the lung with manifestation of chronic cough, hemoptysis and roentgenographic infiltrates, alterations that can be difficult to distinguish from the lesions of tuberculosis. The diagnosis is established by the finding of Paragonimus eggs in the sputum or stool. On the basis of a case report on pulmonary paragonimiasis characterised by some peculiarities in a Congolese the clinical and roentgenological as well as the pathological features of pulmonary paragonimiasis are shortly described. The importance of this parasitosis is emphasized because of increasing migration of people from endemic areas to European countries.

Adult↗
PubMed1984

Paragonimiasis in the Philippines: current status.

Paragonimiasis in the Philippines was first reported in 1907. The first attempt to study its life cycle was made in 1941 when metacercariae of Paragonimus were found in fresh-water mountain crabs. At present the causative agent of human paragonimiasis in this country is Paragonimus westermani, although the new name, Paragonimus philippinensis, has been proposed instead. The second species of Paragonimus, Paragonimus siamensis, was reported in cats in 1973. The prevalence of disease in two endemic areas ranges from 0.5 to 12%. Transmission to man is attributed to the preparation of local delicacies using raw crab juice, eating of undercooked roasted crabs by children and eating of raw crabs by adult males with local alcoholic drinks. Microscopic examination of sedimented sputum collected over 24 h and dissolved in 3% sodium hydroxide appears to be the best diagnostic technique when performed twice. Intradermal testing followed by sputum examination is recommended in paragonimiasis surveys. Bithionol and probably praziquantel (2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a]++ +isoquinolin- 4-one, EMBAY 8440, Biltricide) are drugs of choice for treatment. The first intermediate hosts are Antemelania asperata and Antemelania dactylus, formerly Brotia asperata, with an infection rate of less than 1%, while the second intermediate crustacean host is Sundathelphusa philippina, formerly Parathelphusa grapsoides, with an infection rate ranging from 50 to 100%. So far, the natural animal reservoir hosts are cats, dogs and field rats.

Adult↗
PubMed1997

Pulmonary paragonimiasis and tuberculosis in Sorsogon, Philippines.

The clinical epidemiology of pulmonary paragonimiasis and tuberculosis was investigated in a known endemic municipality of Sorsogon, Philippines. Records of diagnosed tuberculosis patients on treatment and follow up at the local Rural Health Unit over a two year period from 1993 to 1994 were reviewed to provide an overview of pulmonary tuberculosis in the area, specifically to describe the population at risk, the basis for diagnosis and the proportion of case notification who were sputum negative. Patients from the same group of individuals as well as undiagnosed tuberculosis patients with productive cough, fever with chest and/or back pain, or hemoptysis were examined to look into clinical manifestations, duration of symptoms, history of crab-eating and sputum examination results for acid-fast bacilli and Paragonimus. There was difficulty in determining the number of non-responders as the records did not have any provision for the recording of such. Annual tuberculosis case notification rates for the two years (374 and 401 per 100,000 population) were higher than the national figure in 1991 (325 per 100,000 population) indicating that tuberculosis is still a major health problem in the area and tuberculosis control efforts may have to be more aggressive to better contain the disease. Twenty-six out of 160 individuals surveyed were sputum smear positive for Paragonimus. Paragonimiasis rates were not significantly different in the two groups (15.6% vs 16.9%, respectively) indicating that there is a need for routine sputum examination for Paragonimus which is not available at present. Only six patients surveyed were sputum smear positive for acid-fast bacilli. A high index of suspicion is necessary to diagnose paragonimiasis and to be able to differentiate it from tuberculosis. The diagnosis may be suggested by a patient's place of origin being a known endemic area, a long period of chronic cough and the habit of eating raw or insufficiently cooked crabs or crayfish. Laboratories in endemic areas should have the capacity to differentiate between the two infections by being able to provide the routine laboratory procedures necessary for definitive diagnosis and treatment.

Adolescent↗
PubMed1997

Recent advances in diagnosis of paragonimiasis.

Paragonimiasis in endemic areas can be diagnosed by clinical symptoms. However, the diagnosis should always be confirmed by microscopic examination of the sputum or stool in order to find Paragonimus eggs. Within recent years marked advances in diagnosis of paragonimiasis have been made. Two new approaches comprising a genetic probe and immunological tests have been developed with claims to be as good or better than microscopic examinations. This report reviews these two areas, especially in paragonimiasis caused by Paragonimus heterotremus and P. westermani. In addition, problem areas in assay development are discussed.

Animals↗
PubMed1998

[Paragonimiasis: a rare little known disease].

BACKGROUND: Paragonimiasis, caused by a lung fluke, is an parasitic disease rarely encountered in France. CASE REPORT: A 52-year-old man developed dyspnea, cough, mild fever and chest pain. Pleural effusion suggested possible pulmonary embolism or tuberculosis. Cell counts in blood and pleural effusion fluid revealed major eosinophila in this patient who had recently returned from a trip to Japan. Paragonimiasis was confirmed by ELISA. Treatment with praziquantel led to complete clinical and radiographic recovery. DISCUSSION: The clinical and radiographic features of paragonimiasis are often similar to tuberculosis with pleuropneumopathy, mild fever and dyspnea. ELISA has now replaced parasitologic diagnosis. Cure is achieved with praziquantel.

Animals↗
PubMed1983

[Comparison Of Agar-Gel Diffusion Tests, Counterimmunoelectrophoresis And Enzyme-Linked Immunosorbent Assay In The Sera Of Skin Test Positives For Paragonimiasis]

Agar-gel diffusion test (AGD), counterimmunoelectrophoresis (CIEP) and enzyme-linked immunosorbent assay(ELISA) were examined with the sera of skin test positives for paragonimiasis. The crude antigen(Paragonimus whole worm extracts: protein concentration, 7.56mg/ml) and human sera were used in AGD and CIEP. And in ELISA test, diluted antigen with 1:40,000 of crude antigen and diluted sera with 1:100, 1:200 were used in the test. The positive identical ratio between AGD and CIEP reactions is 98 % and negative identical ratio is 100 %. One or three precipitin bands are observed in AGD. One to seven precipitin bands are also revealed in CIEP. Especially, deeply stained bands are observed in CIEP than those of AGD. The positive identical ratios between AGD and ELISA tests are 96 % in 1:100 diluted sera, and 94 % in 1:200 diluted sera. But the negative identical ratios between AGD and ELISA tests are 97 % and 99 % respectively in 1:100 and 1:200 diluted sera. The positive identical ratios between CIEP and ELISA tests are 98 % and 96 % respectively in 1:100 and 1:200 diluted sera, but also 97 % and 99 % in 1:100 and 1:200. Control sera, such as clonorchiasis, amoebiasis and toxoplasmosis, revealed all negatives with Paragonimus antigen in AGD, CIEP and ELISA tests. By above results, ELISA was most sensitive, next CIEP and AGD. But AGD test appears to be more useful when used to crude antigen without cross reaction with other parasitic infections. CIEP test is basically equal in terms of precipitin reaction, but CIEP is able to be detected more sensitively and rapidly though less simple in handiwork than AGD. Consequently, three methods for immunological tests of paragonimiasis have good correlations with one another. Also, each of these has both merits and demerits in immunological test for paragonimiasis. But the ELISA test was proved to be the most sensitive and convenient tool for mass screening test, especially in case of using purified antigen.

Journal Article↗
PubMed1982

Paragonimiasis. Atypical appearances in two adolescent Asian refugees.

Paragonimiasis is a parasitic disease endemic to Asia, Africa, and South America. With the increasing number of Southeast Asian immigrants arriving in the United States, physicians should be aware of the various manifestations of this disease. We describe two adolescent Asian refugees who had atypical cases of paragonimiasis. One experienced acute abdominal pain mimicking appendicitis, and the other had asymptomatic left upper-lobe cavitation.

Abdomen↗
PubMed1986

Primary rhabdomyosarcoma combined with chronic paragonimiasis in the cerebrum: a necropsy case and review of the literature.

A necropsy case of a primary rhabdomyosarcoma with chronic paragonimiasis in the cerebrum of a 68-year-old man is reported. The clinical data showed a right hemiplegia and dysarthria which became lethal in 6 months even though operation and radiation therapy were performed. Computed tomography revealed a large low-density area associated with the peripheral enhancement in the left basal ganglia, and multiple conglomerated calcified masses in the left temporal and occipital lobes. Biopsied and necropsied materials of the tumor in the basal ganglia was reddish brown in color and histologically was composed of purely mesenchymal derivatives with both embryonal and mature striated muscle cells but neither neuronal nor glial elements. Some of the tumor cells with extending slender cytoplasms showed obvious cross striations at the light and electron microscope levels and immunohistochemical reactivity for myoglobin. All tumor cells were also positive for vimentin, but not for glial fibrillary acidic protein. The clinical and necropsy findings revealed no primary lesion anywhere but in the brain. In addition, numerous dead oval eggs of Paragonimus westermani were found in many cystoid lesions encapsulated by thick connective tissues with calcification and/or ossification. Clinicopathological features of 24 cases of primary rhabdomyosarcoma of the central nervous system reported in the literature are reviewed briefly. The histogenesis of this tumor are discussed together with comments on cerebral paragonimiasis.

Aged↗