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PubMed2006

Two cases of pulmonary paragonimiasis on FDG-PET CT imaging.

Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is useful in cancer diagnosis owing to its sensitivity to the differences in glucose metabolic rate between benign and malignant diseases, especially in the lung. One pitfall in PET imaging of lung disease, however, is the overlap in metabolic rate of inflammatory and neoplastic entities. Paragonimiasis is a food-borne parasitic disease that causes the pulmonary and pleural inflammation. We present two cases of pulmonary paragonimiasis that showed high uptake suggestive of tumor on FDG-PET CT images, both confirmed on histopathology by visualization of Paragonimus westermani eggs in the involved tissues.

Diagnosis, Differential↗
PubMed2006

Molecular cloning and characterization of a major egg antigen in Paragonimus westermani and its use in ELISA for the immunodiagnosis of paragonimiasis.

A recombinant protein of a Paragonimus westermani egg antigen was produced and tested as an antigen for the serologic diagnosis of P. westermani infection. The P. westermani egg antigen gene contains a single open reading frame of 966 base pairs encoding 322 amino acids from 5' methionine to the 3' stop codon. The predicted amino acid sequence of this egg antigen was 40, 38, and was 35% identical to heat shock proteins from Schistosoma japonicum, Schistosoma mansoni, and Taenia saginata. The distribution this antigen was investigated in adult worms by indirect immunofluorescence assay, and found to be distributed in eggs and uteri. The specificity and sensitivity of the recombinant antigen were assessed by enzyme-linked immunosorbent assay (ELISA) using sera from patients infected with different parasites, which included 41 patients with paragonimiasis, and negative controls. The diagnostic positive and negative predictive absorbance value was 0.24 and the sensitivity of ELISA using the recombinant antigen was 90.2%, and its specificity 100%. Our results suggest that the developed recombinant major egg antigen-based ELISA offers a highly sensitive and specific assay for the diagnosis of paragonimiasis.

Amino Acid Sequence↗
PubMedDate not supplied

Comparison of two single-day regimens of triclabendazole for the treatment of human pulmonary paragonimiasis.

A well-tolerated single-day treatment regimen is required for the community-based treatment of pulmonary paragonimiasis. To identify an optimal single-day treatment regimen, an open clinical trial was performed to compare the efficacy of 2 single-day regimens of triclabendazole. From 1991 to 1993, a total of 154 Ecuadorian patients were allocated to receive either a single dose or 2 doses of 10 mg/kg triclabendazole. Treatment with both regimens was associated with a rapid parasitological response (determined by clearance of Paragonimus eggs from sputum), resolution of most clinical symptoms and radiological signs, and only mild adverse effects. At 3 months after treatment, the cure rate (clearance of eggs from sputum) was 90.9% in the 2-dose group and 84.4% in the single-dose group. Re-treatment with a second 2-dose regimen was curative in all remaining patients by 1 year of follow-up. Our findings show that both single-day treatment regimens of triclabendazole were highly effective in the treatment of pulmonary paragonimiasis and suggest that patients should be re-examined at 3 months to determine the need for repeat treatment.

Adolescent↗
PubMedDate not supplied

Treatment of human pulmonary paragonimiasis with triclabendazole: clinical tolerance and drug efficacy.

An open clinical trial to determine the efficacy and tolerability of postprandial doses of triclabendazole against Paragonimus mexicanus in 62 patients with pulmonary paragonimiasis from the Ecuadorian Amazon region was performed. Praziquantel was used as therapeutic control. Patients were allocated at random to the following 4 therapeutic regimens: triclabendazole, 5 mg/kg once daily for 3 d (16 patients), 10 mg/kg twice on one day (15 patients), and 10 mg/kg in a single dose (16 patients), and praziquantel, 25 mg/kg thrice daily for 3 d (15 patients). Clinical tolerance, based on the frequency and severity of adverse reactions, was superior in all 3 triclabendazole regimens to that of praziquantel. No alteration was observed in hepato-renal functions or haematological values. The clinical symptoms resolved at a comparable rate in all 4 treatment groups. A more rapid parasitological response to treatment, as determined by the reduction in the average number of parasite eggs found in sputum, was seen in patients treated with triclabendazole than with praziquantel. By day 90, 60 patients had no egg detected in their sputum; 2 patients, treated with a single dose of 10 mg/kg, had a few and were re-treated with triclabendazole (5 mg daily for 3 d). On day 365, none of the patients had eggs in their sputum. Triclabendazole can be recommended as an alternative drug of choice for the treatment of pulmonary paragonimiasis; it is as effective as praziquantel in clearing infections and better tolerated.

Adolescent↗
PubMed1998

Indirect haemagglutination test using monoclonal antibody-affinity purified antigens for diagnosis of human paragonimiasis due to Paragonimus heterotremus.

An indirect haemagglutination test (IHA) using antigens purified by monoclonal antibody-affinity chromatography was developed for the diagnosis of human paragonimiasis caused by Paragonimus heterotremus. Sera from patients with paragonimiasis (n = 30) were evaluated, along with sera from other parasitic infections (n = 92), pulmonary tuberculosis (n = 18) and healthy controls (n = 30). The sensitivity, specificity as well as positive and negative predictive value of the IHA, calculated at the prevalence of disease at 17.6%, were all 100%.

Animals↗
PubMed1998

Soluble CD23 and IL-5 levels in the serum and culture supernatants of peripheral blood mononuclear cells in a girl with cutaneous paragonimiasis: case report.

We examined the levels of soluble CD23 (sCD23) and IL-5 in the serum and culture supernatants of the peripheral blood mononuclear cells of a 9-year-old girl with cutaneous paragonimiasis without respiratory symptoms. Before treatment, levels of both sCD23 and IL-5 in her serum and culture supernatants were elevated compared with those of controls. After successful treatment with praziquantel, sCD23 and IL-5 levels rapidly reduced to normal levels. These results indicate that sCD23 and IL-5 are involved in the immune-mediated pathological responses seen in paragonimiasis.

Antiparasitic Agents↗
PubMed2001

Clinical features of paragonimiasis cases recently found in japan: parasite-specific immunoglobulin M and G antibody classes.

We retrospectively analyzed clinical features in 30 patients who were referred to our laboratory and given a diagnosis of Paragonimus westermani infection in 1999. Our results indicate that pleurisy with eosinophilia and dominant immunoglobulin (Ig) M antibody are characteristic features of the early stage of paragonimiasis, whereas IgG antibody is dominant in the late stage. Thus, in addition to tests for parasite-specific IgG antibody, tests for IgM-class antibody should always be considered for patients with pleurisy in whom paragonimiasis is suspected.

Adolescent↗
PubMedDate not supplied

Paragonimiasis: diagnosis and the use of praziquantel in treatment.

Paragonimiasis was diagnosed in eight patients: five with sputum specimens positive for characteristic ova and three with only stool specimens positive for ova. Clinical symptoms, roentgenograms and serologic findings appeared to correlate with severity of disease. All eight patients were treated with praziquantel (oral dose, 75 mg/kg of body weight daily for two consecutive days). Of seven patients who completed the treatment, six had ova-negative sputum and stool specimens by day 90; the seventh patient's specimens became ova negative by day 120. The eighth patient, who had failed to respond to prior treatment with bithionol, could not tolerate the daily dosage of 75 mg/kg because of nausea. Although he received the same total dose (150 mg/kg) over four days his specimens remained ova positive on day 90. Adverse effects included nausea (two patients), headache (one patient), and urticaria (two), the last effect possibly secondary to release of antigen from drug-damaged parasites. A review of the epidemiology, clinical presentation, and treatment of pulmonary paragonimiasis is presented.

Adolescent↗
PubMed2003

Cavitary mass lesion and recurrent pneumothoraces due to Paragonimus kellicotti infection: North American paragonimiasis.

North American paragonimiasis is well described in omnivorous and carnivorous animals on this continent. Humans are rarely infected, largely because of dietary customs, but are at risk for infection if raw or undercooked crayfish are consumed. We describe a patient with a pleuropulmonary infection due to Paragonimus kellicotti that presented as recurrent pneumothoraces and a cavitary lesion. This is the first case of North American paragonimiasis in which the diagnosis was based on the morphology of the eggs present in histologic sections.

Adult↗
PubMedDate not supplied

Perirectal cystic paragonimiasis: endorectal coil MRI.

We report the transrectal ultrasonographic (TRUS) and endorectal surface coil MR findings for paragonimiasis involving the perirectal space. The patient presented with voiding difficulty. TRUS showed a well demarcated, oval-shaped hyperechoic mass in the perirectal space. On endorectal MR images, the lesion was depicted as a well defined cystic mass with homogeneous intermediate signal intensity on T1-weighted images and heterogeneous hyperintensity on T2-weighted images. Ectopic paragonimiasis can appear as a well defined cystic mass in the peritoneum and should be included in the differential diagnosis of cystic mass in the abdomen and pelvic cavity, including the perirectal space.

Aged↗
PubMedDate not supplied

Heterotopic paragonimiasis in the omentum.

Paragonimus westermani is a lung fluke but may be found in organs other than the lungs. A case of omental paragonimiasis was found incidentally by plain radiography and computed tomography and showed multiple, irregularly shaped, conglomerated calcifications in the intraperitoneum. Many P. westermani ova were detected in the resected omentum. This uncommon calcification on the plain abdominal radiography and computed tomography scan was considered to represent radiologic findings of ectopic paragonimiasis.

Calcinosis↗
PubMed1986

Pulmonary paragonimiasis: diagnostic value of pleural fluid analysis.

Pleural fluid studies showing a glucose value of less than 10 mg/dl, an LDH level greater than 1,000 IU/L, eosinophilia, a high protein value, and low pH are characteristic of paragonimiasis. In a patient with a pleural effusion and compatible clinical, radiologic, and serologic findings, pleural fluid analysis will allow diagnosis with reasonable certainty even in the absence of positive ova studies, and is useful in distinguishing paragonimiasis from tuberculosis.

Adult↗
PubMed1983

Paragonimiasis in Indochinese refugees. Roentgenographic findings with clinical correlations.

Twenty-five Indochinese refugees with paragonimiasis were reviewed. Thirteen patients were diagnosed by ova identification in sputum specimens, but 12 patients were diagnosed by an elevated complement fixation titer in conjunction with clinical and epidemiologic criteria. Roentgenographic lesions included diffuse (44%) and segmental (24%) infiltrates, nodules (20%), and cavities (20%). The classic ring shadow was present in only 8%. Of note was the frequency of pleural effusions (48%), which were massive in 6 patients and the sole manifestation in 5. Although tuberculosis should always be excluded, work-up of pulmonary effusions and infiltrates in immigrants from Southeast Asia should include a serologic and microbiologic search for paragonimiasis.

Adolescent↗
PubMed1982

Paragonimiasis in the United States. A report of nine cases in Hmong immigrants.

Nine cases of paragonimiasis have been encountered in Laotian Hmong immigrants from Camp Ban Vinai in Thailand. Symptoms included cough, hemoptysis, and fever. Chest x-ray films showed segmental infiltrates and pleural effusions, often bilateral. The clinical presentation mimics tuberculosis. All Hmong patients with chronic infiltrates and pleural disease in whom tuberculosis has not been proven should have parasitologic and serologic evaluation to exclude paragonimiasis.

Adolescent↗
PubMedDate not supplied

Antibody isotypes, including IgG subclasses, in Ecuadorian patients with pulmonary paragonimiasis.

An ELISA test was developed to detect Paragonimus-specific antibodies, including IgG subclasses, using P. mexicanus crude water-soluble antigens. The test was standardized to detect antibodies in sera of Ecuadorian patients with pulmonary paragonimiasis and negative controls from the endemic area. The detected mean levels of IgG (0.753, SEM: 0.074) and IgM (0.303, SEM: 0.033) were significantly elevated (P < 0.05). Within the IgG subclasses, IgG4 showed the highest detected mean level (0.365, SEM: 0.116) and the other three subclasses showed considerably lower mean levels (IgG1, 0.186 SEM: 0.06; IgG2, 0.046 SEM: 0.01; IgG3, 0.123 SEM: 0.047). The number of P. mexicanus eggs found in sputum of infected individuals showed a positive correlation with the level of antibodies detected for IgM, IgG and its subclasses (P < 0.001). The relevance of these findings in Ecuadorian patients suffering from pulmonary paragonimiasis is discussed.

Animals↗
PubMed1995

Pulmonary paragonimiasis with pleural effusion containing paragonimus ova: sonographical appearance of pleural effusion.

In the pleural effusion of a 46-year-old man with pulmonary paragonimiasis, numerous floating particles containing parasitic ova and granulation tissue were observed. The floating particles appeared as diffuse hyperechoic foci in the anechoic pleural effusion on ultrasonography. We concluded that rupture of the intrapulmonary paragonimiasis lesion into the pleural cavity caused the formation of these floating particles.

Humans↗
PubMed1992

Cerebral paragonimiasis--report of five cases.

Five cases of cerebral paragonimiasis presenting with hemianopsia, convulsion, and gait disturbance are discussed. The cases were all in the chronic stage. The intradermal paragonimiasis reaction, complement fixation, and Ouchterlony tests were not useful for diagnosis. Computed tomography demonstrated calcifications in all cases in sites consistent with the foci of symptoms. Surgical treatment in two cases failed to improve symptoms.

Adult↗
PubMed1993

[A case of pelvic paragonimiasis combined with myoma uteri and pelvic inflammatory disease].

Paragonimus westermani is a lung fluke of humans that is usually found in the lungs but may be found elsewhere in many unusual locations. A case of pelvic paragonimiasis was found incidentally by surgical intervention of inflammatory disease and myoma uteri. She was a 51-year-old Korean woman complaining of lower abdominal pain and intermittent vaginal spotting. Numerous Paragonimus ova were observed in the resected omentum in the pelvis after total abdominal hysterectomy. It is suggested that pelvic paragonimiasis may be one of causative agents of pelvic inflammatory disease.

Female↗