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PubMed2005

Pleuropulmonary paragonimiasis mimicking pulmonary tuberculosis--a report of three cases.

Paragonimiasis is an important cause of pulmonary disease worldwide. Infection in humans mainly occurs by ingestion of raw or undercooked freshwater crabs or crayfish. The disease is well known in endemic regions of Asian countries, where culturally based methods of food preparation foster human transmission. Three patients with clinical and radiological features compatible with pulmonary tuberculosis had been treated for tuberculosis without remedy despite an inability to demonstrate acid fast bacilli in sputum smears. All patients had history of ingestion of raw crabs and crayfish. The confirmed diagnosis of pleuropulmonary paragonimiasis was made based on the demonstration of Paragonimus eggs in the sputum, and high absolute eosinophilia in their peripheral blood and pleural fluid. All the patients had been treated with praziquantel successfully.

Adolescent↗
PubMed1985

A field study of paragonimiasis in Venezuela.

In a natural focus of paragonimiasis in the northeastern region of Venezuela, 130 people were clinically, parasitologically and immunologically evaluated. A specific intradermal test was positive in 13%. Besides an index case, three other active cases of paragonimiasis were identified. Adult Paragonimus worms and metacercariae were recovered from Didelphis marsupialis and Eudaniela garmani, respectively. Previous reports of Paragonimus infection in Venezuela are discussed.

Adolescent↗
PubMed1992

Parasite-specific IgE and IgG levels in the serum and pleural effusion of paragonimiasis westermani patients.

In seven patients with paragonimiasis westermani, parasite-specific IgE and IgG levels in sera and pleural effusion were determined by an enzyme-linked immunosorbent assay (ELISA). The sensitivity to adult excretory-secretory (E-S) antigen was compared with the sensitivity to whole worm extract antigen, and the former was more sensitive in both an IgE-ELISA and IgG-ELISA. Both parasite-specific IgE and IgG could be detected by ELISA at levels much higher than those in control subjects using E-S antigen. When specific IgE and IgG levels in sera and pleural effusion of individual patients were compared, the latter had higher values. The difference between levels of specific IgE in pleural effusion and serum did not correlate with that of specific IgG. These results indicate that specific IgE and IgG antibodies form locally, i.e., in the lung, and that pleural effusions from patients with paragonimiasis are more suitable than serum for immunodiagnosis.

Animals↗
PubMed1998

[Paragonimiasis].

Paragonimiasis is a helminthic disease of carnivorous animals. Man is infected accidentally. It has a worldwide distribution but is mainly encountered in Southeast Asia, particularly in Korea. Other endemic areas include Africa and South America. Cerebral paragonimiasis is not rare, but pleuropulmonary manifestations are the most prevalent. They include hemoptysis (frequently rusty-colored), unilateral or bilateral pleural effusions, and pulmonary infiltrates or cavities. This constellation of symptoms often mimics those of tuberculosis. Cerebral and lung involvement has recently been investigated by CT-scan and NMR. The diagnosis is based on the identification of parasite eggs in sputum or feces, and on ELISA serology. The treatment of choice is praziquantel.

Anthelmintics↗
PubMed1999

Re-emergence of paragonimiasis in Kyushu, Japan.

During 1986-1998 we found 104 paragonimiasis cases, which were referred to our laboratory for immunodiagnosis or identification of parasite eggs in sputum or bronchoscopic aspirate smears, or in histopathological sections. A majority of patients were middle-aged males. Except for 2 cases of chronic occult infection in an unexpected site, 102 cases were assumed as having active infection. Abnormal findings in chest radiograms were noted over 80% of the patients, though about 20% of them were asymptomatic. Parasite egg detection rates in sputum or bronchoscopic aspirate smears were about 50%. About 80% of patients have eosinophilia and/or elevated serum IgE level. Paragonimiasis is a re-emerging public health issue in Kyushu, Japan.

Adolescent↗
PubMed2000

[A case of paragonimiasis westermani with a high level of interleukin 5 in bronchoalveolar lavage fluid].

A 49-year-old man was admitted to our hospital with a productive cough and bloody sputum. Peripheral blood eosinophil counts and serum IgE values were elevated. Chest radiography and chest computed tomography revealed a solitary nodule with cavitation and satellite lesions in the right middle lobe, in contact with the pleura. The diagnosis of paragonimiasis westermani was confirmed by detection of ova in the sputum and bronchoalveolar lavage fluid (BALF) samples, and by immunoserological examination. The patient was treated with praziquantel for 3 days at a daily dosage of 75 mg/kg. After treatment, his clinical symptoms and radiological abnormalities disappeared. The IL-5 level was high in BALF, but it was undetectable in the plasma, suggesting that IL-5 in inflammatory lesions may be particularly important in mediating eosinophilia in the blood and BALF in paragonimiasis westermani.

Anthelmintics↗
PubMed2001

Clinics in diagnostic imaging (58). Chronic cerebral paragonimiasis.

A 36-year-old Korean man presented with a history of epilepsy. MR imaging of the brain revealed multiple conglomerated round nodules that were hypointense on both T1-and-T2 weighted images. These were located at the left temporal and occipital lobes and had surrounding encephalomalacia. CT scan confirmed the presence of large calcified nodules in the corresponding regions. These imaging findings were typical of chronic cerebral paragonimiasis. The clinical, CT and MR features of cerebral paragonimiasis are reviewed.

Adult↗
PubMed2001

Protein A immunocapture assay detecting antibodies to fluke cysteine proteinases for immunodiagnosis of human paragonimiasis and fascioliasis.

Enzyme-linked immunosorbent assays (ELISAs) which detect specific antibodies to fluke cysteine proteinases have provided good sensitivity and specificity for the immunodiagnosis of trematode diseases. To detect specific antibodies without the need for purified proteinase antigens, an immunocapture assay using Protein A was applied for the immunodiagnosis of paragonimiasis and fascioliasis. ELISA plate wells were coated with Protein A, incubated with diluted patient sera, then incubated with a preparation containing fluke cysteine proteinases, excretory-secretory (ES) products of adult Paragonimus westermani or Fasciola sp. The activity of fluke cysteine proteinases bound on the wells was measured by adding fluorogenic peptidyl substrate, Z-Phe-Arg-MCA or Boc-Val-Leu-Lys-MCA. This assay detected specific immunoglobulin G to cysteine proteinases of P. westermani and Fasciola sp. by measuring proteinase activity on the plate wells. Patient sera showed significant high values of proteinase activity when the wells were treated with the respective homologous ES products, whereas the sera had low values after treatment with the heterologous ES products. The sera of patients with other parasitoses and uninfected healthy individuals also showed low values after treatment with the above fluke ES products. Thus, Protein A immunocapture assay, which detected IgG specific for fluke cysteine proteinases, provided a high sensitivity and specificity for immunodiagnosis of paragonimiasis and fascioliasis.

Antibodies, Helminth↗
PubMed2001

The present situation of paragonimiasis in endemic area in Phitsanulok Province.

A cross-sectional survey and evaluation of paragonimiasis situation from endemic area in Phitsanulok Province was studied. Studies on the species and prevalence of parasites which infected people in Noen Maprang, Phitsanulok Province were also conducted during October 1999-March 2000. The sputum specimens were collected and examined to identify Paragonimus heterotremus eggs. In addition fecal samples were collected and examined for parasites by the formalin-ethyl acetate concentration technique. P. heterotremus eggs were detected in 2 out of 391 sputum specimens; a prevalence of 0.51%. A total of 584 stool specimens were obtained and examined. It was found that the prevalence of parasitic infection was 36.30%. Opisthorchis viverrini infection was the most prevalent (10.78%), followed by Strongyloides stercoralis (9.59%), hookworm (8.22%), Echinostoma spp (2.23%), minute intestinal flukes (1.54%), Taenia species (1.37%), Enterobius vermicularis (0.68%), Entamoeba coli (1.03%) and Giardia lamblia (0.86%). The prevalent rate of paragonimiasis in this endemic area in Phitsanulok Province has decreased during the past decade. However, there were other important parasite infections, especially opisthorchiasis and strongylodiasis and these should be studied further.

Adolescent↗
PubMed2001

[A clinical trial of triclabendazole in the treatment of human paragonimiasis skrjabini].

OBJECTIVE: To observe the therapeutic effect of triclabendazole in patients with paragonimiasis skrjabini. METHODS: Four patients were treated with triclabendazole at dosage of 10 mg/kg bid for 3 days and were followed up for 6-10 months. The clinical symptoms, chest X-ray, hemogram and liver function tests were observed before and after treatment. RESULTS: Migratory subcutaneous nodules in three patients all disappeared. Small amount of pleural effusion were absorbed in two patients. Severe headache subsided in a patient with cerebral lesion. MRI showed a bean-sized calcified spot in the right frontal region. Chest X-ray in 2 patients showed that pulmonary lesions were markedly absorbed and disappeared. There was no adverse effect of the drug. CONCLUSION: Triclabendazole has marked therapeutic effect on paragonimiasis skrjabini. It is safe in administration and well tolerated.

Adolescent↗
PubMed2004

[A case of paragonimiasis westermani with a worm migration track on chest CT].

A 59-year-old man with rusty-colored sputum was admitted for evaluation of a nodular shadow on his chest radiograph. Chest computed tomography (CT) revealed nodules and nodular opacities with a cavity in the right S3. Chest CT also showed clearly a double linear shadow other than the bronchovascular bundle, with a different course from that of the bronchovascular bundle, suggesting a worm migration track. The diagnosis of paragonimiasis westermani was confirmed by detection of Paragonimus eggs in a bronchoscopic aspirate smear and by immunoserological examination. The linear lesion on the chest CT is uncommon in paragonimiasis, but the finding is thought to be useful for the diagnosis of this disease.

Animals↗
PubMed1992

[Paragonimiasis and pulmonary tuberculosis].

Paragonimiasis (infestation by the Paragonimus species) in Spain is a very infrequent entity within the group of imported infectious diseases. A native, resident of Equatorial Guinea who was affected by pulmonary and probably extrapulmonary paragonimiasis together with active pulmonary tuberculosis is described. This association is relatively common and may complicate the diagnostic process. The identification of the parasite was established from samples of pulmonary secretion obtained by natural expulsion and by fiber bronchoscopy in which Kinyoun carbonfucsine dye, Giemsa dye and argentic impregnation were used. The possibility of neurological disease existing (medullar and cerebral) produced by the same parasite is also discussed. Antituberculous treatment and the use of praziquantel satisfactorily control both infections.

Adult↗
PubMed1992

Pulmonary paragonimiasis in Southeast Asians living in the central San Joaquin Valley.

We describe four cases of pulmonary paragonimiasis in Southeast Asians who emigrated to the central San Joaquin Valley of California. Physicians should be alerted to the possibility of this disease in Asian patients with hemoptysis and pulmonary infiltrates. Paragonimiasis can masquerade as pulmonary tuberculosis, especially in patients from areas that are endemic for both the parasite and the tubercle bacillus. The ease and safety with which this infection can be treated, in contrast to tuberculosis, reiterates the importance of diagnosing this lung fluke when it is present.

Adolescent↗
PubMed2005

[A case of Westermani Paragonimiasis with atypical change of CT findings].

A 47-year-old man presented with bloody sputum and a cavitary mass shadow was formed in his right middle lobe. Transbronchial lung biopsy revealed the presence of parasite eggs and eosinophil infiltration. Based on the positive reaction against Westermani Paragonimus by multiple dot ELISA, Westermani Paragonimiasis was diagnosed. The cavitary mass shadow disappeared after the treatment with Pragiquantel. This is a rare case of Westermani Paragonimiasis showing interesting changes of chest CT findings during its clinical course.

Diagnosis, Differential↗
PubMed2005

Evaluation of human IgG subclass antibodies in the serodiagnosis of Paragonimiasis heterotremus.

Immunoglobulin G subclass antibodies (IgG1, IgG2, IgG3, and IgG4) responses to the excretory-secretory antigens of the lung fluke, Paragonimus heterotremus, were analyzed using the immunoblotting technique in an attempt to further improve the sensitivity and specificity for serodiagnosis of human paragonimiasis. Serum samples from patients with proven paragonimiasis, from patients with other parasitic infections, pulmonary tuberculosis and from healthy counterparts were analyzed. The results indicate that immunoblotting for the detection of IgG4 antibodies to an excretory-secretory product of P. heterotremus of an approximate molecular mass of 31.5 kDa, is the most reliable test. It gives accuracy, sensitivity, specificity, and positive and negative predictive values of 97.6%, 100%, 96.9%, 90% and 100%, respectively.

Adult↗
PubMed1992

[CT findings in "fresh" cerebral paragonimiasis].

There are few reports on CT findings in "fresh" cerebral paragonimiasis. We have experienced four cases of "fresh" cerebral paragonimiasis examined by CT scan. Three patients were children aged 7, 9, and 14 years, and one was an adult aged 25 years. Three patients were examined by CT scan 2 to 6 months after the onset of high grade fever, convulsion and focal deficit signs, and a patient was examined one month after his progressive visual disturbance. The unique CT findings are multilocular cystic lesions in temporo-occipital or in temporo-parietal lobes with extensive brain edema. Two cases were also associated with "soap-bubble" calcifications. The cysts were more dense than CSF and enhanced by contrast media. The histopathological specimen showed that the eggs of paragonimus were in the abscess cavity, of which the wall was composed with highly vascular gliomesenchymal capsule and numerous cell infiltration. Three patients underwent craniotomy for removal of abscess and decompression. Bitionol were administered and all patients recovered well. We also discussed the differential diagnosis of cerebral parasitic granulomas.

Adolescent↗
PubMed1991

Paragonimiasis in Mae Hong Son Province northern Thailand: case report.

Two cases of paragonimiasis have been reported from Srisangval Hospital, Mae Hong Son Province, Thailand. These two patients (Thai-Karen) resided in Nam-Piang-Din, Mae Hong Son. 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. A survey for intermediate and reservoir hosts are still in progress and this area can be considered as an additional area for paragonimiasis in Thailand.

Adolescent↗
PubMed1991

Recent trends of paragonimiasis westermani in Miyazaki Prefecture, Japan.

Miyazaki Prefecture has long been known as one of the endemic areas of paragonimiasis westermani. The prevalence of this disease peaked around 1956 and then drastically decreased. A few sporadic cases are still occasionally found in Miyazaki Prefecture; however, the number of new cases has gradually increased during the last 5 years. One important point to be noted is the change of clinical manifestations in the patients. A classically known form of paragonimiasis westermani is characterized by persisting cough, bloody sputum, and nodular or ring shadows in the lung field by chest x-ray. However, the patients recently found in Miyazaki Prefecture rarely showed such typical symptoms. Only four of 13 cases were found to have pulmonary infiltration and nine cases showed massive pleural effusion without pulmonary infiltration. Such atypical cases may be caused by low intensity of infection or, alternatively, be due to the earlier diagnosis.

Adult↗